How HS2 and IPRS put musculoskeletal health at heart of Covid response

The overnight switch to home working in 2020 created a range of health challenges, not least musculoskeletal problems caused by suddenly more sedentary lives. The innovative response taken by HS2 and provider IPRS Health led to it winning ‘Best musculoskeletal initiative’ in last year’s Occupational Health & Wellbeing Awards. Nic Paton spoke to the teams behind the ‘Get Active’ programme.

We all undoubtedly remember vividly what we were doing and where we were when prime minister Boris Johnson announced the first Covid-19 lockdown on 23 March 2020, an anniversary we noted last week.

That move, unprecedented at the time but which became almost familiar as further lockdowns followed during 2020 and 2021, meant employers suddenly had to switch to completely new ways of working and operating.

This was very much the case at HS2, the company behind the new high-speed rail line under construction between London, the Midlands and the north of England. With some 1,700 employees, it became clear that the overnight switch to home working was bringing with it some health consequences, especially in terms of physical and musculoskeletal health.

As Fiona King, head of occupational health and wellbeing, tells OHW+: “One of the things we quickly identified was that people were talking about how their physical wellbeing was being impacted, as well as their mental wellbeing.

“I was acutely aware that there was the potential of people becoming deconditioned from doing less activity. Even just the lack of a daily commute, of no longer going into an office every day or using public transport, when you are still moving; suddenly we all became much more sedentary. Also, there was the fact that not every home was set up to be able to work as well from home. So, people were developing new physical and musculoskeletal issues.”

An internal health and wellbeing survey carried out in July 2020 had identified employees reporting a decline in general wellbeing in comparison to previous surveys. Employees were also reporting a significant increase in general aches and pains since working from home.

The solution was the development, with provider IPRS Health, of an innovative, bespoke, one-to-one exercise virtual programme called ‘Get Active’. The programme received the accolade of winning ‘Best musculoskeletal initiative’ in the 2021 Occupational Health & Wellbeing Awards, in large part for its significant results, which we shall come to shortly.

Twelve-month motivational programme

The programme combined referral screening, clinical assessment, exercise prescription, and motivational sessions between HS2’s occupational health nurses, IPRS health physiotherapists and a range of other healthcare professionals, including cognitive behavioural therapists, counsellors, GPs, and consultants.

The 12-month motivational exercise programme consisted of an initial assessment with a chartered physiotherapist. This included physical resilience and wellbeing screening, Covid-19 screening, musculoskeletal screening, and functional testing.

From here, clinicians determined if the employee was suitable for a physical activity programme. Following this assessment, a shared three-month, six-month, nine-month, and 12-month physical activity plan was agreed between the patient and physiotherapist.

The programme was then broken down into:

• Twelve weekly one-one virtual/telephone sessions. This allowed the clinician and patient to monitor their progress and address any barriers to sustaining physical activity consistently.
• Three-month assessment and then a six-month and nine-month follow-up. These sessions reviewed the agreed goal plan, addressed any barriers, and finally updated the physical activity plan.
• A final 12-month follow-up. This was designed to reassess all outcomes from the initial assessment, and provide motivation, support, and advice to sustain these changes.

Participants also had access to the IPRS Health app. This included access to its ‘physitrack’ exercise prescription service, weekly updates, and virtual assessment and rehabilitation communication, which took place via Microsoft Teams or by phone. The programme also gave participants access to IPRS Health, a peer-reviewed self-management resource for musculoskeletal health issues.

Paul Scallan, IPRS Health clinical lead of occupational health physiotherapy services, tells OHW+: “The whole focus for me was to empower people to be able to change themselves. Behaviour change really underpinned this programme. It was not just, ‘let’s give them some exercise and hope they get a little better’.”

“It was very much a long-term programme and HS2 was genuinely amazing. They said, ‘we don’t want this just to be a short-term three-month thing, we want this to make a difference’. That gave us that wiggle room to really focus on creating that behaviour change and addressing some of that motivation and self-determination element,” Scallan adds.

The programme launched in the autumn of 2020, as the first wave of the pandemic was easing and employees were tentatively coming back into offices (even though things, of course, reverted back during subsequent waves later that winter).

“To expect people to suddenly come back into the workplace and then wonder why they were getting injured, I wanted to be proactive to prevent those sorts of injuries from happening,” explains King.

“Initially we did target it; it was not for everyone within the organisation. I didn’t want to offer it out to everyone as, actually, we had loads of people who were already quite fit. We also contacted those who had had Covid because we were also aware of the then emerging evidence that was coming out that they were struggling with regaining that physical stamina.

