In our final profile of the winners of the 2021 Occupational Health & Wellbeing Awards, Nic Paton speaks to the OH team at St Helens and Knowsley Teaching Hospitals NHS Trust, winner of the coveted ‘Occupational health team of the year’ award.
One of the common strands running through the winning entries for last year’s Occupational Health & Wellbeing Awards was the impact of, and response to, the Covid-19 pandemic, perhaps unsurprisingly given that it has been the biggest public health crisis we have experienced in a generation.
Nowhere was this more the case than in the coveted 2021 ‘Occupational health team of the year’ award, which was won by the occupational health and wellbeing teams at St Helens and Knowsley Teaching Hospitals NHS Trust in Whiston on Merseyside.
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Serving some 20,000 staff (STHK acute trust and lead employer), the team was highlighted by our judges for its sterling work in helping the trust and its employees in four key areas. These were: navigating staff absence associated with the Covid-19 pandemic, developing a new bespoke and multidisciplinary wellbeing ‘hub’, in acting as a lead employer for Health Education England, and in managing its annual season flu campaign during that challenging period.
Before discussing how things have evolved subsequently, let’s first recap on its winning entry, as there were many different elements to it.
Delivering on flu in adversity
Looking first at the flu campaign, maintaining uptake of the flu vaccine was of great importance during 2020/21 because of the high prevalence of Covid-19 circulating within the community and, of course, at that time there was still no Covid-19 vaccine protection.
The intense pressure the trust was under because of the pandemic meant that, where the OH team would normally have had six months to deliver its flu programme, in 2020/21 it was required to step up and deliver it in three.
A dedicated flu project team was therefore created, operating 24/7 to vaccinate frontline staff. The team also devised and delivered a marketing strategy, which included health promotion events, and worked in collaboration with senior leaders to encourage uptake.
The result was some 4,000 flu vaccinations were delivered to 95% of frontline healthcare workers across the acute trust, ranking it second in performance out of 255 NHS organisations.
Managing Covid absence
When it came to navigating Covid-19-related absence, a multi-disciplinary team comprising the medical director, HR, managers and OH physicians was brought together to identify staff who were deemed vulnerable to Covid-19.
A nurse-led team was then mobilised and managed by the Health, Work and Wellbeing Department to support Covid-19 testing of staff and family members to enable a safe and prompt return to work and reduce the spread of infection.
As a result, and during what was of course an exceptionally challenging year for all NHS trusts, the department reduced sickness absence rates across the trust by 1%, which was higher than an initial agreed key performance indicator of 0.5%.
Creation of a wellbeing hub
A further key element of the STHK Covid response was the creation of a new multidisciplinary wellbeing ‘hub’.
This brought together a network of wellbeing champions and mental health first aiders throughout the trust (and from all levels of the organisation), working in collaboration with the trust’s wellbeing coordinator.
It offered staff access to counsellor-led debrief sessions, one-to-one and departmental consultations, listening events, mindfulness and resilience sessions, promotion of self-care, incident management and lessons learnt sessions, and pre-recorded sessions and virtual events. Its service provision was also increased to 24/7.
Staff can also access the trust’s employee assistance programme via the hub, as well as various apps to support mental health, better sleep hygiene and so on.
The hub now has some 70 wellbeing champions and 33 mental health first aiders and, in the 10 months prior to its entry for the awards, had carried out 65 wellbeing events that had been attended by 478 staff.
A total of 566 counselling sessions had also been delivered, along with 755 mental health nurse appointments and 488 psychologist sessions.
Fast-tracking OH clearances
Finally, as a lead employer for Health Education England, the trust had to put in place a multitude of assessment methods (including, for example, virtual consultations), safely revise the criteria for occupational health clearances and prioritise workload and workflow planning.
In all, the OH department was able successfully to clear approximately 3,000 doctors within agreed timescales.
