NHS staff psychological ill-health crisis: A call for urgent systemic reform

Only a system-wide overhaul of the NHS that invests in staff wellbeing can address the psychological ill-health crisis amongst healthcare workers, according to research led by the University of Surrey in partnership with the University of Exeter.

GettyImages - Nurse sitting on the floor while people walk by

The research, which is funded by the National Institute for Health and Care Research (NIHR), focussed on nurses, midwives and paramedics who are disproportionately affected by psychological ill-health, which leads to significant consequences for both individual wellbeing and patient care.

The study found that whilst high-pressure environments, heavy workloads, and chronic staff shortages are key drivers of stress and anxiety among healthcare professionals, it is the features of the work environment, such as lone working and career stage, such as being newly qualified, that can be key. The NHS staff survey reports that almost half of all NHS staff reported feeling unwell due to work-related stress in the past year (47%), with many experiencing unrealistic time pressures and inadequate staffing levels.

The researchers identified several key findings, including:

An underlying blame culture undermines staff psychological wellness by creating a toxic work environment.

A prevalent “serve and sacrifice” culture prioritises institutional needs over individual wellbeing.

Healthcare professionals often experience moral distress and emotional exhaustion due to the tension between upholding professional values and the realities of clinical practice.

A more comprehensive approach is needed to address the cumulative effects of workplace stressors rather than only focus on individual-level strategies and acute stressors.

Developing effective psychological wellbeing interventions for diverse healthcare workers is complex.

By addressing these systemic issues, the NHS will not only improve the psychological health of its workforce, but will also enhance the quality of patient care and reduce costs associated with turnover and absenteeism. Professor Jill Maben, Professor of Health Services Research and Nursing

A series of recommendations emerged, aiming to improve staff wellbeing and create a healthier workplace culture. First and foremost, prioritising staff wellbeing is crucial. This involves addressing essential needs such as providing access to food and hydration, break rooms, staff parking (including disabled parking), and financial security.

A holistic and collaborative approach to staff wellbeing is also recommended. By focusing on both prevention and intervention, organisations can adopt a systems-level strategy to promote and protect wellbeing effectively.

Other key recommendations include:

Normalising and proactively managing psychological ill-health: Recognising that psychological stress and burnout are common challenges in healthcare is essential.

Giving equal consideration to psychological safety alongside physical safety within the healthcare workplace.

Developing compassionate leaders for the future: Investing in leadership development fosters a compassionate and supportive work environment.

Fostering a learning culture and encouraging open communication: Creating a psychologically safe environment where staff feel empowered to speak without fear of retribution is vital.

We have produced a comprehensive guide to assist NHS leaders and staff in implementing our recommendations. This resource provides practical advice on how to address poor psychological wellbeing in nurses, midwives and paramedics to create a more supportive healthcare system, allowing staff to thrive and deliver excellent care for patients. Professor Cath Taylor, Professor of Healthcare Workforce Organisation and Wellbeing

For more information, and to view the guide, visit: https://workforceresearchsurrey.health/projects-resources/cup2/

This project was supported by the NIHR HS&DR programme with grant number 129528. The views and opinions expressed herein are those of the authors and do not necessarily reflect those of the HS&DR programme, the NIHR or the Department of Health and Social Care.