Targets in NHS have hindered staff wellbeing
The target-based approach of recent years in the NHS has resulted in red tape which has had a bad impact on staff communication and health and wellbeing, according to HR and OH professionals at Airedale NHS Trust.
“In the NHS in the past few years we’ve introduced unbelievable amounts of mechanistic systems,” said Chris Lisle, HR director. “We’ve introduced more of this on the basis of the target mentality.”
She argued that delivery models and data “can only be a shadow of reality” and said: “It’s all about messy human reality. It’s all about relationships – that’s the key.”
She urged HR and OH practitioners to take a lead in getting employees to embrace staff health and wellbeing.
“For years we’ve been struggling with organisations that don’t care about their workforce. There is no excuse now – it’s not even that hard to convince people because the evidence is so strong. We’ve got to be putting ourselves about and finding out more about our systems than we do now.”
Lisle recommended that OH and HR professionals contracted with allies in the NHS to raise awareness of the health and wellbeing agenda.
“Be quite explicit with them that you’re contracting with them to help you,” she said.
Karen Swann, head of occupational health at the trust, said: “This is a fantastic opportunity for OH to really make a difference, and if we don’t take it we’ll lose out and someone else will.”
The OH service is repositioning itself to move from the perception of being concerned mostly with vaccinations and pre-employment screening to leading and offering advice about the health and wellbeing of staff through improved communication with employees.
Boorman urges NHS OH staff to work with HR to improve health
Dr Steve Boorman, author of a major review into the health of NHS workers in 2009, urged NHS OH staff to work with HR and form strategic partnerships to improve awareness of OH and boost the wellbeing of NHS staff.
“When you look at health and wellbeing at a strategic level it is for you to design those initiatives with your HR department,” Boorman said.
He also called for strategic partnerships between trusts. “The way the NHS is structured has resulted in silo delivery that has prevented OH service being delivered as well as it could have been,” he said.
Last year’s Boorman review showed that OH in the NHS is hampered by poor visibility among staff and management, inefficiencies due to lack of protocols, service level agreements and specifications, and infrequent use of intelligent system support.
“I heard far too often in the review excuses for why things are as they are,” he said. “It comes down to individuals. They just keep going until someone says ‘yes’ and they find the money and resources somehow.”
While there were many examples of excellent results, there is poor awareness among employees overall of the image or brand of OH. Boorman said the experience of staff was “skewed by hurdle contacts”, and that sickness absence services were poorly understood as an employee benefit.
Hurdle contacts referred to a negative approach to absence management, for example, and OH was “still [seen as] part of the management police” in many NHS trusts. “OH can have a negative handle as part of the bureaucracy, and that makes it difficult to have that positive brand image,” he said. “Good employee health should be part of the employer brand.”
Boorman urged OH teams to “move from the model of care that waits for people to be off sick” and “move towards awareness and prevention”.
He also said that OH teams should look at the impact on patient care as a key indicator of the impact of OH on staff health.
“Far too often in the review I asked if it made any difference. The outcome for patients is the thing that is most important at the end of the day,” he said.
However, he did not argue against NHS Plus teams earning income from external contracts with small to medium-sized companies.
“I don’t see any harm in chasing income as long as that income is helping people in the NHS,” Boorman said. “That income is not always being developed profitably.”
Engagement is key to boosting care standards
Employee engagement and team working are proven ways to improve patient care, said staff engagement lead at the Department of Health Steve Jupp.
He presented evidence from Michael West published in the Journal of Organisational Behaviour 27 (pages 983-1002) that “genuine team working” can achieve a 7% reduction in the mortality of patients.
Jupp said some NHS managers and clinicians resisted embracing employee engagement because they saw it as “fluffy” or not essential for health and wellbeing, quality and productivity. He said that in the current economic downturn, some NHS boards saw it as a “fair weather” activity.
But he said that low engagement is associated with low quality and safety, higher staff turnover and sickness costs, failure to attract good employees, and lower quality and productivity.
Nestlé OH revamp cuts absence rates and cost
Food company Nestlé has overhauled its OH service using electronic medical records and cut costs and sickness absence as a result, said Dr Andrew Millman, consultant occupational physician at York Hospitals NHS Foundation Trust.
“We had to transfer the OH service from an old-fashioned treatment-based service [OH nurses backed up by GPs] to one fit for the 21st century,” said Millman.
The OH team did an internal review of the service in response to economic pressures, automation, workforce downsizing and the need to cut costs.
All local OH departments were closed and replaced by a central service in York with a telephone-based helpdesk and central administration team. This was backed up by regular site visits focusing on difficult cases and maintaining a network with managers and staff.
Paper records were centralised using a customised version of the OPAS OH system from IT supplier Warwick International. Evidence-based standards were made available on the intranet, automated and used to assess OH service delivery against standards.
The introduction of OH technicians saved costs and allowed OH nurses to focus on case management, and physicians to focus on complex cases.
“It was run by OH technicians with no input from expensive nurses and doctors,” said Millman. “It allowed nurses to focus on case management, which meant we could dispense with a range of GPs.”
In 2007 and 2008, the cost of running OH solutions at Nestlé was reduced by £630,000 a year while sickness absence was reduced from 7% to 3.1%, saving “several million pounds”.
Capita Health Solutions cuts back on clinics, contracts and staff in company restructure
External OH services provider Capita Health Solutions has pulled out of 302 client contracts, closed 15 clinics and reduced staff numbers by 25% in a restructure of its business.
However, Simon Dickinson, business development director, told delegates that rumours in the OH market that Capita was closing its OH service altogether were unfounded.
The restructure followed the appointment of a new senior management team, which refocused the business on stronger client relationships and moved out of contracts where satisfaction with the service was low.
The company has also developed a “more disciplined approach to sales” to avoid “over-generous promises” about service delivery. There has also been investment in IT and web-enabled technology.
Administration has been centralised in Coventry, with clinicians reporting to operations managers, allowing medical professionals to focus on clinical issues.
“Many [OH professionals] were surprised and concerned,” by the change, he said. However, the rationale was to allow clinical staff to focus on their areas of expertise, rather than administration.
“Why would we expect our doctors and nurses to be very good at process analysis, key performance indicators and IT systems?” Dickinson said.
While there was poor morale during the change programme there have been benefits for employees, including OH nurses who have been able to have more engagement with clients and develop skills such as developing work and wellbeing strategies.
OH overhaul for Mid-Yorkshire Hospitals NHS Trust helps save millions of pounds
An overhaul of OH services in Mid-Yorkshire Hospitals NHS Trust in the past two years has contributed to a £6m saving to the organisation in absence costs in the first year, and approaching £13m in the second.
An audit of the service revealed a number of shortcomings, including unco-ordinated nursing activity, limited counselling and manual handling cover, OH nurses focusing on external contracts, and delays in pre-employment screening.
Elizabeth Wood, head of OH services, reviewed the costs of sickness absence related to musculoskeletal disorders (MSDs) and mental health and rapid access to physiotherapists and counselling. Wood’s cost-benefit analysis resulted in savings of more than £444,000 for MSDs, and more than £1m in mental health.
Wood persuaded the board to release funds for the services by focusing on cost savings from reducing time off work rather than reducing numbers going on sickness absence. “I requested £333,000 and I got it,” she told delegates.
Services introduced with the funding included a paper-free digital service resulting in a 34% increase in OH activity, reduced waiting times to see nurses from three weeks to three days, and the introduction of a consultant OH physician which reduced average absence times for MSDs from six to eight weeks to three days.
Sickness absence rates have not fallen significantly but the length of time off for staff is decreasing – for example, time off for back injuries is down from 25 to seven days.