The scale and breadth of all this activity was very much recognised and applauded by our judges. “The OH team at STHK clearly put itself front and centre in responding to Covid-19. It has been a great example of how NHS OH practitioners, in truth not just at STHK but up and down the country, have been rising to the challenges posed by the pandemic,” they said.
Adam Hodkinson, assistant director of health, work and wellbeing at STHK, acknowledges the unprecedented change that the trust has been through since 2020. “We’re moving at such a pace,” he tells OHW+.
“Obviously, the NHS as an organisation tends to move at quite a pace anyway. But it has been more so during the pandemic. Covid has really added that extra layer of engagement in different ways, different working practices, and influencing the impact on the workforce from a health and wellbeing perspective,” he adds.
While OH and wellbeing work very closely together – with some 40 people working across both the OH and wellbeing teams (including expanded administrative and Covid support) – the trust now does treat them as separate entities, he points out.
Separation of OH and wellbeing
The occupational health team, comprising screening nurses, OH-trained nurses, clinical leads and OH physicians, carries out what could be termed as ‘traditional’ OH service delivery. This includes health screening and pre-employment work, immunisation, vaccination, return to work, taking bloods, pre-employment screening and so on.
The wellbeing team, on the other hand, comprises two counsellors, a psychologist, two mental health nurses, a co-ordinator, and one wellbeing lead.
“We do treat them as independent teams but we also recognise we work collectively as well. The wellbeing team complements the OH team, but it is our new way of thinking to have them as two standalone teams,” Hodkinson explains.
“The core is that we have occupational health as our specialty. That is our traditional model and is embedded into everything that we do. But, actually, now we practice in a completely different way now; we are focused on much more of a holistic offer for our staff.
“Wellbeing in the round for us is spiritual, emotional, social, psychological, physical, environmental, and financial. We consider all of those core principles from a holistic perspective and we think ‘how can we support someone’s wellbeing from those?’,” he adds.
What we are trying to do is change the tide of OH being, essentially, a reactive service. The traditional scenario is that you get a referral in and that individual or person is already broken” – Adam Hodkinson, assistant director of health, work and wellbeing, STHK
The wellbeing hub, as you might expect, is very much focused on encouraging a preventative health approach.
“Some of it is hands-on, assessments and counselling sessions and so on,” explains Hodkinson. “But the majority of it is all about prevention. We use a lot of our time to go out and engage with the workforce, which is that preventative bit. That is where we get the most value.
“What we are trying to do is change the tide of OH being, essentially, a reactive service. The traditional scenario is that you get a referral in and that individual or person is already broken; they are already off work, they are already sick. That just makes everyone’s life that much more challenging, including the individual employee.
“We’ve got a model that is much more about engaging with the workforce; we’re being proactive, we’re supporting both the individual, empowering them from a self-help perspective. But also supporting the managers and people who make those decisions within the organisation,” Hodkinson adds.
This is all also closely tied to a comprehensive schedule of health promotion events every year. “We’ve tied into learning and development teams to be part of their curriculum and their strategies, especially supporting managers to help support staff in a better way and consider wellbeing,” he explains.
Layered approach beyond ‘workplace’ health
This layered approach, combining reactive with preventative, has led to much work being done to embed as many wellbeing champions or advocates as possible across the organisation.
“For example, we have a wellbeing guardian who is a non-executive director in the organisation. They provide assurances to the trust executives and is very much a pivotal role for us. We are making sure we have a wellbeing voice in all layers of the organisation and all corners,” Hodkinson points out.
“People respond best to experiences and seeing stuff actually tangibly take place and happen,” he adds.
Alongside this, the OH team is working hard to improve and streamline the management referral process, including educating managers on when – and crucially when not – to refer on to OH.
“What we’re trying to do is be quite clear about treatment or care pathways that we can send someone down. Because it might not be that you make a management referral into OH and is not the most appropriate thing to do,” says Hodkinson.
