Chapter 5 – Wellbeing, dignity and respect in the workplace
By: Dr Emma Wain and Dr Reshma Khopkar
Wellbeing encompasses many aspects of an individual’s life. Essentially it is about feeling good and functioning well, and can be both objective and subjective. Objective wellbeing is based on assumptions about human needs and rights, and include matters such as access to adequate food, health, education and safety. Subjective wellbeing is based around how individuals think and feel about their own wellbeing. Fundamentally wellbeing is multifactorial and there is no one size fits all solution.
Within the NHS, staff wellbeing is a very important matter as it can affect patient experience and health outcomes as well as the staff who work within the organisation. NHS organisations with higher levels of staff wellbeing tend to have lower levels of staff absence, lower turnover of staff and higher patient satisfaction.1
In general, rules for a good work–life balance can be summarised as:
- Do not work more than full time unless you want to
- ‘No’ is a complete sentence
- Always know when your next set of annual leave is
- Use your full leave entitlement every year
Employers’ responsibilities
Below are some general suggestions that would potentially improve the working environment for all anaesthetists working in the NHS. These might help remove some of the barriers we all face in doing our job, make life better for everybody and assist in fostering a good relationship between employer and employee:
- Providing enough lockers for personal belongings to be stored safely whilst in theatre
- Having an ID card available on an individual’s first day at work
- Providing access to all areas in which an individual has to work
- Arranging a parking permit for an individual’s first day at work
- Having enough car parking spaces so that all staff who wish to can have a permit and park at the hospital whatever their arrival time
- Providing facilities so that bikes can be left securely
- Providing sufficient changing facilities including showers
- Having a rota provided sufficiently in advance so that life outside work can be planned
For SAS doctors working within a department there are suggestions pertinent to them that can help foster a culture of belonging and positive wellbeing. These include:
- Inclusion in departmental email circulation lists and WhatsApp groups
- Inclusion in departmental business meetings
- Invitations to any Medical Advisory Committee (MAC)/senior staff meetings
- Ensuring roles within the department and wider Trust are open to application from SAS doctors as well as consultants
- As per Guidelines for the Provision of Anaesthesia Services (GPAS) The Good Department appoint an SAS lead in the department and provide details of who this is at induction
- Provision of details of the Trust’s SAS tutor and SAS advocate, and how to contact them
- Ensuring all SAS doctors are on the correct contract for the work they are doing and that any rotas that they are on meet the contractual requirements
- Ensuring that all SAS doctors are allocated their supporting professional activities (SPA) time every week, and that the time is appropriate for the work they are doing. One SPA is a contractual minimum not a maximum
- Consider providing an SAS educational supervisor to all those who might benefit from advice and guidance as to their development and career
- Consider producing an SAS handbook containing all the relevant information for your department
Appraisal
SAS doctors can also help themselves by using their appraisal in a way that encourages their development. Appraisal is often viewed in a negative way, but it can be used to provide support for an individual’s career:
- Ensure that any courses that you wish to attend in the next year are recorded in your personal development plan (PDP). This can help with applying for finance to cover expenses
- Any work that is done in an autonomous way should be recorded here; this will help with providing evidence of progression and could assist with moving onto becoming a Specialist
- Discuss with your appraiser any career aspirations that you may have and any additional roles or responsibilities that you would be interested in taking on. Word of mouth is often a very good way to find out about opportunities that are available, and often individuals are given roles because they have put themselves forward for them where they might not otherwise have been considered
Fatigue
- This is a common feature of doctors’ lives. It can be experienced at any stage of a doctor’s career for different reason, for example working excessive hours, working night shifts, having young children, menopause and dealing with elderly parents
- We all have a responsibility to ourselves, our colleagues and our patients not to work when excessively fatigued and to look after each other. If you do feel too fatigued to be at work, then you must declare this and not work
- The Association led the way in raising this problem with the Fight Fatigue campaign which can be accessed here Fatigue (Association of Anaesthetists). Amongst the very useful information contained here, are standards for the provision of rest facilities and advice on how to approach night-shifts (Tips for night shifts)
- A full-time SAS contract consists of 10 PAs. There is no requirement to work more than this, additional PAs above this require the agreement of the doctor