“I do think one of the reasons it has been such a success is because it was a targeted programme in this way. We have continued to follow up and see how or if people have sustained their outcomes; what have been their health behaviour changes on the back of it? It is still very much work in progress. After all, what we might find in 18 months is that people have actually reverted back to their original state of play, and so why is that the case?” King adds.

The improved health outcomes many employees made via the programme were significant, and something that really stood out for our judges.

For example, at the initial three-month follow-up session, 87% of participants reported that they had met their physical activity goals. There was a 225% increase in weekly minutes of exercise, a 23% increase in general resilience scores, an 18% increase in general wellbeing scores, an 88% increase in the functional upper body strength, a 26% increase in lower body functional strength, and a 60% improvement in self-perceived long Covid symptoms.

Qualitative feedback from the programme was also impressive. “It helped me to get back on track and offered motivation and encouragement to improve my health and wellbeing,” said one participant. “Started half dead – now I’m fully alive and back to my youth,” said another.

“Great programme to get back into forming a routine of exercise. This programme has given me the motivation I needed to get me moving more, as physical exercise had dropped significantly since working from home due to Covid-19… By embedding it into my daily routine it definitely helped towards me sticking to routines and the variety of exercise made it flexible and easier to commit to,” said a third participant.

As our judges also put it: “The experience of the pandemic illustrated the downsides as well as the positive of home working, with musculoskeletal issues emerging as a key health and wellbeing concern.

“The way HS2 and IPRS responded to the challenge was proactive as well as effective and should, rightly, be applauded.”

Collaboration and buy-in

Clearly, then, the Get Active programme has been a success and, now on its fifth cohort of participants, continues to be so. But what is the secret to a successful occupational health intervention, especially when it comes to making a difference around musculoskeletal health; what makes OH ‘stick’?

For King, with a relatively small in-house OH team of just herself and senior OH manager Fay Simpkins, it is first about working effectively with your external contractors, in HS2’s case both Optima Health and IPRS Health.

“When you have a provider and someone who is OH-trained to call on, you can get the best out of your service because you know what you need and what is or isn’t right. It works for us,” she points out.

“For me as a clinician I am always interested in outcome measures,” agrees Scallan. “So it was important when we were developing this programme that we planned it at the start to make sure that a) we delivered what the client wanted in terms of what the main aim was and b) we would be able to evidence that with some good, standard outcome measures plus some generic outcomes.”

Senior leadership buy-in is also key, recommends King. “Our CEO and exec team were very much supportive of this. It is something we talk about regularly at our senior health and safety committees, where our board members attend,” she explains.

“We also engage with our health and wellbeing champions, who are driving those messages. We communicate with those different networks; we’re communicating it the whole time.

“It also comes down to having the personal touch. We reached out to people and said, ‘look we have got this, we were thinking of you for x, y, z reasons, would you be interested?’. People felt that, as an organisation, we were living our values of ‘I care, you count, we matter’. We talk about things; we share the results.

“Because we have done so much around wellbeing in the last two years, our reach has expanded. People see that we do good stuff. People will know we do things from an evidence base; that it is about doing the right thing,” King adds.

Value of external validation

Finally, how had winning in the Occupational Health & Wellbeing Awards changed things, both for King and her team but also for IPRS Health?

“For me, there are two things when it comes to awards,” highlights Scallan. “Entering – and winning – an award is great because it shows we can provide these really meaningful services and really make the change, and to have the awards recognise that is fantastic.

“I also think that, with this service, it is a classic example of where there was, and is, good collaboration between different stakeholders. We have all come across people in different occupational health environments who are not that proactive in terms of thinking ahead. But that was very much not the case with Fiona and the team at HS2.

“They are constantly thinking long term and looking at what can be the next innovative services. What’s going to make the change they need? We are exactly the same at IPRS Health as a company. So that collaboration just shows how much you can make a change,” he adds.

“It has just been a huge success,” agrees Jenni Cook, client relationship manager at IPRS Health. “The fact that, despite being launched in a pandemic, it has continued as we’re coming out of the pandemic is really great. We have learnt from it as a business and we can see where we can adapt the programme based on different workforces, clients or sectors.”

“Winning this award is a fantastic achievement; it shows the value of working together with your health partners,” says HS2’s King. “It is very much about that partnership, that collaboration. And it is very much about putting evidence-based practice into action.

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“Winning an award helps you to know that you are doing the right thing for your employees, and for your organisation as well. And to be recognised for it was just great, of course; to be able to show that this is not just another campaign, that it is making a real difference. We were really super proud. The fact we now have waiting lists now to get on the programme just tells you how word has got around.

“We found out [about winning] on a Thursday night and, weirdly, we were presenting our health and safety performance at a board meeting the next day. So it was a lovely thing to be able to tell the board that day. They were equally proud as well,” King adds.