STRESS MANAGEMENT POLICY

STRESS MANAGEMENT POLICY NWAS Stress Management Policy Page: 1 of 21

Recommending Committee: Health, Safety and Security Sub Committee Approving Committee: Trust Board Approval Date: October 2010 Version Number: 2 Date of Development: August September 2010 Date of Issue: October 2010 Review Date October 2012 Responsible Executive Director Medical Director Responsible Manager Assistant Director, Healthcare Governance Competent Manager Head of Risk & Safety For use by: All Trust staff This Policy is available in alternative formats upon request. Please contact the local Healthcare Governance Department NWAS Stress Management Policy Page: 2 of 21

CHANGE RECORD FORM Version Date of Change Date of release Changed by Reason for change X1 1 May 2008 18 June 2008 F Buckley Document Creation X1.2 1 August 2008 27 August 2008 F Buckley Revised draft following consultation X1.3 1 September 2008 10 September 2008 F Buckley Revised in line with NHSLA requirements X 2.0 September 2010 October 2010 F Buckley Periodic review, minor amendments made NWAS Stress Management Policy Page: 3 of 21

STRESS MANAGEMENT POLICY Ref Contents Page 1. Introduction 5 2. Scope 6 3. Aims & Objectives 6 4. HSE Stress Management Standards 7 5. Duties 8 5.1 Director of Organisational Development 8 5.2 Line Managers 8 5.3 Emergency Control Centre / PTS Control Centre 9 5.4 Healthcare Governance Team 9 5.5 Occupational Health 10 5.6 Human Resources 10 5.7 Employees 11 5.8 Role of the Safety Representatives 11 6. Management of Work Related Stress 12 7. Risk Assessment Process 13 8. Supporting Staff through Difficult Incidents, Claims or Complaints 15 9. Monitoring the Policy 16 10. Reference Documents 17 Appendix 1 - Advice for Managers Appendix 2 - Advice for Individuals Appendix 3 Equality Impact Assessment NWAS Stress Management Policy Page: 4 of 21

1. Introduction The North West Ambulance Service is committed to protecting the health, safety and welfare of our employees and those affected by our undertaking. The Trust recognises that workplace stress is a health and safety issue and acknowledges the importance of identifying and reducing workplace stressors. The Health and Safety Executive (HSE) defines stress as, An adverse reaction a person has to excessive pressures or other types of demands placed upon them. This makes an important distinction between pressure, which can be a positive state if managed correctly, and stress which can be detrimental to health. Given an excess of pressure, stress can therefore happen to anyone, and should not be seen as a weakness. Instead, an individual needs to be helped to deal with these pressures. As reactions to stress will vary from one individual to another and may also vary at different times of our lives it is important that we learn to recognise stress and understand what to do to reduce it. Tackling personal stress is an individual s responsibility; however, the Trust has a responsibility to help reduce any stress which may arise in staff as a result of their work. Practical information for individuals and managers is contained in Appendices 1 and 2. This policy is available on the Intranet and as part of the Health, Safety and Security A-Z Toolkit. Some level of pressure is a normal aspect of everyday life; most people manage this well and accept it as part of everyday life. In fact for many, the effects of pressure, even when considerable, can be positive. Responding effectively to this kind of pressure can lead to job satisfaction and increased motivation for some people. Work related stress is experienced when the demands of the work environment exceed the ability to cope with or control them or when external stressors reduce a person s ability to cope with the demands of their work environment. Stress is not an illness, but intense stress or stress experienced over a prolonged period of time can lead to problems with our physical or psychological health. NWAS Stress Management Policy Page: 5 of 21

It is accepted that recognising, managing and reducing stress can have substantial benefits in improving our general health. As well as affecting health, stress in the workplace also contributes to reduced productivity, performance, commitment, and motivation. Stress in the workplace is also a cause of sickness absence. The HSE reports that:- Work-related stress accounts for over a third of all new incidences of ill health. Each case of work-related stress, depression or anxiety related ill health leads to an average of 30.2 working days lost. A total of 13.8 million working days were lost to work-related stress, depression and anxiety in 2006/07 The purpose of this policy is to define the Trust s plan to mitigate work-related stress. 2. Scope This policy will apply to everyone in the Trust. Managers are responsible for implementation and the Trust is responsible for providing the necessary resources. 3. Aims and Objectives It is the policy of NWAS to take all reasonable and practicable steps to safeguard the health and safety of employees while at work. We recognize that excessive levels of stress, especially if, endured for long periods can lead to ill health. Harmful levels of stress can arise as a result of factors both in the workplace and from employees personal and family lives. While it has no control over external factors, the Trust will - identify workplace stressors in consultation with staff and conduct risk assessments to eliminate stress or control the risks from stress. These risk assessments will be regularly reviewed. consult with the staff side representatives on proposed action relating to the prevention of workplace stress. NWAS Stress Management Policy Page: 6 of 21

