Continuing our profiles of the winners of the 2021 Occupational Health & Wellbeing Awards, Nic Paton meets the team behind York and Scarborough Teaching Hospitals’ staff health checks programme which, with provider Health Diagnostics, won ‘Best wellbeing initiative’.
From the most senior to the most junior, from those working on the healthcare frontline to the army of backroom support, we all know NHS workers went above and beyond during the pandemic.
We also know Covid-19 took an immense toll on their health and wellbeing, both directly in terms of the risk of catching the virus and/or being left with long Covid, and indirectly in terms of the mental and emotional cost of dealing with the pressure and trauma of that period.
The challenge for occupational health professionals in the NHS was not just about picking up the pieces and supporting workers through the greatest public health crisis of a generation. It was to do this on top of the fact the health and wellbeing of the NHS workforce has been a growing concern for some time.
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Even before the pandemic, it was estimated that as many as 6,000 NHS staff in England were off work every day because of musculoskeletal problems. A quarter of NHS nurses were reported in 2017 to be obese and as many as 700,000 across the board. The Boorman Review of 2009 found that almost half of all NHS staff absence was accounted for by musculoskeletal disorders and more than a quarter by stress, depression and anxiety.
One way to mitigate or manage this is through regular health screening or health checks of NHS staff. However, while pre-employment health checks or assessments are commonplace in the NHS, ongoing health checks have traditionally been less common or accessible to staff.
Pioneering staff programme
The mainstream NHS Health Check programme, for example, is only available to eligible 40-74-year-olds, once every five years, and generally needs to be accessed through a GP, something that many working in secondary care may struggle to fit into their shift schedule.
This was why a pioneering initiative to introduce regular health checks for the 9,000 NHS staff at York and Scarborough Teaching Hospitals NHS Foundation Trust (Y&S), in conjunction with provider Health Diagnostics, caught the eyes of our judges in last year’s Occupational Health & Wellbeing Awards.
It [winning the award] validates how we’re trying to adapt through the changing times and how we’re looking to improve things,” – Carol Dickinson, York and Scarborough Teaching Hospitals NHS Foundation Trust
The initiative was described as “innovative” and “important, especially now, given the pressures NHS staff have been under, and continue to be under, during the pandemic”, and won the two partners the ‘Best wellbeing initiative’ award.
“It definitely validates what we have been doing for the last five or six years really, right from the beginning of the health checks, through to how it’s evolved and to where we are now,” Carol Dickinson, health promotion adviser at Y&S tells OHW+.
“It validates how we’re trying to adapt through the changing times and how we’re looking to improve things,” she adds.
“It also shows what you can do when you put your mind to it, especially when you have got a limited budget and a limited number of staff. It is working within very tight limitations but being adaptive and innovative – and not giving up!” agrees Julie Evason, managing director of Health Diagnostics.
To recap on the programme, although you can also find out more here, the partnership between Y&S’ occupational health and wellbeing team and Health Diagnostics, a digital health checks’ solution specialist, began back in 2016, when they came together to test out new ways of supporting health and wellbeing as part of an NHS England pilot project.
Part of this has included the introduction of regular staff health checks, unrestricted by age or frequency. This has enabled staff to attend multiple appointments, if they so wish, and track changes in their health status over time. It has also meant Y&S has been able to monitor the effects of the initiative by comparing results from initial consultations to later ones.
Following their health check, staff can access their results online via a personalised reporting portal. Importantly, given social distancing restrictions during the pandemic, the system was adapted to enable checks to be conducted remotely, even if elements that required blood being taken inevitably became more limited during that period.
The programme was promoted through a combination of digital and hard-copy materials. Invitation letters were sent out by department (rather than A-Z across the trust), a more ‘word of mouth’ approach designed to encourage uptake and also ease the administrative burden for the OH team. Line managers were proactively engaged with the initiative, as it was recognised their ‘permission’ would be critical to ensuring staff were released to attend any check.
Tangible, positive health outcomes
Because of having the ability to track health improvements over time, the programme led to a number of tangible positive health outcomes across the trust, something that, again, was noted by our judges. This included an average 4cm reduction in waistlines, an average 4.2mmHg reduction in systolic blood pressure, an estimated 18% reduction in relative risk of death from cardiovascular disease, and a lowering of diabetes risk.
People can self-assess and validate their details through their smartphone, via a website or over the phone, and provide updates on things such as cholesterol, blood pressure, weight, BMI, physical activity, smoking status and so on,” – Matt Mellor, Health Diagnostics
Since winning in the Occupational Health & Wellbeing Awards, one big change to the programme has been the introduction of a digital self-assessment model.
