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Workforce Healthand WellbeingFramework

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ENABLERS HEALTH INTERVENTIONS

Implementation GuideLeadership

& ManagementHealthy Working

EnvironmentMental Health

Muscoskeletal Health

Healthy LifestylesData & CommunicationIntroduction

Contents

Introduction

Enablers

Health Interventions

Implementation Guidance

Evaluation Guidance

Business Case Guidance

To go to each of these sections please click on the tabs on the bottom of each slide. Within each section you can use the Previous page and Next page buttons to navigate.

Introduction

Leadership & Management

Healthy Working Environment

Mental HealthMuscoskeletal

HealthHealthy LifestylesData & Communication

Board Leadership Organisation Wide PlanEffective Line Management

Introduction Implementation Guide

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Improving staff health and wellbeing

Improving staff health and wellbeing is a pressing challenge, with clear benefits

There is a clear case that poor staff health and wellbeing has a significant impact on the performance of NHS organisations (Michael West, 2018).

Estimates from Public Health England put the cost to the NHS of staff absence due to poor health at £2.4bn a year – accounting for around £1 in every £40 of the total budget. This figure is before the cost of agency staff to fill in gaps, as well as the cost of treatment, is taken into account. Investing in staff health and wellbeing delivers benefits for NHS organisations, their staff and ultimately patients:

Financial and Performance Case

‘Workplace Wellbeing’ programme“95% of staff reported making changes to their health or lifestyle…for every pound spent on the programme, the NHS as an employer saved £3” Yorkshire and Humber AHSN

MSK intervention “Priority treatment referrals to a local physiotherapist for injured staff cost £21,000 to set up… as a result, lost days due to sickness absence reduced by 40 per cent; and the savings on direct costs of musculoskeletal injuries to the trust were £170,000.” West Suffolk Hospital NHS Trust

Good people management practices“Trusts that made the most extensive use of good people-management practices had absence rates of around 3.7%...Trusts that made least use of good people management practices had absence rates around 4.4%...if all Trusts reduced their absence rates to 3.7%, then this could lead to an annual saving of over £200m” What Works Wellbeing Centre

Social and Clinical Case

Patient care“85% of staff felt that their health and well-being impacts upon patient care, and virtually none disagreed” RAND Europe

Quality jobs and workplaces“Work is strongly related to the quality of individuals’ lives and their well-being. Quality jobs increase participation rates, productivity and economic performance…Low quality work can also affect worker health…In 2016, 15 million working days were lost due to stress, anxiety or depression.” Taylor Review into Modern Working Practices

Patient safety“Doctors who feel more engaged are significantly less likely to make mistakes…Better staff wellbeing is even associated with reduced MRSA infection rates and lower standardised mortality figures…the Keogh review of 14 trusts with high levels of patient mortality found that these trusts tended to have high rates of sickness absence, particularly among doctors and nurses” Royal College of Physicians







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Organisational Enablers

Data driven decision making

Health Needs Assessment

Engaging with staff

Data & Communication

Physical Infrastructure

Nutrition and Sugar


Effective Line Management

Board Leadership

Organisation wide plan


Workforce Health and Wellbeing Framework

Psychological interventions

Mental Health Healthy LifestylesMusculoskeletal

Accessible physiotherapy

Lifestyle change interventions

Prevention & Self-management



Promotion & Self-management

There is no single answer for how NHS organisations can solve the challenge of improving staff health and wellbeing. While there is a lot of useful advice and guidance, this isn’t always accessible or easy for NHS organisations to use in a practical way.

The Framework, supporting information and the Diagnostic Tool has been created to help people working in all NHS organisations plan and implement their own approach for improving staff health and wellbeing.







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Introduction to the Workforce Health and Wellbeing Framework



The Framework has been developed over the past two years through working with twelve NHS organisations, learning from what works and distilling it into these sections. We have also worked with partners across the NHS, voluntary sector and government, drawing their best practice research and insights into the Framework.

The Framework and accompanying resources are designed to be used in a flexible way to meet the needs of your organisation. They can be used to start, revise or relaunch a programme, and either be used in total or in parts depending on your starting point.

Framework is ordered to prioritise delivery time and resources on

enablers first. And then prevention and self-management and then

targeted interventions

Organisational Enablers: Essential leadership, structural,

cultural building blocks for improving staff health and wellbeing

Health Interventions: Core health areas to focus delivery, as they are

the largest cause of sickness absence

The diagnostic tool helps you assess your progress against each section, helping you know where to start

Each section of Framework has a section in this document covering

what it is and how to deliver it

Content in each section is evidence based and developed with NHS workforce health and wellbeing

practitioners







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Overview of the Framework sections

Enablers

The enablers, many of which are core to organisational development, are also the essential building blocks of good staff health and wellbeing (NICE Guidance 13, NICE, 2015). They are the leadership, structural and cultural essentials that need to be in place at an organisational levels.

Enablers should be prioritised in delivery plans as they are the most effective and impactful ways to create sustainable staff health and wellbeing (Eight elements of health and wellbeing, NHS Employers). They are linked to overall organisational development and improvement and require a whole organisation approach.

The work needed to achieve the enablers should be led by the board through a proactive vision for change sustained over several years. Staff should be involved at all stages as co-designers and stakeholders.

Working on the enablers to improve staff health and wellbeing doesn’t require significant dedicated investment as they are about making structural changes and unlocking organisational support to improve quality.


The three health areas have emerged through working with NHS organisations and reviewing the data nationally on the causes of absence, presenteeism and the staff survey results.

When starting work you should identify staff needs by carrying out with a health needs assessment. This should inform a plan for delivery.

Interventions fall under two categories and we suggest a balance of delivery between both categories based on organisational need:

• Prevention and self-management: these are approaches to keeping people well at work through good working conditions, timely training and information and the skills needed to self-management.

• Targeted support: these are targeted clinically appropriate interventions for staff in need of specific healthcare and support, such as counselling and physiotherapy.







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What are the Framework resources and how should they be used

Start Understand Plan

Ho

w?

Wh

at?

Introduction to Workforce Health and Wellbeing Framework

Explanation of Framework structure

and purpose

Excel based tool to assess your organisation against the Framework,

helping to prioritise where to focus delivery

Practical delivery guidance to support

delivery of health and wellbeing programmes

with case study examples

Detailed information on each Enabler and

Health Intervention in the Framework, covering three core components in each to focus on and

case study examples

Framework Diagnostic

Guidance:

Implementation

Evaluation

Business Case

Do

Framework: Enablers

Framework: Health Interventions







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Guidance for using the Framework and resources

The Framework and accompanying resources can be used in flexible ways depending on your needs and progress on staff health and wellbeing. They can be used as a whole to plan and deliver a new programme from the beginning or as a way to improve existing activity to ensure it is strategically aligned to the wider organisation.

Implementing the Framework should be a long term commitment phased over time in line with your organisational needs and priorities.

Are you?

Improving existing activity

1. Complete the diagnostic tool (link) to understand gaps between the Framework and current delivery and provision

2. Incorporate actions to fill gaps in the current health and wellbeing plan and/or update objectives

3. Use Framework resources to develop and deliver against gaps, then monitor and evaluate impact and effectiveness

4. Write a report for the board and workforce committee (or equivalent) on compliance against the Framework. Agree a date to be fully compliant with the Framework.

Planning a new programme

1. Complete the diagnostic and Health Needs Assessment to understand current status of organisation

2. Work with Board and senior team to agree priorities. The enablers should be prioritised. This should be followed health interventions for prevention and self-management.

3. Use Implementation Guidance to understand the tasks and activity, develop logic models and make the business case

4. Agree and sign off on health and wellbeing plan. Agree a date to be compliant with the Framework.

or

ENABLERS

Introduction

HEALTH INTERVENTIONS





Healthy LifestylesData & Communication




Engaging with staff



Nutrition and Sugar



Board Leadership






Targeted interventions




Organisational enablers







ENABLERS

Introduction


Implementation Guide

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1. Board Leadership

2. Effective Line Management

3. Organisation Wide Plan

Organisational enablers: Leadership & management






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Introduction



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Board leadership

Why does this matter? What does this look like?

The board, both exec and non exec, has clear accountability and regularly reviews reporting on staff health and wellbeing. The board promote staff health and wellbeing and individual members lead by example. The board should role model the culture it wants for the organisation and the way it wants staff health and wellbeing to be valued.

The board has clear accountability with regular reporting on health and wellbeing • There is a named board member responsible for staff health and wellbeing

planning and delivery• The board promotes joint working and regularly reviews staff health and

wellbeing across teams and disciplines• There is regular, at least quarterly, reporting to the board on the delivery and

performance of measures and interventions. Updates on progress against health and wellbeing objectives included in annual report

The board sets and promotes a clear vision and strategy

• The board set specific staff health and wellbeing objectives directly linked to the wider organisational strategy. They ensure the plan is implemented by the health and wellbeing lead and reviewed in line with the planning cycle (e.g. annually)

• Both enablers (e.g. Physical Environment) and the health interventions of the Framework should be addressed. The enablers are critical in order to address the structural and cultural factors that influence staff health and wellbeing

• Board members actively promote health and wellbeing, and lead by example through visibly participating in interventions, health and wellbeing planning and setting the culture they want to see across the organisation

Effective resourcing

• The board provide the resources (financial and non-financial) to effectively meet the organisation’s staff health and wellbeing objectives

• The board engages clinical expertise in planning, delivery and evaluation• A health and wellbeing lead is in place with access to the necessary support and

expertise, for example data analysts and clinical leads

• “ There is clear evidence that trusts with higher engagement levels have lower levels of sickness absence among staff, and also have lower spend on agency and bank staff…NHS leaders should investigate the importance of nurturing positive, trusting cultures within which staff have high levels of wellbeing”

(Employee engagement, sickness absence and agency spend in NHS trusts, NHS England/The King’s Fund, 2018)

• “ It is essential that all NHS Trusts put staff health and wellbeing at the heart of their work, with a clearly identified board-level champion and senior managerial support”

(NHS Health and Wellbeing Review, Boorman, 2009)

• “ There is correlation between working environments where staff are more supported and wellbeing is good, and high quality patient care”

(Kings College London, 2013)






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Best practice examples

Birmingham Women’s and Children’s NHS Foundation Trust

CEO & board level leadershipBirmingham Children’s Hospital joined with Birmingham Women’s Hospital in 2017. The board have provided clear leadership on staff health and wellbeing, ensuring that it is always on the agenda, and accounted for in decision making.

There have been a number of efforts to make this happen. Being the ‘best place to work’ is listed the number one goal to support the organisation’s vision and places staff health and wellbeing at the front and centre of board focus. Each year the CEO, exec and non exec directors hold a series of listening events to understand what is important to staff.

The board have prioritised integrating health and wellbeing into in all aspects of workforce management. Staff health and wellbeing is included in broader organisational objectives for senior management. The trust have challenged a reactive ‘crisis culture’ by investing in preventative & long term approaches to staff health and wellbeing. Performance on this agenda is overseen through regular ‘Quality Committee’ reports to the board. Key points are shared across the organisation through the CEO’s monthly briefings. The efforts have helped the trust to maintain its reputation as an appealing place to work with stable sickness absence and no major recruitment challenges. CEO, Sarah-Jane Marsh, was rated third best chief executive in the NHS by Health Service Journal in 2018.






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University Hospital Southampton NHS Foundation Trust

CEO leadership on staff health and wellbeing Dr Julia Smedley, Head of Occupational Health

Despite a good track record we felt that we could give staff health and wellbeing more visibility at board level and build engagement across the organisation. Our pre-existing health and wellbeing group sometimes struggled to maintain good attendance and profile, and this hindered progress on health and wellbeing issues.

We discussed the optimum form of leadership of our Health and Wellbeing group and our CEO offered to take on the role. She has been an outstanding personal role model for healthy behaviours. She articulated clearly and frequently the crucial link between recruiting and retaining fit, healthy, happy, motivated staff and both the values and success of the organisation i.e. that this will ultimately enhance the quality of patient care and patients’ experience. The CEO repeatedly said that, by looking after staff wellbeing, organisations gain a crucial advantage in attracting the best staff in a competitive environment.

The CEO chairs a refreshed quarterly Health and Wellbeing group meeting. The membership was updated and there was an open invite to anyone who had relevant skills and interest. There are a broad range of new perspectives and we have been able to identify pockets of support and resource of which we were previously unaware.

The results are clear. Staff wellbeing has been mentioned more frequently than previously at board meetings. The Director of Finance recognises that staff health and wellbeing is an important driver of financial success, even in the absence of measurable cost savings.






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Southampton University Hospitals: supporting line managers

The trust have embedded staff health and wellbeing into the line management practices for staff. All staff have a line manager that they meet with on a regular basis.

The trust’s web-based line management training includes a module on staff health and wellbeing. Every staff member has to have a conversation with their line manager about their health and wellbeing at work, as there is a dedicated section in the trust’s annual appraisal process.

How Who Potential measures More information

The board has clear accountability and regularly reviews reporting on staff health and wellbeing• Appoint a board lead for staff health and wellbeing. They should have the

knowledge and capabilities

• A board report is prepared on a quarterly basis

• Board define clear accountabilities for staff health and wellbeing. Link these to delivery plans and workforce planning

• Annual report includes staff health and wellbeing

• Health and Wellbeing lead

• Board lead

• Named board member for staff health and wellbeing (yes/no)

• Progress against objectives related to staff health and wellbeing

• Number of reports/ meetings covering staff health and wellbeing per year

• Reporting on staff health and wellbeing in Annual Report

Section 1.2, Guideline 13, NICE Overview of board responsibilities

Quality Standard 147, NICE Improving employee mental and physical health and wellbeing

The role of senior/board and clinical leads, NHS Employers

The board sets and promotes a clear vision and strategy• Work with the board to ensure that staff health and wellbeing objectives are

included within a wider workforce strategy

• Ensure objectives are turned into defined actions within a health and wellbeing delivery plan

• The delivery plan gives board members a formal role in visibly championing staff health and wellbeing. This should make the best use of executive and non-executive members’ skills, roles and interests


• Board lead

Health and wellbeing presentation for your executive board, NHS Employers

Partnership working across your organisation, NHS Employers

Reducing sickness absence in the NHS using evidence-based strategies, NHS Employers

Effective resourcing • Work with board, HR and occupational health to ensure resources are available

to improve staff health and wellbeing

• Resourcing of health and wellbeing is reviewed regularly as part of business planning and governance processes


• Board lead

• Finance director

Engaging your board and building your business case, NHS Employers

How to deliver board leadership

https://www.nice.org.uk/guidance/ng13

https://www.nice.org.uk/guidance/qs147

http://www.nhsemployers.org/~/media/Employers/Publications/Role descriptors - NHS England Healthy Workplaces.pdf

http://www.nhsemployers.org/case-studies-and-resources/2016/09/health-and-wellbeing-presentation-for-your-executive-board

http://www.nhsemployers.org/your-workforce/retain-and-improve/staff-experience/health-work-and-wellbeing/protecting-staff-and-preventing-ill-health/partnership-working-across-your-organisation

http://www.nhsemployers.org/your-workforce/retain-and-improve/staff-experience/health-work-and-wellbeing/protecting-staff-and-preventing-ill-health/partnership-working-across-your-organisation

http://www.nhsemployers.org/~/media/Employers/Publications/Reducing sickness absence in the NHS.pdf

http://www.nhsemployers.org/~/media/Employers/Publications/Reducing sickness absence in the NHS.pdf






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Effective line management


Line managers are trained and supported to provide high quality management, including health and wellbeing, in one to one meetings, reviews and appraisals. Resources and training are available to support this as well as supporting organisational culture.

