‘Where the change really needed to take place was at policy level’

Image above:

‘The Weight of the Ambulance Queue’, by Dr Jo Daniels

‘At the time [I took the photo] I was writing up my research on the systemic pressures on the emergency care workforce. The long wait of the ambulance crew is a significant contributor to this problem, and symbolic of how overloaded the emergency department was likely to be. If there is an ambulance queue full of the injured or unwell, then there likely to be many more on the inside of that building, where staff ratios are low and burn out is high. This image was submitted to and won the Research Images award last year at University of Bath, and I use it in many of my research presentations. This image conveys a thousand words, as they say.’

Why and how did you turn your attention to engaging with policymakers?

My work with policymakers was borne out of frustration with the lack of progress being made in terms of staff wellbeing in frontline services, and a pressing need to act on our research findings. At the start of the pandemic, we reported how those working right at the frontline (Emergency Care, Anaesthetics, ICU) were experiencing high levels of distress. These findings were replicated by other research groups and we also followed our cohort at later time points, repeatedly establishing mental health needs in the most vulnerable healthcare worker groups. But little was being done to meet the needs of this group.

In response to this, we built on our earlier work and developed the CoCCo model of care. This model was derived from empirical work and outlined a coherent pathway of care that reflected the levels of support clinicians indicated they needed. It was clear quite quickly that our research had shone a spotlight on already longstanding problems that were exacerbated by the pandemic.

At that early stage, the wellbeing hubs were emerging, and there were also pop-up services, but little else and no formal infrastructure or guidance on how to support these groups. I started to receive emails about how services were using the CoCCo model as a template of what should be available, and it was at this stage that I started to think about policy, both on a local and national level. I could see that where the change really needed to take place was at the policy level, which would then inform practice.

So what was the next step?

Securing funding from UKRI for a secondment to the Royal College of Emergency Medicine (RCEM), where the scope of the work was specifically focussed on Psychologically Informing Policy and Practice, the PiPP Project. Within this project, we conducted qualitative research to generate policymaker-facing recommendations on how to address workplace concerns and barriers to wellbeing and retention in emergency care.

My sense was that embedding myself within a target policy setting would be an opportunity to influence and act as an agent of change. It was an incredible experience, working with policymakers behind the scenes and gaining a greater understanding of how practice and policy fit together at a professional body level. I am delighted to say that our work has informed the Presidential campaigns and strategy, parliamentary briefings, and policy development. It was a real high point receiving a communication that our work was referred in high level meetings with Chris Witty and Rishi Sunak. Since then I have represented RCEM at the Liberal Democrats party conference roundtable, which was also quite an extraordinary experience.

Can you tell me about some of the outcomes to this work?

We have been overwhelmed with the response to both the CoCCo and the PiPP Project, it felt as though we were riding on the crest of the zeitgeist; the urgent retention crisis was a concern both in the UK and internationally. We have been invited to present our work in the USA, Australia, Canada as well as many regions and committees and specialist interest groups in and around the UK. Due to the scope and focus of our recommendations, and the empirically grounded and specific nature of the recommendations, we were offering guidance in areas where there was an identified need but lack of solutions, so engagement and interest was high.

To drive forward the aspect of our work that speaks to unmet basic needs in the workplace, we have collaborated with the Healthcare Workers’ Foundation, a fantastic charity, to provide rest rooms, sleep pods, water fountains, comfortable chairs and basic items which most of us don’t think twice about. We are currently evaluating the implementation of these changes. We have also been active contributors to the #NoHungryStaff and @NeedsAtWork campaigns, which has offered opportunities to engage staff and the public in these important issues.

We are now continuing the work with professional organisations such as the Royal College of Emergency Medicine (RCEM) and the International Federation of Emergency Medicine on their Leadership strategies, again, a core area of recommendation in our report. It has been a real pleasure to work with organisations which have an appetite for using research to underpin policy development and address areas of outstanding concern. We have many other plans in the pipeline too!

How did your policy fellowship at the Department of Health and Social Care come about and what will it involve?