“It is quite pioneering, how we are trialling this,” explains Matt Mellor, senior research and development manager at Health Diagnostics. “People can self-assess and validate their details through their smartphone, via a website or over the phone, and provide updates on things such as cholesterol, blood pressure, weight, BMI, physical activity, smoking status and so on.
“It is something that can be used by people from the comfort of their own home to conduct a self-assessed health check digitally. The idea was to allow the team at Y&S to be able to use the results being collected to triage, essentially, to be able to determine who of the staff cohort may or may not be at risk and requiring follow-up,” he adds.
“We are able to use the data to run a predictive risk algorithm as to whether this is someone who might benefit being seen in person. It is also means we are able to look at the demographics, look at the profiles of those individuals and give them meaningful information that will allow them to leave with a self-assessed report that will indicate high, medium or low risk and information they may be able to start acting on.
“It is still early days, however; York are still pioneers in trialling this but there is some interesting data coming in already,” Mellor continues.
“There has been quite a big change, clearly, since Covid but also because Covid has really impacted those with certain issues, whether it’s diabetes or obesity,” agrees Julie Evason.
“There has been a lot more awareness and we have noticed this; a lot of individuals who wouldn’t normally have come forward now are. The idea with the self-assessment is they can do it themselves. They’re not being ‘judged’ by anybody, they’re not having to go into the occupational health department, where they may fear, ‘what are they going to say to me? Are they going to tell me that I can’t do my job?’. It is completely confidential and they can just complete part of it.”
“It has been really useful,” echoes Rachel Marson, health promotion advisor at Y&S. “I’ve been interested to look at things like high blood pressure because we know how dangerous that can be. We’re also really interested in assessing BMI and being able to track things like smoking data and the physical activity levels.
“All this will help us to focus on other interventions that we’re interested in running. Physical activity, for example, is often something that can just tick along in the background. But, actually, from the data we’re getting do we maybe need to be putting more focus on this?” she adds.
Split between OH and wellbeing
When it comes to the Y&S team, as is increasingly common across the NHS, it is both relatively small and split between OH and wellbeing, although both teams do collaborate and work together closely.
The occupational health team is largely clinical and nurse led. Its focus is on areas such as vaccinations for new staff, ability and return to work, redeployment because of illness and so on.
The wellbeing side, explains Marson, is just her and Carol Dickinson and more focused on preventative health. “We focus more on health promotion campaigns. So if, for example, from this data we suddenly see there are lots of people who are smokers, we might want to bring in some expert smoking cessation trainers from the local council or something like that. We can target resources and support to actually look at what our staff may need,” she says.
The team can access in-house psychological wellbeing support, as there is a staff-facing element within that department. Support such as physiotherapy is more problematic, however. “A lot of our physiotherapists and other clinicians, all their time is allocated to patients, not staff, so there is a challenge there in terms of how to access other support for staff,” Marson adds.
“We’ve got staff in all sorts of roles, facilities, porters, cleaners, catering, who don’t have access to computers during the day and who can’t be released to come and have a health check a lot of the time,” agrees Dickinson. “Nurses can’t be released to come and have a health check; if people get a lunch break they’re lucky sometimes. They have smartphones so it is trying to make a wellbeing offer that much more accessible and try to engage with staff in a variety of different ways.”
It is just keeping on at it. But also having different messages for different people. For example, men will often respond to health messages in a different way to women. A lot of it is the way you talk to people,” – Rachel Marson, York and Scarborough Teaching Hospitals NHS Foundation Trust
Given all that, what do they all feel is the secret to an effective occupational health and/or wellbeing intervention?
“Just keep promoting it!” says Marson. “It is just keeping on at it. But also layering, having different messages for different people. For example, men will often respond to health messages in a different way to women. A lot of it is the way you talk to people. A lot of it is the way it is put across.”
When it comes to entering awards, as well as the validation highlighted, Matt Mellor agrees that just the process of entering can almost be as important as the kudos of winning.
“The reflective process can be massively valuable, whether or not your entry wins. It can be really helpful to sit down and focus on what you have achieved; it perhaps encourages you to take a closer look at your data and outcomes,” he tells OHW+. “It all feeds back; it helps you to establish your outcomes and further improve what you are doing,” he adds.
“Obviously we fed that back to the team and everyone felt very proud,” says Carol Dickinson.
“It can be a good platform for opening up discussions higher up in the organisation,” agrees Rachel Marson.
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“I think it was a massive pat on the back for Rachel and Carol at the end of the day,” agrees Julie Evason, in conclusion.
“They’ve got limited resources and a massive area to cover. Sometimes you’re in the background, just getting on with it, doing the day-to-day job and nobody ever sees the great work that you’re doing. Somebody then brings out something like this and they go, ‘oh wow, we didn’t know that was what you were doing’,” she adds.