Essential structures

• All staff have a named line manager and line management conversations take place on at least a monthly basis

• Line managers have access to support in occupational health and human resources• Line managers are able to offer core guidance on health and wellbeing at work,

and refer and signpost to support and advice for example, ensuring breaks are taken and reducing presentism

Supporting good line management

• Health and wellbeing responsibilities are included in core competencies and job specifications for line managers

• Performance reviews for line managers take into account action taken to support staff health and wellbeing

• Training is in place to develop line management skills including how to have health and wellbeing conversations with staff and provide preventative support

Managing sickness absence

• Line managers are able to support staff to remain in work and to manage unplanned absence. This happens through a case management approach, where support from HR and occupational health is available to prioritise cases within the available time and resources

• Policies and procedures should be reviewed with line managers to ensure a common understanding of the case management process and systems. Policies should be reviewed regularly to ensure they are practical, effective and easy to understand

• Line managers are able to access sickness absence data through a relevant system such as e-rostering. This will enable them to identify issues and trends and deliver key aspects of case management such as calling staff on first day of absence

• “ There is a proven link between good people-management practices in the NHS and increased staff engagement, reduced sickness absence and improved patient satisfaction”

(Good Work, Wellbeing and Changes in Performance in Outcomes, What Works Wellbeing, 2017)

• “ Promote effective people management to ensure all employees have a regular conversation about their health and well-being with their line manager, supervisor or organisational leader and train and support line managers and supervisors in effective management practices”

(Recommendation 5, Thriving at Work: Stevenson/Farmer review of Mental Health and Employers, 2017)






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Building the skills of line managers Jane Carter, Management and interpersonal skills leadWe have integrated health and wellbeing into our appraisal processes alongside explicit discussion about workload and work life balance. We also decided that line managers needed additional support to assist them with supporting their staff to manage stress.

Building on an existing course, we have delivered a training course on effective stress management using a “train the trainer” model. After the “train the trainer” training each trainer was tasked with organising courses in their division and trust-wide courses were organised by the leadership team. Delegates completed pre and post evaluation forms and these were assessed and reports produced. The feedback we received on the course was extremely positive. All of the courses were well attended, and delegates reported feeling much more well-equipped to support and assist their staff. They commented that they valued the opportunity to practise the new skills acquired through the course, and that they felt confident in putting the knowledge and skills into action promptly with their teams.






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West Midlands Ambulance Service NHS Foundation Trust

Embedding health and wellbeing into line managementThe Trust has a health and wellbeing Steering Group comprising of HR, staff side and operational managers and peer supporters. There is a joined up approach to supporting line managers and staff. Each of the 15 hubs has a dedicated HR professional attached to them, so line managers have advice on hand. All supervisors (Band 4-6) and managers (Band 7+) all are mandated to complete an Engaging Managers or Engaging Leaders course, and this includes a health and wellbeing module.

The Trust have policies to help staff if they need to leave work at short notice or if they have caring responsibilities. There are a range of flexible working options to allow staff to balance their work life and home. As part of the Performance Development Review process line managers ask staff “How are you feeling?” as opening question to a conversation about health and wellbeing.

HR provides absence management training for all supervisors and managers. The level of support provided has a direct impact on how quickly we can provide medical interventions and enable the member of staff to return to work. The absence management procedure asks for individuals to be contacted on the first day of absence with the offer of support. Contact is maintained with staff during their illness to help avoid staff feeling isolated.






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How to deliver effective line management


Essential structures• HR to ensure all staff have a named line manager

• Guidance is shared on content and regularity of one to one support

• Health and wellbeing is formally included in ongoing management and annual appraisal meetings

• Line managers have access to support from occupational health and human resources

• Line managers given tools to be able to offer core health and wellbeing guidance and have conversations with staff on their health and wellbeing


• Senior HR lead

• Senior managers

• Number of line managers trained in health and wellbeing

• Appraisal completion rates

• Satisfaction with line management training (post-training survey)

• Awareness of line management training and support (survey or focus group)

• NHS Staff Survey data

Sections 1.7-9, Guideline 13, NICE Overview on the role of line managers and behaviours

Making Every Contact Count Supports behaviour change through staff interactions

Supporting good line management• Review learning and development provision for line managers to ensure it includes

health and wellbeing

• HR ensure line manager appraisals include question on action taken to support staff health and wellbeing

• Training and support is available for line managers to improve line management skills and knowledge


• Senior HR lead

• Senior managers

Front Line Managers Toolkit, ACAS

Supporting line managers resources, NHS Employers

Health and Safety Line Managers Competency Indicator tool, Health and Safety Executive

Managing sickness absence • Line managers can access support from HR and occupational health to ‘case

manage’ staff who are absent or at risk of becoming absent

• Policies and procedures should be reviewed with line managers to ensure they are accessible, practical and widely understood

• Line managers should be given access to clearly presented data on sickness absence


• Board lead

• Occupational health lead

Sickness absence: A simple guide for NHS managers, NHS Employers


http://www.makingeverycontactcount.co.uk/

http://www.acas.org.uk/media/pdf/j/4/Front-line-managers-advisory-booklet.pdf

http://www.nhsemployers.org/your-workforce/retain-and-improve/staff-experience/health-work-and-wellbeing/protecting-staff-and-preventing-ill-health/supporting-line-managers

http://www.hse.gov.uk/stress/mcit.htm

http://www.nhsemployers.org/sickness

http://www.nhsemployers.org/sickness






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Develop a single organisation wide staff health and wellbeing plan. The vision and core objectives should be set by the Board and implementation detail developed with occupational health, HR, operational teams and staff. The plan should make best use of available data and feedback.

Health and Wellbeing plan

• The board commission an annual workforce health and wellbeing plan. They should set the vision, objectives, resource and ensure alignment with workforce strategy and planning

• A delivery plan should be created, using organisational evidence and data where available (e.g. causes of unplanned absences). The plan should address the needs of a diverse workforce, including people with characteristics protected by the 2010 Equality Act. This should explain how the vision and objectives will be achieved and which teams will be responsible for delivering specific activities e.g. occupational health, HR, operations, estates

Health and wellbeing lead

• A health and wellbeing lead should be in place to lead work across the organisation with the visible and active support of the board and senior team

• The lead should build good working relationships with senior clinical and operational managers, and have a clear budget to deliver the plan

Health and Wellbeing integration

• Health and wellbeing objectives and responsibilities are included in core workforce plans particularly occupational health and human resources

• Sickness absence procedures are reviewed to include proactive preventative support for all staff, and targeted interventions for those who need them

• A commitment should be made to support integration of teams and individuals responsible for workforce support and management. This could involve co-location and multi-disciplinary case management of staff who need support. It may also involve working across local systems such as STPs or devolution areas

• A single organisation-wide plan will ensure that workforce health and wellbeing is delivered efficiently, integrated into key areas of the organisation and makes the best use of available resources. Providing support to staff in a structured manner is a requirement of the NHS Constitution and the 2017 ‘Thriving at work: Stevenson/Farmer review of mental health and employers’

• The development of the plan should be used to solidify support from the board, occupational health, HR and operational teams, who all should ‘own’ key objectives







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West Midlands Ambulance Service NHS Foundation Trust: Organisational journey

Key learning on reducing sickness and implementing health and wellbeing:• Line managers ‘own’ staff wellbeing and engage in processes/systems to improve staff health and reduce sickness absence• Change view of sickness from 100% well or 100% sick, to a more nuanced one focused on redeployment and on what staff can staff do• Re-designed and implemented a new sickness absence policy, with input from Trade Union• Contact staff on first day of sickness and discuss and support quickly and honestly• Sickness absence a powerful financial motivator, use that to make fundamental changes and improvements for long term• Making Health and Wellbeing and sickness absence a recruitment-related issue, helping buffer from organisational shocks, retains and attracts staff• Communicate health and wellbeing support consistently and in many ways using champions• Using data to identify where intervention needed most and to engage managers. Make data as live and available as possible to managers• Deliver health and wellbeing support through in-house teams who have in-depth knowledge and understanding of staff

Sickness absence ranging from 8-14% Sickness absence 2016-17 3.29%Culture change ➞ illness not binary, more complex

Trust formed from 4 previous services.

New CEO and Dir Workforce

Opportunity to re-structure and plan

for long term

Boorman Review focuses attention

on staff health and wellbeing

Agreement from finance to focus on

recruitment

Need to find out why staff were

off sick

With this information there

was an opportunity to target support

Sickness absence a performance

indicator

Sickness absence a big HR + Ops agenda item

Re-designed sickness absence

policy

Trust status authorised

Large range of preventative and targeted health and wellbeing

support available across mental and physical health

Physio brought into OH team

➡

2006 2009 2010 2013 20172016

Sickness absence rate – once stabilised at low level, allowed much more preventative Health and wellbeing activity






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How to deliver an organisation wide plan


Health and wellbeing plan • Board lead for health and wellbeing leads the development of a vision

and objectives

• The health and wellbeing lead should form a working group from across the organisation, to turn the vision and objectives into an achievable health and wellbeing plan

• Plan based on health needs assessment and recognises the needs of a diverse workforce

• A business plan is developed (if needed) to agree and allocate funding

• Board lead for staff health and wellbeing

• Health and wellbeing lead


• Health and safety

• Completed cross organisational objectives for staff health and wellbeing

• Current cross organisational objectives for staff health and wellbeing

• Accreditation with the SEQHOS (Safe, Effective, Quality Occupational Health Service) standards for occupational health services

• Staff satisfaction with OH, HR and health and wellbeing support (survey)

Section 1.1, Workplace health: management practices, Guidance 13, NICE

Role of senior leaders, clinicians and board in health and wellbeing, NHS Employers

Developing a health and wellbeing strategy, NHS Employers

Read more in the Implementation Guidance

A representative and supported workforce, Equality Delivery System for the NHS (EDS2), NHS England

Rapid access to treatment and rehabilitation for NHS staff, NHS Employers

Health and wellbeing lead• Lead in place to manage and coordinate delivery

• The lead reports on the progress of the delivery plan to the board

• Health and wellbeing lead is able to work effectively across the organisation

• Board lead



Health and wellbeing integration • The delivery plan includes actions to integrate workforce health and wellbeing

into core workforce plans involving occupational health and human resources

• HR review sickness absence procedures and trends. This plan should include provision of proactive preventative support for all and targeted interventions

• Long term plan to integrate workforce support teams considering co-location and arrangements for multi-disciplinary case management

• Board lead

• Senior team




http://www.nhsemployers.org/case-studies-and-resources/2016/06/nhs-healthy-workforce-the-role-of-senior-board-and-clinical-leads

http://www.nhsemployers.org/your-workforce/retain-and-improve/staff-experience/health-work-and-wellbeing/the-way-to-health-and-wellbeing/strategies-policies-and-guidance


https://www.england.nhs.uk/about/equality/equality-hub/eds

http://www.nhsemployers.org/case-studies-and-resources/2018/03/rapid-access-to-treatment-and-rehabilitation-for-nhs-staff

http://www.nhsemployers.org/case-studies-and-resources/2018/03/rapid-access-to-treatment-and-rehabilitation-for-nhs-staff





Data Driven Decision Making

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NEXT PAGEEngaging with staffHealth Needs Assessment

Enablers: Data & communication


1. Data driven decision making

2. Health Needs Assessment

3. Engaging with staff





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NEXT PAGEData Driven Decision Making Engaging with staffHealth Needs Assessment


What does this look like?

Data and organisational intelligence is used to inform decision making on matters related to staff health and wellbeing

Aligning health and wellbeing programme to workforce challenges

• Existing data is identified and used to inform the health and wellbeing plan. This data includes staff survey results, sickness absence, demographics, data about people with protected characteristics, retention rates and patient feedback. Further surveys and qualitative research can supplement this data, for example focus groups

• Data is used to build an accurate staff profile e.g. absence at organisational level and in specific teams. This is used in conjunction with the health needs assessment to build a whole picture of staff health and wellbeing

• Data is used in case management. This enables the identification and monitoring of staff who are absent, or at risk of being absent from work. The quality of data is improved over time to ensure that it is as accurate and up-to-date as possible

Reporting links to the health and wellbeing plan and organisational objectives

• Reports to the board and other committees are regular and use a wide range of data sources

• Data (quantitative and qualitative) is used to measure and improve performance against the health and wellbeing plan and org strategic objectives

• Data is shared across teams e.g. between occupational health and HR. This supports joint activities such as case management

The impact and quality of interventions are measured and reviewed

• The impact and quality of staff health and wellbeing interventions are measured and included in reporting e.g. intervention impact, staff feedback

• Quality improvements are identified and implemented

• Target groups for health and wellbeing interventions are identified using data e.g. teams with the highest absence rates. Feedback is collected to identify any reasons for low take-up e.g. shift-patterns. A plan is made to address reasons for low take-up or poor quality support

• By using data organisations can make more evidence based decisions to improve staff health and wellbeing. Reviewing detailed and accurate absence data allows interventions to be more targeted so that they can better help to reduce unplanned absences


• “ Routinely monitor employee mental health and wellbeing by understanding available data, talking to employees, and understanding risk factors”

(Recommendation 6: Thriving at Work: Stevenson/Farmer review of mental health and employers, 2017)

Why does this matter?





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Imperial College Healthcare NHS Trust

Improving measurement of sickness absence: Penny Parker, Head of People Planning and InformationImperial College Healthcare NHS Trust was created through the merger of two NHS Trusts in 2007 operating different absence recording and reporting methods which didn’t reflect and accurately capture the wide variety of working patterns within its workforce; only 20% of their staff work a standard Mon-Fri for example.

The Trust moved to capture working hours lost to sickness absence as a percentage of contractual hours for all staff across all sites, interfacing this data to the Electronic Staffing Record (ESR) on a monthly basis. From this, the Trust exports the absence data from ESR to report both internally and externally.

By using working hours lost, the Trust is able to report sickness absence, from employee level upwards, reflective of all shift and working pattern arrangements. This allows for comparative analysis and consistent management of the sickness absence triggers across all staffing groups.

Recording sickness absence in this way has allowed for the accurate provision of sickness absence information to line managers and their HR support at employee level. With this increased visibility, the Trust is capturing all recorded absence data, enabling proactive management support and intervention.

The implementation of a comprehensive sickness absence management policy, introduction of training for managers, centralising of the Employee Relations Service, and this more accurate data recording has resulted in the sickness absence rate, in the last 5 years, reducing from 3.6% (12/13) to 2.9% in 17/18.

Any central reporting through the data warehouse will default to the standard ESR calculation used i.e. reporting on days lost as a proportion of whole time equivalent. Reporting on working hours lost, as a percentage of contracted hours, results in a higher sickness absence rate than the standard ESR calculation, at approximately 0.50 percentage points.