Many of us are familiar with research fellowships which are usually grant funded and focused on a specific research area; with policy fellowships, funding bodies match researchers to work in particular government departments that are aligned with their interests, in order to support research and policy development collaboration. When I saw the fellowship at the Department of Health and Social Care (DHSC) advertised, funded by the UKRI and ESRC and a key stream identified as workforce, it felt like a natural next step – I was really excited at the prospect of becoming more embedded within an organisation that shapes national mandatory policies.

Altogether, it is an 18-month secondment, the first policy fellowship of its kind with the DHSC. My role will be supporting decision making on workforce and recommendations, advising on the scientific and evidential side of things to ensure that the policies are underpinned by evidence. I’ll be working directly with policymakers – engaging them in knowledge exchange activities and conducting research in identified priority areas, as well as learning to understand policy a little more.

I’ll be identifying what they need to know more about, and I will be involved in commissioning research or carrying out research that will be used to shape or advance strategy and policies at the Department of Health and Social Care. I’m hoping that, alongside the policy work, I can continue my programme of research and address current gaps around workplace interventions, whether this is related to leadership, mental health or implementation science. We’ve done a lot to establish need but more is needed to understand what is necessary in workplace settings to retain the workforce.

What is the role for psychologists in working in policy, and why do you think some people are reluctant to get involved?

I do think psychologists are well suited to this area of work. We understand research, we are good at communicating complex information, we are often advocates of those we represent, and we are commonly driven by research that is meaningful and seeks to advance not only the field but the lives of those we work with.

The thing that prevented me from moving into policy or policy engagement work previously was because I didn’t really understand the process of policymaking and the role that psychology could have – I do think it’s probably more about lack of awareness and information, I think we should consider this when we are training psychologists of the future. It can also be very challenging work. You have to be very confident in your knowledge of the evidence and in engaging people who perhaps need persuasion. You have to possess that ambition of pushing things forward and being able to come up against people who perhaps are not interested in what you’ve got to say and being okay with that (and regular rejection!).

I also think that there aren’t obvious roles carved out for psychologists in policy; while we are often on NICE guidance panels, consultation documents and indeed we do have a psychologist as an MP, these appear to be exception without a clearly defined path to policy. When I first approach the Royal College of Emergency Medicine to offer my time on secondment, they said they didn’t want ‘to look a gift horse in the mouth’… I think they were surprised at the request and wondered what I’d do while I was there. Now, I am sure they would agree that our collaboration has been incredibly fruitful and will continue on beyond this project I am sure. But perhaps the lack of understanding goes both ways, from a policymaker's point of view, do they know what role psychology can have, for example.

In reality, we should be engaging and working with policymakers as part of our programmes of research, or at least producing research which is policymaker facing where relevant. Policymakers range from a team leader in an NHS service right up to government, but between there’s a lot a lot of people in between who are also making policies – including chief executives and professional bodies like the BPS and royal colleges. It is an important area to achieve impact and we are really well placed to do that. [Find Jo’s top tips for policymaker engagement]

I understand you’re hoping to form a network of psychologists working in emergency care – how might people get involved?

Based on the work we have done so far, we have learned that the problems we are facing in the NHS retention and staffing crisis are no different from elsewhere. There is a great need and interest in the work we are doing, but it makes sense for us to pull together to influence policy and practice rather than reinvent the wheel in our corners of the country or indeed the globe.

My co-investigators and I are part of REACH (Research in Emergency Care, Avon Collaborative Hub @REACHBristol) who are a leading research group doing fantastic work across all areas of research within Emergency Care both in the UK and further afield. There are plenty of exciting plans ahead in terms of how we progress our research in the international arena, however, it would be great to pull together a national network of psychologists and psychological therapists working clinically within or attached to, emergency care.

We know from our recent research that the emergency department is fertile ground for psychological work and from experience, emergency care is an incredibly exciting and varied place to work as a psychologist, yet many psychologists are working up and down the country alone in silos. Emergency care is an area of tremendous growth in terms of the role of psychology, and we can make the most progress by working together, sharing resources and thinking about key areas of development.

So if you are a psychologist or psychological therapist working in this area, please do drop me a line on j.daniels@bath.ac.uk, or @drjodaniels on X.’

All articles posted on this blog give the views of the author(s), and not the position of the IPR, nor of the University of Bath.