- The 2021 SAS contract limits the amount of work that can be undertaken by SAS doctors in premium time. The amount of work that can be undertaken Monday to Friday between 21:00 and 7:00 (England, Wales and Northern Ireland) and 19:00 and 7:00 (Scotland and all day Saturday and Sunday (UK wide) is limited to 40%. This is a contractual requirement and SAS doctors are not required to undertake more work out of hours than this
- In addition, SAS colleagues are no less susceptible to the effects of ageing than their consultant colleagues. They should be considered in any departmental arrangements made to allow individuals to relinquish on-call work. Useful information with regard to this can be found here Age and the anaesthetist: considerations for the individual anaesthetist and workforce planning (Association of Anaesthetists)
Leave
An important contributor to remaining well at work is the provision of leave. Leave is a period of (normally) paid time off granted to employees by their employer. There are several different types of leave available to SAS doctors under their terms and conditions of service. The main types are summarised below:
- Annual leave – all SAS doctors on first appointment to the SAS grade are entitled to 5 weeks + 2 days of annual leave (unless they already received 6 weeks in their immediately previous appointment in which case they are eligible for 6 weeks + 2 days on appointment). After 2 years of service as an SAS doctor, this increases to 6 weeks + 2 days. After 7 years of service as an SAS doctor, an additional day of leave is granted and therefore the entitlement increases to 6 weeks + 3 days. The rules on the booking and taking of annual leave can vary between Trusts, but 6 weeks’ notice of the intention to take leave is required and leave needs to be approved
- Study leave – this is time away from work granted by the employer for a specific educational purpose, for example to attend a course, study for an exam. It is granted with pay and expenses. All Trusts will have a study leave policy, which will detail the conditions under which it can be booked at that Trust, and most Trusts have a study leave budget for individuals setting out the maximum finance that can be claimed in any 1 year (normally within the financial year from April to March, but this can differ in some Trusts). The number of days allowed is 30 in any period of 3 years, although some Trusts do apply this as 10 days per year
- Professional leave – the allowance for this is included within the 30 days described above. Examples of professional leave include sitting on committees, teaching, examining, duties in relation to postgraduate medical education
- Sick leave – a doctor absent from work due to illness is entitled to receive an allowance. This increases with increasing length of service, and rises from 1 months’ full pay and 2 months’ half pay during the first year of service to 6 months on full pay and 6 months on half pay after 5 years of service
- Parental leave – all NHS employees have the right to take 52 weeks of maternity and/or adoption leave, or up to 52 weeks of shared parental leave (minus any maternity or adoption leave taken). The terms around the payment for this leave will vary depending on the individual’s length of service for the NHS. It is important to be aware of your rights around this, and there are some very specific requirements. It is all detailed in Part 3, Section 15 of the NHS Terms and Conditions of Service, which can be accessed here: NHS Terms and Conditions of Service Handbook - amendment 52 (nhsemployers.org)
- Statutory parental leave – this refers to parental leave that all parents have a right to take once they have worked for their employer for a minimum of 1 year. It is different from the parental leave referenced above. Each parent is entitled to 18 weeks leave in total per child. A maximum of 4 weeks’ leave can be taken per child per year, up to a total of 18 overall and the leave must be taken in whole weeks. Twenty-one days’ notice is required for this leave, and it can only be delayed if the employer can demonstrate a significant reason, for example that it would cause serious disruption to the business. It also cannot be delayed if this would mean the leave has to be taken after the child’s 18th birthday. If it is delayed, a new date must be offered within 6 months of the requested date. Full details can be found here: https://www.gov.uk/parental-leave. In Scotland, in the NHS the first 4 weeks of this leave is paid, in the rest of the UK, it is all unpaid
- Bereavement leave – all parents are entitled to 2 weeks’ paid leave in the event of the death of their child. Full details can be found in Part 3, section 23 of the NHS Terms and Conditions of Service Handbook - amendment 52 (nhsemployers.org)
Flexible working
Individual working needs are variable, and it is important that staff have options to work in ways that best suit their individual needs and preferences. All staff have the right to request flexible working arrangements from their employer from their first day of employment. Examples of flexible working include working less than full time, job sharing, working term time hours, working compressed or elongated hours. Trusts must consider all requests and each Trust will have a locally agreed policy with the process to follow when such a request is made. The emphasis when considering these requests should be on exploring and finding a mutually agreeable solution. Your Trust will have a local policy on flexible working and details can also be found in Part 5, section 33 of the NHS Terms and Conditions of Service Handbook - amendment 52 (nhsemployers.org).
