A UK-based think tank called Autonomy has recently published a report on the four-day week, indicating that the shorter working week would not impact productivity and would improve wellbeing. After the first meeting of the CPI People’s Panel, I found myself ruminating on my table’s discussion of the effective delivery of public services and the barriers to it.
I work as a psychologist for vulnerable adults at a London local authority. One part of my job is considering how to support the staff teams that provide direct care, often in challenging circumstances. Services for vulnerable adults in the UK have been restructured and reorganised several times in the last ten years, but a second Panorama documentary – eight years after the programme highlighting the scandal of Winterbourne View – showed that the same problems continue to exist.
The accountability structures provided by the Care Quality Commission do not, it seems, necessarily make care staff more empathetic.
In 2016, I completed my doctoral thesis on Chronic Embitterment in the NHS; the result of a yearlong study dedicated to some of the psychological phenomena experienced by public sector workers who attend occupational health clinics. “Chronic Embitterment,” also known as “Post Traumatic Embitterment Syndrome,” describes stress phenomena that cause people who are affected by events at work to get stuck in rigid patterns of thinking – from which they often struggle to free themselves. As a result, their lives and personalities become dominated by persistent feelings of embitterment.
As I decided to pursue this research, it was clear that – while stress and mental health were often identified as the biggest reason for sickness absence in the NHS – it remained an under-explored topic. This was a problem, particularly because there is a raft of evidence that patient care is strongly influenced by aspects of staff wellbeing.
Major projects have stated unequivocally that staff wellbeing is a prerequisite for high-quality patient care.
When the organisational climate is positive and supportive, patient mortality goes down. Your doctor’s job satisfaction affects the likelihood of your taking medication as prescribed. Doctors who are dissatisfied in their work often show riskier prescribing profiles and, of course, less satisfied patients.
A lack of power over the changing face of their roles diminishes people’s ability to think creatively and flexibly about problems. The dismal failures in empathy that led to the abuses shown in the Panorama documentaries speak to relational and organisational failures.
One of the key things that my study focused on were the core elements which make people productive, action-focused and good at coping, summarised in the public health term “sense of coherence.” It describes a person’s ability to see things as meaningful, manageable and comprehensible, and therefore to address problems rather than avoid them.
You get an engaged workforce by creating a culture in which staff are happy in themselves, are valued, have a good amount of control over their own lives and time, and feel that they can manage their workload – or reduce it, if needs be. Chronic Embitterment, therefore, is a response to the lack of these things.
During the first meeting of the panel, we discussed devolving power structures, new models of accountability, and the distorting effect of targets. But all these solutions are likely to falter if the people delivering them are not given the time, space and support to embrace them.
It’s neither logical nor valid to expect more empathy from a workforce which lacks freedom, support and resources. A shift in focus towards attending explicitly to the needs of staff could find an expression in lots of things, from debrief structures to increasing support for Continuing Professional Development.
Perhaps, I thought, as I waited for the train home, the most obvious step that public sector organisations can take to support and empower close to 20% of the UK workforce is to reduce their core working week to four days.
When I read in Autonomy’s report about enthused staff in a wide range of industries and countries who were keen to make these arrangements work and thought back to the NHS staff I questioned, of whom almost half met the criteria for Chronic Embitterment, I thought – well, why not?
Jo is a member of the CPI People’s Panel, a group of people who are passionate about the impact that government can and should have on people’s daily lives. We meet regularly to discuss issues that are front of mind for the group, and to gather insights that can feed into our work with government. Read more about the insights from the first gathering of our #PeoplesPanel.