Mental Health Support: Frontline Staff

Nadine Dorries Excerpts

Thursday 8th October 2020 Westminster Hall

[The Minister for Patient Safety, Mental Health and Suicide Prevention (Ms Nadine Dorries)]

I echo the sentiments of the hon. Member for Tooting (Dr Allin-Khan): it is an absolute pleasure to see you in the Chair, Ms McDonagh. I thank the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) for securing the debate. I have heard her speak many times in Westminster Hall, including when I have been in the Chair. She always speaks with passion, particularly on this subject, and she always bring her experience as a consultant psychologist. We are the better and the richer for it.

The onset of the covid-19 pandemic in March was the beginning of a hugely challenging time for all our frontline staff, who have so brilliantly supported our essential frontline workers. I echo everything that has been said in praise of our frontline workers. They have been beyond exceptional—beyond words. I spoke to some of them this week. When they were going into work in March and April, every day it got a bit worse. Every day they had no idea what they would face that day, but they did it, sometimes working 12 hours without a break. Those staff in ICU went on a hugely emotional journey with their patients. As we know, the pathology of covid once someone is in ICU changes very rapidly. That took some getting used to for the staff who were nursing those patients—one moment they thought they were doing fine, and the next their condition fell off a cliff. That was hugely challenging emotionally for the staff who were nursing those patients.

I endorse everything that has been said in the debate, and I give my thanks and praise to staff. They worked long hours doing emotional and draining work, which is why it was important to ensure that support was put in place. We know that staff resilience has been tested to the nth degree, and the Government recognised early on that this would be a difficult situation and that we had to prioritise the mental health of the staff who were working in those very challenging conditions—not just staff in ICU and in hospitals, but staff who were working in care homes and social workers, too. That is why, at the beginning of covid-19, we commissioned NHS England and NHS Improvement to develop a comprehensive package of emotional, psychological and practical support for NHS workers. We ensured that the same offer was in place for all social care staff and their colleagues in the NHS, wherever possible.

Throughout the pandemic, NHS and social care workers have been able to access a dedicated and confidential staff support line operated by Samaritans, which is open from 7 am to 11 pm. It is there for people if they have had a tough day, if they feel worried or overwhelmed about what they are facing at work, or if they have a lot on their mind that they need to talk through. Trained advisers are available and can help with signposting to further services, or they can simply listen in confidence. A text helpline runs parallel to the phoneline and is open 24/7 to all NHS workers, social workers and care staff. A separate bereavement helpline has also been established by Hospice UK; it is manned by a team of fully qualified and trained bereavement specialists. So we had one-to-one care, the helpline, the text service and the Hospice UK bereavement line available for frontline staff.

Alongside the helplines, workers were given free access to a range of mental health and wellbeing apps, including Daylight, Sleepio and SilverCloud, and there have been over 150,000 downloads of these apps by key workers. For NHS workers, virtual staff common rooms have been established in partnership with NHS Practitioner Health. It has given staff the opportunity to reflect, share experiences and find ways to cope with how covid-19 is affecting their life at home and at work. Line managers have also been given the tools that they need to effectively support their teams through covid-19. For example, mental health conversation training has helped to equip NHS managers, supervisors and those with caring responsibilities for NHS staff to confidentially hold local, supportive and compassionate mental health and wellbeing conversations.



In addition to everything we have done through the NHS and the Department of Health and Social Care to provide a complete safety net and blanket of support around our NHS staff, the trusts went further. There are amazing stories of what some trust managers put in place straight away for their staff, including making space in the hospital where staff could go and download, and talk about their day; putting in place a practice of buddying up with another NHS worker; and putting into practice the process of staff not just finishing shifts and giving a handover report, as they used to, but then having a coffee session afterwards to debrief and go through what had happened that day. NHS trust managers also need to be praised for the huge package of care that they put in place for their staff, going over and above what the NHS supplied. NHS England and NHS Improvement also launched a new framework that enables employers to buy in additional occupational health and support for their staff.

Additionally, in partnership with the trusts, chief social workers published guidance for social workers and social care professionals, which can be accessed via Skills for Care. It explains the need to support the emotional wellbeing of employees during and after the pandemic, what managers can do to support that and what social care professionals should do to support themselves. To support our frontline workers more widely, NHS mental health services have remained open for business throughout the pandemic; no mental health services closed or ceased to look after patients during the pandemic.

In fact, during the pandemic we were able to accelerate parts of the long-term plan. For instance, 24-hour mental health crisis helplines opened across our trusts throughout the pandemic. Every one has been established and every one is now open. They have not been open long enough for us to gather data on how many people have used them and how they have been accessed, but I have heard anecdotally from ambulance support services, who are aware that the helplines are being used, that they know the helplines are working because there are fewer call-outs for mental health crisis.

To increase support throughout the covid-19 pandemic, we provided £5 million to national and local mental health charities, through MIND and the mental health consortia. On 22 May, the Chancellor announced a further £4.2 million for mental health charities as part of the Government’s UK-wide £750 million package of support for the voluntary sector. These additional moneys for mental health charities will support adults and children, including frontline and key workers. However, we still have to go further. We continue to learn from our experience during covid-19.

On 18 September, we published, “Adult Social Care—our COVID-19 Winter Plan 2020/21”, for adult social care settings outside the range of support we are making available, to ensure we support the workforce throughout the winter. A tough winter is coming, so as well as everything we have put in place, we need to go further to ensure that those services continue to be provided throughout the winter and that we have well-established support for our frontline workers.

