The health of our nation depends upon many factors but none is more important than the quality of care that is available to vulnerable citizens from health and social care professionals in the public sector. The quality of this care is itself dependent on the state of mind of those professionals. If care giving professionals are stressed, fatigued, troubled, burdened, ‘burned out’ or distracted, then they will not be in a position to listen, focus and attend fully to the needs of those that they care for.
Caring in itself is a stressful business and the rates of sickness/absence, mental health problems and even suicide are elevated in these professions compared to the general population. A person in a vulnerable situation needs, above all, to be listened to, attended to and be thought about in a compassionate and personalised way. If the professionals that vulnerable people turn to are themselves not in a state of mind to tune in, then care giving is more likely to fail, creating a vicious cycle of ineffective or even failed care. This is not about the training or competence of care professionals but about their energy levels, mental state and focus.
The mind of the care giving professional can be undermined by many factors including:
• Poor or limited supervision and back-up
• Poor and/or uncompassionate management
• Lack of support and validation in the role
• Lack of resources to do the job
• Unrealistic expectations or targets.
There is a danger of seeing any lapse in the quality of care as primarily an issue of competence or moral character when this is often not the case. With some inevitable exceptions, most people who enter the caring professions are of above average compassion and highly motivated to help others.
For example, a competent, well-trained GP has 20 patients consecutively without a break to talk or think about the emotional impact of all these individuals with their own personalised needs and important life stories. By the time this GP gets to number 20, how is he/she going to be in a position to listen in a personalised way? This is without considering the other distractions and pressures of the job that get into a GP’s head and drive out that emotional energy and attention capacity that might otherwise be available for listening.
Care giving will only be as good as the quality of the organisational culture or ‘professional family’ that supports the care giving. If carers are not cared for by their professional family, care cannot be sustained over the longer-term and the system could even eventually become toxic. No matter how dedicated and competent an individual professional may be, they cannot sustain a high quality level of care without being supported to do so.
The quality of support that care giving professionals get at present in public organisations is hard to measure accurately but high absence and sickness rates tell their own story. There is also a lot of anecdotal evidence that suggests a need to address a deep problem in the support cultures in which health and social care professionals are expected to work.
The proposed model: a kind of ‘OFFCARE’
This would be for health and social care professions, including medicine, psychology/psychotherapy, social work, nursing and occupational therapy. The professional bodies could all own the model and buy into it and the relevant trades unions could also participate and pay a subscription. This would support all care staff collectively but be independent of organisations and government control.
It could have a confidential phone line where professional care staff would get prompt back up for any issues that are troubling them. In addition, there could be a website with access to confidential one-to-one support and forums for specific professional peer groups and general forums for all.
It could also provide virtual and face-to-face staff support groups and networks, which would be confidential, but if enough individual practitioners from a single organisation are found to be making contact, and if the same theme is emerging from many different individuals then feedback on these broad statistics at least can go to government inspection bodies for independent investigation. This can help to measure organisations in terms of how well they are supporting their staff and make them more accountable.
Those manning the service should understand the constituent professions and have a professional background in health and social care.
The proposed organisation would have a number of goals to improve the quality and level of care that is delivered across public health services by providing accessible and flexible back-up, support and validation to practitioners. It would look to prevent staff burnout, stress and fatigue and improve sickness and absence.
In addition, it would look to empower and protect caring professionals within their organisations and to make public care organisations more accountable to their staff and bring a sense of a national enterprise and shared professional family values back into the public sector. More widely, it would look to increase a sense of national public service and community.
Funding for the organisation could be provided by:
• Subscriptions from stakeholders including: relevant trade unions (e.g. UNISON, UNITE)
• Professional bodies: General Medical Council, British Medical Association, Royal College of GPs, Royal College of Physicians, British Psychological Society, UK Council for Psychotherapy, British Association for Counselling and Psychotherapy, Royal College of Medicine, Royal College of Nursing, British Association of Social Workers, College of Occupational Therapists
• Voluntary donations from professionals and other carers.
However, it would need to be independent of government funding and control.
About the authors
Mike Bush has worked in the social health care area for more than 40 years. His experience has been predominantly in adult services and mental health, mainly working in community mental health teams as a mental health social worker.
In November 2000, he suffered a major mental breakdown and was actively suicidal. He is now heavily involved in a range of national and regional mental health organisations and mental health user involvement campaigning groups.
Martin Seager is a consultant clinical psychologist and an adult psychotherapist with the charity organisation Change, Grow, Live. He is a clinician, lecturer, author, campaigner, broadcaster and activist on mental health and male gender issues. He worked in the NHS for more than 30 years and was head of psychological services in two large mental health trusts. He was an adviser on mental health to the Labour Government (2005-2007) and had a regular monthly mental health slot on BBC Radio Essex (2003-2007) and BBC Radio 5Live (2007-2009).
He has written widely primarily about mental health, male gender, compassion, attachment and homelessness. He is co-founder of a men’s mental health research team running an annual male psychology conference at University College London. He has been a branch consultant psychologist with the Central London Samaritans since 2006 and is also a member of the Mental Health Advisory Board of the College of Medicine. He is now also an adviser to the Self-Esteem Team, which provide mental health education and support to UK schools.