Career break
The option to take a break away from work is one that could be very valuable to an individual to maintain their wellbeing. Trusts may have a local policy on employment breaks, but in essence, this allows an individual unpaid time away from work to pursue another purpose. This could include parental or caring responsibilities, additional training or study or work abroad. Paid work for another employer is not normally acceptable whilst on a career break unless work overseas or charitable activity could be viewed as broadening an individual’s experience. Employees are generally entitled to request this after 12 months’ service. The minimum career break is normally 3 months and the maximum is 5 years. Details can be found in Part 5, section 34 of the NHS Terms and Conditions of Service Handbook - amendment 52 (nhsemployers.org) and your Trust may have a local policy about this.
Bullying
Experiencing bullying is not unique to those of us working in the SAS grade, but it can be a significant problem for us. A General Medical Council (GMC) survey of SAS and locally-employed doctors (LEDs) in 2019 revealed that 30% of SAS and 23% of LEDs had been bullied in the past year. Only 25% of those who had suffered from this had reported it with over 30% from both groups stating that they did not know how to report it.
Suffering bullying and incivility at work can cause stress to the individual, low self-esteem, feelings of anxiety and depression, physical ill health, burnout and, in healthcare, can have a detrimental effect on patient safety. Witnessing unprofessional behaviours and incivility can cause performance to decrease by 20% and this also leads to individuals being less likely to assist others.
As well as the potential harm caused to individual patients and employees, there is a financial cost. The estimated cost to the NHS in 2020 of bullying at work was £2.28 billion due to sickness absence, staff turnover and lost productivity2.
We provide some resources here to assist everyone at work with this issue. We describe what bullying is and give practical advice to those being bullied as well as those witnessing bullying – it is only by all of us being aware and acting on what we see that this can be stamped out.
What is bullying?
- ‘a form of abusive behaviour where an individual or a group of people create an intimidating or humiliating work environment for another.’3
It consists of repeated inappropriate behaviour, which can be physical or verbal directed against one or more individuals by one person or a group of people. This can be through written communications including email, verbal contacts including telephone calls and can be witnessed by others or occur on a one-to-one unwitnessed basis.
Examples in the workplace include:
- Being set unreasonable targets/workloads
- Being humiliated in front of others
- Always being the individual highlighted/picked on
- Being shouted at
- Being overlooked for training opportunities
- Having your opinion derided or ignored
What to do if you are being bullied?
- Acknowledge the problem – often taking the first step and acknowledging there may be a problem is the most difficult to do. Try to evaluate the situation objectively to determine that it is bullying; it is important to try not to become emotional about it.
- Keep a record – write down everything, who said what when to whom, who witnessed it, what your response was, what if any action was taken. Be as detailed and factual in this as possible.
- Keep copies of all written documentation – print off any emails or store them off your employer’s server, you need to know you can access these when necessary in the future.
- Confide in a friend – allies in work are really important; one effect of bullying is to feel isolated and alone, so try to identify someone that you trust and in whom you can confide. This is helpful under any circumstances but particularly when you are under pressure like this.
- Talk to the individual yourself if able – if it has just been a one-off incident and you feel safe and able to, then approaching the individual who has behaved in a detrimental manner may be reasonable, either yourself or through a trusted intermediary. This can be enough to provide individuals with insight into their behaviour to cause a change.
- Speak to a manager or human resources representative – speaking to your clinical lead or head of department or even a representative from human resources, is a legitimate next move. Involving them informally can address the problem.
- Take trade union advice if available – these are stressful situations and it is important to have support from outside your organisation. Belonging to a trade union is not compulsory, but in situations like these, they do provide an experienced and knowledgeable source of assistance.
- Take formal action – this is not a decision to be taken lightly. These processes are stressful and the end result may not be the outcome that you want. Just going through this can have a significantly detrimental effect on you.
- Be prepared to move on – if the situation remains unresolved, then you may need to leave your employer. This is not an admission of defeat, but actually is a brave thing to do – you are not beaten but are taking your skills and contribution elsewhere where they will be valued. And if it is resolved, then you will need to move on emotionally – behavioural change takes a long time and is often difficult to achieve. You will still be dependent on your employer to protect you and provide you with an acceptable working environment.