How the NHS plans to embrace employee health and wellbeing

The NHS has a poor record on employee health and wellbeing, which, in turn, has had a disastrous impact on patient care. But the health service plans to tackle this issue with a £5 million initiative. Nic Paton reports.

No one could accuse NHS England chief executive, Simon Stevens, of failing to be candid about how far the NHS needs to come in terms of turning itself into an exemplar of workforce health and wellbeing when he said: “When it comes to supporting the health of our own workforce, frankly the NHS needs to put its own house in order.”

Stevens made this comment in September 2015, at the launch of a £5 milllion initiative to improve the health, fitness and wellbeing of NHS staff in England, which also included offering hard pressed GPs access to a new OH service.

A growing problem

Arguably, however, Stevens had little option but to be candid, as anxiety, stress and depression all appear to be growing problems within the service.

Findings from the Health and Social Care Information Centre; the King’s Fund; the Royal College of Physicians; and figures obtained by the BBC all separately suggested that health and wellbeing was often something seen as a “nice to have” in a service under growing operational, as well as financial, pressure.

Go back further, and the 2013 Francis report into the failings at Mid-Staffordshire NHS Foundation Trust firmly made the link between performance and safety and employee health, wellbeing and morale. The 2009 Boorman report made a clear connection between staff ill-health and absence and poorer health outcomes.

Public Health England (PHE) has put the cost to the NHS of staff absence at £2.4 billion a year, accounting for around £1 in every £40 of the total budget.

Indeed, Professor Jane Dacre, president of the Royal College of Physicians, pointed out in her response to Stevens’ announcement, that 38% of NHS staff in England report having suffered work-related stress and 68% of NHS staff in England report having attended work in the previous year when they did not feel well enough to perform their duties.

And Stevens, to his credit, does appear to be grasping this particular nettle. His October 2014 Five year forward view for the NHS highlighted how health and wellbeing would be a key priority for the future. In particular, he said that the NHS would be working with the Faculty of Occupational Medicine to strengthen OH, and access to OH, within the service.

Stevens has now announced a plan to tackle the problem. Predictably, the mainstream media focused on staff being given access to Zumba classes but, in truth, what Stevens has outlined has the potential to go much deeper than that.

Three-pillar initiative

Stevens articulated his initiative as being based around three pillars, or strands, of activities.

The first involves 10 local NHS organisations and NHS England committing to six key actions all designed to boost the health and wellbeing of NHS staff.

These include providing NHS staff with access to: over-40s health checks; physiotherapy; counselling; smoking cessation; weight management; healthier canteen options; and Zumba classes.

But Stevens has also committed NHS England to fully implementing PHE’s Workplace Wellbeing Charter, which is a tool that can be used systematically to improve workplace health.

But Stevens has also committed NHS England to fully implementing PHE’s Workplace Wellbeing Charter, which is a tool that can be used systematically to improve workplace health.

On top of this, trusts have been told to ensure that there is a board-level director and senior clinician to champion staff health and wellbeing.

While, for now, the initiative is only within a limited number of trusts, the aim is that the programme will be extended to all NHS employers over the next five years, targeting those with the highest rates of sickness absence and recruitment and retention pressures in 2016/17.

The hope is that the NHS will become a “standard-bearer for workforce health”, as Duncan Selbie, chief executive of PHE, put it in the wake of the programme launch.

But it could go further than that. “The positive steps the NHS is taking to systematically improve the health and wellbeing of its workforce will have trickle-down benefits for the health and wellbeing of the wider population,” predicted Selbie.

“The money saved on reducing staff sickness can be spent on services for the public, and the healthier habits picked up by public-sector employees can be passed on to the people they serve,” he added.

What, then, of the second strand? This is “the launch from April 2016 of a new nationally specified occupational health service for GPs. Last year, NHS England indicated that it intended to cut centrally funded OH services for GPs, so the move is quite an about-turn.

