Karl Douglas knows all too well the financial and personal cost of back pain. Douglas, a former intensive care nurse, was paid £800,000 compensation by Bexley and Greenwich Health Authority in 2000 after suffering a debilitating back injury that cost him his job and health.
His compensation is, to date, thought to be the largest paid to a nurse for a back injury, but it is by no means the only sizeable payout of the past few years.
In 2003, former nurse Joyce Rowe was awarded £47,621 after she aggravated a spine condition while tending a patient.
A year earlier, former nurse Angela Knott won £420,000 in a case described at the time as “ground-breaking”, after claiming poor staffing levels and inadequate equipment caused her crippling back pain.
Absence as a result of manual handling accidents – of which back injuries are a key part – is estimated to cost the NHS £400m a year, with such accidents accounting for about 40% of all absence in the service.
One in four nurses has, at some time, taken time off work with a back injury sustained at work, and every NHS employee who retires early because of a back injury costs the NHS at least an extra £60,000, the Department of Health (DoH) has estimated.
Such vast figures put the launch of the DoH’s Back in Work campaign and awards two years ago into perspective, and show just how important its work, and that of other bodies, is to the NHS.
The campaign is intended to build on work already done, and guidance already issued, by bodies such the Royal College of Nursing (RCN), Unison and the Health & Safety Executive (HSE).
As the DoH puts it: “There has never been a truly national campaign aimed at all NHS staff, addressing this very important issue. The Department of Health has now brought together all of the interested parties to launch a national NHS campaign aimed at all NHS employees from the boardroom to the kitchens and the boiler room.”
Looking at the campaign what is clear is the amount of work now being done in the NHS on this issue as a whole, and in particular the need to continuously educate NHS staff, both medical and non-medical, about back care and back injuries.
There is also much more manual handling equipment available now than there once was and, critically, much more inclination and understanding of how to use it properly.
Of particular interest to OH professionals is an increasing investment by trusts in specialist teams, working alongside OH, specifically to look at back and musculoskeletal injuries, so leaving OH free to concentrate on wider health and absence issues.
The Back in Work Awards, organised in conjunction with the HSE, were run this year for the first time by NHS Employers, the body set up in November to promote OH and other HR issues within the NHS.
The 2004 winners were announced in January and, says Mary Newsome, NHS Employers’ OH policy manager, the main trend she is seeing from the entries this time around is that trusts do not have to spend a fortune to reduce their back, manual handling and musculoskeletal injuries rate.
“Cost-effectiveness has been the big theme. It is all about treating people quickly and getting them back into work,” she explains.
The types of ideas being put into practice are often very simple – such as East Sussex County Healthcare NHS Trust’s photo booklet (see box on page 16) – but are all the more effective for that.
“If people can prove cost-effectiveness then it is much harder for their funding people to ignore them,” Newsome adds.
The work being done has also shown the importance of having a co-ordinated approach when it comes to tackling musculoskeletal injuries, she suggests.
“Trusts need to remember that back injuries are not just caused by people lifting heavy loads. They can happen to anyone if they are not trained in proper manual handling techniques. They can easily affect nurses at 23 or chief executives at 55, and the effect can be as devastating and life changing for one as for the other,” she says.
This year’s round of awards is being launched at the NHS Confederation’s annual conference in June, and closer links are also being developed with Scotland, Wales and Northern Ireland on awareness raising and information sharing.
This year’s overall winner (and winner of the Stakeholder Engagement with Successful Outcome category) was Isle of Wight Healthcare NHS.
The key to its success, argues back care advisory team manager, Judy Green, has been in working as a bridge between OH, the clinical teams, management, employees and support specialists.
The team has also made a particular effort to target non-clinical staff and load handlers, who, with the focus so often on the stresses and strains experienced by nurses and other clinical staff, can all too easily get overlooked.
Government targets on areas such as waiting times and referrals do not only put clinical teams under pressure, but the clerical and other service workers who support them, Green suggests.
“People can self-refer or they can come to us through the OH advisers. We also get involved in return-to-work packages. There is a lot of emphasis on graduated return-to-work,” she says.
There is also now much more emphasis on the issues surrounding working with display screen equipment, workstation risk assessments and dealing with over-crowded and cramped working environments.
“We are able to take some of the pressure off of OH and sort out things such as a fast-track to a physiotherapist or chiropractor. It is very much a multi-faceted package,” Green adds.