“In days gone by it would have been that you’d just do a referral for all elements of health and wellbeing. But we are working to get managers to think a little bit more differently about the management or support for someone’s health and wellbeing within the workplace.
We are trying to empower people to make more informed decisions, even before they have got to us. We’re almost filtering out the workload really, but appropriately giving them the tools to do that”
“You might find as a manager, for example, that, in fact, it is not a referral into occupational health you need to be making. You might find that you can support them through, say, a self-referral to physio, or that you can create a bit of an wellbeing action plan for them to be able to support themselves. We provide them with the tools to do that.
“We are trying to empower people to make more informed decisions, even before they have got to us. We’re almost filtering out the workload really, but appropriately giving them the tools to do that,” Hodkinson tells OHW+.
This more layered, more nuanced, approach is also changing how the organisation thinks about employees, health and workplace health support, Hodkinson emphasises, particularly the idea that ‘workplace’ health starts and finishes at the hospital entrance.
“The other half of an employee is that person out in the community,” says Hodkinson. “They have their own personal lives to lead and if they want to get access to support for their own wellbeing, they might go and see their GP; they might get social prescribed solutions, or even if they have had an injury, referred on to physio. So we are looking at a model of, ‘let’s see how we can support them from a wellbeing perspective both in and out of work’.”
This has involved creating a better understanding of what support and care pathways are out there in the community that employees can engage with, and then working to signpost and connect staff to them. An ‘extranet’ has just been launched to this effect and STHK is proactively using its wellbeing and mental health first aider networks to promote this understanding and awareness.
“For example, do people understand who are social prescribers in the area or what is available out in the community? We know that if we can support them out of work, in an indirect way, we’re going to be supporting them in work too,” says Hodkinson.
“It is, ‘what can we do to support people in their personal lives?’ because often people just don’t know where to turn, which is why they tend just to go to the GP, which in turn relieves pressure on primary care. So it could be that, if our OH advisers are treating someone for a management referral, that they have this signposting available or they have those connections, so they could initiate a referral for them,” he adds.
Reflective practice and recognition
Given all this activity and focus, and in so many different areas, what does Hodkinson feel is the secret to a successful, effective intervention, whether occupational health or wellbeing?
“Occupational health is still at the core of what we do, and the key principle of OH is supporting people in the workspace, making sure they are being put to work safely and effectively and doing all the health promotion stuff you would expect, and we still do that. But we just do it with support on collaborative ways of working,” he says.
“By bringing in teams that are focused on wellbeing we are relieving some of the pressure on occupational health. So, we can turn to OH as the subject matter experts to support with any content or make sure it is on point. It is using OH almost in a consultative, knowledge-based, subject matter expert-style role to move things forward. It is quite dynamic and forward thinking,” he adds.
Finally, what kudos has being an Occupational Health & Wellbeing Awards winner brought to the STHK teams and the trust more widely?
The team now showcases the fact it is ‘an award winner’ in forums. It is that external, independent acknowledgement. It has been great to be able to show you’re on the right track”
Hodkinson concedes that occupational health as a specialty often isn’t great at singing its own praises; practitioners often simply quietly and professionally get on with the job in hand. But this sort of external recognition does have real value, he agrees.
“For me, I do see the value in that validation; it just helps. The recognition and winning the award has been an absolute morale boost for the team. It has been a very valuable process to go through,” he says.
Even just the process of gathering evidence for the entry was valuable in terms of reflective practice, if challenging to do in practice because of the intense workload pressures everyone was under at the time. “However, I do think the reflective piece was really useful,” says Hodkinson.
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“Just to acknowledge that and being able to reflect back on what we had achieved so far, how we were doing on our journey. And then to give that back to the team, to get input and feedback before the entry was submitted, was very good.
“The team now showcases the fact it is ‘an award winner’ in forums. It is that external, independent acknowledgement. It has been great to be able to show you’re on the right track,” says Hodkinson in conclusion.