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Northumbria Healthcare NHS Foundation Trust

Using data to inform decision makingThe trust runs a psychology and counselling service that works closely with HR and occupational health colleagues. The service is routinely evaluated using a range of measures including valid and reliable pre and post measures of psychological change as well as service satisfaction rates. The clinical outcomes are generally positive with staff showing significant clinical change. For example, a City University academic paper demonstrated that following resilience training one group of 68 nurses went from ‘clinically relevant’ (3.87 General Health Questionnaire Score) mental health difficulties to a level that that was better than average (1.11 GHQS).

The trust utilises this data and feedback from clients to adapt the service to fit the changing needs. For example information has helped the trust explore and identify a range of interventions for meeting staff mental health needs beyond one to one counselling /therapies such as providing self-help materials, online resources and psychological skills training. To ensure accountability the service produces an annual report that summarises evaluation outcomes and feedback from users. As a result mental health sickness absence has reduced over the years that the service has been operating.





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Multi-disciplinary Case ManagementHaving a good case management system in place when staff go off sick is vital. Providing or offering relevant support to staff early on in their absence is critical in reducing the length of sickness absence.

Our staff health and wellbeing support is led by occupational health, with a focus on addressing clinical and health concerns and providing effective support. The team has caseworkers to provide tailored return-to-work support. These are multi-disciplinary and include clinical, managers and HR professionals. This enables them to manage a range of cases/situations and bring different views to provide the most effective support. They feel that as an internally based service they understand how the organisations works and the pressures and routines of staff. This new case management system focussed on treating staff early was considered a “game changer” in managing sickness absence.





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How to deliver data driven decision making


Aligning health and wellbeing programme to workforce challenges • Work with analytics team to understand current data

• Address gaps through new data collection

• Use data (quantitative and qualitative) to understand where absence and health challenges impact most on the organisation

• Develop targets for staff health and wellbeing. Include these in plans e.g. health and wellbeing, HR, occupational health and whole organisation


• Analytics team

• Reporting uses data to demonstrate performance against health and wellbeing objectives (yes/no)

• Qualitative data on issues related to staff health and wellbeing (yes/no)

• Relevant outcome measures to measure each intervention (e.g. MSK-HQ Health Questionnaire)

Developing your strategy: Assessing need guidance, NHS Employers

Six Steps methodology to Integrated Workforce Planning toolkit, Skills for Health

Advice on using data to inform decision making, NHS Employers

Evaluating health and wellbeing interventions for healthcare staff toolkit, NHS Employers

A representative and supported workforce, Equality Delivery System for the NHS (EDS2), NHS England

Workforce Race Equality Standard (WRES), NHS England

Workforce Disability Equality Standard (WDES), NHS England

Sexual orientation monitoring standard, NHS England

Reporting links to the health and wellbeing plan and organisational objectives• Work with board lead and senior leadership to agree data metrics to measure

progress of objectives

• Include performance data against objectives in regular reports to board and committees. Use data to inform action to improve performance

• Aim to capture sickness absence by hours and days and as regularly as possible

• Share data across teams regularly as part of joint working activities

• Relevant director


• Analytics team

Impact and quality of interventions and support are measured and reviewed• Develop a plan for measuring impact and quality of delivery of health and

wellbeing plan. Use existing quality standards such as the SEQOHS standard for occupational health

• Collect data on an ongoing basis and share regularly

• Review data formally at least once per year

• Identify the target groups for interventions and support


• Analytics team




http://www.skillsforhealth.org.uk/resources/guidance-documents/120-six-steps-methodology-to-integrated-workforce-planning

http://www.nhsemployers.org/your-workforce/retain-and-improve/staff-experience/health-work-and-wellbeing/sustaining-the-momentum/health-and-wellbeing-metrics

http://www.nhsemployers.org/your-workforce/retain-and-improve/staff-experience/health-work-and-wellbeing/sustaining-the-momentum/health-and-wellbeing-metrics

http://www.nhsemployers.org/case-studies-and-resources/2014/11/evaluating-health-and-wellbeing-interventions-for-healthcare-staff

https://www.england.nhs.uk/about/equality/equality-hub/eds/

https://www.england.nhs.uk/about/equality/equality-hub/eds/

https://www.england.nhs.uk/about/equality/equality-hub/equality-standard/

https://www.england.nhs.uk/about/equality/equality-hub/wdes/

https://www.england.nhs.uk/about/equality/equality-hub/sexual-orientation-monitoring-information-standard/





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Workplace health needs assessment


Organisations understand the specific health and wellbeing needs of individuals and groups of staff. Staff feel enabled to talk about their health and wellbeing needs and health conditions. The data and feedback is collected and analysed as part of developing the organisation wide health and wellbeing plan.

Information gathering• Review existing data on staff health and wellbeing such as staff surveys,

unplanned absence rates and reasons, employee relations cases, employee assistance programme (EAP) activity

• Identify any knowledge gaps. Collect data and feedback using methods such as pulse surveys, interviews and focus groups. Consider using the PHE Workplace Health Needs Assessment tool

• Combine and analyse existing and new data to identify trends, gaps and opportunities

Culture of disclosure• Disclosing health issues is promoted and encouraged and a supportive culture is

developed in line with this. Line managers know how to give basic support staff who disclose any health and wellbeing issues

• When staff need further support line managers know where to find information and where to sign-post staff to. Reasonable adjustments are made when appropriate

• The organisation uses data and information from disclosures to understand organisational trends and inform the health and wellbeing plan

Use results to inform the health and wellbeing plan • Health needs assessment results are reported to the board and inform short and

long term planning for staff health and wellbeing• Priority should be given to addressing any immediate risks to staff health

and wellbeing• The health and wellbeing plan should address the issues identified and focus on

meeting the requirements of the enablers and health areas of the Framework

• By understanding the health and wellbeing needs of staff organisations can develop effective plans for addressing specific issues. This will help maximise the impact of any investment


• If staff feel able to disclose health and wellbeing issues then organisations can provide targeted support. Support will help staff perform their duties to a high standard and reduce the likelihood of unplanned absence

(Quality Standard 147, NICE)






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Health needs assessment Kylie Murrell, Staff Health and Wellbeing LeadWe recognised that we needed to understand the health behaviours, needs and interests of staff. As a result, since 2013 we have run two health needs assessments. Both have been given a high profile launch that included a global email from the Chief Executive, significant promotion through internal communications channels and health advocates. Paper copies were also made available in areas where staff didn’t have easy access to a computer. Prize incentives were made available and assurances were given that data was anonymous. Each occasion had 1,500+ responses.

The results were combined with results from the NHS Staff Survey, local health profiles and internal data such as sickness absence in order to identify the priorities for our health and wellbeing plan. Using the results the trust’s Healthy Workforce Steering Group has overseen an organisation-wide action plan on staff wellbeing. New initiatives and interventions were designed using a tiered model. As a result the Trust has seen an improvement on key finding 19 (organisation and management interest in and action on health and wellbeing) of the 2017 NHS Staff Survey and is amongst the top 20% of acute trusts for this.





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Disclosing problems through peer supportThe Trust manages a Staff Advice and Liaison Scheme (SALS), which supports staff who have had to deal with particularly traumatic cases. This is a compliment to formal mental health support.

It is composed of a peer support network of 40 staff who have been trained in: tackling bullying & harassment, the grievance procedure, sickness policy, suicide, suicide ideation and stress. SALS Advisors have different professional roles and come from a range of backgrounds enabling them to relate to staff with different needs and experiences.

SALS has direct links into HR which enables timely intervention and they operate on a 365-day basis. It has been promoted widely and over a 12-month period over 10% of Trust staff will have contacted the support line.





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West Midlands Ambulance Service: Case Management Ensuring managers would speak to staff on their first day off to sign-post to support etc. is a key element of their restructured approach to dealing with sickness absence (rather than leaving people to go through the system and eventually be referred to OH).

HR triage all people absent each day with ops leads in each division and support line managers to take action, including provision of HW support.

How to deliver a workplace health needs assessment


Information gathering • Identify existing data on staff health and wellbeing needs of different staff groups

including those with protected characteristics under the 2010 Equality Act. Map any gaps and understand patterns of support uptake (or lack of) and underlying reasons

• Collect new data and information to fill gaps using surveys or focus groups and workshops

• Combine data to form a full picture of the health needs of staff and breakdowns by division and team

• Work with a data analyst to identify issues and trends


• Board

• Human Resources

• Occupational Health

• Analyst

• Communications Team

• Number responses to Health Needs Assessment

• Current objectives that meet needs identified in assessment

• Completed objectives that meet needs identified in assessment

• Awareness, uptake and quality of support (survey, NHS staff survey, and focus groups)

• Perceptions of staff about willingness to disclose any health and wellbeing issues and experiences of disclosure (survey)

Workplace Health Needs assessment tool, Public Health England

Take stock of mental health in your workplace, Mind

Management Standards tools and stress audit, Health and Safety Executive

‘Writing an effective questionnaire’ NHS England

Identifying and managing stress, Quality Standard 147, NICE

Culture of disclosure • Provide all line managers with training or information on supporting staff to

disclose health issues and have difficult conversations

• Work with occupational health and HR to implement a process for managing disclosure. Ensure there are suitable options for support

• Create a process in for collecting and analysing disclosure information

• Human Resources


• Line Managers

• Board

• Communications Team

Disclosure tools for managers, MIND

Managing staff experiencing mental ill health tools, ACAS

Use results to inform the health and wellbeing plan • Report findings from health needs assessment to the board

• Board agree an action plan for managing immediate risks

• Assessment used as basis of health and wellbeing planning process using Framework as a structure

• Board

• Estates

• Health and Safety


• Human resources

https://www.gov.uk/government/publications/workplace-health-needs-assessment

https://www.mind.org.uk/media/42862/Resource_2_Take_Stock_of_MH_in_your_workplace_final.pdf

http://www.hse.gov.uk/stress/standards/downloads.htm

https://www.england.nhs.uk/wp-content/uploads/2018/01/bitesize-guide-writing-an-effective-questionnaire.pdf

https://www.nice.org.uk/guidance/qs147/chapter/quality-statement-3-identifying-and-managing-stress

https://www.mind.org.uk/media/44253/Managing_and_supporting_MH_at_work.pdf

http://www.acas.org.uk/index.aspx?articleid=6064





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Engaging with staff


There is a communications and engagement plan, which is aligned to the organisation’s staff health and wellbeing objectives. The board and staff at all levels are included in ongoing communications and targeted campaigns

Communication and engagement plan

• A communications and engagement plan is developed in conjunction with the health and wellbeing plan. There is input from the internal communications team and key stakeholders

• There are universal communications to the whole workforce, which cover key messages. Targeted messages are directed at specific staff groups (see below)

• The plan ensures line managers have basic information to inform staff about the core health and wellbeing offer and how to access it

• Engagement objectives and activity ensures staff are able to feedback on their work, team and the organisation such as focus groups, surveys, presence on relevant committees and working groups. Staff should have opportunity to provide feedback and shape the health and wellbeing support they receive

Board and managers as champions

• All board members and senior managers should act as staff health and wellbeing champions. Each part of the communication plan has a named board member as communications champions. Both executive and non-executive board members should be involved

• The board and senior managers lead by example by sharing stories and case studies at events, inductions and team meetings. The board is seen as leading by example in terms of health and wellbeing practice and culture of working

Targeted engagement

• Target groups who have the highest barriers to accessing support are identified (e.g. using staff survey breakdowns) and approaches to tackling stigma are developed with these groups, for example staff with disabilities and long term conditions

• There is direct engagement with groups through methods such as surveys and focus groups. This helps understand the needs, lived experience and preferences of these target groups. This is used to inform the design and delivery of effective support

• A plan for ongoing engagement is included in the main plan to ensure its effectiveness and reach

• The NHS Constitution includes a pledge from the NHS to “engage staff in decisions that affect them and the services they provide, individually, through representative organisations and through local partnership working arrangements. All staff will be empowered to put forward ways to deliver better and safer services for patients and their families”

• Staff who are aware of health and wellbeing support are more likely to use it. This will help improve staff health and wellbeing outcomes. Actively engaging staff in the design and delivery of health and wellbeing support will also improve its quality and effectiveness






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Developing a communication and engagement plan Julia Smedley, Head of Occupational Health, Emma Abdulaal and Rachel Belli, Communications teamHealth and wellbeing communications were not always reaching staff. Information wasn’t always easy to find, and there was no visible identity. The trust developed a new single brand for staff health and wellbeing to increase visibility and to create more opportunities to engage staff on their views about the programme.

We worked jointly between the occupational health and communications team to deliver this project. We developed options for a brand identity that worked in line with the trust’s communications and branding guidelines. Early ideas were shared with health and wellbeing stakeholders for consultation. We developed a new logo for around £400. A new brand, strapline and logo (LiveWell and Inspire) was created and used to badge all strands of the staff health and wellbeing programme. We developed a plan to support the adoption of the new brand across all communications. This included web information, printed literature, drop in events, promotions, emails and presentations.

We are using the brand to engage with frontline staff who are often hard to reach. One of example of this was the LiveWell day-long event we held in September 2017. The event was held in the main reception of the hospital, which staff from all departments (as well as patients and visitors) regularly walk through.

The LiveWell brand has helped boost staff engagement with health and wellbeing by 10% between 2015 and 2016 in the staff survey. A main learning point is that engagement with staff works best when a distinctive brand is combined with two-way contact with staff about their health and wellbeing including opportunities for staff to offer their own ideas.





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Targeted engagement using staff health advocates Kylie Murrell, Staff Wellbeing LeadWe have 58 staff health advocates to promote staff health and wellbeing to different groups across the organisation. Advocates can be any grade and from all departments (e.g. there are representatives from clinical teams, estates, IT). They have an interest in health and wellbeing and wish to contribute to a positive culture in their work area.

Staff who make a successful application to be an advocate must attend a training session, where they learn how best engage others and promote behaviour change. Advocates attend quarterly meetings to discuss upcoming interventions, share feedback from staff and help create new campaigns. They wear ‘badges’, which raises their profile and brings cohesion to the programme. We strongly believe that advocates play a vital role in raising awareness of the staff wellbeing programme and in engaging colleagues in all parts of the organisation. Feedback from staff has been overwhelmingly positive.





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Staff engagementIn 2012 the trust recognised team and inter-team working and employee satisfaction as critical to provide high quality, efficient services. The organisation adopted four pillars of employee engagement to make this happen: strong strategic narrative, organisational integrity, engaging managers and employee voice.

Using staff survey results as a guide the CEO and board held listening events on an annual basis to understand what is important to staff. Learnings from these listening events shape ’InTent’, the trust’s annual engagement week. These events typically have 1-2,000 attendees, and previous topics have included team working and resilience. Following the merger of the Children’s and Women’s hospitals in Feb 2017, nearly 2,000 people participated in events to create a vision, goals and values for the new organisation. This is all built around the vision of ‘a world class team providing world class care’. The years 2013-2017 saw a steady increase in staff engagement scores. There is a demonstrable link with organisational performance as the trust received an Outstanding CQC rating in 2017.