provide training for managers, team leaders and supervisors in good management practices and stress identification provide information to staff (copied in Appendix 2) available to staff on the intranet, through HR and Healthcare Governance and in Health, Safety and Security A-Z toolkit. offer confidential counselling for employees affected by stress caused by either work or external factors. support staff involved in stressful or traumatic complaints / claims / incidents provide an adequate framework to enable managers to implement this policy engender a culture where raising the issue of stress is acceptable so that stressors can be openly discussed and solutions identified recognise that external factors can affect an individual s ability to deal with workplace pressures and will deal with individuals in a flexible and responsive way consider a range of interventions and actions to help address stress in the workplace We have a duty of care to ensure that the health of our employees is not adversely affected by their working environment, and we are committed both to fulfilling our duties under Health and Safety legislation, and to achieving best practice in managing workplace stress. The Trust will use the HSE Guidance Managing the causes of work related stress (the Management Standards) in dealing with stress management. 4. HSE Stress Management Standards The Management Standards identify six key potential stressors at work that, if properly managed proactively, can help to reduce work-related stress. The following areas will be considered by the Trust in the management of stress. Demands Includes issues like workload, work patterns and the work environment. Control NWAS Stress Management Policy Page: 7 of 21

How much say the person has in the way they do their work. Support Includes the encouragement, sponsorship and resources provided by the organisation, line management and colleagues. Relationships Includes promoting positive working to avoid conflict and dealing with unacceptable behaviour. Role Whether people understand their role within the organisation and whether the organisation ensures that they do not have conflicting roles. Change How organisational change (large or small) is managed and communicated in the organisation. 5. Duties General responsibilities for staff health, safety and well being are detailed in the Trust s Health and Safety policy. The responsibilities defined here relate specifically to the management of work related stress. 5.1 Director of Organisational Development The Director of Organisational Development is the executive director with overall responsibility for the management of work related stress. The Director shall ensure that this policy is implemented along with other measures to reduce stress and promote workplace health, safety and welfare supported by the Health and Safety and Sub Committee as required. 5.2 Line Managers All managers shall ensure:- Good communication between and with staff, particularly where there are organisational and procedural changes. Staff are fully trained to discharge their duties. NWAS Stress Management Policy Page: 8 of 21

Staff are provided with meaningful developmental opportunities, through the use of the Knowledge and Skills Framework Workloads and working hours are monitored to ensure that people are not overloaded or working too many hours Staff are taking their full entitlement of annual leave They attend training as requested in good management practice and health and safety. That bullying, harassment and discrimination is not tolerated within their area of responsibility. They are vigilant regarding their staff s wellbeing and offer additional support to a member of staff who is experiencing stress outside work e.g. bereavement or separation. They offer appropriate support (including external support) to staff who may be subject to an investigation arising from incidents, claims or complaints. Ensure advice is given to staff who are called as witnesses. That a positive culture is developed in their area of responsibility which encourages staff to raise concerns and discuss problems and where there is a tolerance of difference 5.3 Emergency Control Centre / PTS Control Centre The Emergency Control Centre / PTS Control Centre shall be responsible for:- Identifying ongoing incidents where staff may need support and for dispatching the appropriate Duty / Line Manager to attend. Invoking the on call procedure as required 5.4 Healthcare Governance Team The Healthcare Governance team shall be responsible for:- Establishing an effective framework for ensuring that risk assessments are completed and recommendations identified are implements where necessary NWAS Stress Management Policy Page: 9 of 21

