Great collaborative working and a proactive biopsychosocial focus has been key to the success of the occupational health team at Lancashire Teaching Hospitals NHS Foundation Trust, winner of the “Best musculoskeletal initiative” category in last year’s Occupational Health & Wellbeing Awards.
Working within healthcare can be both physically demanding and mentally and emotionally draining, as any OH nurse who has come up through the NHS into the profession will know only too well
That’s why, when it comes to managing and supporting musculoskeletal injuries and conditions in NHS staff, the approach at Lancashire Teaching Hospitals is both proactive and biopsychosocial in its focus, emphasises Steve Shore, OH specialist physiotherapist and lead physiotherapist at the trust’s Royal Preston Hospital for the past decade.
“The psychosocial flags are a big part of what we do,” he explains. “There can often be a psychological aspect alongside the physical. So, someone with a back problem, say, could have psychosocial barriers to return to work on top of the physical problems, which really does compound our problems really.”
The OH team at Lancashire Teaching Hospitals is an in-house service but technically delivered through the trust’s Well Being Partners spin-off OH service. It was the winner of the “Best musculoskeletal initiative” category in last year’s Occupational Health & Wellbeing Awards, notably for its achievement in working collaboratively with the Health and Wellbeing team at Lancashire Teaching Hospitals to set up a highly effective “MSK Task Force”.
In such a large organisation, no one day is the same. Steve and his physio team and nurse manager Susan Haresceugh and her OH team are constantly dealing with a wide variety of cases, conditions and injuries.
“Anything can come through the door. But we do have criteria in terms of referral, mainly that the condition has to be affecting normal work duties or hours. In terms of MSK conditions, the main problems we see are probably backs, neck, shoulder, probably in that order. Upper limb problems – elbows, wrists, knees, ankles – that sort of thing,” says Steve.
“We can liaise and cross-refer to the counsellors and contact our doctors and seek their assistance as well. It is a two-way thing. Doctors can refer to me for functional testing, for special skills which I might have and counsellors who have a patient with physical issues might want to refer to me.
“There is also a lot of contacting and liaising with GPs in terms of requests for scans that we can’t do within occupational health and a lot of communication with managers in terms of restrictions on duties and things. We also have an accelerated pathway for staff with shoulder problems to get seen rapidly,” says Steve.
Raising profile of occupational health
Much as elsewhere in the population, increasingly sedentary lifestyles are an ongoing issue. “A big problem we have at the moment is general staff fitness for work, for task. The general population is more sedentary, less active; people go to work, come home, sit and watch TV or play on a computer and generally people are less active, less fit. This does compound the problem when you are trying to rehab somebody to be fit for task, to encourage them to exercise and take on more activity, to help the healing process. So psychosocial and general lack of fitness are two key areas that we are trying to address through the processes of vocational rehab,” emphasises Steve.
To that end, the MSK taskforce was a great way to try and bring things together as well as to raise the profile and awareness of OH support among staff and managers. “It is about educating staff to take responsibility themselves to counter some of these problems,” says Steve.
“They come and see a physio like myself or one of the doctors or nurses and they expect to be ‘fixed’, but it doesn’t work that way. People have to take on personal responsibility, they have to be empowered to help themselves to get better, and part of that process is being more active.
“A lot of the NICE [National Institute for Health and Care Excellence] guidelines are about activity. But for staff who are maybe obese or less active, it can a major problem, especially for someone in a physically demanding role.
“If someone is not fit for task and they have a musculoskeletal problem, it can be a real problem to rehab them back into it again and, ultimately, there could be a risk of them losing their job down the line. So it is a problem we are trying to address in any way we can, through the MSK taskforce, classes, education and health promotion, workshops, campaigns; it is all sort of programmed to get staff to look after themselves rather than relying on us,” Steve says.
Another issue, especially in such a busy and often intense working environment, is staff even being able to carve out the time to come and see them. So, increasingly, it is about trying to take education and support out to staff in their working environment.
“We’re very much looking at more ‘at-the-coalface’ initiatives in 2020. We are acutely aware that sometimes it is difficult for staff to be released to come and see us, especially in certain roles, such as theatre staff,” says Steve.
“So, en masse as the whole health and wellbeing team, we will be trying to go out into the workplace and to meet the staff and see problems first hand. We are aiming to be more proactive and more out there, more in-the-face of people but in a nice way, to try and encourage better health, better wellbeing.
“And then, from there, it is about trying to address issues we are aware of, such as poor manual handling techniques, poor working position techniques and so on,” Steve adds.
Being an Occupational Health & Wellbeing Awards’ winner last year has certainly helped in terms of raising and improving the team’s profile within the trust, and Steve says the team will definitely be considering putting in another entry this year.
“It is just about recognition. A lot of what we do within occupational health, a lot of what I do especially, is unseen. The greater public, the greater staff, don’t often know what we do. So I think recognition of the work that we do is important. It is certainly a nice to have, definitely,” he adds.
The Lancashire Teaching Hospitals/Well Being Partners team in a nutshell
- Team of seven OH nurses/advisers and one nurse manager (Susan Haresceugh)
- Access to OH physicians on all three sites, led by OH consultant Dr Surinder Kumar
- One lead physiotherapist (Steve Shore) and another physiotherapist available on a rotational basis
- Access to a range of counsellors and other allied health professionals, including mental health nurses
- Serving approximately 8,000 employees across the trust, which encompasses Chorley and South Ribble Hospital, and Royal Preston Hospital, as well as a number of smaller sites.
How Lancashire Teaching Hospitals/Well Being Partners was an OH&W winner
Winner of the “Best musculoskeletal initiative” in last year’s Occupational Health & Wellbeing Awards, the key to Lancashire Teaching Hospitals’ success was in proactively bringing its occupational physio department and health and wellbeing team together to target three main areas: improving health promotion, reducing sickness absence, and improving the workplace in order to tackle recurring musculoskeletal problems.
Initiatives included creating a page on its intranet to give staff instant access to advice and the ability to self-refer to OH and the dissemination of a monthly newsletter promoting a range of activities to address MSDs. These activities included things such as fortnightly back-care workshops, weekly exercise classes, health and fitness checks, and health challenges.
An “MSK Task Force” was set up which brought together specialist knowledge from Occupational Health physiotherapy, moving and handling trainers, health and safety practitioners and health and wellbeing champions. Bringing ergonomics and display screen equipment within OH’s remit allowed the workplace environment to be improved. A slideshow of desk-based exercises was introduced on to computer screensavers, videos promoting exercise at home were produced, and staff were able to try ergonomic equipment in order to make their desk environment more suitable for them.
The result? Staff with suspected musculoskeletal issues are now seen within 10 days, unless urgent. Almost three-quarters of employees who responded to the hospital’s staff survey agreed they had not suffered an MSK problem as a result of work activity in 2018.
Our judges felt this was “a good example of adapting clinical practice to meet the needs of today’s NHS workforce” plus a positive way to increase the profile of OH and raise awareness among staff as to the support available to them, especially around MSKs.