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How to deliver ‘engaging with staff’


Communications and engagement plan • Work with internal communications to develop a plan to raise awareness and

increase the uptake of support

• Ensure plan includes universal (all staff) and targeted communications and engagement

• Tailored information is provided to line managers to improve knowledge on an ongoing basis

• Objectives and activity planned to ensure staff can have a voice in the organisation

• Board lead

• Internal communications


• Number of staff engagement activities

• Estimated reach of staff engagement activities

• General awareness of staff health and wellbeing activities programme (survey and NHS staff survey results)

• Level of awareness/ uptake of Health and Wellbeing programme among target/ ‘harder-to-reach’ groups (focus group, analysis of referral data)

• Board members have specific responsibilities for promoting staff health and wellbeing (yes/no)

Health and Wellbeing Communications Guide, NHS Employers

Staff Engagement resources, NHS Employers

Effective Communication with Staff, CIPD

Board and senior managers as champions • Work with board lead to secure board involvement as champions for specific parts

• Ensure board and senior team role model behaviour and share e.g. in blogs, speaking at events, taking part in exercise activity

• Board lead and wider board



Effective resourcing • Use data and consultation with managers to identify groups least likely to be

aware and take up support

• Use focus groups, surveys and outreach to these groups to understand barriers and support required

• Ensure ongoing engagement and build learning into future communications and delivery



• Operations Managers

• Line Managers

• Staff

http://www.nhsemployers.org/case-studies-and-resources/2016/12/health-and-wellbeing-communications-guide

http://www.nhsemployers.org/case-studies-and-resources/2016/12/health-and-wellbeing-communications-guide

http://www.nhsemployers.org/staffengagement

https://www.cipd.co.uk/knowledge/fundamentals/relations/communication/factsheet



HealthHealthy Lifestyles

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Implementation GuideData & Communication

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Physical Infrastructure Nutrtion & Sugar

Healthy Working Enviroment

1. Physical Infrastructure

2. Nutrition and Sugar

Enablers: Healthy working environment




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Physical infrastructure


Employers should ensure that staff work in conditions that enable them to stay safe and keep healthy. Employers must provide the facilities and empower staff to make use of them. All facilities and equipment should comply with health and safety regulations.

Infrastructure and facilities to promote active lifestyles

• Staff are encouraged to walk or cycle to work wherever possible and facilities and support are in place to enable this (e.g. cycle parking, showers and changing facilities)

• Staff are encouraged to take the stairs rather than use lifts with appropriate signage

Break, rest and food preparation facilities

• Staff should have access to break rooms away from patients where they can relax in an ‘off-duty’ environment

• Staff should have access to facilities to store and prepare food they have brought in from home, including fridges and microwaves

• Staff should have access to free clean drinking water on all sites and wards

Empower staff to use the available infrastructure to support their wellbeing

• Managers actively encourage staff to take their breaks in the middle of shifts

• There is a culture where staff feel able to regularly drink water in order to stay hydrated and to take bathroom breaks when needed

• Facilities managers should ensure that staff break rooms are preserved for staff rest time and not re-purposed (e.g. to store medical records or equipment)

• “ Provide employees with good working conditions and ensure they have a healthy work life balance and opportunities for development.”

(Recommendation 5, Thriving at Work: Stevenson/Farmer review of mental health and employers, 2017)

• People tend to perform better and be happier at their work if they are working in a safe and healthy environment. Working conditions that are safer will reduce the risk of accidents and improve patient safety

(Guideline 13, NICE. Regulations, Health and Safety Executive, 1992)





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West Midlands Ambulance Service (WMAS) NHS Foundation Trust

Providing a healthy environment for all staffWMAS serves 5.6 million people across an area of 5,000+ square miles. The Trust’s 5,200 staff are based at fifteen major hubs and over fifteen Patient Transport Service locations. Taking care of a large number of staff working over a wide area is challenging.

Most of the hubs have been upgraded, often with brand new purpose-built buildings that have suitable rest and changing areas. All hubs have kitchens with microwaves and fridges to allow staff to prepare food. The hubs all have rest areas with soft furnishings and televisions to allow staff to relax on breaks. Any member of staff can go into any hub or location to take their break. There is ongoing work to put a ‘Quiet Room’ in every hub. The trust ensures equipment is modern and fit-for-purpose e.g. all ambulances are under five years of age and each year the trust invests in new vehicles.

Keeping staff hydrated is important and all hubs have drinking water stations. In 2017 each operational staff member was issued with a water bottle to enable them to stay hydrated during their shift.

Vending machines are compliant with the NHS initiatives on food and drink e.g. CQUIN and sugar sweetened beverages. There is a CQUIN compliant staff run ‘tuck shop’, and the proceeds are used to fund free fruit for staff at the HQ. Wellbeing champions are looking to replicate this across the hubs.

Trust staff have high expectations that they will be taken care of and have a good working environment. This has been an essential part of a broader approach to improving absence levels. Data shows how the Trust has progressed from having absence rates of 5.13% in 2011/12 to 3.29% in 2016/17 (NHS Digital). This is 2.11 percentage points lower than the average for the ambulance sector (5.4%) and is the lowest of all ambulance services in the UK.




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How to create good physical infrastructure


Infrastructure and facilities to promote active lifestyles • Work with board/ senior managers to encourage visible leadership on this issue

• Work with estates team to complete an audit of existing cycle storage and changing facilities; and to identify gaps in provision

• Ensure that there is signage posted in and around all lifts setting out the benefits of walking and encouraging staff to take the stairs

• Estates team


• Board lead for health and wellbeing


• Compliance against CQUIN

• Compliance with HSE Welfare at Work standards (audit)

• Staff satisfaction with facilities (survey)

• Staff perceptions about self-care and wellbeing at work (survey including NHS staff survey 9a results)

Employer regulations guide, Health and Safety Executive

Welfare at Work NHS Healthy Working Lives

Practical tools for audit and planning changes to the working environment, Health and Safety Executive

Break, rest and food preparation facilities • Work with estates team to complete an audit of existing staff facilities (break

rooms, food storage and preparation, drinking water) to identify gaps in provision

• Identify the parties that will be involved in filling any gaps (e.g. PFI provider, sub-contractors)

• Make the case for investment in additional facilities to fix the gaps

• Estates team



• Operational managers

• Trade unions

Empower staff to use the available infrastructure to support their wellbeing• Work with board/ senior managers to encourage visible leadership on this issue

• Board / senior managers encourage line managers to promote these behaviours

• Incorporate into communications and branding campaigns


• Operational managers

• Trade unions

http://www.hse.gov.uk/pubns/indg293.pdf

https://www.healthyworkinglives.scot/workplace-guidance/managing-health-and-safety/Pages/welfare-at-work/welfare-at-work.aspx

http://www.hse.gov.uk/managing/delivering/index.htm




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Nutrtion & SugarPhysical Infrastructure

Nutrition and sugar


Staff should have access to healthy food and drink at work. Healthier food and drink options should be provided and promoted wherever food is sold on NHS premises. These options should be available to patients, visitors and staff; including those working night shifts.

Nutritional content of food and drink sold on premises

• All outlets that sell food and drink on site are compliant with the Health and Wellbeing CQUIN standards and latest PHE advice on nutrition, whether these are in-house outlets or operated by external providers. These include reducing the proportion of confectionary and sweets that exceed 250 kcal, reducing the proportion of pre-packed sandwiches and other meals exceeding 400 kcal or 5g saturated fat per 100g, and banning price promotions and advertising for foods that are high in fat, sugar or salt

• Work to reduce or eliminate the sale of Sugar Sweetened Beverages (SSBs) on site, ensuring compliance with the SSB voluntary scheme and service condition 19 in the standard contract

• Promote healthy options in cafes and restaurants, with signage and other media highlighting the benefits of healthy options

Build food standards into tender processes for external organisations

• When going out to tender for external suppliers build in evaluation criteria relating to the nutrition of food and drink that will be sold, and ensure these criteria are weighted sufficiently so that they are key factor in deciding on the successful supplier

• The criteria built into tender processes should reflect the latest Health and Wellbeing CQUIN indicator requirements as a minimum

Ensure all staff have access to nutritious food

• Ensure that staff across all sites have access to nutritious food options

• Staff working nightshifts have access to nutritious food options 24/7 (this may involve healthy vending machines or trolley services)

• Improving the nutritional quality of the food and drink sold in hospitals makes it easier for staff to make healthy choices, reduce their sugar intake and manage their weight. This will help make a positive overall change to staff healthand wellbeing

(Obesity prevention, Clinical Guidance 43, NICE)

• By improving its food offer, the NHS can set an example for other industries to follow, and empower staff to give patients credible information on diet and lifestyle choices

(Five Year Forward View, NHS England)





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Creating a healthy food environment Julia Smedley, Head of Occupational Health, Will Pentony, Contract Director, SercoWe wanted to provide more healthy food and drink options for staff working throughout the hospital, including availability of healthy food for staff working out of hours. Retailers were initially concerned that this would lead to a loss of profit on popular unhealthy products.

When the catering contract was renewed it included a requirement for compliance with the CQUIN for healthy food The trust worked closely with retailers to support the provision of healthy food for staff and compliance with CQUIN.

Retailers now provide healthier food and drink options. Meal deals offer water and fruit instead of sugary drinks and snacks. Retailers have signed up to a voluntary ban on sugar sweetened beverages. Vending machines were rebranded under ‘therudefoodvengingco’ name and include healthier food choices. Hot food is available 24/7 through the ‘Bon Appetit’ vending system. This includes healthy options such as ‘Weight Watchers’ ready meals.

Dieticians regularly audit retailers and they have verified compliance with the CQUIN for healthy food. The retailers report that there has been no significant drop in profit as a result of the changes to the food offer.




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How to improve nutrition and reduce sugar


Nutritional content of food and drink sold on premises • Review the Health and Wellbeing CQUIN guidance

• Identify all existing suppliers of food and drink, both managers of in-house outlets and external commercial suppliers

• Work with outlets to understand current compliance with standards and to develop plans to improve provision

• Develop promotional material to encourage staff to pick healthy options in cafes and restaurants

• Catering lead

• Estates

• Commercial teams

• 80% of confectionery and sweets not exceed 250kcal

• At least 75% of pre-packed sandwiches and other savoury pre-packed meals (wraps, salads, pasta salads) available contain 400kcal (1680 kJ) or less per serving and not exceed 5.0g saturated fat per 100g

• 90% of drinks lines stocked have less than 5g of added sugar per 100ml. In addition to the usual definition of SSBs it also includes energy drinks, fruit juices (with added sugar content of over 5g) and milk based drinks (with sugar content of over 10g per 100ml)

Indicator 1, Implementation Support, NHS staff health & wellbeing, CQUIN 2017-18, NHS England

Food Standards, 2017/18 NHS Standard Contract, NHS England

Principles for managing the sale of high fat high sugar foods, Government Buying Standards

Build food standards into tender processes for external organisations • Work with estates teams to identify when any existing contracts are due to expire

or if there are any plans to go out to tender for new contracts

• Work with the relevant commercial team to embed CQUIN standards for nutrition (or more stringent criteria) into the evaluation process

• Catering lead


• Number of tenders that include nutritional standards

Ensure all staff have access to nutritious food• Work with estates team to identify all sites where staff are located and to review

what food and drink provision is available to those staff

• Identify what is currently available for staff working the nightshift

• Catering lead


• Healthy options are available at any point including for those staff working night shifts

https://www.england.nhs.uk/publication/nhs-staff-health-wellbeing-commissioning-for-quality-and-innovation-cquin-2017-19-indicator-1-implementation-support/

https://www.england.nhs.uk/nhs-standard-contract/

https://www.gov.uk/government/publications/sustainable-procurement-the-gbs-for-food-and-catering-services

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Engaging with staff



Nutrition and Sugar



Board Leadership






Lifestyle change interventions




Health interventions



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HealthLeadership

& Management

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HealthLeadership

& Management

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HealthLeadership

& ManagementMental Health


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Prevention & Self-management Psychological Interventions

Healthy Lifestyles

Health interventions: Mental health

Mental Health

1. Prevention and self-management

2. Psychological interventions




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Mental health: prevention and self-management


Working practices and conditions that are identified as contributing to poor mental health are managed. Workplace support is available for staff to maintain good mental health and manage mental health conditions. Connections are made across mental and physical health.

Create a healthy and supportive working environment

• The organisation’s culture does not stigmatise people with mental ill health and actively encourages people to maintain good mental health and feel able to talk about it. Line managers have training and support to assist staff who disclose a mental health issue

• Working conditions are conducive to promoting good mental health. Policies and practices that encourage a good work life balance, taking regular breaks, challenging bullying and harassment and whistleblowing are in place and enforced

• Reflective practice is encouraged where time is made to reflect on experiences that occur in the job and to learn from them, for example using Schwartz Rounds, peer support or providing quiet space to ‘decompress’

• Risks to the mental health of staff are identified and managed, for example having an effective procedure in place to support staff following a traumatic incident. These are regularly reviewed e.g. annually

Upskilling staff and line managers • Staff and line managers have access to information about how to improve their own and others

mental health and wellbeing through self-management• Training for line managers covers how they can promote the mental health and wellbeing

and be aware of the signs and symptoms of poor mental health. Training or advice is available on making reasonable adjustments for mental health e.g. changes work hours, temporary redeployment

Access to interventions • Staff have access to interventions that help to improve mental health and wellbeing, and

support self-management. The workplace Health Needs Assessment should identify the issues which require preventative or self-management interventions

• Examples include peer support, Schwartz Rounds, stress management exercises, mindfulness, mental health first aid, physical activity, support groups (e.g. for carers), primary care referral, sleep advice and apps. Connections with local voluntary sector organisations should also be explored


• “ Mental health should be discussed openly with employees wherever possible and appropriate. This is not just about discussing mental health problems, but about creating an environment in which employees feel able to talk openly”

(Thriving at Work: Stevenson/Farmer review of mental health and employers, 2017)

• “ Investments and wellbeing programmes should improve both the local work culture and the wider organisation’s performance…acknowledge that health problems are an ordinary part of life and respond positively and helpfully when staff become unwell.”

(Understanding staff wellbeing, its impact on patient experience and healthcare quality, Picker Institute, 2015)




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West Midlands Ambulance Service (WMAS) NHS Foundation Trust

Staff Advice and Liaison ServiceStress, anxiety and depression is the leading cause of absence at WMAS accounting for 9,404 days or 17.8% of all absences in 2016. The peer led Staff Advice and Liaison Service (SALS) is a key part of the staff support offer that WMAS provides to address this issue. SALS aims to provide the timeliest possible interventions to prevent worsening stress for a busy and dispersed workforce. The service is run by a peer group of trained volunteer staff who provide advice, reassurance and signposting. It is a confidential service that operates on a 24/7 basis, and staff are especially encouraged to attend after experiencing particularly traumatic incidents. In 2016 there were over 600 referrals to SALS, which equates to over 10% of the workforce. Staff feedback showed that 83% respondents said the service was a positive experience.