Ensuring that Health and Safety Sub Committee / Workforce and Organisational Development Sub Committees are aware of the results of risk assessment process and the recommendations identified Providing specialist advice and guidance on the management of stress Ensuring managers are supported in implementing the results of stress risk assessments Supporting managers and staff in response to stressful / traumatic incidents, assisting with the investigation as required. Working with Human Resources to ensure the effective management of stressors Updating the business groups and sector forums of any changes and developments in the field of stress at work. Monitoring and reviewing the effectiveness of measures to reduce stress. Publishing advice to staff who may be required to attend court as a witness Liaising with the HSE as required 5.5 Occupational Health The Occupational Health advisors shall be responsible for:- Advising managers on the well being of individuals and any support measures and/or adjustments required to support staff in the workplace or on a planned return to work Offering support to staff who may be involved in difficult claims, complaints or incidents Referring staff to the counselling service specialists as required. 5.6 Human resources The Human Resources Team shall be responsible for: - Giving guidance to managers on the stress policy. Advising Safety Representatives of sickness absence including stress, depression and anxiety through the Joint Trust Council, twice yearly. Helping to monitor the effectiveness of measures to address stress by collating sickness absence statistics, including reasons for absence. NWAS Stress Management Policy Page: 10 of 21

Advising managers and individuals on training requirements. Providing continuing support to managers and individuals in a changing environment and encourage referral to the counselling service where appropriate. Procurement and management of occupational health and counselling services Promotion of a culture of positive wellbeing and the benefits of openness and counselling 5.7 Employees All employees shall, wherever possible, ensure that they: - Raise issues of concern with local Safety Representative, line manager or occupational health. Accept opportunities for counselling when recommended. Recognise stressors in themselves and colleagues, seeking help when necessary Raising problems and issues appropriately Raising with the Line Manager concerns relating to incidents, claims or complaints. 5.8 Role of Staff Safety Representatives The Trust will ensure that staff side are meaningfully consulted on any changes to work practices or work design that could precipitate stress. The Trust will also support staff side to consult with members on the issue of stress including being meaningfully involved in the risk assessment process and with workplace inspections to ensure that environmental stressors are properly controlled. To support staff who may be part of an investigation arising from a claim, complaint or incident. Staff side colleagues support will be sought for the implementation of identified control measures. NWAS Stress Management Policy Page: 11 of 21

6. Management of Work Related Stress Common Causes of Stress Life events that can cause stress could be the death of a partner, member of the family or close friend; illness of self, close family or friend; financial worries; divorce or relationship problems and moving house. In addition, there are everyday pressures such as travelling, caring, parenting, living alone etc. Some staff may also experience cultural and societal pressures as a result of perceived difference e.g. racism, managing with a disability. Possible work-related stressors are job insecurity; violence; lone working; conflict with home/life balance; unrealistic deadlines; increased workload; excessive hours; boredom; poor communications; relationship problems; lack of reward, either financial or otherwise; harassment and/or bullying and physical hazards such as noise, heat, ventilation etc. Common Effects of Stress Stress causes a variety of symptoms and these vary in different individuals. The effects of the risk (or perceived risk) of stress, can be emotional, physical and / or behavioural. It has also been recognised over recent years that constant or prolonged exposure to stress can result in serious mental or physical illness, such as depression, ulcers, diabetes, heart problems, high blood pressure etc. Experiencing any of these or observing them in others, for short periods of time, does not necessarily indicate that you are stressed. However, when one or more of these signs persists and you have difficulty in making adjustments to cope, this may be an NWAS Stress Management Policy Page: 12 of 21

early indicator of stress. Where possible, talk to your line manager. You can also refer to Occupational Health and HR or go to your own Doctor. Common Signs Persistent or recurring moods: anger, irritability, frustration, detachment or withdrawal from others, worry or anxiety, depression, guilt, sadness. Physical signs: aches and pains, raised heart rate, increased sweating, dizziness, blurred vision, skin problems, sleep disorders, exhaustion, nausea, lowered resistance to minor illnesses. Behaviour changes: difficulty concentrating, losses of memory, an inability to "switch off", poor judgement, loss of creativity, making more mistakes, checking things repeatedly, eating disorders, loss of interest in sex, increasing use of coffee, alcohol, drugs or tobacco. 77.. Risskk Asssseessssmeentt Prrocceessss The Trust is committed to adopting a pro-active approach, aiming to prevent workrelated stress occurring whenever possible and where this cannot be achieved, to reduce the incidence and the effects. However the Trust recognises the need to act reactively to deal with the symptoms as and when they occur where necessary. In taking a pro-active approach to stress management three levels of intervention are considered:- Level 1 through the process of risk assessment, possible causes of stress will be identified and the seriousness of risk determined, to both the individual and the organisation. A risk assessment need not be complex but must be thorough and should include employee involvement to ensure their awareness of work-related stress and input into the control measures. NWAS Stress Management Policy Page: 13 of 21