As part of what we are doing throughout the winter, the NHS is in the process of setting up a first wave of staff mental health hubs, which will provide proactive outreach and engagement; overcome barriers to seeking help for frontline staff; build capacity in local employer organisations or teams; provide rapid clinical assessment; and provide care co-ordination and supported onward referral to deliver rapid access to mental health treatment. These hubs will be particularly useful and successful because we can focus mental health services into the infrastructure of the hubs. That will be of huge additional benefit, along with everything else that we have been providing to frontline staff. We are committed to providing essential mental health support to our frontline workers as they continue their work in response to the covid-19 pandemic. Ensuring that the health and adult social care sectors are well staffed with colleagues, to look after patients and prevent the pressures from becoming too great, is an absolute top priority for the Government.

The hon. Member for East Kilbride, Strathaven and Lesmahagow asked a question about clinical negligence claims against staff. There is a clinical negligence scheme for trusts that provides indemnity cover for all staff. I knew that was in place, because I signed it off at the beginning of the pandemic; I just could not remember what it was called. No staff member or frontline worker needs to worry. This is, I believe—I will be corrected if I am wrong—aside from what is provided by the Medical Defence Union and what normally applies. This package, which I believe came about as part of the emergency coronavirus regulations, is available to all staff, and all staff are covered.

We are committed to continuing to provide services to staff. If I went through every trust and listed every measure and initiative that has been put in place to support staff, I would be here for quite a long time. As well as the helplines, the apps, the one-to-one psychological care sessions provided to frontline staff, the trust support, the download rooms, the buddying up and the coffee debriefs, additional trust-by-trust measures have been put in place. As we know, staff were also provided with free meals. A huge package went in, and rightly so. This was not just a job during the recent pandemic, and it will not be in the future.

The hon. Member for East Kilbride, Strathaven and Lesmahagow mentioned post-traumatic stress disorder. We are going into a difficult winter, so I made inquiries this week as to what evidence we have about the rise in mental health issues that she spoke about, and other things. At the moment, we are seeing that the pandemic has had an impact on those with pre-existing mental health issues, as we would expect. Somebody who already suffers from bipolar, schizophrenia or a medically diagnosed mental illness will have found the pandemic challenging, and they will still find it challenging. The same is true for people with eating disorders—I think the hon. Lady has spoken about this—which I regard as the most serious of all mental health issues, because they are linked with morbidity. One in five people with eating disorders dies, and that is the highest morbidity rate of all mental illnesses. There is support here. That is why we have provided funding to increase the capacity to deal with those who have eating disorders and who need quick access to someone they can talk to.

We know that those with pre-existing mental health conditions are going to suffer. It is really important that we unpack wellbeing from mental health. There is some very unhelpful dialogue taking place that does not help people at all. We may see in the newspapers or hear people saying that suicide rates are going up, but they are not. We have no evidence of that; in fact, the recorded suicide rate from April to June was down. That could be for a variety of reasons, and we will not know what the true rate is until next year. However, we know that writing and talking in such a way has an impact out there, and that is why we ask the media to be careful about how they discuss suicides. We all need to be careful about how we talk about mental health. As for whether there is going to be a tsunami of mental health problems, I asked the clinical lead director of NHS England about that yesterday, and there is no evidence of that either.

We know that the other group of people who will be impacted are the frontline workers who have gone through the pandemic. As we know, post-traumatic stress disorder takes a long time to manifest, so those people may not even be presenting. We are expecting a problem, but it has not manifested itself yet. I do not have to tell a clinical psychologist how long it can take for the impact to fall out, but apparently it can be some time. We have prepared for that and we expect to see it in the future, but it has not happened yet.

I say that we should unpack wellbeing and mental health because a lot of what people are experiencing now—anxiety, apprehension, fear of the unknown and fear of covid—is a wellbeing issue, and it is normal to feel like that. Nobody ever goes into an adverse situation without experiencing such emotions. It is okay, and very normal, to feel anxious and fearful in an adverse and quite frightening situation, and people will develop their resilience. We want people—particularly frontline workers and students—to reach out and talk to their friends and their family, and to use the support networks that they would normally use to get through a difficult situation.

The problem arises if those feelings persist over a long period, and if that happens, we then urge people to seek help. However, we are not at that point, and we are not seeing that manifest yet in referrals or people seeking help. What we know is that people are going through a phase of anxiety. We therefore launched Every Mind Matters, because we need to provide people with the tools to get themselves through a difficult situation of anxiety and fear. Every Mind Matters launched for adults and, on 8 September, for children. It is now launching for students, too, alongside Student Minds.

Interestingly, when we talk about mental health, there is almost no such illness that cannot be helped in some way, and no experience of wellbeing that cannot be assisted, but people need the tools. They need improving access to psychological therapies services, 70% of which are available online, and tools to get them through such difficult situations. Those tools are available on Every Mind Matters, which I believe has had 2 million downloads for adults. They are there to help people get through. It is amazing that people do not know what they should do—I did not, until I looked into this—and how they should help themselves to get through a difficult situation now.

I caution everyone that we need to be careful about the language we use, such as “falling off a cliff edge”, or the “tsunami” of mental health issues. According to the clinical lead at the NHS yesterday, there is no evidence to support any of that yet. Hundreds of surveys are going on, some of which are showing that some people’s mental health has been improved—some people are enjoying working from home and do not ever want to go back to doing the commute, which they now realise was making them feel pretty miserable. They are welcoming the social change that has occurred. It is not at all a case of one size fits all, and that is why we need to be careful.

Hopefully, we are prepared, particularly when it comes to frontline workers. The services that they require have been put in place, after consultation with frontline workers, and we will have even more ready as we move forward into the winter.