This is part of a wider support offer that ensures staff are supported at all times. After a traumatic situation staff go through a ‘Critical Incident Debrief’. These are tailored to the needs of the individuals following an incident. They aim to address the trauma by defusing the situation, debriefing, and following up e.g. through SALS, managers, or HR. SALS is helping WMAS maintain its position as the best performing ambulance trust for sickness absence, which in 2016 stood at 3.41%.




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Resilience training“We were aware of the strong links between patient and staff experience and wanted to design an intervention that could improve mental health of staff and increase levels of engagement. Working with a specialist we decided on a model known as ACT (Acceptance and Commitment Therapy) to improve wellbeing and resilience. The Trust’s psychology and counselling team were trained as trainers to roll out this intervention.

Approximately 1,850 staff at all levels have received the training to date on a voluntary basis. A quantitative evaluation by City, University of London with a sample of nurses found that “the training elicited a significant, and clinically meaningful, improvement in nurses’ mental health over a three month assessment period. There was also a significant increase found in nurses’ ability to be less reactive, and to recover faster from, stressful events; and, an improvement in nurses’ ability to engage in actions that were consistent with their personal values.”




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Sheffield Teaching Hospitals Foundation Trust (STHFT)

Online mindfulness support Rhian Bishop Staff Engagement LeadSTHFT employs 16,750 staff across 5 hospital sites and many community sites. The chaplains had provided mindfulness sessions for staff but were facing increasing demand. We purchased headspace codes for all staff and targeted teams reporting illness due to work related stress in the staff survey.

Uptake was slow but accelerated when we changed the code distribution from HR to staff engagement team as we heard some staff did not want to admit stress problems. To reach all staff we used staff engagement leads, a poster campaign and an email to all staff during winter pressures which resulted in 500 code requests which was the same as the previous 6 months.

The number of staff reporting feeling ill due to work related stress in the staff survey has stabilised. In areas that were targeted we have seen some improvements e.g. A&E nursing although it has been used alongside other interventions through the Employee Psychological Support Service.

“I have found it very relaxing and it helps me with the anxiety and stress of day to day living. It has also helped me at work as I have been sleeping better so have not been feeling so fatigued during the day.“ Nurse - Geriatric and Stroke




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West London Mental Health Trust

Improving wellbeing of the IAPT workforce At the Back on Track Improving Access to Psychological Therapies (IAPT) service in Hammersmith and Fulham staff fed back that their wellbeing was being affected by working long hours and having to manage stressful clinical situations, particularly the management of risk. A number of frontline clinical staff formed a wellbeing team and surveyed their colleagues. This captured a number of ideas for changes to working arrangements.

Changes implemented include:• A weekly reflective practice group

• A review of risk management procedures. Procedures were clarified and risk management actions taken were regularly communicated to the team

• Thank you emails when team members had helped someone else

• Wellbeing information was shared to remind the team to look after themselves and how to access further support if needed

• Better workstations

• Team led mindfulness exercises

• Monthly team socials

These low cost changes helped to significantly improve staff wellbeing. From 2014 to 2016 the number of staff rating themselves as having good mental health rose from 57% to 84%. In the same period the number of staff who were comfortable in meeting the demands of their role rose from 58% to 86%.




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Birmingham Women’s and Children’s: Structures and support

HWB sits within the Workforce Directorate, as part of the Staff Experience who are co-located with HR to encourage joint working.

This allows an broad approach to supporting line managers that focusses on training, teamwork and leadership. Staff Experience are also responsible for inductions ensuring all new line managers are engaged from the beginning.




Create a healthy and supportive working environment• Information and support is available for people who disclose mental health issues and concerns

• Review and update policies for working hours, breaks, dealing with trauma and bullying and harassment. Develop a plan for addressing gaps and making improvements

• Carry out a mental health risk assessment at an organisational and department level. Risks are managed and regularly reviewed

• The board and senior team should be asked to ‘front’ the promotion of prevention and self-management through events, blogs, team meetings and accessing support

• Identify any ‘quick wins’ to implement such as taking part in the ‘Time to Change’ campaign or creating mental health champions


• Occupational health

• Specialist clinical input

• Board leads

• Health and Safety leads

• Level and type of mental health needs of staff

• Staff and manager awareness of mental health issues and provision (survey, focus groups)

• Levels of referral and self-referral to mental health support services

• Staff absence rates due to mental health

• Number of mental health cases referred to OH

• Uptake of mandatory staff training and mental health awareness activity

Stress risk assessment and reduction tools, Health and Safety Executive

Mental Health at work toolkit, Business in the Community (BITC)

Identifying and managing stress, Quality standard 147, Quality statement 3, NICE

Mental Health First Aid

Time to Change campaign resources, Mind

Guide to Wellness Action Plans, Mind

Mental Health in the workplace advice and training, ACAS

Standards, p5, ‘Thriving at Work: the Stevenson/Farmer review of mental health at work’

Upskilling staff and line managers• Review existing resources available to support line managers on mental health prevention and

self-management and any gaps

• Ensure managers are able to identify basic symptoms of stress and poor mental health

• Develop plans with board lead and HR, OH and learning and development to provide information and deliver training



• Learning and development

Access to interventions• Use Health Needs Assessment to identify what interventions should be offered

• Work with board lead, HR and OH to finalise plans aligned to strategic objectives. Secure resources for interventions

• Board and senior leaders to promote interventions




How to deliver mental health prevention and self-management

http://www.hse.gov.uk/stress/index.htm

https://wellbeing.bitc.org.uk/all-resources/toolkits/mental-health-employers

https://www.nice.org.uk/guidance/qs147/chapter/quality-statement-3-identifying-and-managing-stress

https://mhfaengland.org/

https://www.time-to-change.org.uk/resources

https://www.time-to-change.org.uk/resources

https://www.mind.org.uk/media/1593680/guide-to-waps.pdf

http://www.acas.org.uk/index.aspx?articleid=1900

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/658145/thriving-at-work-stevenson-farmer-review.pdf







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Mental health: Psychological interventions

What are the benefits? What does this look like?

Staff have access to clinically sound, confidential and timely psychological interventions

Psychological support is available to staff with mental health issues

• Ensure interventions in place can effectively respond to organisational and clinical needs• These should meet NICE guidelines and have clear eligibility criteria• A range of possible interventions can be used e.g. CBT, stress management, and counselling.

Delivery may be face-to-face on-site, through an external partner, or via a remote Employee Assistance Programme provider. Staff are supported to complement their treatment with suitable self-management tools and techniques, such as mindfulness or peer support

Develop a clear referral pathway and support uptake

• Provide or signpost staff in a timely manner to evidence based psychological interventions that are designed to meet staff needs

• Ensure managers and key staff in human resources and occupational health know how to identify, refer and provide support to staff who need access to psychological interventions

• Use a personalised case management approach to ensure this is complimented with other HR and line management support. This will help to speed up recovery and the return to work process for staff who are absent

• Health needs assessments and engagement with staff ensure interventions are designed to meet the needs of target groups

• Signpost staff with more severe mental health issues to their GP or local mental healthcare services

Provision is evaluated to ensure it meets individual and organisational needs

• Interventions are monitored and evaluated to measure their impact and quality, in line with the relevant professional and clinical standards

• Data is used in reporting to board and any sub-committees• Data is used to improve the quality, targeting and delivery of service

• “ Psychological interventions can improve mental health and help with the management of mental health issues. Interventions can play a role in helping staff to stay in work, return to work and improve general health and wellbeing, which can contribute to improvements in patient care and organisational productivity”

(The effectiveness of workplace counselling: A systematic review, Counselling and Psychotherapy Research, 2010).

• “ Ensure provision of tailored in-house mental health support and signposting to clinical help”

(Recommendation 10, Thriving at Work: Stevenson Farmer review of mental health at work, 2017)




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Staff Psychology and Counselling TeamNorthumbria Healthcare NHS Foundation Trust has a long-term commitment to staff health and wellbeing, and mental health in particular. It has a dedicated internal psychology team, and in 1999 was the first trust in the UK to have a staff clinical psychologist.

Staff can access a wide range of support services, including triaged and fast-track access to a range of one-to-one therapies. Triage supports people with mental health sickness absence to return to work. The interventions are effective at reducing clinically significant levels of distress. For example in one sample of staff absent due to mental health who accessed this service, 80% experienced a clinical and statistically significant reduction in their level of distress. One staff client said:

“Talking to someone not connected to work or home was beneficial. I started to feel more relaxed and ready to return to work...”

As well as offering psychological interventions to staff, the team works extensively on preventative measures across the trust. Interventions include resilience training, bespoke risk assessments to identify and manage stress ‘hotspots’, and joint working with the staff physiotherapy service to support with the mental health element of musculoskeletal problems. As a result of these efforts the Trust received the gold level of the regional Better Health at Work Award in September 2016.




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How to deliver psychological interventions


Psychological support is available to staff with mental health issues• Complete Health Needs Assessment to understand the mental health needs of

the workforce

• Access clinical expertise to decide on the modality (or modalities) of psychological intervention(s) needed and how it might be delivered

• Consider need, ability to access and resources available. Flexible models include Employee Assistance Programmes, local arrangements with IAPT services and STPs.

• Agree the desired impact, a feasible approach and timescale for delivery

• Engage the board and clinical leadership in to make the business and clinical case for interventions

• Health and wellbeing leads


• Clinical governance team

• Internal clinical expertise

• Staff and manager awareness of interventions (survey)

• Levels of referral and self-referral

• Number of self-referrals

• Time from initial call/ management referral to first assessment/ appointment

• Satisfaction with services (post-intervention survey)

• Staff absence rates

• Impact/ outcomes measures relevant to each intervention

Mental Health at work toolkit, Business in the Community (BITC)

Guidelines for Workplace Counselling, British Association for Counselling and Psychotherapy (BACP)

Standards, p5, ‘Thriving at Work: the Stevenson/Farmer review of mental health at work’

Guide to Wellness Action Plans, Mind

Local IAPT services

Develop a clear referral pathway and support uptake• Develop a clear and timely referral pathway and upskill managers to refer and

support staff through process

• Identify and target staff groups with the highest need

• Use board and senior leaders to promote this support and raise awareness

Provision is evaluated to ensure it meets individual and organisational needs• Review any the impact of current provision

• Implement and evaluation process to evaluate the impact and quality of current provision

https://wellbeing.bitc.org.uk/all-resources/toolkits/mental-health-employers

http://bacpworkplace.org.uk/_sitedata/1432298849 nolsemLr4/Guidelines.pdf


https://www.mind.org.uk/media/1593680/guide-to-waps.pdf

https://www.nhs.uk/Service-Search/Psychological-therapies-(IAPT)/LocationSearch/10008


Healthy Lifestyles

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Health

Prevention & Self-management Accessible Physiotherapy

Health interventions: Musculoskeletal (MSK) health

Musculoskeletal (MSK) Health

1. Prevention and self-management

2. Physiotherapy


Healthy Lifestyles

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Health


MSK health: Prevention and self-management


Workplace support is available for staff to maintain good musculoskeletal health and manage conditions in the workplace. A culture of self-care should be promoted as well as connections across mental and physical health. Working practices and conditions identified as contributing to poor musculoskeletal (MSK) health and injury are proactively managed.

Create a healthy and supportive working environment

• The organisation promotes and enforces a culture that doesn’t stigmatise people with injuries or MSK disorders. Staff are encouraged to disclose any MSK disorders and injuries. They receive support from line managers if they make a disclosure

• The working environment is safe. Risks to the MSK health of staff are identified and managed e.g. equipment is altered or instructions updated in a timely manner. Risks are regularly reviewed. Reasonable adjustments are made as needed

• Faulty or damaged equipment is repaired or replaced in a timely manner. New equipment is ergonomically assessed before use with training provided on how to use and maintain. For example, physiotherapist input may be included in the risk assessment for new equipment

Upskilling staff and line managers

• Staff and line managers have access to information about how to improve their own and others MSK health such as ‘train the trainer’ training on MSK resilience and creating MSK champions

• Core training for line managers includes how to promote good MSK health in their staff and how to signpost to preventative activity such as exercise, active travel and display screen equipment training

Access to self-management interventions• Staff have training that is tailored to meet the needs of their role and designed to

promote self-management and prevent injury. Review current training to ensure that it meets these requirements

• Interventions should be offered for prevention and self-management based on the Health Needs Assessment. Examples include exercise classes to maintain a healthy weight, massage and physiotherapists drop-ins. Connections with the local voluntary sector should also be explored

• “ Investing in prevention and self-management organisations can lower the likelihood of absence due to injury in or out of work. This will improve staff wellbeing and contribute to better patient care and improved productivity”

(Self-management of chronic musculoskeletal disorders and employment, The Work Foundation, 2014)

• “ MSK problems such as back, shoulder and knee pain are the leading cause of working days lost in the UK – it is estimated that 31 million days a year are lost due to these problems.”

(Musculoskeletal health in the workplace: a toolkit for employers, BITC, 2017)


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Musculoskeletal (MSK) staff trainingMandatory moving and handling training had had little to no impact on the trust’s MSK absence rate. Incident and absence data and qualitative feedback revealed that the significance of a MSK injury was underestimated by staff, and that people’s approach to protecting their MSK health was not rigorous enough. The trust tackled this by building a culture that promoted physical resilience. The first action was to redesign the mandatory online training package. The trust ran a co-design process bringing in subject experts alongside front line staff and managers to scope out their interpretation of the national mandatory training requirements and organisational needs.

The new content focuses on memorable areas and delivery is tailored to maximise its relevance to the different staff groups. The trust’s lead physiotherapist acts as the voice of the trainer. There is a simple evaluation tool at the end of the learning that assesses user’s memory of the content. Early feedback on the appearance of the new training package is positive. The trust found that it was helpful incorporate best practice from outside of health sector, give enough time to the co-design process and support internal subject matter experts to understand the learning needs and styles of all staff.


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Epsom and St Helier University Hospitals NHS Trust

Musculoskeletal (MSK) Self-management Zahra Alexander, Head of Occupational HealthAfter reviewing absence and staff survey data we decided to focus interventions on prevention and self-management to see if they would make a difference. We introduced a fast track programme for staff off sick with MSK health issues offering them an appointment with physiotherapy as soon as they phoned in sick. We also developed a DVD showing strengthening and resistance exercises for staff involved in moving and handling duties in the clinical environment. We have also introduced desk based exercises. We saw a decrease in time off work for back related causes of MSK absence; and non-back related causes of MSK sickness have now steadied. Our fast track physiotherapy programme is popular and appreciated by managers who can signpost staff to it. The physiotherapist and Head of OH meet monthly to discuss the data and then use that to shape the interventions and how /where they are delivered.


