The Need for NLP in the NHS
 
By Henrie Lidiard  
(First published in NLP News: March 2005)

 
My own experience 
When my mother was in hospital and during her subsequent stay in a hospice, it seemed clear to me, both from her experience of care and from my direct experience of medical staff, that there were some areas that could really be helped by some awareness of NLP techniques.   When I asked staff directly at both the hospital and the hospice about areas they felt they would like some help in, three themes came up consistently.  They were:
 
1. dealing with high stress levels
2. ways of dealing with anxiety in patients and
3. ways to deal effectively with depression in patients. 
 
The only options that the nurses I spoke to said they had, were medication (and many patients in cancer wards are already taking a lot of drugs) or a sympathetic listening ear. They found that the latter didn’t always help patients and they didn’t always feel they had the energy to give it because of the toll on their own emotions. 

More and more change
The NHS in Britain is undergoing huge changes, not solely because of re-organisation of the way the Health Service is managed but also because of changes in the society we are part of.  
 
For instance: patients are in some ways better informed than they used to be (as a result of using the internet to research their condition). They may also, for similar reasons, have higher expectations than in the past. Patients also don’t seem to have such respect and deference for Health practitioners as they once did (RCGP 2002). In addition users of the health service seem to be becoming more litigious when things go wrong and cases are given a high profile in the media.
 
There are worrying life-style trends particularly amongst young people in Britain (for example binge drinking, poor diet, lack of exercise and smoking) which mean that problems such as obesity (and the attendant effects on heart disease, cancer and diabetes) are likely to put more strain on resources. Increasingly, as part of preventative medicine, doctors and nurses may be seeking to influence peoples’ decisions about the way they take care of themselves.
 
Stress and depression seem to have risen in the general population and prescribing for depression has risen to record levels. These factors combined with the aging population trend in Britain and difficulties in recruiting and retaining highly qualified staff suggest that there is likely to be more change ahead as we find ways to cope.

Stress in the health-care professions and its effects on staff and patients:
Stress seems to be an important issue for Health professionals. It isn’t only rising in the general population but it seems that it is increasing within the profession also. Some statistics suggest that 50% of GPs and a similar proportion of NHS managers and consultants are suffering borderline or more severe anxiety and a quarter of GPs have borderline or more severe depression (RCGP 2002). (I don’t have statistics for the mental health services but anecdotally the situation sounds similar). In addition, as a coping strategy 23% of GP’s drink to relieve stress and 7% are addicted to alcohol or other chemicals. (RCGP report 22). A BMA report 1998 found that ‘many senior doctors suffer high levels of stress and this impairs their health and also compromises their ability to provide high quality care to patients’.
Burn-out of medical staff is a recognised problem and can cause the following effects:
 
  • Emotional exhaustion
  • Depersonalisation (treating patients and other people as if they were objects)
  • Low productivity and feelings of low achievement.

In one study of 16 Bone marrow transplant units half of all Doctors and nurses were sowing marked symptoms of burn-out (Molassiotis 1995).

There are potentially high costs associated with these levels of stress. These may include not only the suffering of the individuals involved but the costs of sickness absence, premature retirement, health-care and rehabilitation, even premature death. In addition as stress impairs performance a lowered standard of patient care can mean complaints, bad publicity, litigation and compensation (BMA 1998). It seems that there is a pressing need for medical staff to have access to effective strategies for managing their own emotional states and looking after their well-being. It is possible that if they had access to these, they might also be able to pass these on to their patients.
Some areas of the health service seem to work together more effectively than others. This is critical as research also points to an unequivocal connection between the impact of dysfunctional teams and patient mortality (Aiken et al 1994, West 2002). It is still all too common for breakdowns in communication to occur between different parts of the system e.g. between consultants and referring doctors (Tattersall and Ellis 1998 and Bain and Campbell 2000)
 
The needs of professionals in the cancer field:
This is captured in an excellent review by Sargent et al (2004). In summary, it seems critical that health professionals in the field of cancer care have access to ways of managing their own emotional wellbeing. The research also highlighted a need for  communication, inter-personal and
Psycho-social support skills in providing quality, patient-focused care. It also found, that despite official policy, health professionals were not yet receiving adequate communication and interpersonal skills training.

