Boorman Review urges NHS to prioritise staff health

In August Dr Steve Boorman’s interim report on the health of NHS staff was published, calling for “a sea change in the way in which staff health and wellbeing is perceived” and asking NHS leaders to put the health of staff “at the heart of the NHS mission and operational approach”.

The NHS Health and Wellbeing Review found that 10 million working days are lost each year to sickness absence in the NHS and that occupational health service quality is inconsistent and, in some cases, inadequate. Employees are absent owing to sickness for 10.7 days a year compared with 9.7 days in the public sector as a whole, and 6.4 days for the private sector, at a cost of £1.7bn per year. On the other hand, many staff struggle in to work when they are unwell.

The review was undertaken in response to Dame Carol Black’s review of the health of working age people in 2008. Boorman found that many staff do not believe that senior managers take a positive interest in their health and wellbeing and there are cultural barriers to investing money in services for staff and to enabling people to access services effectively.

But staff wellbeing is not the only concern of the review. Productivity levels in the NHS will need to increase to keep pace with rising demand for services and possibly lower staff numbers. The review finds that more than £555m a year could potentially be saved and claims there are clear links between workforce wellbeing and key measures such as patient satisfaction and trust performance.

Boorman wants staff health and wellbeing measures and performance monitoring included in NHS governance frameworks. He recommends that trusts collect and publish annual data on sickness absence in the NHS, drawn from the Electronic Staff Record (ESR) in a way that allows performance to be compared across the service.

In particular, annual data on sickness absence should be collected and reported to boards and metrics introduced for monitoring service effectiveness and return on investment perhaps using a simplified version of theBusiness Healthcheck tool, developed by employers’ group Business in the Community.

At the launch of the interim review, David Nicholson, chief executive of the NHS, promised more funding over the next eight months. “It will mean investment over the next period… but there is a really powerful payback and business case for this,” he said.

The review calls for a “rebranding of OH services with a more positive wellbeing focus and a consistent identity, such as ‘NHS Staff Health and Wellbeing’.”

Recommendations include:

  • A national minimum standard of OH services across the NHS

  • Common simple performance metrics (relating to standards of delivery, client and customer satisfaction, and quality of service through audited outcomes) to enable benchmarking and monitoring

  • An improved provision of wellness and early intervention services for staff

  • Regional consultant OH nurses

  • Protocols for handling routine issues such as pre-employment screening.

Boorman told Occupational Health that other trusts should follow the examples of best practice in the NHS, some of which are cited in the review.

“Over the past two months we have visited every strategic health authority region in Britain, and have seen many OH initiatives that are delivering long-term savings and opportunities for improved patient care,” says Boorman. “These will inform our final recommendations and contribute to the establishment of a service-wide minimum standard in OH provision.”

He also hopes that, in future, best practice can be shared systematically and recommends the establishment of an electronic health and wellbeing library for the NHS, containing up-to-date studies on effective health and wellbeing interventions, case studies from within and outside the NHS, and guidance for treating particular conditions, illnesses or injuries.

“Such an approach would aid health and wellbeing practitioners in maintaining and improving practice and help to avoid the need to re-invent the wheel,” says Boorman.

According to Dr Kit Harling, programme director of the NHS Plus OH service, the review has been broadly well received.

“It’s really crucial that the health and wellbeing of NHS stuff is an organisational problem and needs an organisational solution,” says Harling.

He believes the critical factor will be to change the attitudes of employees with managerial responsibilities. “It’s not about OH doing this. It may be about OH training and mentoring people with management responsibilities how to do it,” says Harling.

The review recommends that induction of new staff should include material to make sure managers are aware of OH services, referral routes and confidentiality.

OH practitioners are already involved in developing the recommended national minimum standard for OH services, through the Faculty of Occupational Medicine with funding support from NHS Plus.

The Boorman review also addresses concerns that NHS Plus services provided to local businesses could affect the quality of those offered to NHS staff. One recommendation is that “income generating external service provision is reviewed in order to be sure that marginal costing does not result in such services being delivered without profit and that NHS staff are aware of the benefits to them”.

Harling supports this aim. “We are aware a number of trusts have viewed their OH departments as money-making rather than delivering OH services. It was specifically foreseen at the beginning of NHS Plus to make sure this didn’t happen but there was no mechanism to stop it happening. His [Boorman’s] call is timely”.

Response to the Boorman review seems muted in some parts of the NHS. For example, members of the JISCMAIL OH online forum, many of whom work in the NHS, have posted no comments about the review. OH consultant Dr Richard Preece points out that many of the recommendations appeared in the 2003 National Audit Office report A Safer Place to Work – Improving the Management of Health and Safety Risks to Staff in NHS Trusts, and little has changed to reduce ill-health among NHS staff as a result.

Harling thinks the Boorman review will be different. “What’s different this time is the whole context of health and wellbeing, Black’s appointment, her review, the whole programme that has come out of it, that to me is the difference this time,” says Harling. “This is an opportunity that doesn’t come round very often and we’ve really got to make it work.”

The final part of the review is due in late autumn.

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