The identification of workplace stressors can be completed by using a range of methods, including some of the following non exclusive methods: running of staff focus groups use of surveys e.g. HSE s indicator tool feedback mechanisms, such as staff suggestion scheme workplace inspections formal and informal meetings sickness absence increase in incident report forms reporting stress Where the need for an individual risk assessment is identified this will be completed by the line manager with support from Risk and Safety, HR and / or Occupational Health. Level 2 - implementing risk assessment recommendations aims to eradicate or reduce stress levels. This level of intervention will include a stress awareness programme aimed at dispelling myths, improving communications and providing suggestions for dealing with stress causation, both for management and individuals. Interventions will follow the guidance in the Management of Health and Safety at Work Regulations 1999, i.e. avoid risk, combat risk at source, adapt work to individuals, develop procedures, prioritise collective protective measures and give appropriate information and instructions. Interventions will be recorded with appropriate timescales will be agreed, monitored and reported to the appropriate Business Group or Sub Committee. Level 3 - unfortunately, there will still be individuals who suffer ill health caused by work related stress, either because the intervention came too late, did not sufficiently address the risk or the additional pressures of externally related pressures complicated the risk. For this reason, the Trust will ensure there are suitable and adequate support systems in place to provide contacts where individuals can get NWAS Stress Management Policy Page: 14 of 21

advice, counselling if appropriate and, where necessary, to rehabilitate employees back into the workplace after a period of absence. Counselling can take place at any time, not only when an individual becomes ill. 8. Supporting Staff through Difficult Incidents, Claims or Complaints It is recognised that there are times during the provision of healthcare when staff may be involved in traumatic or stressful incidents or part of an incident or investigation into complaints or claims. During a difficult incident, the Emergency Control Centre will inform the Duty Manager so that contact can be made with staff to offer support available. Wherever possible the Duty Manager will attend the scene. Access to external support such as counseling can be sought via Occupational Health by the individual or through the Line Mangers as required. Following the incident, consideration may be given to an incident de- brief as well as extra provision of counseling and support services for staff. During an ongoing investigation the staff member will be supported through the Line Management function and potentially HR, Healthcare Governance and Occupational Health. Consideration should be given to the appointment of a welfare officer who will act as a point of contact for communication and advice for the Trust and the individual. Line Managers and staff can refer to the Legal Services Department for advice and support in the event of being called as a witness. Where staff are experiencing difficulties, managers should consider (non exhaustive):- Referral to Occupational Health and any onward referrals including counseling NWAS Stress Management Policy Page: 15 of 21

Legal support either through staff side or the Trust depending on the circumstances Consideration whether the staff member should remain on normal duties, temporarily redeployed to other duties or remain with colleagues Reduction of amendment to working hours or change in base station Consideration whether staff should remain on duty 9. Monitoring this policy Area for Monitoring duties Process for accessing information on the management of workrelated stress process for identifying workplace stressors requirement to undertake appropriate risk assessments for the prevention and management of work-related stress Immediate and ongoing support offered to staff advice available to staff in the event of their being called as a witness (internally and, if necessary, externally) Monitoring Process Responsibilities of staff will be monitored on an annual basis through attendance at meetings, development of reports and by line managers via the KSF process Appendix 2 monitored by the Head of Risk and Safety as part of the policy review The Stress Management Action Plan, including the process of identifying workplace stressors, will be reviewed at least annually by the Health and Safety Sub Committee The Stress Management Action Plan, including the requirement to undertake appropriate risk assessments will be reviewed at least annually by the Health and Safety Sub Committee Report on general themes arising from the counselling services provided to the HR Senior Management Team at least twice a year by the HR Manager (Corporate) The advice available to staff in the event that they are called as a witness will be monitored on an ongoing basis through the number of requests submitted to the Legal Services Coordinator NWAS Stress Management Policy Page: 16 of 21

