As this year’s Occupational Health & Wellbeing Awards 2021 are launched, we will over the next four months be revisiting our amazing 2020 winners. First up is the team at Swansea Bay University Health Board, who were our first ever double winners, winning both “Best multidisciplinary initiative” and the coveted “Occupational health team of the year (public sector)”.
We have all read about, and been humbled by, the bravery and commitment of frontline NHS staff working on Covid wards and in intensive care during the past 12-18 months.
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‘You need good managerial and clinical leadership, visibility and credibility’
But, it is only when you speak to NHS occupational health that you get a sense of the pressure – albeit more of a backroom pressure – they were also under, especially in the early days of the pandemic in spring 2020 when the Covid pandemic commenced.
As Paul Dunning, head of staff wellbeing at Swansea Bay University Health Board (SBUHB), explains: “The original request when Covid kicked in was, ‘you need to make occupational health a 24/7 service’. It was a challenging first few weeks because the demand on the service increased dramatically and significantly,” he says with studied understatement.
“It is strange to look back because there were at that time no testing centres; we were the initial screening/assessment centre for staff, and staff were phoning up with symptoms – 400-500 calls a day – and we suddenly had this huge backlog. I worked with the executive directors to try and get as much resource into occupational health to help manage some of those early challenges” he adds.
“The original request when Covid kicked in was, ‘you need to make occupational health a 24/7 service’. It was a challenging first few weeks because the demand on the service increased dramatically and significantly.” – Paul Dunning, head of staff wellbeing.
All hands on the wellbeing ‘deck’
How the SBUHB OH and wellbeing teams responded and rose to the challenge of the pandemic by quite literally, getting all hands on to the wellbeing ‘deck’ was at the heart of their winning the “Best multidisciplinary initiative” in the 2020 Occupational Health & Wellbeing Awards. But one of the reasons it was able to respond so effectively to the public health crisis of the pandemic was in no small part because of a longer term transformation of OH service, something that also caught the eyes of our judges, and led to SBUHB becoming our first ever double winner, winning in our “Occupational health team of the year (public sector)” category as well.
“The pandemic has been different things at different times,” continues Paul. “The initial pressure on occupational health was very quick and very acute. It was almost, ‘OK we have agreed that occupational health will manage the symptomatic staff assessments’.
“This was when we were still asking people if they had travelled to China or Italy in the previous two weeks, and as staff increasingly displayed symptoms of Covid, there were frustrations with entire households having to isolate due to one member having symptoms – no one had ever had to do this in our lifetime.
“There was a recognition that by bringing together resource from different areas, we could maximise the support for staff so I linked in with the heads of psychology, chaplaincy, learning and development to talk about how we could work in an integrated way to maximise the resources across the different teams. Sarah, myself and a colleague Joy Lewis, occupational health service support manager, spent many hours planning how we could make things work to meet the growing demand.”
The “Sarah” Paul mentions here is Sarah Davies, senior OH nurse manager who oversees the OH nursing team that supports the health board’s 12,500 staff. “The reputation of the service, really, has come through during the pandemic; we have shown how we can add value,” she emphasises. “How we are really reactive in supporting the organisation. The perception of occupational health has really changed, and in a positive way.”
“The reputation of the service, really, has come through during the pandemic; we have shown how we can add value. How we are really reactive in supporting the organisation. The perception of occupational health has really changed, and in a positive way.” – Sarah Davies, senior OH nurse manager.
Truly collaborative Covid response
The other string to the service is the wellbeing team, led by workforce programme manager Bethan Lavercombe. Of the Covid multidisciplinary response, she explains: “From the wellbeing point of view, what we did, we worked closely with our other colleagues – psychology, learning and development, staff experience, chaplaincy and IT – none of us could have done it on our own. We were dependent on each other, and I remember thinking at the time, (when we were in planning meetings), ‘none of us could do this on our own’.
