North Tees and Hartlepool NHS Foundation Trust signed the Time to Change Employer Pledge on 4th September 2020. The decision to sign the Pledge was a result of an ongoing project called Treat as One, which involves partners from across the local acute and mental health Trusts, ambulance services, service users and the Trust Board. Treat as One was introduced in response to the NCEPOD (National Confidential Enquiry into Patient Outcome and Death) ‘Treat as One’ report, which concluded that much work was needed nationally to bridge the gap between physical and mental health care for patients in acute healthcare settings. Over time, the project expanded to include a discussion about how best to support the wellbeing of Trust staff.

The Trust recognised the mental and emotional toll that issues such as caring for patients, dealing with difficult situations and shift work were having on its employees. In common with many other NHS organisations, results from the annual NHS Staff Survey, as well as sickness absence data, indicated that mental health problems including anxiety, depression and stress were an issue for the Trust. As a result, even before signing the Pledge, initiatives were being introduced to support staff health and wellbeing and develop a compassionate and inclusive leadership culture to encourage conversations around mental health in the workplace.

The Trust had for some time been running Schwartz Rounds, an evidence-based forum for staff to come together to talk about emotional and social challenges in the workplace. After the NCEPOD report, a group of passionate employees came together to look at its recommendations, focusing on the concept of ‘mind and body together’. As part of this, the Trust signed the Time to Change Employer Pledge, cementing its commitment to the mental health and wellbeing of its employees.

 “…compassionate and inclusive leadership really is at the forefront of what we’re trying to develop.”

Since signing the Pledge, the Trust has put into practice some very well-received activities, events and initiatives to raise awareness of mental health in the workplace, and has been displaying fantastic creativity in making use of various resources provided by Time to Change. Information, flyers and posters made available by Time to Change have been displayed in prominent positions across both hospital sites, as a reminder of all the great work that has been done to date. The Organisation Development team has also been out to community bases to share resources and engage with staff who work outside of the hospital setting.

As part of its Pledge-signing event, the Trust set up some ‘Pledge Trees’ in each of its Spirituality Centres; the leaves on the trees can be used by employees to write down an individual pledge, and already a huge number of employees have made personal pledges around topics such as focusing more on self-care, taking the time to listen to colleagues, and being honest about how they are really feeling.

Five Time to Change Champions have been formally trained, with a further 25 members of staff volunteering as Activity Champions and receiving monthly supervision session opportunities with the formal Time to Change Champions. The role of the Activity Champions is to organise and run regular activities within their own teams to encourage conversations around mental health, and their work is being documented on the Trust’s intranet, to raise awareness and encourage more teams to get involved.

In addition, as part of the Trust’s Employer Action Plan, a new two-day managers’ programme has been devised with a focus on the “softer skills of leadership … including Time to Change and mental health awareness … not only to support their staff in their teams but also for themselves as leaders”. Together with the local mental health Trust, a full review of mental health training within the Trust has been undertaken, resulting in the development of a completely new tiered system of training, which includes mandatory mental health awareness sessions for all staff and targeted training for staff needing more specific development.

A particularly creative and thoughtful initiative developed by the Trust is the staff storytelling page, which has been set up on the organisation’s intranet. Staff are encouraged to share their own experiences of mental health and wellbeing, whether they have been diagnosed with a mental health problem or not; contributors can write a rough draft of their story, choose a title and some appropriate images if they wish, and can choose to put their name to it or remain anonymous. To date, every contributor has agreed that their name can be shared, which demonstrates the shifting attitudes towards mental health conversations in the Trust. Further engagement is planned over the coming months to encourage more staff to share their stories.

In 2020, with the arrival of the Covid-19 pandemic, it became even more important for the Trust to support the mental health and wellbeing of its employees. The Trust’s Psychology Service quickly set up a staff support hub, which meant that employees could call and chat to a psychologist about how they were feeling. The service reported that not only were they seeing a significant increase in employees experiencing stress and anxiety at work, but that staff had also been found to be suffering with moral injury and PTSD as a result of being confronted with scenarios that they would not normally be exposed to. As a result, action was taken swiftly to increase support for staff across the organisation. 

During the Covid-19 pandemic, “We’ve held lots of supportive discussions with staff to try and provide that support, because we knew that there was increased anxiety and stress.”

The Organisation Development team, the Health and Wellbeing team and the Trust’s Psychology Service collaborated to run a series of pandemic learning events in July and August 2020, which provided staff with an opportunity to reflect on what had been happening over the past few months and what it meant for them as individuals, for their teams and for their services. In addition, the Trust’s Schwartz facilitators have developed modified Schwartz Rounds, which have become known as ‘Team Time’ , in which specific teams that might need additional psychological support as a result of the pandemic can get together with the facilitators and safely discuss how they are coping.

As the pandemic situation worsened across the UK, the Trust hired a luxury bus, dubbing it the ‘Wellbeing Bus’, which became a space where staff could go for some time out of their usual work setting whenever they needed support and relaxation. In response to positive feedback, the Trust is currently developing some permanent ‘Recharge Hubs’ to support staff wellbeing, which are being funded through money raised by Captain Sir Thomas Moore and are due to open in December 2020. The Trust also signed up to the Listening into Action (LiA) app, which enables organisations to engage with thousands of employees simultaneously about a whole range of pressing issues, gather instant feedback and deliver wide-ranging solutions to problems accordingly. Feedback from the pandemic learning events, supportive discussions, the psychology hub and the LiA app has been reported to executive level and is being used to inform future development within the organisation.

Soon after signing the Time to Change Employer Pledge, the Trust achieved something that it had been aiming to for some time: it incorporated mental health and wellbeing into all staff one-to-ones and appraisals. There is now a dedicated health and wellbeing section, which explicitly requests that a conversation be had between employee and line manager about mental health – from discussing flexible working options to identifying specific employee needs and appropriate signposting. In doing this, the Trust will be facilitating and encouraging conversations around mental health in the workplace for many years to come.

Looking to the future, the Trust will continue with its compassionate and inclusive leadership development programme. As of April 2020, with the full support of the executive team, it has become mandatory for all staff to receive mental health awareness training, with the focus on encouraging individual members of staff to think about their mind and body together and reflect upon their own mental health and wellbeing, as well as on that of their patients and colleagues. Mental health awareness activities have also been incorporated into other training sessions, making use of Time to Change resources such as Elephant in the Room and Spontaneous 8 to generate thought-provoking conversations about mental health. In addition to training a significant number employees in Mental Health First Aid, the Trust has developed additional, more advanced tiers of mental health training, which will be delivered in-house; the Trust is hoping to build on this over the coming months by making some of the training available to staff through its partnership with a local university.

The Trust hopes that signing the Time to Change Employer Pledge is a marker of its demonstrable commitment to supporting staff and patient wellbeing, mind and body together.