When it came to the awards, the five-strong team was praised for its integrated and comprehensive approach to reducing musculoskeletal injuries among the 3,000 employees at the trust.
This included ensuring all staff were trained in moving and handling during their induction period, that all accidents and incidents were risk assessed, and that back care advisory team members promoted return-to-work programmes that allowed staff who had been off sick to return to work slowly, according to their situation.
The judges particularly flagged up the team’s purchase of two powered bed pushers, which allow staff to push beds and trolleys around hospital corridors without straining their backs.
This also showed another key advantage for the Isle of Wight team – the fact it has its own budget. This, suggests Green, gives it a modicum of autonomy and independence, particularly when it comes to deciding that a piece of equipment is needed and simply being able to go out and buy it.
Both Green and Newsome agree that while the awards inevitably emphasise particular achievements, the fact they exist at all is symptomatic of changing attitudes to back injuries within the NHS.
“There has certainly been a change of attitude in the past six or so years,” Green says. “When the health and safety regulations were amended in 1999, you started to get a lot more back care advisers and advisory teams.”
“There has also been a huge change in terms of NHS staff looking after themselves and being more aware of how to protect themselves. There is much less of the macho attitude that there might have been in the past,” Green suggests.
Ambulance staff, for instance, are now much more aware of the dangers of picking up patients and much more likely to carry out a risk assessment before acting, at least in non-emergency situations.
“A lot of nursing staff, who are often the most vulnerable because of the sort of service they provide, would not dream of lifting someone manually when there is the equipment available to do it.
“There is much more advice available and more equipment – we, for instance, offer a 24-hour support service,” Green explains.
In an ideal world, NHS staff would be able to work free from the fear of suffering a back, manual handling or musculoskeletal injury. Realistically, in an organisation as large, complex and busy as the NHS, that is unlikely to happen.
But as this year’s round of Back in Work Award winners shows, the development and expansion of specialist teams, such as that at Isle of Wight and the others highlighted, can go a long way in helping to educate employees and prevent injuries occurring.
In the process, the burden on OH can be eased, both in terms of directly having to deal with such cases and indirectly in having to pick up the pieces due to increased levels of absence.
OH will, of course, always have a hugely important role to play when it comes to back, manual handling and musculoskeletal injuries, but there is clearly the potential for the two sides to become valuable allies.
Hopefully, as a result, personal tragedies such as those experienced by Karl Douglas, Joyce Rowe and Angela Knott will become, if not completely a thing of the past, then at least much less common.
Back in Work Awards: the other winners
Most Improved Service: East Midlands Ambulance Service NHS Trust
Increasingly, the Ambulance Service is being asked to transport larger and heavier patients. The judges recognised that the trust had introduced ambulances equipped with specialist patient handling equipment to transport urgent patients, a role traditionally carried out by A&E ambulances. The ambulances have a range of patient lifting equipment, including hoists, emergency lifting cushions, specialist stretcher trolleys and a battery-operated, stair-climbing chair. Staff are trained in the use of this equipment to reduce musculoskeletal injuries. Benefits have included a reduction in the risk of injury to patients and to staff, a fall in staff sickness among urgent ambulance crews, and the freeing up of A&E ambulances to respond to emergency calls.
Evidence of Problem Solving: Causeway Health and Social Services Trust, Northern Ireland
The trust is encouraging mothers in labour to adopt alternative birthing positions to benefit both themselves and their babies. However, these positions can increase the risk of musculoskeletal injury to midwives. The trust has therefore produced a range of patient information leaflets and posters to promote alternative birthing positions to protect mothers, babies and midwives.
Trust maternity staff have also undergone training in these positions.
Innovative Programmes and Ideas: East Sussex County Healthcare NHS Trust
Mental health service users take on jobs while they are inpatients as part of their rehabilitation. Many of these jobs involve lifting, carrying, packing and sorting. The trust has designed two workbooks to help train service users in keeping good posture while lifting and carrying.
These are used by trainers on a one-to-one basis and include photos demonstrating good and bad postures.
Joined-up Working Practices: Sandwell and West Birmingham Hospitals NHS Trust
The trust has an occupational therapy team comprising doctors, nurses, physio-therapists, an ergonomist, a moving and handling co-ordinator and trainers. This team assesses departments with high staff sickness from musculoskeletal disorders, and works with the department to solve problems. For instance, drug cabinets on wards have been moved next to beds instead of above them after several staff reported neck and shoulder pain because they had trouble reaching the cabinets.