Healthy concerns

Reducing the amount of time its staff take off due to sickness is one of the biggest workforce challenges facing the NHS. The NHS health and wellbeing review (see below), published at the end of last year, made clear the vast scale of the problem, finding that 10.3m working days are lost through staff sickness every year. This equates to an average of around 10.7 days a year for each employee, compared with a public sector average of 9.7 days and a private sector average of 6.4 days. The annual cost of this absence to the health service is £1.7bn. The review, led by occupational health expert Dr Steve Boorman, surveyed 11,500 NHS staff, and was broadly welcomed in consultations with nearly 1,000 staff after the interim report was published last August. Following the publication of the review's final report, this roundtable event – held in association with Benenden Healtchare Society – gathered together occupational health experts, union representatives, senior NHS and independent healthcare managers and policymakers, to discuss the findings of the review and how its recommendations should be enacted. The event was conducted under the Chatham House rule to encourage frank discussion, so this report highlights the issues debated without attribution. Recommendations The final report made 20 recommendations to improve the health and wellbeing of NHS staff. There was general backing for the first and third recommendations that make a link between NHS organisations working to improve the health and wellbeing of their staff and wider public health goals to tackle issues such as obesity, smoking and alcohol misuse. "If the NHS is to deliver a public health prevention agenda it needs to lead by example," one participant commented. Furthermore, as the NHS is one of the largest employers in every area of Britain, it should be an exemplar in terms of encouraging and enabling staff to adopt healthier lifestyles. However, participants warned that staff should not feel stigmatised, and the message put across shouldn't be "if you are overweight, smoke or drink then don't come to work for the NHS". It was suggested subtle changes could be made to improve levels of physical activity, such as ensuring all staff events offer the chance to participate in exercise. The review was praised for not singling out lifestyle factors but also raising the importance of occupational health in reducing staff sickness. All participants backed the review's ninth recommendation that staff should have consistent access to early and effective interventions for musculoskeletal and mental health conditions – the main causes of ill-health in the NHS workforce. Several panellists criticised the current state of occupational health across the NHS as highly variable. There was general agreement of the need for more access to physiotherapy and talking therapies for mental ill-health, such as cognitive behavioural therapy. Participants believed that trusts which invested in counselling or physiotherapy got a good return on the investment. "A small amount of investment in occupational health services pays off," said one panellist. "It means many staff don't have to take time off work and those who are off come back earlier." The question as to whether frontline NHS staff should take priority over patients on waiting lists emerged as a thorny issue. "In the outside world it's perceived as queue-jumping", said one participant. While acknowledging this was a risk, the panel agreed that it made little sense to have a lot of NHS staff on waiting lists. The participants agreed it made sense for staff to be given priority, as preventing their ill health or aiding their return to work would have the knock-on effect of reducing patient waiting times. "It benefits the organisation, the staff and the patient," contended one panellist. Another way to reduce waiting times for unwell staff would be allowing them to self-refer for treatment, another participant pointed out. Several panellists raised concern as to whether human resources would engage with the review's agenda. One claimed HR had a rather narrow view of its role with regard to staff health and wellbeing. For example, not enough was being done to improve flexible working opportunities that could improve staff work-life balance and reduce the number of nurses who leave the NHS to become agency workers. Some panellists called for HR departments to become more strategic and share best practice. The panel welcomed the review's recognition that the problem was not merely absenteeism but also with many staff coming into work when unwell. The review's finding that the highest rates of sick leave were found among those who worked the longest hours illustrated the high level of stress and pressure faced by frontline NHS workers. Several participants said the challenge of changing the strong culture of "carry on until you drop" should not be underestimated. This made it essential to involve unions and other staff representative bodies in tackling staff concerns about workloads and fears about letting patients down if they took sick leave. The panel concurred with the review that good management was critical to reducing sickness rates, backing recommendations six and seven that respectively call for training in health and wellbeing to be made an integral part of management training and that they have the skills and tools to support staff with mental health problems. Responsibility for the health and wellbeing agenda must "go down the line" so everyone from board level to the most junior staff is engaged. Barts and the London NHS trust was put forward as an exemplar. Research had found that department at the trust with the least sickness and lowest turnover of staff was casualty – arguably the most stressful hospital department to work in – because it was very well managed, said one participant. Good management, including regular appraisals, did reduce absence rates, as staff felt more valued and respected, said another. Savings mean better patient care On the question of how to engage management with staff health and wellbeing, the Boorman review won praise from the panel for making the business case for reform, highlighting the massive savings to be made in terms of working days and money that could be channelled into improving patient care. The panel heard that the Department of Health has calculated that a £100,000 investment in occupational health by an NHS trust could lead to savings of £2m. However, another panellist questioned how robust the evidence was and called for further evaluations to build a more persuasive business case. Another suggested funding should be earmarked for such research. The panel also agreed that commissioning must be another major driver to change, particularly given that no extra central government funding would be made available to implement the review's recommendations, something not explicitly recommended in the final report. "Commissioners should be ensuring providers have an engaged workforce that can provide quality care," said one participant. One participant suggested that a simple way to ensure NHS trusts followed the recommendations was to ask each of them what measures they were taking to achieve their share of the £555m possible saving identified by the Boorman review. The panel heard that (in line with recommendation 16 of the review) measures to ensure NHS bodies, such as commissioning organisations and partner agencies, took on the Boorman agenda needed to be robust. This was particularly important, as the NHS was set to see a decline in the record levels of investment it has enjoyed in the past decade. One participant summed up the consensus view: "The NHS is going to be facing significant challenges in the coming years, with financial resources dropping, so you really need an engaged workforce. If you have a well-engaged, healthy carer, the quality of care you are delivering as an organisation will be better. It is not just business as usual for the NHS. This has to become the usual business." The Boorman review The Guardian roundtable event followed the publication last November of the final report of the NHS health and wellbeing review. Led by occupational health expert Dr Steve Boorman, the review found that more than 45,000 NHS workers call in sick each day - one-and-a-half times the rate of absence seen in the private sector. To reduce this figure, the final report made recommendations to improve staff health and wellbeing. It emphasised the business case for investing in occupational health services, highlighting how those NHS trusts that prioritised the health and wellbeing of their staff provided higher-quality care, had higher levels of patient satisfaction, lower staff turnover and lower rates of staff sick leave. The report said if the best practice became standard throughout the health service, current rates of sick leave would fall by one-third, saving £555m a year. nhshealthandwellbeing.org/index.html This Guardian roundtable was in association with Benenden Healthcare