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How to deliver MSK prevention and self-management


Create a healthy and supportive working environment• Activity to improve disclosure includes detail on MSK health

• Review policies on reasonable adjustments

• Involve OH and health and safety lead to ensure the delivery plan includes preventative actions

• Do an annual risk assessment to identify risks to MSK health

• Identify any ‘quick wins’ to implement such as sharing case studies and ergonomic assessments


• Health and safety lead


• Specialist clinical input

• Board leads

• Level and type of MSK needs of staff

• Referral and self-referral to MSK services

• Staff absence rates due to MSK

• Uptake of training

• Staff and manager awareness of interventions (survey)

• Time from initial call/ referral to appointment

• Satisfaction with services (postintervention survey)



Musculoskeletal health in the workplace toolkit, Business in the Community (BITC) and Arthritis and Musculoskeletal Alliance (ARMA)


Workplace Health: management practices, Guideline 13, NICE

‘Ergonomics and human factors at work’ guide, Health and Safety Executive

Musculoskeletal Health Questionnaire (MSK HQ), Arthritis Research UK

Exercise advice leaflets, Chartered Society of Physiotherapy

Upskilling staff and line managers• Identify existing resources and any gaps in provision

• Work with board lead HR, OH and learning and development to develop plans for providing information and training

• Board and senior team should be asked to ‘front’ the promotion of prevention and self-management through events, blogs and meetings





Access to self-management interventions• Review training and assess whether it supports positive behaviours for all

staff groups

• Use Health Needs Assessment information to identify what interventions should be offered

• Work with board lead and stakeholders to finalise plans for interventions and agree resourcing

• Board and senior leaders promote interventions and maintaining a healthy weight





https://wellbeing.bitc.org.uk/all-resources/toolkits/musculoskeletal-health-toolkit-employers



http://www.hse.gov.uk/pubns/indg90.pdf

http://www.arthritisresearchuk.org/policy-and-public-affairs/resources-for-policy-makers/for-healthcare-practitioners-and-commissione rs/msk-hq.aspx

http://www.csp.org.uk/publications/exercise-advice-leaflets


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Health

Accessible PhysiotherapyPrevention & Self-management

MSK health: Physiotherapy


Where necessary staff have access to clinically sound and timely physiotherapy.

Physiotherapy is available to staff with musculoskeletal disorders and injury

• Ensure physiotherapy is offered in a timely manner effectively responding to organisational and clinical needs of the individual

• The service should meet NICE guideline, the relevant clinical standards and have clear eligibility criteria

Develop a clear referral pathway and support uptake

• Provide or signpost staff to physiotherapy. Staff should also be able to self-refer to the service

• Ensure managers and key staff in human resources and occupational health know how to identify, refer and provide support to staff who need access to physiotherapy

• Use a personalised case management approach to ensure this is complimented with other HR and line management support. This will help to speed up recovery and the return to work process for staff who are absent

• Needs assessments and engagement with staff ensure physiotherapy is designed to meet the needs of target groups

• Signpost staff with more severe musculoskeletal injuries or conditions to their GP or other local healthcare organisations

Provision is evaluated to ensure it meets individual and organisational needs

• Interventions are monitored and evaluated to measure their impact and quality, in line with the relevant professional and clinical standards

• Data is used in reporting to board and any sub-committees

• Data is used to improve the quality, targeting and delivery of service

• “ Physiotherapy is a clinically proven way of improving outcomes and supporting recovery and management of injuries and musculoskeletal disorders. It can play a role in helping staff to stay in work, return to work and improve general health and wellbeing which can contribute to improvements in patient care and organisational productivity”

(Workplace policy and management practices to improve the health and wellbeing of employees, Chartered Society of Physiotherapists, 2013)


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Staff Musculoskeletal (MSK) ServiceBetween April 2014 and March 2015 13,044 working days were lost to MSK sickness, calculated at a cost of £443,741 to the trust. The trust established an onsite staff physiotherapy service in March 2016. In the first year 239 patients were seen, with an average of 2.8 appointments per patient. A range of services are offered (see diagram).

There is a strong focus on encouraging prevention and self-management. Before receiving treatment all patients have an interview that establishes the problem, gives the physio an idea of the person’s work and home environment and agrees a plan for management. In some cases this advice is sufficient. Following the introduction of the service there has been a decrease in the mean absence related to MSK conditions from 0.85% of staff (2014-15) to 0.67% of staff (2016-17).

Key success factors:

• Providing a triage service reduces face to face contacts, reduces DNAs and speeds up the recovery process as advice and exercises can be given to patients

• Working closely with HR and OH services allows for physiotherapy to link up with the broader staff support offer and supports the return to work process for absent staff

• Physiotherapy should be seen as part of a wider pathway as it is not possible to prevent or treat all MSK issues. Often giving self management exercises or referring to the GP are more appropriate strategies and 18% patients

BCH Physiotherapy

service

Assessment & Advice

Liaison with Occupational

Health

Assessment & onward referral

to GP with recommendations

Assessment Treatment & Advice

Risk Assessment & Training

Assessment Exercise Advice

Assessment for work / RTW

Work hardening


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How to deliver physiotherapy


Physiotherapy is available to staff with musculoskeletal (MSK) disorders and injury• Complete Health Needs Assessment to understand what physiotherapy

intervention(s) is needed and how it might be best delivered

• Access clinical expertise to support this process and the design of the service. Flexible models include ‘in reach’ sessions in wards and accessing physiotherapists through local arrangements and STPs

• Agree the desired impact, a feasible approach and timescale for delivery

• Engage the board and clinical leadership in making the business and clinical case for physiotherapy


• Health and safety lead and manual handling trainer(s)


• Clinical governance team

• Internal clinical expertise

• Staff absence by reason


• Uptake of physio services

• Staff and manager awareness of interventions (survey, staff survey)

• Time from initial referral/self-referral to first assessment/ appointment

• Satisfaction with services (post-intervention survey)



Musculoskeletal health in the workplace toolkit Business in the Community (BITC) and Arthritis and Musculoskeletal Alliance (ARMA)


Workplace Health: management practices, Guideline 13, NICE

Musculoskeletal Health Questionnaire (MSK HQ), Arthritis Research UK

Chartered Society of Physiotherapy Physiotherapy Works resources

Providing physical activity interventions for people with musculoskeletal conditions, Arthritis Research UK

Develop a clear referral pathway and support uptake• Develop a clear referral pathway which is timely and focused on recovery and

return to work

• Upskill managers to refer and support staff through process

• Identify and target staff groups with the highest need

• Encourage self-referral options

• Board and senior leaders to raise awareness of support

Provision is evaluated to ensure it meets individual and organisational needs• Review the impact of current provision

• Use data to identify equipment or processes causing recurrent incidents and injury

• Implement and evaluation process to understand the impact and quality of provision

https://wellbeing.bitc.org.uk/all-resources/toolkits/musculoskeletal-health-toolkit-employers



http://www.arthritisresearchuk.org/policy-and-public-affairs/resources-for-policy-makers/for-healthcare-practitioners-and-commissioners/msk-hq.aspx



http://www.arthritisresearchuk.org/policy-and-public-affairs/policy-reports/physical-activity-report.aspx


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Health

Promotion & Self-management Targeted Interventions

Healthy Lifestyles

Health interventions: Healthy lifestyles

Healthy Lifestyles

1. Promotion and self-management

2. Targeted interventions


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Healthy Lifestyles

Healthy lifestyles: Promotion & self-management


A positive workplace and rewarding work can support good health and mental wellbeing with knock on effects for families, communities and patient care. Workplace support should be available for staff to maintain good health and manage conditions in the workplace. This may cover health and non-health related issues such as: smoking, mental health, sleep, alcohol/drug misuse, debt, physical activity and obesity.

Creating a healthy and supportive working environment

• The physical working environment encourages staff to make healthier choices, such as encouraging healthy food and drink choices (e.g. meals and snacking) and physical activity such as taking the stairs or attending provided classes

• The workplace culture supports people to take good care of themselves and self-manage any stress or health conditions. The board and management ead by example. The culture rewards positive health activity such as leaving at the end of shifts, rather than doing extra hours

• Risks are identified with staff and actively monitored and managed. Staff are supported to disclose health and non health issues as part of this process

Upskilling staff and line managers

• Staff and line managers have access to information about wellbeing and leading healthy lifestyles (and their wider benefits to MSK and mental health)

• Line managers are trained to encourage staff to make healthier choices. They should provide core guidance and signpost to support for issues that may affect their health and wellbeing at work, such as caring responsibilities and debt related stress

Access to interventions

• Staff have access to interventions that help them to make healthier lifestyle choices. A needs assessment will identify what interventions should be offered and what the wider benefits may be on MSK and mental health

• Example interventions include physical activity sessions (e.g. pilates), in-house challenges (e.g. step counting), peer-support and smoking cessation programmes. Sign-posting could be made to citizens advice bureau, debt relief support and primary care. Discounts/vouchers for specific activities can help where it isn’t possible to provide a service internally

• “ I am continually reminded of the impact of social and environmental factors on health and that when good health can best be restored by the provision of healthcare, the delivery of that healthcare needs to be sensitive to the patient’s circumstances in the home, at work and in society.”

(Working for a Healthier Tomorrow, Carol Black, 2008)

• “ Several studies indicate that combining change to the work environment with healthy lifestyle interventions in employees increases the probability of them adopting health-promoting behaviour…Focusing interventions around these dimensions and targeting less privileged groups within the workforce is a high priority.”

(Fair Society, Healthy Lives (The Marmot Review), Marmot, 2010)


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Healthy Lifestyles



Supporting Healthy LifestylesThe trust wanted to deliver healthy lifestyle information and exercise opportunities in a way that was widely accessible and which sustained long term behaviour change.

A physical activity co-ordinator was appointed. This role gave the trust the capacity to deliver a range of activities such as new and refreshed wellbeing intranet pages, on-site activity classes and one to one exercise advice, agreeing discounts with local gyms and activity centres and walks during lunch times. They worked closely with occupational health, dieticians, physiotherapists, psychologists, and communications experts.

Activities and programmes were regularly reviewed and refreshed as needed. For example, weight management programmes were viewed by many staff as time consuming so the trust launched one–to-one ‘Drop in, Weigh in’ sessions. These are run in occupational health by the physical activity coordinator and a dietician who share ideas and personalised goals for healthy eating and exercise.

A key learning was to avoid focussing physical activity offers on on-site exercise classes alone, but to offer a range of activities both on and off-site and to keep reinvigorating ideas so they remain fresh.


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Healthy Lifestyles



Health and Wellbeing OfferThe Trust wanted to provide the best possible HWB service for our staff by offering a range of interventions to support them in their everyday life.

A key success has been to make sure staff are aware of what is on offer and the benefits of support. The trust provides all staff with a health and wellbeing Handbook, which covers information on service provision and proactive advice about self-managing your own health. It covers areas such as smoking cessation, alcohol misuse, weight management, exercise tool kits and maintaining a healthy heart.

Alongside this there is an ongoing NHS Health Check scheme which is offered by the Trust, whereby staff can have a free health check. This is offered at a range of locations and it is aimed at helping staff to highlight any potential health and lifestyle issues and prevent diabetes, heart disease, kidney disease, stroke and dementia.


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Health


Healthy Lifestyles


Rotherham Clinical Commissioning Group

Support through bereavement: My storyI returned to work in late April after 3 months of sickness absence following the death of my husband, just 11 weeks after being diagnosed with cancer. In addition to being bereft, the circumstances and trauma leading up to his death had destroyed my self confidence and I was struggling to cope.

I initially joined the Pilates class offered after work as I was looking for something that would help to settle my mind and provide me with something to do. Frankly, I was aware that I was working longer hours to avoid going home to an empty house. I enjoyed spending more time with my colleagues and the posture and stretching techniques of Pilates taught me to stand up tall and improved my confidence. This initial step was a great boost and made me realise that I could help myself to feel better through exercise and taking more care of my physical health.

I had been part of a hiking group at work for a couple of years, but I increased my participation and really looked forward to our weekend walks. Through this I was invited to take part in a trip to climb Scafell Pike in May 2017 and this gave me a clear goal to work for. I took up the opportunity to join a gym through the [workplace] scheme and training three times a week throughout winter gave me a much needed routine.

The combination of the distraction and sense of well-being it has provided, along with the amazing support I’ve received from my friends and colleagues here at the CCG has carried me at times. I’ve lost over 3 stone in weight, and for the first time in my life I appreciate that my mental health requires as much maintenance as my physical health, and that the two are inter-linked. I haven’t had a days sickness absence since my initial return to work in April 2016.


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Health


Healthy Lifestyles




How to deliver ‘healthy lifestyles promotion & self-management’


Creating a healthy and supportive working environment• Health and wellbeing plan includes objectives and actions based on a Health Needs

Assessment

• One to ones and performance reviews include conversations on health and wellbeing and opportunity to disclose challenges

• Board encourage reflective working and time is made for handovers, team learning and post-incident support. The purpose of this these activities are clearly communicated

• Board lead• Health and

wellbeing lead• Health and safety

and estates• Occupational health• Human resources• Line managers• Public health

• Level and type of general health lifestyle needs of staff as captured in health needs assessment

• Levels of referral and self-referral to any support services

• Staff and manager awareness of lifestyle related issues interventions (survey)

• Staff and manager awareness of lifestyle related interventions (survey)

Creating Healthy NHS Workplaces toolkit, NHS Employers

Alcohol and drugs guidance, NHS Employers

Healthy Weight and the Workplace, Workplace Wellbeing Charter Topic Guide

Local Public Health teams

Workplace Toolkits and Resources, BITC

Local and national voluntary sector

One You Campaign resources, Public Health England

Health Matters: public health issues resources, Public Health England

Upskilling staff and line managers• Line managers receive targeted information and advice on how to share positive

health messages with staff e.g. in day to day and formal line management meetings

• Health promotion campaigns are regularly run in line with national and local campaigns

• Human resources

• Line managers


Access to interventions• Use Health Needs Assessment information to identify what lifestyle interventions

should be offered

• Work with board lead, HR, OH and learning and development to finalise delivery plans aligned to strategic objectives. Secure resources for interventions

• Board and senior leaders promote interventions

• Outreach and partnerships are developed with wider community support to support staff, for example citizens advice bureau, local banks for debt advice and local gyms and sports groups

• Board lead• Health and

wellbeing lead• Health and safety

and estates• Occupational health• Human resources• Line managers• Public health• Local authority

http://www.nhsemployers.org/-/media/Employers/Documents/Retain-and-improve/Health-and-wellbeing/Creating-healthy-workplaces-toolkit.pdf

http://www.nhsemployers.org/~/media/Employers/Publications/Alcohol and drugs.pdf

http://www.wellbeingcharter.org.uk/media/Weight Management Topic Guide.pdf

https://wellbeing.bitc.org.uk/all-resources


https://www.gov.uk/government/collections/health-matters-public-health-issues


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Health


Healthy Lifestyles

Targeted interventions


Where necessary staff have access to clinically sound and timely workplace support and/or signposting to relevant external support and advice. This could include weight loss programmes and smoking cessation support in the workplace. The board and senior management lead by example as role models.

