Workplace Stress: Time to Think About It Now

Many people will be back to work today. Faced with an inordinately high in-tray or seemingly endless list of unread e-mails to be tackled urgently they will feel an immediate ramp up in stress levels after being able to take it easy for a couple of weeks. Of course a few others will feel relief at getting back to work after a stressful fortnight at home with the kids but the majority of people returning to work today will feel an increase in their stress levels as they get down to their days work.

Obviously there are many who never stopped working and workplace stress is a constant factor that never goes away.

The issues of workplace stress are well recorded as is the impact it has on sickness levels and general well-being yet we talk very little about workplace stress in front line social care. The Health and Safety Executive state the 40% of work related illnesses are stress related and that ‘human health & social work’ is one of the areas where the highest rates occur (http://www.hse.gov.uk/statistics/causdis/stress/index.htm)

Front line care workers, whether providing care in a person’s home or working in a care home are subject to stress in the work place as much as (if not more) to anyone sitting in an office, working in a shop or factory etc. Stress is not limited to the ‘big’ events in life, stress accumulates as the small things niggle away at us and without the opportunity to release that stress externally it eats away inside us causing physical illness that, eventually, can do significant damage to our health.

Imagine the pressure on a home care worker who has to do a number of 30 minute visits to vulnerable people. The time pressure to get their work done in that 30 minutes followed by the pressure of travelling to visit the next person who needs support and care, this can be made even more demanding if the worker never knows who they will be visiting that day or they have a workload that means they have even less time to travel between homes.

Working in a care home can be stressful too. Meeting the needs of those who depend on others for many aspects of their daily lives can take its toll on those responsible for delivering that support and care. Imagine dealing daily with incontinence, challenging behaviour and even death. The stress of working in a shop or office is mild in comparison.

And if that stress is not enough for the front line care worker there are also the issues of low pay and unsociable hours to contend with.

Where people have high levels of stress they react by either internalising it, which leads to health problems or they externalise it, usually by demonstrating aggressive behaviour. In front line social care both are dangerous.

Internalising stress can affect our concentration and, in front line social care, which can lead to dangerous errors, stress also impacts on our immune system making us more prone to any bugs or ailments floating around. In front line social care this can lead to spreading those germs to vulnerable adults whose immune systems are already weak. Given the nature of front line social care, with its culture of low pay and only paying statutory sick pay there is a reluctance for many care workers to take time off for illness unless they are physically unable to leave their house.

Externalising stress is even more dangerous in front line social care. It can lead to abusive behaviour.

Yet despite the acknowledgment that workplace stress has a real impact on peoples’ lives, in social care this is something rarely mentioned or acknowledged. For example, the Skills for Care Manager Induction Standards do not mention the need to monitor and address workplace stress (http://www.skillsforcare.org.uk/Document-library/Standards/Manager-Induction-Standards/Manager-Induction-Standards.pdf) and the Care Quality Commission Standards focus more on competency in their “Guidance about Compliance” on the standard of supporting workers rather than tackle the real issue of workplace stress and its potential to lead to failure to deliver safe services (http://www.cqc.org.uk/sites/default/files/media/documents/guidance_about_compliance_summary.pdf).

If we truly want the best services for the most vulnerable in society then we need to recognise the stress that can be placed on those delivering the actual services. Everyone deals with stress in different ways and, because of that, there needs to be a focus on managers and providers having good quality training and awareness of the issues associated with workplace stress and being able to demonstrate competency in dealing with workplace stress issues.

Winterbourne View Report: Smoke & Mirrors?

Any action to improve the lives of those with learning disabilities has to be welcome and many of the proposals in the Governments Winterbourne View Final Report are good yet that does not mean the report should go unchallenged especially as there are some inconsistencies where it appears the Government may be trying to deflect responsibility introducing ideas that, actually, really already exist.

Norman Lamb and others have focused a lot on corporate responsibility. Norman Lamb said “This case has revealed weaknesses in the system’s ability to hold the leaders of care organisations to account. This is a gap in the care regulatory framework, and we intend to close it”.

In fact the Health and Social Act 2008 made care organisations accountable and open to prosecution if they fail to meet the regulations, and Castlebeck certainly failed on a number of them. The Care Quality Commission also has the power to cancel a providers registration. In addition there are also the legal requirements under the Health & Safety Act 1974, the HSE’s guidance states:

“Recent case law has confirmed that directors cannot avoid a charge of neglect under section 37 by arranging their organisation’s business so as to leave them ignorant of circumstances which would trigger their obligation to address health and safety breaches.
Those found guilty are liable for fines and, in some cases, imprisonment.”

As the abuse at Winterbourne View clearly breaches the Health & Safety requirement to keep everyone in the place of business safe, surely Castlebeck should have been prosecuted.

Rather than taking time to draft new legislation surely it would make more sense to ensure existing legislation is being used effectively.

We also need to take care over how the Government frames the action which it proposes to take, for example in its timetable for action we have:

From June 2012 – CQC will take enforcement action against providers who do not operate effective processes to ensure they have sufficient numbers of properly trained staff, &;

From April 2013 – CQC will assess whether providers are delivering care consistent with the statement of purpose made at the time of registration
Although welcome moves the real question, unanswered by the report, is why were these not already happening? Both are required by the Health & Social Care Act regulations and, as such, form part of the requirements of registration. Yes there has been a change of leadership at the CQC and things have improved but it does not mean that such things should be omitted from the report nor does it excuse the absence of any action to ensure such things do not happen again.

The report also fails to answer the question of Government inaction on social care, particularly in terms of those with Learning Disabilities where the principles of Valuing People seemed to have faded in to dim memory. Much of what is being proposed should already have been in place and it is the Governments neglect of social care that means they are now only acting because they are forced to.

There is also a serious omission from the report that is equally important to the Winterbourne View case and that is Whistleblowing. Action could have been taken much sooner if the reports to Castlebeck and CQC were acted upon and some of the abuse witnessed in the Panorama film would not have happened. Yet nowhere in the list of action to be taken is a review of existing Public Interest Disclosure law, the responsibilities of statutory bodies to act or even report when abuse is alleged.

For all the effort to prevent abuse it is still down to people reporting it before it can be truly uncovered, I doubt very much if regulatory bodies have uncovered abuse through annual inspections, and therefore there has to be much more done in the way of encouraging people to disclose abuse along with a much more robust response when such reports are made that reports all allegations not just those that make it to safeguarding referral stage.

It would be wrong throw out the baby with the bath water and there are some very positive proposals in the report. It is right to end the existence of these pseudo-hospitals and it is right to move all people with learning disabilities toward person centred support.

We need more action on learning disability services and not just for those who find themselves confined in so called hospitals. Abuse happens in other places to and we need equal action to eradicate hate crime in the community where life is not regulated by the CQC.

This report should just be a start, let's have a new white paper on how the Government and society will support those with Learning Disabilities to lead fuller and safer lives.