“It really was a joined-up approach, and those links will now, hopefully, will be strengthened. And we still are liaising with those teams and colleagues; so it has fostered some really good working relationships. For example, my colleagues in learning and development and staff experience, through our collaboration in the last year, learnt that we often get quite similar requests from teams for elements of support where there is an overlap of interventions.
“We now meet regularly just to oversee team requests to make sure they are getting the right intervention, the right support, and to make sure that we’re not duplicating. It is like triaging team requests to make the intervention more prudent and appropriate,” she adds.
Paul Dunning continues with the story. “During March, April and May Sarah and her team were dealing with that initial, almost emergency, response. By comparison at that point it was relatively quiet in the wellbeing service as staff laid aside their own needs to focus on the developing pandemic.
“Where the significant increase in demand came within the wellbeing service was during July and August, once the first wave had eased. People had more time to think about what they had just been through, and that is where we saw an increase in some of the trauma and bereavement-related referrals. Fortunately, we had additional resource to provide support for staff, particularly around bereavement and trauma.
The Swansea Bay University Health Board team
Last autumn, as the second wave developed, we had a better idea of what we were doing and what was needed. Even though it has been a difficult few months, I think the first wave served us well in terms of helping us to get our heads around the models and the staff and the processes that we needed to have in place,” Paul adds.
So, what’s next as, hopefully, we can begin to look beyond the pandemic? Paul Dunning points out that he has been working on a post-Covid staff wellbeing strategy. “There is a sense that, like last summer, there is going to be a space where people get a chance to think and reflect and, hopefully, as they move back to their day jobs, process what they’ve been through. And I think it is going to be a challenge,” he points out.
“Like every other NHS service, we are being asked to reset and turn services back on quickly to deal with the backlog that has built up. So there is a tension between needing to move into the ‘reset’ transformation space quickly versus wellbeing/looking after our staff.”
Positive spotlight on OH
The spotlight the pandemic has thrown on to staff wellbeing as well as occupational health has, arguably, been a positive. Paul, for example, highlights the additional investment in nurses and temporary counselling support that has been made available to help bolster the services.
It does force you to reflect, and you realise everything you have done and have achieved. Because you can be so busy sometimes just doing it. Sometimes you have to get off the dancefloor and spend some time looking down from the balcony; it is a great opportunity to reflect and think about what you can achieve.” – Bethan Lavercombe, workforce programme manager.
And being able to say the service is not just ‘award winning’ but ‘double award winning’ has definitely helped in these conversations. “We have clearly highlighted that we have won not one but two awards. We have pushed the message that we were up against some big names. It was a real cause for celebration at that point. Once we knew we had been shortlisted and who we were up against, it created quite a conversation for those few weeks before the announcement was made.
Even if the service had not won – twice – entering the awards would have been valuable in terms of reflective practice, agree both Sarah and Bethan. “It helped us to look back, not just at Covid, but the previous four to five months of the transformation of the service,” Sarah points out.
“It does force you to reflect, and you realise everything you have done and have achieved. Because you can be so busy sometimes just doing it. Sometimes you have to get off the dancefloor and spend some time looking down from the balcony; it is a great opportunity to reflect and think about what you can achieve,” adds Bethan.
“I remember us talking it through and working out what we were going to submit, and it all came flowing out really quickly,” agrees Paul. “It was done out of hours when – of course – there wasn’t really enough time to do it, but it gave us all a real sense of what we had achieved in a very short time-span and it reflects the commitment and hard work of every team member and gives external validation to this,” he adds.
The Swansea Bay University Health Board team in a nutshell
Led by Paul Dunning, the health board’s head of staff wellbeing, the SBUHB team is split between occupational health, led by senior nurse manager, Sarah Davies, and the wellbeing team, led by Bethan Lavercombe, workforce programme manager.
The OH team had a five-strong full-time-equivalent OH team pre Covid but, unsurprisingly, this has increased during the pandemic. Now it comprises two OHNs and four OH advisers, with a further two set to be recruited. “From the occupational health point of view, we were relatively small prior to Covid, but Covid has actually increased the size of our team,” points out Sarah.