Action for managers or individuals to take if the staff member is experiencing difficulties associated with the event Reported by exception through the Line Manager to HR to ensure an Occupational Health referral. 10. Reference Documents Advice and guidance is available from http://www.hse.gov.uk/stress/index.htm. Health & Safety Executive (HSE). (2004f). Working Together to Reduce Stress at Work: A Guide for Employees. Available at: www.hse.gov.uk. Health & Safety Executive (HSE). (2005). Tackling stress: The Management Standards approach. Available at www.hse.gov.uk. Health & Safety Executive (HSE). (2007a). An example of a stress policy. Available at: www.hse.gov.uk. Health & Safety Executive (HSE). (2007c). Management Standards for Work-related Stress. Available at: www.hse.gov.uk. Health & Safety Executive (HSE). (2007d). Overview: The Management Standards and the 5 Steps to Risk Assessment. Available at: www.hse.gov.uk. NWAS Stress Management Policy Page: 17 of 21

Appendix 1- Advice for Managers Managers have a key role to play in the implementation of the Stress Management Policy. The recognition and management of stress are integral to that role. The following points are actions you can take to help reduce workplace stress. Maintain open communication lines with staff Carry out KSF reviews to identify the training and development needs of your team members. Monitor your own and their progress in meeting those needs. Ensure that all new starters, who join your team, have a planned local induction programme, which fully prepares them to carry out their job effectively. Allow time for your staff to attend training events including safety training Set time aside to discuss training, review its effectiveness and agree how it will be applied in the workplace. Take care over the allocation of work. Do your team members have the necessary skills? Are the timescales reasonable? Do they have the right equipment? When an employee is absent, find out why in a sensitive and appropriate manner. Maintain contact and offer support to employees on longer-term absences. Seek advice from the Human Resources or Health and Safety when you are unsure how to deal with a problem. Identify posts where work-related stress has been or is a problem. See what can be done to reduce the risk of stress to the post holders. If a team member is promoted, redeployed or their job changes, ensure you give them advice, support and any necessary training to help them adjust to the new situation. Treat all team members fairly and consistently. Encourage employees to talk to you if they have a problem or grievance. Encourage a supportive and positive culture in your team. Never tolerate any harassment or bullying. Discourage gossip. NWAS Stress Management Policy Page: 18 of 21

Encourage clear communication and sharing of information. Use meetings to discuss local issues, explain objectives, and celebrate achievements. Encourage team members to contribute ideas and opinions and ask questions. Treat personal problems sensitively, and maintain confidentiality when team members disclose matters to you that are not work-related. NWAS Stress Management Policy Page: 19 of 21

Appendix 2- Advice for Individuals As an individual, stress related issues can be tackled by considering the following options:- Talk to your manager. If they don t know that there is a problem, they can t do anything to help you. If you don t feel able to talk to your manager, ask a staff side representative or colleague to raise issues on your behalf. Support your colleagues by encouraging them to talk if they experiencing stress, including to their manager or staff side representative Seek support from Occupational Health or the Trust s counselling services. Discussing with your manager the possibility of altering your job to make it less stressful for you, recognising your needs as well as those of your colleagues Trying to channel your energy into trying to solve the problem rather than worry about it. Think about what would make you happier at work and discuss this with your manager Learn to say no have the confidence to say no if you are feeling overloaded Take breaks at work don t stay glued to your work, take a break, go for a brisk walk during your break Plan your work. Sit down and work out what needs to be done. If you have an excessive workload, delegate if possible and decide on what is the priority to be done. What about outside of work? The following advice is there to help you deal with work related stress, it s meant to help you take care of yourself so hopefully the problem won t get any worse:- Eat healthily Stop smoking it doesn t help you stay healthy though you might think it relaxes you Try and keep within the recommended daily allowance for alcohol NWAS Stress Management Policy Page: 20 of 21

Keep an eye on your caffeine intake as it may contribute to making you feel more anxious Be physically active it stimulates you and gives you more energy Try learning relation techniques some people find that it helps then cope with pressures in the short term Talk to family and friends about how you are feeling they may well be able to support you, including giving you the support to raise your concerns at work Take time to exercise regular and frequent exercise is a good stress reducer NWAS Stress Management Policy Page: 21 of 21