The needs of cancer patients/carers:
Patients value many things in their care, in addition to technical competence one study (Farrell 2001) found that they value:
  • being treated with humanity,
  • kindness,
  • patience,
  • a willingness to listen and answer questions,
  • honesty, straight-forwardness
  • an encouragement of feelings of confidence,
  • approachability
  • sense of humour,
  • consideration,
  • treating patients as individuals and
  • having respect for patients.
These qualities and behaviours would all be harder to deliver if the medical staff were stressed, anxious, depressed or burnt-out. In fact descriptions of being treated like a symptom or a disease (a thing?) were all too common in the Patients’ and Carers focus group held in Ellesmere Port as part of the Living with Cancer research project (Sargent et al 2004).
It is interesting that where patients expressed views on how their care could be improved they do seem to mirror the symptoms of professional burnout.

The "Interior" beckons:
In short there are several areas where there seems to be an increasing need for skills in the health service, they include:
  • Influencing patients behaviour with respect to their life-style choices
  • Managing stress, anxiety, depression and burnout (theirs and their patients)
  • Providing emotional and psycho-social support to patients
  • Working together more effectively to deliver high quality care in a period of accelerating change.
All of these needs reflect the "interior subjective" or the "interior collective" aspects of the system (Wilber 1988, 2001). This intangible aspect of our interior experience is the very one science has for a long time pretended doesn’t really exist because it is hard to measure. It is also the aspect of health-care that medical practitioners currently feel ill-equipped to deal with (Department of Health 2000).

NLP can help:
NLP can be of profound and practical help in this area as it provides not only a logical and consistent understanding of the structure of subjective experience but also a systematic and effective way of working with it to make positive changes. 
 
References:

Aiken L.H. Smith, H.L., Lake E.T., 1994 Lower medicare mortality among a set of hospitals known for good nursing care. Medical Care 1994. Vol. 32: (8) p 771 – 787.
 
Bain N.S. .Campbell N. 2000. Treating patients with colo-rectal cancer in rural and urban areas: a qualitative study of the patients perspective.   Family Practice Vol. 17: (6) p475 – 479.
 
British Medical Association report 1998 by BMA Health Policy and Economic Research Unit. Work related stress among senior doctors: Review.
 
Department of Health 2000. The NHS Cancer Plan. A plan for investment. A plan for reform. Department of Health London.
 
Farrell C. 2001. There is no system to the whole procedure: Listening to patients views and experiences of NHS cancer services in NHS Cancer services. Supporting paper: 1 NHS cancer-care in England and Wales. London: Commission of Health Improvement.
 
Molassiotis A. ,Vander-Akker O.B., Boughton B.J. 1995. Psychological stress in nursing and medical staff on bone marrow transplant units. Erratum in Bone Marrow Transplant Vol. 15: (3) 328 .
 
Royal College of General Practice. 2002 Information sheet No. 22. Stress and General Practice. 
 
Sargent, P., Thurston M. ans Kirby, K. 2004   An evaluation of the Living With Cancer Project. Using NLP techniques to maximise the coping strategies of carers and patients living with cancer in Ellesmere Port. ISBN: 1-902275-34-9.
 
Tattershall M. and Ellis P. 1998 Communication is a vital part of are. Britishe Medical Journal Vol. 316: p1890 – 1893.
 
West M. 2002 A matter of life and death. Article in People Management magazine February 2002 p 30 – 36.
 
Wilber K. 1988 The marriage of sense and soul. Integrating science and religion. New leaf. Dublin.
 
Wilber K. 2001 Eye to Eye: the quest for a new paradigm. Shambala Publications Inc. Massachusetts.
 

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