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.

Shift from Care Service to Customer Service

I am fairly certain that you, like me, have been to a restaurant at some point in time where the staff rushed you through your meal and that you, like me, found it irritating and uncomfortable. I am also pretty certain that you, like me, would think twice about using that restaurant again and that many people who experienced that would, like me, probably tell any number of people about that bad service.

Now transpose that scenario to social care.

The now infamous 15 minute care visits are just one aspect of this, longer visits may equally involve care staff having to rush around leaving the individual who needs the service bemused and bewildered at the very least. At the worst it will leave the feeling a burden, someone in the way while the care staff do what they have to before shooting off to the next person. Add to this the times when the individual never knows who is going to turn up to help as staff rotation is based on the needs of the provider rather than continuity for the individual.

Of course this is not limited to home care, many care homes I’ve seen have a task-orientated culture where staff rush around trying to get jobs done and individuals merely become another box to tick on the endless ‘to do’ list and in the worst cases, as demonstrated on the Fiona Phillips’ Panorama programme last year (http://www.bbc.co.uk/programmes/b01gybn7) sometimes staff even fail to acknowledge the individual when they are undertaken their jobs.

The crucial issue here is that the person who needs the care service cannot just suddenly stop using the service because they are unhappy with it and if they are left feeling like a burden to the care service then they are unlikely to complain anyway and, equally, there may be a lack of opportunity for them to mention the bad service to anyone else.

Unfortunately we do not look upon those who need care services as customers. Look at the terminology, ‘service-user’, ‘client’, ‘resident’ or even ‘patient’.

Could you honestly imagine sitting down with your bank manager and having a ‘co-production’ meeting about your finances?

People who need social care services are getting a service and, as such, should be treated as customers no matter how that service is paid for. In many instances of course they are paying directly for that service.

We need to become a customer focused service which starts with acknowledging the individual as someone who has the right to be treated as a paying customer. Social services departments need meet the needs of customers rather than ‘commission’ services and regular reviews should not be just about immediate care needs but should also focus on customer care and the level of customer service that goes with the tasks being provided.

The needs to be a culture change in social care with a shift from task based commissioning to real customer service and customer service skills need to be high on the training list for all staff of undertake services for their customers. Personalisation must mean the customer comes first and what we want as customers will always vary. Some may like short sharp visits just so they can get on with their lives without strangers getting under their feet, many others will prefer visits that include a chat about what’s happening in the world, especially if they are isolated and unable to leave home. Whatever they want though it should be at the top of the list of services provided, after all, the customer is always right.