Doctors’ leaders have long been vocal about the need for GPs to be given greater support. In July, the Royal College of General Practitioners warned that stress and fatigue among GPs was putting patient safety at risk. And in May, the British Medical Association (BMA) called for a fully funded GP OH service to be reintroduced, highlighting that nine out of 10 GPs felt that workload-related stress was negatively affecting their ability to care for patients

The new service will build on a range of existing specialist services for doctors, argued Stevens. He cited The London Practitioner Health Programme; the House Concern programme in the north of England; the Somerset Clinician Support Service; and MedNet, a service provided by South London and Maudsley NHS Trust and the Tavistock Centre.

“At a time when the pressures on GPs have never been greater, we need to extend the local practitioner health programmes that have been shown to help GPs stay healthy and get back to work when sick,” Stevens added.

But the new service was given a cautious welcome by the BMA, with GPs committee chair Chaand Nagpaul describing the proposal as “encouraging” but pointing out that it needed to be made available to all GP practice staff, not just GPs themselves.

The third “pillar” of the Stevens initiative is also the least visible. It will see NHS England working with its catering vendors and contractors to discuss how the NHS can improve what it offers staff and patients in the way of healthy food.

Future benefits

Certainly, there is a lot here for OH and wellbeing professionals to digest. The Stevens initiative will, inevitably, be judged on the actual difference it makes on the ground. But it could, in time, prove to be valuable. First, it could provide a visible, direct “best practice” example to others, both employees and employers.The idea of the NHS as the “standard-bearer” for workforce health rather than an also-ran is a compelling one.

Second, the emphasis on senior clinician and board-level champions and training for line managers means that the Stevens programme has the potential to embed real cultural and organisational change.

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It also has the potential to change perceptions around the value and importance of good health and wellbeing in the workplace – both within the NHS and (because it is so large and influential) more widely – and how this links to morale, motivation and performance.

If it also encourages the NHS generally to see “return to” (or even “stay in”) work as a more important health outcome than it often does at the moment, that would be an added bonus. However the Stevens programme turns out, keep watching this space.

What the profession said

• “Ensuring the good psychological health of NHS staff, and of all those working in the health sector, is vital. It is an investment in staff and an investment in patient care. More than 1.3 million people work in NHS England. The NHS must actively support and maintain the psychological and physical wellbeing of its employees, both as a responsible employer and in order to maintain quality and continuity of services for patients. It is absolutely right that the NHS should be an exemplar of workplace wellbeing in England.”
  Professor Jamie Hacker Hughes, president, the British Psychological Society
• “There are over 50% more programmes supporting staff health and wellbeing now, compared to 2010. NHS staff are now more confident than ever in reporting stress and mental health problems. We cannot be complacent. As demand on the NHS grows, efforts to improve the health and wellbeing of staff are very important, not only for staff but also to improve patient outcomes.”
  Sue Covill, director of development and employment, NHS Employers
• “We warmly welcome the recent announcement from Simon Stevens, chief executive of NHS England, and, in particular, the acknowledgement that all is not well with the mental health of the NHS workforce, the largest workforce in the country. It is already known that mental health issues are the single largest contributor to long-term sickness absence, costing the NHS over a billion pounds a year. However, we believe that while it is important to offer individuals within the workforce more help, we must also acknowledge the role that organisations play in either improving or worsening mental health among staff. We hope that NHS England will lead in looking at the organisational factors that must be playing a part in the increase in sickness absence.”
  Professor Sir Simon Wessely, president of the Royal College of Psychiatrists
• “The health and wellbeing of NHS staff at work has a direct impact on patients and this initiative rightly starts recognising that. Addressing physical and mental health issues is important and a step in the right direction, as it will help tackle some of the major causes of stress at work. NHS staff experience some of the highest levels of stress and violence in the country and this can no longer be tolerated. Health unions will be working with employers and NHS England on these issues.”
  Christina McAnea, UNISON head of health and chair of the NHS Social Partnership Forum
• “Fatigue, stress – and eventually burnout – among family doctors is increasing, to the detriment of their own health, and this could have a devastating impact on the care that our patients receive. Better access for GPs to occupational health services is a positive step forward – one that the college has called for – and one that we will be pleased to work with NHS England and others to develop as a priority. It truly is a case of healthier doctors providing safer patient care and being better for patients.”
  Dr Maureen Baker, chair, Royal College of GPs