Through working collaboratively to develop effective pathways to reduce the burden of musculoskeletal disorders, the OH team at Sussex Community NHS Foundation Trust has significantly reduced sickness absence. In the process, it impressed our judges in last year’s Occupational Health & Wellbeing Awards, who voted it “Best multidisciplinary initiative”.
One of the key challenges facing the occupational health team at Sussex Community NHS Foundation Trust is the fact it is a community rather than an acute trust and, as such, is required to support a disparate, geographically dispersed employee population.
As specialist OH practitioner and clinical lead Sarah Harrison explains: “In terms of the geography, we are a Sussex-wide service looking after two large NHS trusts. One is a Sussex-wide mental health trust and the other a community trust that provides community care and specialist services across most of Sussex. In addition to provider services, the team also supplies occupational health services to the Sussex clinical commissioning groups.”
Nevertheless, the in-house OH team has carved out a reputation for efficiency and effectiveness, not least for its collaborative, multidisciplinary approach that led it to win last year’s “Best multidisciplinary initiative” category in the Occupational Health & Wellbeing Awards.
Reductions in short- and long-term absence
That work (and see the panel for more on this) focused on reducing sickness absence around musculoskeletal disorders (MSDs), both in terms of the physical and mental health aspects of dealing with musculoskeletal conditions.
In 2018/19 the organisation was reporting a third of all referrals to OH (29.5%) as being directly related to MSDs. Despite nearly half of its employees being over 50 years old with a 45% likelihood of having at least one chronic health condition, the team’s proactive approach succeeded in significant reductions in both long- and short-term MSD absence.
“People living with long-term chronic pain can also experience psychological issues, understanding this was key to looking at the OH pathway for staff presenting with MSDs; the revised pathways we created within the team have proven to work really well,” says Sarah.
“Our focus has been on providing team support, managing stress as well as supporting physical need; the OH multidisciplinary team collaborated to ensure the pathways meet the needs of staff working in a community setting.”
Identifying that faster ease of access to physiotherapy support was essential in tackling this need, the OH team joined up with an externally run private physiotherapy home-assessment and treatment service, through provider Physio Med.
“The external physiotherapy service has been an efficient way of enabling staff to be fast-tracked to physiotherapy and receive treatment close to their home or work base. Internally, the occupational health physiotherapist manages the contract and report process as well as responding to managers questions when staff are also referred to the OH service,” explains Sarah.
In the six months prior to external physiotherapy services being introduced, 26 staff referred with MSDs were considered unfit to work in any capacity following their occupational Health assessment. During the six month period after the Physio Med services were introduced this had reduced to 14 staff referred with MSDs being considered unfit for any form of work.
In the four months prior to the implementation of the external physiotherapy service the average days lost per full-time equivalent (FTE) because of MSDs were 0.24. This reduced to 0.23 during the following four months after the service had been introduced. A continued improvement has been sustained, with an ongoing 0.22 average days lost per FTE.
Support, supervision, education and ‘huddles’
What, then, is the secret to making occupational health interventions “stick”, to create long-term, sustained change? “Internally within the OH team as well as to the wider trust you need good managerial and clinical leadership, visibility and credibility,” Sarah says. “If you don’t have this in place it is hard to achieve your goal.
“Within the team confident and capable OH advice has proven to be key to successful outcomes; clinical expertise is achieved by making sure everybody is well supported, good supervision is in place along with education and daily ‘huddles’,” she adds.
Fiona Long, professional head of nursing and head of occupational health for the trust, continues: “In terms of general workplace health and akin to most NHS organisations, MSDs and mental health remain the trust’s top two reasons for sickness absence, and the top two reasons for referral to occupational health.
“In addition, it is important to note that the trust has an older female workforce and review of Physio Med data shows that almost all reported cases are female and over 50; this is going to be quite a challenge going forward, but being able to review the occupational epidemiology will help define and determine strategies.
Fiona adds: “It is about being effective in meeting the needs of what is a very geographically dispersed and different population.
“Looking after occupational health in a community trust is challenging; we have to be much more receptive. Our achievements are down to the great leadership; drive and creativity in the OH team as well as credibility within the organisation.”
Finally, winning in the Occupational Health & Wellbeing Awards has been “huge” for the team in terms of helping to raise its profile and its work within the trust, agree both Fiona and Sarah.
The Sussex Community NHS Foundation Trust team in a nutshell
- An in-house team led by Fiona Long, professional head of nursing, including six OH nurses, one physiotherapist, two psychologists and an OH consultant
- Serving 5,000 employees across a large, geographically dispersed area using a “hub and spoke” model of service delivery
- In addition, employees have access to an Employee Assistance Programme (EAP) and a specialist physiotherapy fast-track service provided by provider Physio Med
How Sussex Community NHS Foundation Trust was an OH&W winner
Our judges were impressed by the way the OH team at Sussex Community NHS Foundation Trust, winner in last year’s “Best multidisciplinary initiative” category, worked collaboratively to develop effective pathways to reduce the burden of musculoskeletal disorders, both for staff and the organisation
The first pathway was focused on improving early access to physiotherapy, with funding for access to private physiotherapy, supported by the trust’s workforce health and wellbeing group and approved by the director of HR and chief financial officer. External physiotherapy services were secured and a rollout programme put in place, with referral via OH, management or self-referral.
The second pathway focused on improving support of psychological factors affecting recovery and management of MSDs.
A lower back pain care plan had been introduced in 2012. This was revisited to ensure employees struggling with the associated psychological needs from back pain could now self-refer to the Trust’s EAP. This helped to identified gaps in the service and where more chronic musculoskeletal management services were required, so that staff can be supported to access these when required.
For longer-term complex psychological needs, an access guide to local CBT and talking therapies was developed and made available via the trust’s intranet, while OH was still also able to make more specialist interventions as and when needed.
Prevention of MSDs was also promoted through in-house manual handling training and risk assessment and ergonomic workplace assessments. The trust’s OH intranet pages provide prevention advice and the team also runs regular health and wellbeing events for staff.
The trust’s focus on multidisciplinary teamwork and use of the biopsychosocial model of care enabled the OH team effectively to share knowledge and develop skills. Measurable goal-setting via the use of the care plan enabled the OHNs/physiotherapists to provide better targeted health information on self-management of MSDs.
Our judges praised the programme for its being “well-integrated” as well as “collaborative, well-considered and well-delivered” and “a good demonstration of how multi-professional working is effective, using the skills in each profession”.