Healthy lifestyle targeted interventions are available• Complete a Health Needs Assessment to understand what type of support may be needed

and by which staff groups, divisions or teams. Data should also be reviewed from a range of sources such as sickness and absence, demographics and feedback from staff on issues such as caring responsibilities and long term conditions such as diabetes and coronary heart disease

• Based on this assessment, interventions are in place or signposted to for the most common lifestyle health issues in the workforce. Interventions could include health checks, weight loss programmes, sleep advice, financial advice and addiction support. Delivery may be face-to-face on-site, through an external partner, or via an Employee Assistance Programme

• Staff are supported to complement their support with self-management tools and techniques such as apps, healthy cooking advice and peer support

Develop support pathways and encourage uptake• Managers and staff in HR and OH know how to identify, refer and provide support, both in the

organisation and the local community• Use a personalised case management approach to ensure this is complimented with HR and line

management support. This will help to speed up recovery and the return to work process for staff who are absent

• Interventions are designed to meet the needs of target groups without stigmatising them, for example shift workers, porters, older staff

• Signpost staff with higher needs to their GP or more intensive services as required

Provision is evaluated to ensure it meets individual and organisational needs• Interventions are monitored and evaluated to measure their impact and quality, in line with the

relevant professional and clinical standards• Data is used in reporting to board and any sub-committees to improve the quality, targeting and

delivery of interventions

• “ 95% of staff reported making changes to their health or lifestyle, 98% agreed that the staff health and wellbeing programme would be a valuable workplace benefit…for every pound spent on the programme, the NHS as an employer saved £3”

(Workplace Wellness, Yorkshire and Humber AHSN, 2016)


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Health


Healthy Lifestyles


Epsom and St Helier University Hospitals NHS Trust

Debt advice and support Zahra Alexander, Head of Occupational HealthThe trust wanted to know what health and wellbeing issues were concerning their staff. Findings from NHS health checks and a staff survey revealed that financial concerns were having a large impact on our staff and many staff had concerns around debt management. Many staff did not have an opportunity to discuss financial matters in a confidential setting.

Through their corporate social responsibility programme a local bank offered to attended events across our sites to offer general talks on financial and debt management. Representatives also offered confidential one to one conversations on finance. One challenge has been to make the sessions accessible to staff who have been embarrassed to ask for time away from work to attend. The sessions have proven popular with staff, and there have been requests for more sessions which we are hoping to continue to provide as this is a big area of concern for our staff.


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Health


Healthy Lifestyles



Weight managementOne of the main health and wellbeing areas that we have worked to address is obesity which is linked to many other conditions including high blood pressure, MSK and diabetes. Our support has been delivered through a partnership with Slimming World (SW), in which staff were encouraged to lose weight through access to SW vouchers, as well as useful recipe books and newsletters. Staff can attend SW groups at times that suit their needs. There is a strong emphasis on peer support and sharing experiences and tips. SW provide data every month for us to review and interact with our health and wellbeing events.

After an initial trial of 50 vouchers, we have given out over 520 vouchers and lost 4655lbs as an organisation. One of our members of staff has lost five stone, and many staff have continued to invest themselves in following the SW healthy eating ethos.

One additional benefit is that the families of staff have also lost weight, as they cook the same food for all the household. As the West Midlands has a high obesity rate for young people this gives a wider positive impact.


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Health


Healthy Lifestyles




How to deliver targeted interventions


Healthy lifestyle targeted interventions are available• Include wide range of questions in Health Needs Assessment to ensure a holistic understanding of staff

health, experiences and lives

• Review existing data and examine trends, for example demographics, pay grades and common types of health and nonhealth related absence

• Access clinical expertise to support this process and decisions on how to deliver support e.g. dietician or a public health consultant

• Consider need, ability to access and resources available. Flexible models include ‘in reach’ sessions in wards and offices and accessing support from local PHE teams and voluntary sector

• Ensure interventions are targeted but not stigmatising for example not overtly targeting weight loss programmes at specific groups

• Engage the board and clinical leadership in to make the business and clinical case for interventions


• Board lead


• Human resources

• Clinical leads

• Analyst

• Staff absence by reason (captured on ESR or other system)

• Levels of referral and self-referral to OH

• Staff and manager awareness of interventions

• Number of referrals that result in support

• Time from initial call/ management referral to first assessment appointment

• Satisfaction with services (survey)



Behaviour change: Individual Approaches, Public Health Guidance 49, NICE

Weight management initiative case study, Cambridge University Hospitals Trust/NHS Employers

Adult weight management: commission and provide services, Public Health England

Workplace Health Needs Assessment tool, Public Health England

EAST Four Simple Ways to Apply Behavioural Insights guide, Behavioural Insights Team

Local Public Health teams

Workplace Toolkits and Resources, BITC

Local and national voluntary sector

Develop support pathways and encourage uptake• Develop a clear referral pathway and upskill managers to refer and support staff through process

• Identify and target staff groups with the highest need and work with them to enable awareness and uptake. Make use of Behavioural Insights Team EAST framework

• Board and senior leaders to be role models and to promote this support and raise awareness

Provision is evaluated to ensure it meets individual and organisational needs• Review the impact of current provision

• Implement an evaluation process to evaluate the impact and quality of current provision

https://www.nice.org.uk/guidance/PH49

https://www.nice.org.uk/guidance/PH49

http://www.nhsemployers.org/case-studies-and-resources/2016/01/weight-management-initiative-case-study-from-cambridge-university-hospitals-nhs-foundation-trust

https://www.gov.uk/government/publications/adult-weight-management-services-commission-and-provide

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/674851/Workplace_Health_Needs_Assessment_2018.pdf

http://www.behaviouralinsights.co.uk/publications/east-four-simple-ways-to-apply-behavioural-insights/






Making a plan Business CaseEvaluation

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This pack contains three sets of guidance:

Evaluation Guidance Making the Business Case

Advice and tools for those responsible for implementing health and wellbeing programmes. The guidance draws on best practice and quality

improvement techniques (e.g. Plan, Do, Study, Act cycles), and is focused on promoting sustainable,

evidence-based change.

Making a Plan

Overview of the three sections

Step-by-step guidance on how to evaluate health and wellbeing programmes. This includes advice

on how to identify appropriate indicators (success measures), what questions to explore when evaluating programmes, and what factors to

consider when selecting methods to collect data.

This section includes information and advice on the factors necessary to consider when drafting a business case, the types of data that are useful

to include, and the sources of funding that can be used to deliver health and wellbeing

programmes.






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Steps to planning

Implementation approach:

Step 1: Plan

Step 2: Do

Step 3: Study

Step 4: Act

Making a plan






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Implementation approach: Plan, Do, Study, Act

Act

Study Do

Plan

The Plan, Do, Study, Act Cycle is a recognised framework that has been designed as follows:

Plan the changes to be tested or implemented

Carry out the changes

Plan how to improve or scale up what you are doing

Collect data to measure the impact of the changes and what was learned

It is important to be clear on three things when deciding how to improve health and wellbeing in an organisation:

• What changes do you want to achieve?

• How will you measure improvement?

• What ideas and interventions will you deliver to get there?






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Step 1: Plan

What issues do we need to address?

What does success look like for our Board?

Does this align with what staff would like

to see achieved?

1 2 3

Health and wellbeing leadExperience from existing programmes highlights how important this role is. Key skills for this role include the ability to lead on large scale delivery programmes, influencing and engagement skills with senior leaders and staff, knowledge of piloting, scaling and decommissioning approaches.

This role is suited best to a senior manager, who has the experience to influence and provide oversight. They need the right support to do so through strategic support from a nominated board member, and organisational and logistical support. Knowledge of occupational health and wellbeing can also be highly beneficial.

• Review whether existing provision meets current/ future health and wellbeing needs

• Use the Diagnostic Tool and a Health Needs Assessment to do this

• Clarify what the Board and senior leaders would like to achieve (their vision)

• Secure commitment from Board of resources for programme

• Test out a vision and objectives with staff

• Finalise vision and objectives, with the Board and ensure alignment with existing organisational strategies

Setting a vision and objectives

The first step to planning a health and wellbeing programme is to identify what you want to achieve:






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Step 1: Plan

Developing a delivery plan

Most of the early planning should be spent looking at the evidence, and consulting with staff and senior leaders, with the aim of understanding three main questions:

What resources are available to deliver the vision and objectives?

How can these resources be best used?

What will happen as a result of our work?

1 2 3

• Which staff can lead/ deliver the programme?

• Can we afford to bring in an external provider?

• What has worked before?

• What do we want to test?

• How many staff will access the services?

• What impact will there be on their health and wellbeing, performance, engagement etc?

The responses to these questions will inform your delivery plan, but they are not easy to answer. They take time to be answered, and need to be explored systematically to make sure that all relevant views are considered.

Use the Framework Enabler and Health Intervention sections to think through question 2 – what you need to focus your resources on.

A helpful tool that can be used to answer these questions is a logic model. These are diagrams that summarise what the aims of a programme are and how they will be achieved.

“ Don’t underestimate the amount of time you need at the beginning to just sit and listen, and to have the time or bring people in”.

Deputy Director of Public Health, Royal Free Hospital, Health as a Social Movement






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Step 1: Plan

Using a logic model to develop your delivery plan

Here is a simple logic model for a typical health and wellbeing programme:

Inputs

• Delivery staff

• Cost of external provider

• Released time for staff to access interventions

• Rooms to deliver interventions

• Administrative time and cost

Inputs are capital and in-kind resources (e.g. staff time)

Activities

Interventions:

• Mental health

• MSK

• Healthy lifestyles

Enablers, e.g.

• Board level engagement

• Training

• Data collection

Outputs

• Delivery models agreed

• Services for staff embedded in sickness/ line management processes

• Managers referring staff (referral rates)

• Staff accessing services (uptake numbers)

Impact

• Reduced sickness absence.

• Improved staff recruitment and retention

• Decreased spend on addressing staff shortages

• Improved treatment continuity/ patient journey

Activities include specific health interventions and enablers

Outputs are short-term deliverables (6-12 months)

Impacts are mid/long term deliverables (12 months+). They align with strategic objectives.

Logic models are useful to develop because they cause you to think about what resources you need, how you expect the interventions to lead to outcomes, how you will measure success, and what assumptions you are making.

The Evaluation Guidance also provides an example of a logic model for an individual intervention (a staff counselling service) – logic models are useful to develop at both the programme and intervention level.






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Step 1: Plan

Making a delivery plan

A delivery plan needs to set out clearly the practical steps that will be taken to achieve the vision and objectives. Below is an example of what a small section of a plan could look like with some of the key components in place.

Objective (Impact) Activity/Tasks Milestones Time

scaleIndicators to measure success Lead Support

Reduce MSK sickness absence by x% within 2 years

Measure and report on MSK absence • Quarterly reductions by X Quarterly reductions by X Board lead HW lead

OH Ops Managers

Ensure board & clinical MSK champion are in place

• Champions recruited

• Work plan agreed

Speak at 5 staff events

Staff awareness improved by X%

Board lead HW lead

Review and redesign manual handling training

• Redesign completed

• Rolled out

100% of manual handling training with new content

Learning and Dev team

HW Lead

Introduce case management for all MSK cases on day 1 of absence

• New system piloted

• New system in place

Successful pilot and learning

100% staff on MSK absence called and supported on day 1

HR and OH HW Lead

Ops Managers

Increase referrals to physio by 20% • Business case for extra physio capacity

• Run info campaign

New capacity in place

20% increase in referrals

HR and OH HW Lead

Ops Managers

Specific and measurable objective signed off by board

Activity to reach objective – this should be agreed using a logic model

Key deliverables on the journey to reach the objective

You have reached your objective if you can measure & achieve these

Lead: responsible for objective Support: needed to achieve

objective






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Step 2: Do

Six top tips to use when delivering your programme

1Be clear on target groups and desired impact. Only deliver new interventions when you are clear on who they are targeting and what the desired impact is. This includes considering how hard-to-reach groups will be impacted

Don’t overlook organisational context. Organisational issues, such as organisational stability, adequate staffing levels and sickness absence rates, can have a significant influence on health and wellbeing. Make sure that these wider issues are addressed in your programme – the Framework document provides useful advice on what to focus on

Start small and scale in phases. Start delivering to a small number of staff and increase as you refine what you are doing. This is especially true for new approaches

Don’t be afraid of failure. Some new ideas will take off, others won’t. Don’t be afraid of testing new ideas, but only scale them up when you are confident they will deliver the results you want to achieve

Ensure appropriate governance and oversight processes are in place.Using workforce committees (or similar) to review delivery, set ongoing priorities, manage expectations and ensure cross department involvement is important

Plan for sustainability. Encourage and support staff and teams across the organisation to take on leadership roles from the outset (e.g. through involvement in steering groups, as leads, or as champions). This is important, as it can take time to see the impact of health and wellbeing programmes, and momentum needs to be maintained during this time

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3

4

5

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Step 3: Study

Reviewing delivery

A health and wellbeing programme needs to be reviewed regularly to ensure continuous improvement and alignment with organisational priorities:

• Monthly by leads to manage ongoing delivery and performance

• Quarterly by the Board to maintain commitment and improvement

• Annually to formally review delivery and impact

The views of all key stakeholders should be considered during reviews, including the expected beneficiaries (i.e. staff). It is also important to pay attention to both what is working (successes) and what is not working (failures). The Evaluation Guidance provides advice on what questions to use when structuring reviews, and the best methods to collect feedback and information.

Are we on track and

what changes are needed?

Revised Delivery Plan

All staff

Leads from HR, OH and operations

Committees/ programme board

Board

What happened and did it

work?






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Step 3: Study

Reporting to key stakeholders

Key stakeholders need to be kept up to date with developments in the programme and the outcome of reviews. Here are some things to keep in mind when reporting back:

Tailor reporting How often do different stakeholders need to be updated and what do they need to know? Generally, Boards need quarterly updates, service leads monthly updates, and delivery managers weekly updates. Be creative in how you report information

How often do different stakeholders need to be updated and what do they need to know? Generally, Boards need quarterly updates, service leads monthly updates, and delivery managers weekly updates.

Build reporting into business-as-usualHow can reports be shared to encourage joined-up working? How can the findings of reviews be aligned with wider reporting?

Look at the full pictureWhat has not gone as well as it should have? What qualitative feedback have we had (aside from hard data)

Use a common set of measuresWhat common success measures can we identify, which resonate at Board level, but also with wider staff?






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Step 4: Act

Ways to improve your programme Learning from Dr Julia Smedley, Head of Occupational Health, University Hospital Southampton

Steps you can take to improve your programme:

• Revise service specifications for health and wellbeing support, to ensure it is meeting the needs of your staff. Do you need to deliver new services, stop delivering some services, or refine what you are already doing?

• Update your health and wellbeing delivery plan, to ensure it still reflects your key objectives and the way you intend to deliver them. Revisiting your logic model can be useful here.

• Review your data and feedback, to be clear on what it is telling you (or not telling you) and whether you are collecting what you need to keep track of delivery and impact.

• Revisit your communications and engagement plan, to make sure it is generating enough momentum. Are you ‘telling the story’ that you want to, reaching the key audiences, and using the right communication channels? Spend time with staff and review staff survey results in detail to understand groups and individuals who may be underrepresented and in most need of support.

We keep our health and wellbeing plan effective by:

• Involving staff at all levels in shaping the programme

• Keeping focused on staff and patient outcomes

• Aligning staff health and wellbeing clearly with wider organisational objectives and values

• Regularly refreshing and updating it as priorities change

• Setting challenging, but realistic targets

• Demonstrating progress






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Step 4: Act

Scaling ImpactAre you scaling up the reach of an intervention or aiming to deepen its impact amongst a specific group? These require different approaches.

Replication through other delivery teams Can an intervention be replicated across other teams or sites? What parts are replicable and what parts are intangible? What methods can be used to replicate e.g. training, toolkits?

