Taking the Trouble to Notice

Taking the Trouble to Notice

This is the third part of the promised three blogs on wellbeing; the first looked its importance to society and then the next to each of us individually.  For those of you who had a go at the on-line assessment I hope you found it interesting and you should be feeling all the better for making the effort!  Now I should like to reflect on the particular importance of wellbeing to health and social care and in particular the workforce.  As I mentioned last time Professor Frude reminded us that personal wellbeing is positively correlated to our capacity for compassion and kindness and he challenged us all by saying: “We have a duty to improve our own wellbeing as the benefits will be felt by those we support”.

Last year’s Reith lectures were given by the surgeon Dr Atul Gawande (voted last week by Prospect Magazine readers as one of the ten top world thinkers).  The lectures are still available for viewing and I should like to draw your attention to one in particular: The Idea of Wellbeing.


Dr Gawande makes an eloquent and well-argued case that medical advances, although marvellous in so many ways, cannot in themselves compensate for a growing lack of wellbeing within society.  His evidence is to point to the growing isolation of people at the end of their lives, the increases in stress related illnesses, the rapid rise in personal harm from maladaptive lifestyles and the widening health inequalities and discrimination. Of course this is not just an issue for those of us who work within health and social care and Dr Gawande challenges society’s over dependence of what he terms “health and survival”.  He encourages us to take a different path:

“…to invest in a science of exploration and discovery of how our systems succeed and fail, just as we have invested in a science of how our bodies’ systems do. Because when we pull back the curtain, we find not only knowledge, we also find hope”

However the key message I want to bring out of the lecture is this quotation which is addressed directly to those of us working the health and social care sectors, in particular frontline practitioners:

“…if no one cares when someone takes the trouble to do things right, nothing changes. And the overwhelming message to the people who work at the frontlines of care around the world is that no one notices excellence and no one cares. That is the biggest source of burnout and discouragement for health care workers everywhere.”

A powerful message that I think I should cut and paste and keep front of mind of everything I do as simple reminder: take the trouble to notice.

The Social Care Act will, in just a matter of days, put the principle of wellbeing at the heart of social care policy in England.  I am sure there will be many readers who will be quite cynical about how this will play out in reality and it is not my intention at this stage to speculate.  What I do want to celebrate is the clear recognition given to the importance of wellbeing and as such it is a more effective policy direction than merely promoting “health and survival”. A report by the All-Party Parliamentary Group on Wellbeing Economics (Sept 2014)1 even linked wellbeing to the broader benefit of saving public money.  They too emphasised the importance of the workforce:

A key first step for unlocking this potential is to train health and education professionals (doctors, nurses, teachers) in mindfulness”.

Mindfulness if you recall is one of the elements of the New Economics Foundation’s “5 Ways to Wellbeing” in which they refer to it as being “present”.  There has been so much discussion over the past few years on the core issues of respect and compassion in health and social care.  On the back of some notorious scandals and a seemingly constant stream of bad stories there has been a deepening concern that somehow the health and social care workforce are becoming less kind and more focused on tasks and targets.  The latest NHS Staff Survey (2014) received 255,000 responses (42% of the total workforce) and of them only 41% reported that they felt their work was valued by their employers.  A whopping 39% reported feeling unwell in the previous twelve months due to work related stress.  However absence through sickness in the NHS workforce has fallen slightly from 4.96% in 2010 to 4.44% last year.  Incidentally there is a large variation between different trusts and job roles with ambulance drivers and healthcare assistants recording sickness absence levels of over 6.2%.  Perhaps a more revealing statistic is the proportion of NHS staff who have felt under pressure to attend work when unwell: this has increased from 21% in 2009 to 27% in 2014.

Whatever the statistics do or don’t illustrate the key point to contemplate is the connection between the perceived stress levels of our frontline health and social care colleagues and proven impact this has on their ability to be compassionate towards others.  Don’t get me wrong I don’t think there is ever an excuse for us to be unkind or mean to someone in our care.  However by not thinking more about the wellbeing of the workforce there is perhaps a greater risk of people becoming less thoughtful, less attentive and less self-aware.

To return to the All-Party Parliamentary Report above they make a make a very pertinent statement about the importance developing wellbeing in children:

“Mindfulness in schools is held back by the perception that wellbeing is irrelevant to the core business of the education system – despite its clear links with academic attainment. Nurturing children’s emotional wellbeing must be given much greater priority.”

Perhaps we should therefore extend this to a positive statement we should all sign up to for the health and social care workforce:

Wellbeing amongst the health and social care workforce should not be held back by the perception it is irrelevant to their training and ongoing professional development- there is clear evidence it is linked with good outcomes for them and others.  Nurturing the workforce’s emotional wellbeing must be given greater priority.

1 http://parliamentarywellbeinggroup.org.uk/