The wellbeing team, by comparison, has two occupational therapists, one part time and one full time, as well as access to a physiotherapist and a clinical psychologist, who also leads the staff counselling service. This, in turn, feeds into staff counsellor support, with this team expanded by two additional temporary part-time counsellors because of Covid-19.
“We try to work very much together,” agrees Bethan. “We redesigned the service a couple of years ago. Previously people could refer in for occupational therapy and counselling but now they refer into one central point and we do triage-style screening. Because what people are referring in for may not actually be the best intervention for them. Or they may even just need information or signposting to other services.
“We were a small team as well and during the pandemic we had to support the whole organisation. The expansion during the pandemic to move to a more multidisciplinary format, so working closely with health psychologists, mental health, our coaching network, learning and development colleagues, staff experience, chaplaincy and IT has meant we could provide more round-the-clock support,” she adds.
“I oversee occupational health, the staff wellbeing service, and then another project that we run in conjunction with Welsh Government,” says Paul. “I suppose you could say I support/work with Sarah from an OH perspective, Bethan from a wellbeing perspective but then am also the link to the exec/senior team. So, I make the case for additional resources or any other kind of conversation that requires resource,” he adds.
How Swansea Bay University Health Board became a double winner
Part of the reason why Swansea Bay University Health Board’s (SBUHB) occupational health service won an unprecedented two categories in the 2020 Occupational Health & Wellbeing Awards was the fact that both its entries were so distinct and discrete.
For the “Occupational health team of the year (public sector)” award, the focus was very much on how the service had remodelled itself away from being an inefficient, paper-based clinical model, with more than 25,000 records spread across four sites – that was not fit for purpose.
This involved the creation of a new leadership team, investment in technology and the creation of a wider multidisciplinary team that included allied health professionals, who were upskilled to meet the service’s needs.
Team members undertook training to become wellbeing “champions” and a focus on social events during lunchbreaks and outside of work enabled more cohesive working.
Paper records were abolished, leading to a more timely response to issues and meant cancelled appointments could be reallocated swiftly. Using digital records also reduced stress levels within the team, as team members spending less time locating missing records.
Waiting times reduced from 12 weeks to two within one year, and reports to line managers were being sent out within five working days instead of the previous eight weeks. Some reports were now being sent out on a same day basis as a result of digital dictation and e-processes.
This transformation was critical in ensuring the team, which was expanded massively, was able to rise to challenge and meet the demands of the Covid-19 pandemic, which was at the heart of its winning entry in the “Best multidisciplinary initiative”.
For this, a steering group was formed of senior managers from staff wellbeing, counselling, psychology, chaplaincy, learning and development and service improvement so as to re-engineer its wellbeing service.
New joint working arrangements were put in place that allowed extended service delivery from 7am to 9pm even days a week where it had previously been 9am to 5pm, Monday to Friday.
This entry clearly describes a service transformation. It is impressive to see the ability to manage and train additional staff to support its response to the pandemic, with a resulting clear benefit in reputation, service continuity and positive stakeholder feedback.”
Therapists and counsellors were brought together to develop new clinical pathways for cases of trauma and bereavement, while the psychology department helped to provide wellbeing support for whole teams and developed a 12-week mindfulness programme.
More than 100 senior staff were trained to use a trauma risk process to help identify early signs of trauma in their teams, with the aim of preventing mental health problems in the future.
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Our judges were impressed by both the service transformation and the Covid response, hence the double win. For the OH public sector team of the year, they said: “This entry clearly describes a service transformation. It is impressive to see the ability to manage and train additional staff to support its response to the pandemic, with a resulting clear benefit in reputation, service continuity and positive stakeholder feedback.”
For the “Best multidisciplinary initiative” win, they added: “Swansea Bay’s approach to wellbeing during the pandemic was exceptional, considering the small-scale OH service in place. What stands out is the involvement and coordination of a wide range of professionals and the compassionate approach taken for sensitive topics.”