Breadth

Depth

Scaling in numbers of people Is the intervention suitable for wider roll out? Even if it can reach large numbers how do you know they want it and can access it?

Creating demand How can we use champions and ‘word of mouth’ to generate demand? What story do we need to tell – e.g. what are the benefits and incentives?

Ways to scale up activity

Once you have demonstrated that an approach or intervention works with a specific group or cohort of people you may need to consider how to scale this up to reach a much larger group of people. Here are four ways to approach scaling up your health and wellbeing interventions:






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Considerations for a successful evaluation

Why evaluate and what should be covered?

Where do I start with an evaluation?

What tools can I use to design an evaluation?

What should I consider when designing my evaluation?

Useful tools for evaluation

Evaluating health and wellbeing programmes






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Why evaluate and what should be covered?

Evaluation is the process of analysing a programme or interventions to make sure they are being delivered well and achieving the results required.

Why evaluate?

Here are three main reasons for doing evaluation:

• Discover what works and doesn’t work – including identifying negative consequences for staff

• Maximise the resources and time you have, as you know what you need to focus on

• Determine impact, which is useful when building momentum and the business case

What should an evaluation cover?

An evaluation of a health and wellbeing programme needs to answer two key questions:

• How effectively have we taken action on health and wellbeing?

• What difference has our programme made, how and for whom?

Inputs

1

Whether resources are being used appropriately - e.g. staff,

funding

Activities

2

The delivery of interventions – what is working and not working

Outcomes

3

The impact of interventions on staff, the organisation and

patients

To answer these questions, your evaluation needs to look at three main areas:






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Where do I start with an evaluation?

Evaluation needs to be integral to health and wellbeing improvement in your organisation. This means that :

• You design your programme with evaluation in mind

• You collect data from the very start, and on an ongoing basis

• And you use this data to continuously improve what you are doing

You might not have prior experience of evaluation, but taking time to decide how you will evaluate your programme will be worthwhile and does not have to be complicated. Generally, a well-planned evaluation is one that is:

Tailored to an your organisation’s needs Honest Inclusive

1 2 3

What matters to us and hence what do we need to measure?

What can we learn from what has worked, as well as what has

not worked?

What difference has this made to different staff groups, including harder to reach

groups?






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What tools can I use to design an evaluation?

One of the most useful tools for deciding how to evaluate programmes is a logic model. This is a diagram that summarises your expected change model – in other words, what changes you will deliver to achieve your desired objectives.

An example logic model for a Health and Wellbeing programme is provided in the Making a Plan, although logic models can also be useful to develop for individual interventions. The following worked example has been developed for a staff counselling service.

Example logic model for a staff counselling service

Inputs

• Cost of counsellors and admin staff

• Senior engagement and championing

• Staff involvement in setting up the service

• Releasing staff to access counselling service

• Confidential room to deliver service

Activities

• Provision of counselling sessions: 1:1 or group therapy sessions

• Training of counsellor(s)

• Policies and Standard Operating Procedures (SOP) written

• Booking system developed

• Awareness raising of service

Outputs

• Essential polices and SOPs produced

• Referral system set up and in use (referral numbers)

• Promotional material distributed/links to intranet site

• Counselling service set up and running (uptake numbers)

Impact

• Improved employee mental health and well being (reduced ‘burn out’)

• Improved patient care

• Improved organisational management of employee mental health and wellbeing and reduced organisational costs

Outcomes

• High staff satisfaction with service

• Improved staff recruitment & retention

• Decreased spend on addressing staffing shortages

• Reduced resources spent on sickness management

• Reduced sick leave and/or absenteeism due to poor mental health






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What should I consider when designing my evaluation?

Collecting and analysing data can be time-consuming and complicated. Keep things as simple as you can:

• Design your evaluation around your logic model – your evaluation needs to cover all three components of a logic model: inputs, activities, outcomes. Using a logic model to design your evaluation also helps you to identify what data you need to measure across these three components

• Look at the existing evidence base - what do you know about existing health and wellbeing needs, and how will what you are proposing improve these? Work through these questions early on. The Diagnostic Tool can help with deciding where to focus

• Use a select set of measures/indicators – the Framework document provides a useful list of measures you can use. Identify the most relevant ones (e.g. 10-15) and track them from the start so that you can compare progress and impact against your starting point. Good measures are up-to-date (e.g. collected routinely), longitudinal (to be able to track change over time), and accurate

• Track short- and long-term impact. It can take time to deliver impact, so have short- and long-term measures in mind and manage expectations on time to achieve desired change

• Ask a consistent set of questions, so that you can compare across different interventions. Good questions include: how aware are staff of the interventions?; how satisfied are they with the support received?; what impact has the support had on their health and wellbeing?; how likely are they to recommend the intervention to others (a good way of measuring sustainability)?

• Gather feedback from different stakeholders, in order that you can see the full picture. This includes collecting feedback from hard-to-reach groups and non-beneficiaries






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Evaluation Frameworks

An evaluation framework is a summary of what you will measure in your evaluation and how you will do so. It is a useful tool to use when designing evaluations, as it makes you think carefully about what you realistically need to collect and how feasible it is to do so. Once agreed these measures can then be included in your delivery plan.

Here is a condensed version of an evaluation framework, which has been developed for a staff counselling service:

Component Measure of success Source/ method Timing Responsibility

Inputs

Budget spent Finance accounts Quarterly Finance team

No. of staff involved in set up of the service / no. of attendees at engagement events

Project records / event attendee lists At each event Delivery team

Time taken by staff to access services Counselling service records Each contact Practitioner

Outputs

No. of counsellors employed HR records Annually HR

No. of people accessing the service Counselling service records Every session Counsellor(s)

No. of staff at engagement events Staff register Every event Communications team

Outcomes

No. of referrals (self-referral or management referral) Booking system Each contact Practitioner

Staff satisfaction with the service Staff survey / interviews/ Before and after implementation

Delivery team

Improved staff health & wellbeing Outcome measures

On initial contact with services & again after intervention and/or 6 months later

HR






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Key Evaluation Questions

The following questions are useful to cover in evaluations. They have been set out to align with the three areas highlighted previously: inputs, activities, outcomes.

Area of focus Review questions

Objectives and rationale • Are our objectives clear and relevant? Does our rationale still make sense?

Inputs • Are the resources we are using sufficient? Are we making the best use of resources?

Activities

• How aware and engaged are staff and senior leaders? Who is most/ least engaged?

• What are the main challenges and barriers to delivery? How do we best address them?

• What are the main enablers to delivery, and how can we build on them?

• Is there anything we need to do differently?

Outcomes

• What impact has the programme had on staff and the organisation? Can we attribute impact to specific interventions?

• Have we had the uptake we expected? If not, why and what needs to be done?

• Are any particular groups benefitting or missing out? What can we do to address this?

• Does the programme provide a good return on investment?

• Has the programme had any adverse consequences? How can these be reduced or managed?

• How can we scale up what is working, or replicate it in other sites or organisations?






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Surveys, interviews and focus groups to gather feedback from staff

Monitoring and finance data can only tell you so much. Getting feedback from staff on their perceptions of the programme/ interventions, and what difference it has made, is vital. All bring different benefits and disadvantages:

Benefits Disadvantages

Surveys Relatively quick to administer and complete, especially if online; useful to gain feedback from large groups

Potential for low response rates (due to survey fatigue); feedback is high-level

Interviews Useful for collecting in-depth feedback Time-consuming to deliver; not always appropriate to undertake (e.g. confidentiality issues)

Focus groups Also useful for collecting in-depth feedback; group setting can encourage unique insights

Group setting can discourage open and honest feedback; may dominated by individuals

Tips for using surveys, interviews and focus groups:• Triangulate methods – use a range of surveys, interviews and focus groups, keeping in mind their benefits and disadvantages

• Encourage honest discussions – people need to be able to speak confidentially and openly. Using ‘peer researchers’ (e.g. staff training in running focus groups) can be useful to encourage this

• Measure change over time – use before/after surveys to measure change

• Use ‘closed’ and ‘open’ questions – e.g. “on a scale of 1-5, how satisfied…?” (closed) vs “overall, how satisfied are you…?” (open) to ensure your data is sufficiently detailed, but also manageable. Closed questions generally work better for surveys

• Think about sample sizes - generally, surveys need at least 50-60 responses to be useful, and data must always be obtained from all key stakeholder groups.






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Making the business case

Considerations when seeking investment

Key components to make the case for staff health and wellbeing

Understand the costs and ways to release funding

Case Study: Making the case for staff physiotherapy pilot service in Northumbria Healthcare

Make good use of data in your Business Cases

Investment in Health and Wellbeing programmes makes commercial sense






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Key components to make the case for staff health and wellbeing

1. Engage the Board and senior leaders, when setting the vision and objectives A business case that will help them to achieve their organisational aims is more likely to be successful

2. Be clear how you will achieve the objectives Developing a logic model (see Making a plan) will help you set out what you will deliver to have your intended impact

3. Confirm how you will evaluate delivery Set indicators against your objectives, such as the number of beneficiaries or the impact on absence rates. It can take time to see impact, so be committed to a medium-long term approach

4. Understand costs and resource needs For each objective, break down what can be delivered within existing resources and what new resources will be required

5. Build the business plan This should include the vision and objectives, interventions (including a logic model), impacts and costs

What are the benefits?

How will the proposed intervention reach short

and mid-long term outcomes?

What is the

evidence?Can you demonstrate how a proposed intervention(s)

is comparable to other examples with an existing business

case?

What are the costs?

Proposed capital (e.g. equipment), revenue

(e.g. salary) and in kind (e.g. Board time)

costs?

Clinical and Social case:• Improved patient care and safety

• Improved quality of life and wellbeing for staff

• Wider community public health impact

Performance and Financial case:• Financial return on investment

• Productivity

• Reduced unplanned absence

• Retention






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Understand the costs and ways to release funding

Health and wellbeing programmes are rarely funded from a single source. In fact, many NHS organisations view health and wellbeing as embedded in the occupational health and human resources services they provide. You may need to pursue several different funding paths to ensure the total programme is covered.

It is also important to demonstrate how much can be achieved within existing resources (e.g. enhancement of existing services or multi-disciplinary working). For each intervention or activity, include how it will be funded and resourced.

This refers to one off funding to buy equipment or resources such as bicycle storage

facilities or exercise equipment.

This refers to releasing or redeploying organisational capacity to support delivery

This refers to ongoing programme funding for repeated/ongoing costs (e.g. salaries)

Capital Funding

Revenue Funding

In-Kind/Redeployment

Total Resourcing

required

Each intervention or activity

Potential sources:

• Trust Charitable Funds and donations

• Core recurrent budgets e.g. OH, HR

Potential sources:

• Trust Charitable Funds

• Core budgets e.g. OH, HR

• Research programme/Trials

• Revenue generation e.g. OH commercial activity

Potential sources:

• Core budgets e.g. OH, HR

• Changing roles of existing staff

• Free support e.g. public health

• Review procurement, supply chains






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Case Study: Making the case for staff physiotherapy pilot service in Northumbria Healthcare

• Reduction in long-term MSK absences

• Potential reduction in short-term MSK absence

• Reduction in absences for treatment off-site

Staff feel ‘cared for’ by the Trust

Savings from reduced sickness absence

Positive attitude towards Trust

Staff with MSK issues treated sooner and on-site

Staff aware of physio service

• MSK identified as key cause of long-term sickness absence within the Trust.

• Occupational Health Physiotherapist already in post, but increased capacity required to enable self-referral and fast-track appointments.

Starting point Success factors

Personal relationships: Health and wellbeing important focus for senior staff across Trust, meaning they support each other to build and make the case.

Resource & capacity: Staff physio service already in place – Trust able to allocate some resource to staff physio to test this new approach.

Evidence: Existing evidence base for the return-on-investment from physiotherapy services that Trust could draw on.

Focus on sickness absence: Sickness absence is so costly that a small-scale pilot project to reduce this is considered to be “low risk”.

Outcome

Process

ImpactsShort-term impacts Longer-term impacts

Actions taken

1. Identified gap in early intervention and self-referral.

2. Occupational Health Physiotherapist compiled business case with support from OH and programme lead, requesting pilot funding.

3. Business case contained:

• Evidence for effectiveness of self-referral and fast-track (appointment within 3 working days)

• Demonstrated return on investment based on small-scale pilot

• Potential outcomes for staff and Trust

The case also focussed on sickness absence reduction.






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Make good use of data in your Business Cases

The data collected through the evaluation of a health and wellbeing programme provides an important base for securing future investment. Collect data on delivery and impact to help build a compelling case.

Below are some useful measures to use in a business case. The Framework Enablers and Health Intervention sections in this document provides other measures that can be used.

Organisational enablers put in place• Uptake of line management training

• Uptake of OH, HR and HW support among staff

• Awareness of programme/ interventions among staff

• Number of health needs assessments conducted

• Uptake of HWB facilities (e.g. bike parking) among staff

Health interventions delivered• Number of health interventions delivered (e.g.

counselling sessions, physiotherapy appointments)

• Uptake of health interventions


Financial• Sickness absence levels (including unplanned)

• Spend on Agency and Bank

• Retention levels

Non-Financial• Staff engagement scores

• Safe staffing levels

• Improvements in health and wellbeing

Some of these measures will be easier to collect than others. When designing your evaluation, make sure that you have data already to hand or can collect it easily, and that you only measure what matters.

Output measures

What the programme will do

Impact measures

What benefits for the organisation

Business cases should include both Output and Impact measures, both Financial and non-Financial.






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Investment in Health and Wellbeing programmes makes commercial sense

“Return on investment (ROI) signifies how successful financially a particular

venture has been” and “is problematic when examining the payback of wellbeing

programmes” (Juniper, 2016).

Cost-effectiveness is not the only driving force for improving health and wellbeing

within organisations. Other reasons include legal compliance and business ethics

or moral reasons (Burton, 2010; Miller, 2009). Therefore, the business case for

employee wellbeing should contain at least legal, financial, and moral justifications

for taking action.

Furthermore, while some employers will look at health and wellbeing through

an ROI lens, increasingly we are seeing greater employee engagement as a key

objective for many health and wellbeing programmes.

Most quoted evidence is based on the ‘Building the case for wellness’ report

published by PWC review in 2008. This states that Workplace Wellness programmes

‘make commercial sense’, with returns varying from 2.5 upwards driven by reduced

absence, turnover and reduced injury

Given that most NHS organisations have both high absence rates and high costs

associated with covering absence (Agency and Bank spend) the potential for

Health and Wellbeing claims to make a positive net contribution to the budget is

significant.

Any business case for a workplace wellbeing programme should be targeted at the organisation’s current priorities.

“Our research has also found that the ROI of workplace mental health interventions is overwhelmingly positive, with an average ROI of 4:1…There are opportunities for employers to achieve better ROI by providing interventions at organisational culture and proactive stages enabling employees to thrive, rather than intervening at the very late stages.”

‘Mental Health at Work: the case for investment’ (Deloitte)

Part of the ‘Thriving at Work: the Stevenson-Farmer review into Mental Health in the workplace’, 2017

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