Supporting colleagues facing challenging ethical decisions

We look at how our partner organisations can help support you and who to talk to when making challenging ethical decisions.

When caring for patients and communities, we can be faced with challenging ethical decisions.  In some instances, you may be faced with a number of difficult options and these decisions made can affect a person’s mental health, which can result in psychological distress.

Our partners are committed to supporting staff and students.

We take a look at some of the services available to support your wellbeing, especially around making clinical care decisions involving challenging ethical issues.

Guy’s and St Thomas’ NHS Foundation Trust

At Guy’s and St Thomas’ NHS Foundation Trust there are a number of services available for staff to help them when making challenging ethical decisions. Many of these services have been developed or enhanced in our response to COVID-19 and are in place to support the wellbeing of our staff during this time:

• The Clinical Ethics Advisory Group provides advisory support to colleagues faced with clinical care decisions involving challenging ethical issues. Its main purpose is to provide an objective opinion to a clinical team to assist their own decision-making process. Throughout COVID-19 the support has continued, with an on-call ethical decision-making support group rota in place. Each group is led by a clinician with two others who also have experience in ethical decision-making.
• As part of the enhanced package of health and wellbeing support, staff are able to request support from our team of staff psychologists. This includes one-to-one psychological support, frontline team huddles and psychological preparedness training.
• Online support sessions by the Trust's medical mediation team give staff access to advice and support on managing conflict, building resilience and leading teams through crisis
• Coaching opportunities - in response to COVID-19 the Trust offered ‘pop-up coaching’ with accredited coaches based in wellbeing zones, online and over the phone.
• Support for leaders and managers - dedicated leadership pages were set up on the intranet so that staff can find out more about the support available to help them lead compassionately during COVID-19, this includes webinars, top tips and online guides.
• Team Time - like Schwartz Centre rounds, Team Time is a new initiative that provides teams with a protected forum to discuss the emotional aspects of working in the NHS at this time.

King’s College Hospital NHS Foundation Trust

Throughout the pandemic at King’s College Hospital NHS Foundation Trust, there have been a number of ways the Trust has continued to support its staff, including when making challenging ethical decisions: 

• The Decision-Support Group working within the Clinical Ethics Forum was set up to support clinicians with complex decision-making during COVID, at a time when we were faced by new challenges and concern about treatment options becoming constrained. 
• However, aside from COVID, we recognise that many of our clinical teams are often faced with clinically, and at times ethically, challenging situations and management decisions. We are keen to embed a decision-making support culture into King’s College Hospital NHS Foundation Trust, allowing teams to draw on expertise from other senior clinicians and colleagues, including legal advice, where this could be beneficial to the patient, family members or clinicians involved in a complex case. 
• Where there are complexities around a case that may benefit from discussion with senior clinicians from the Decision-Support Team, referrals should be made via the complex decision-making support referral form on EPR. 
• The Decision-Support Team will respond to referrals within 24 hours (Monday to Friday). The team are able to convene an urgent decision support discussion or arrange attendance of the clinical team at the next monthly Clinical Ethics Forum. 
• Teams accessing advice from the King’s College Hospital NHS Foundation Trust legal team around Serious Treatment Decisions will also be encouraged to seek support from the Clinical Ethics Forum if this is felt appropriate.
• Staff support work: In response to the pandemic, the Department of Psychological Medicine, Trust Psychologists, the Organisational Development team, Occupational Health team, Workforce, Learning and Development team, Chaplaincy and King’s Health Partners Mind & Body team worked together, and deployed a significant number of mental health professionals into staff support work. This was a voluntary workforce, offering support in addition to usual clinical roles. A substantial offering of support, spanning a range of different strategies across a tiered model, were employed to support individuals, teams and leaders. 
• Wellbeing resources were created and disseminated (see Kwiki), wellbeing hubs were set up and teams received in-reach support and ward ‘Buddies’. The service was enthusiastically welcomed, highly valued and evaluation has been favourable. However, this Staff Support Programme has gradually had to wind down as staff return to their usual work patterns. The Trust is currently in a period of transition as the new staff health and wellbeing strategy is being planned and King’s College Hospital NHS Foundation Trust continue to expand the support they offer staff as a Trust. 
• Team Time - Team Time sessions, an online form of Reflective Practise, similar to Schwartz Centre rounds, are being offered to some teams to help process staff experience over the last few months and reflect on how to sustain ourselves as we move towards autumn and winter. These groups will help to inform our Schwartz round Autumn schedule.
• See the Mental Health and Wellbeing Pathways document which outlines pathways of support available to you.  
• If your team needs support, take a look at the King’s Health Partners Mind & Body Team Wellbeing Toolkit, or send an email to kch-tr.teamwellbeing@nhs.net and let the team know how they can help. 

South London and Maudsley NHS Foundation Trust

South London and Maudsley NHS Foundation Trust continues to support staff faced with difficult decisions due to the COVID-19 pandemic. Its aim as we move through the pandemic is to ensure better processes for managers to learn from how their staff feel. The support has included:

• Guides to making complex ethical decisions and ensuring processes mean certain decisions can only be taken by a team of people so nobody has to make them alone.
• Producing a range of information and resources on end of life care, including webinars where staff could explore issues and questions.
• more generally, the Trust has provided staff support in a number of ways during the pandemic. These have included dedicated spaces at hospital sites where colleagues could connect and practise simple stress management techniques.
• Setting up a support and advice line for staff and publishing a range of mental health and wellbeing information on its intranet.
• The Trust also runs Schwartz Rounds, forums for all colleagues to come together to talk about the emotional and social challenges of caring for patients, and other opportunities for emotional reflection.

King’s College London

NHS Check, a study led by Prof Simon Wessely, King’s College London, explores how the COVID-19 pandemic has disrupted the work of NHS staff, to identify how best to support acute hospital staff during pandemics. The study also explores how to mitigate ethical dilemmas, caused by changes in working conditions because of the pandemic.

The 5 – 10 minute survey can be completed online and will close on 23 August 2020.

King’s College London’s health and wellbeing hub contains useful tips for maintaining health and wellbeing while working and studying remotely, with a focus on mental health and staying connected. 

Free, confidential expert advice and support including counselling is available to all staff on the employee assistance programme. Visit the King’s College London intranet for more information.

Want to find out more about the support on offer to staff across our partnership?  Read our article on Wellbeing Hubs launched to support staff across King’s Health Partners.