Rewarding back to work initiatives

Back pain is a very serious issue for the NHS. Nearly a quarter of NHS workers regularly experience back pain, according to figures from the Department of Health (DoH), with some 5% taking 20 days or more off in a year because of it .

It is also a hugely expensive problem. Absence as a result of manual handling accidents – of which back injuries are a key part – is estimated to cost the NHS some 400m a year, with such accidents accounting for about 40 per cent of all absence in the service.

One in four nurses has at some time taken time off work for a back injury sustained at work, and every NHS employee who retires early because of a back injury costs the NHS at least an extra 60,000, again DoH figures.

Beyond the financial and compensatory costs – and the highest compensation payment made to a nurse because of a back injury currently stands at a massive 800,000 – there is the high emotional and physical cost that comes from a debilitating back injury, along with the “hidden” costs of having to recruit new staff, cover for absent colleagues and so on.

This is why the DoH’s annual Back in Work Awards are becoming so important to the NHS.

The awards were launched two years ago as a way of building on work and guidance drawn together by bodies such the Royal College of Nursing, Unison and the Health & Safety Executive (HSE).

They were quickly seen by ministers and health officials as an easy way of raising the profile of back pain issues with the NHS and showing how relatively simple and cost-effective solutions can often be arrived at with a bit of thought, dedication and innovation.

This year’s round of awards was launched in July, with trusts encouraged to enter teams in one of four categories: joined-up working practices; innovative programmes and ideas; most improved service; evidence of problem solving.

There will also be an overall winner. Teams have until 14 October to submit entries (see box on page 14) and the winners will be announced at the National Occupational Health and Safety Conference next February.

Last year’s awards, organised in conjunction with the HSE, were run for the first time by NHS Employers, the body set up in November last year to promote OH and other HR issues within the NHS.

Mary Newsome, NHS Employers’ occupational health project manager, says this year’s awards, much like last year’s, are very much about singing the praises of the work of back care teams within the NHS, raising profiles and rewarding innovation and excellence.

The award gives OH practitioners the chance to share their findings about effective ways of tackling back pain with colleagues, instead of working in isolation, she explains. “It has been very interesting in the past few years to see what people have been coming up with.”

What is clear from looking at the work of previous winners and entrants is that much of the emphasis is now on prevention, early intervention and cost-effectiveness. Back teams have to work very closely with their trusts to ensure messages are being communicated effectively, taken on board and acted upon.

The overall winner (and winner of the Stakeholder Engagement with Successful Outcome category) at last year’s awards was Isle of Wight Healthcare NHS.

What the awards judges liked was the way the trust’s back care advisory team, lead by team manager Judy Green, worked as a bridge between OH, the clinical teams, management, employees and support specialists.

The five-strong team was praised for its “integrated and comprehensive” approach to reducing musculoskeletal injuries among the trust’s 3,000 employees.

Innovations included ensuring that all staff were trained in moving and handling during their induction period and that all accidents and incidents were risk assessed.

Back care advisory team members also promoted return-to-work programmes that allowed staff who had been off sick to return to work slowly, according to their situation.

Another key factor was the fact the Isle of Wight team has its own budget, so giving it a degree of freedom and autonomy. The award judges particularly praised the purchase of two powered bed pushers that allow staff to push beds and trolleys around hospital corridors without straining their backs.

There was also an emphasis on training and targeting non-clinical staff and load handlers who, with the focus so often on the stresses and strains experienced by nursing and other clinical staff, all too easily get overlooked.

Last year’s other winners included East Midlands Ambulance Service NHS Trust, which won in the most improved service category. The judges in particular liked the way the trust had introduced ambulances equipped with specialist patient handling equipment to transport urgent patients, a role traditionally carried out by A&E ambulances.

Each ambulance had a range of patient lifting equipment, including hoists, emergency lifting cushions, specialist stretcher trolleys and a battery operated stair climbing chair.

Staff were trained in their use to reduce musculoskeletal injuries, with benefits including a reduction in the risk of injury to patients and to staff, a fall in staff sickness among urgent ambulance crews and freeing of A&E ambulances to respond to emergency calls.

When it came to evidence of problem solving (another category in last year’s awards), the winner was Causeway Health and Social Services Trust, Northern Ireland with a particularly innovative approach to the back care issues surrounding mothers in labour, for both midwives and the prospective parents.

The trust encouraged mothers in labour to adopt alternative birthing positions to benefit both themselves and their babies. But it was quickly recognised these positions increased the risk of musculo-skeletal injury to midwives.

So the trust therefore produced a range of information leaflets and posters to promote the alternative birthing positions and gave maternity staff training in how best to work around these positions. A special chair was also introduced to help midwives access and help the mothers more easily without damaging their backs.

Another winner last year, in the innovative programmes and ideas category, was East Sussex County Healthcare NHS Trust. Its team designed two workbooks to help train mental health service users – who often take on jobs while they are inpatients as part of their rehabilitation – in how to keep good posture while lifting and carrying.

These workbooks are used by trainers on a one-to-one basis and include photos demonstrating good and bad postures.

The winner in the last category, joined-up working practices, was Sandwell and West Birmingham Hospitals NHS Trust for its work in developing an occupational therapy team comprising doctors, nurses, physiotherapists, an ergonomist and a moving and handling coordinator and trainers.

This team has had a lot of success in assessing departments with high staff sickness from MSDs and working with the department to solve problems.

One good example included moving drugs cabinets on wards next to beds instead of above them after several staff reported neck and shoulder pain because they had trouble reaching the cabinets.

“There are so many people within the NHS doing good work on back care. It is nice to be able to hold that up,” stresses NHS Employers’ Newsome.

“What we have seen in past years, and what I expect we will see again this year, is money-saving, innovative ideas; people showing that they can think their way around a problem,” she adds.

Finally, while winning an award cannot in itself guarantee you more funding, what the awards have done over the past two years is to raise the profile of the OH and other teams within their trusts, and make managers sit up and take note of the importance of time, effort and innovation going into back care.

“Trusts are recognising that their most valuable resource is their staff and that they have to look after them,” she says. “Retention is becoming a very key focus. If you can retain people you will not be losing their expertise and training.”

As the DoH’s figures show, absence and back pain is rightly high on the agenda within the NHS. While just a part of a much wider agenda, the Back to Work Awards are an important part of keeping the issue at the forefronts of people minds, spreading best practice, educating workers and managers alike and actually making a difference to people’s working lives.

“The NHS deserves to have its profile raised because it is so full of good ideas and innovation. There is so much going on out there,” says Newsome.

How to enter
Entries to the awards must be submitted by 14 October, and the winners will be announced in February 2006.

The only constraint on eligibility is that teams must be working within the NHS, but can be within an acute hospital, the community or a GP practice.

Entries should be about 2,000 words and include a description of the key aims and elements of a project, and can include pictures or diagrams.

Entry forms are available online at or further details can be obtained from Mary Newsome at NHS Employers on 0113 306 3011.

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