High absence rates prompted a trust to make a new appointment so staff could vent their worries and resolve their conflicts. Charlotte Allen reports on its success

Two years ago, managers in one area of Leeds Community and Mental Health Services trust expressed an interest in taking a more active approach to staff well-being.

The idea was prompted by unacceptably high absence rates that showed no signs of improving.

The trust, which employs 4,000 people, agreed to pilot an internal support service for its staff and created the role of staff support co-ordinator.

The project aimed to offer appropriate support to 400 members of staff and explore the issues that led to sickness and absence. I was appointed full-time co-ordinator, having previously worked as a community nurse, and in the community and mental health directorates.

Much thought was given to establishing a service that both managers and staff felt comfortable with, and to marketing the initiative. The pilot set out to offer emotional and practical support from someone inside the organisation who understood the culture. This allowed me to offer confidential one-to-one support for work-related or personal issues - which was separate from any contact the individual might have with a manager, personnel officer or union representative - and to act as an advocate or bridge between an individual and their manager when the individual considered some form of mediation to be helpful.

Developing a coherent confidentiality policy was one of the most challenging aspects of the project.

For staff to feel comfortable about referring themselves to the co-ordinator, the boundaries of confidentiality and any exclusions to that confidentiality needed to be made explicit.

Managers agreed that individuals who sought support would not be identified, and where managers knew of such people, they would not seek information about the nature of that contact.

The project was publicised by meeting managers, team leaders and staff and by circulating leaflets.

The face-to-face contact allowed me to introduce myself, raise awareness in relation to the issues around staff support, clarify the scope and nature of the pilot project, and to encourage staff to seek support. It also allowed staff to begin to get a feel for the project and to express any concerns.

More than 100 members of staff have sought support, encompassing information and advice;

emotional 'offloading'; someone independent to talk to; and someone to negotiate or advocate, especially with a line manager for mediation in a situation of conflict.

When staff ask for support, I offer to meet them in a place of their choice that is private and comfortable. Meetings may take place at work, in a different health centre or office, in someone's home or even at a place not associated with work or home, such as a cafe, so long as a private conversation is possible. I encourage people to have the meeting during work time because that gives a positive message about staff being valued.

Many staff initiate contact at a time of crisis either at home or at work. The duration of contact has varied, but fears of an unmanageable caseload have proved unfounded. The first contact typically lasts up to two hours, is often emotionally intense and allows the individual to 'tell their story'.

In spite of the complexity of many people's concerns, most people choose to have no more than two sessions with the co-ordinator, sometimes opting to stay in touch by telephone.

Reasons for contact vary from the simple and specific, such as a person wanting to know what is held on their personnel records, or wanting to explore how they might approach a line manager to discuss a change in working hours, to the distressing and complex.

Many staff seek the space to express their dissatisfaction with a current situation, often particular relationships either at work or at home, and to look for ways forward. It is no criticism of a line manager, even a highly supportive one, that they may not be the person an individual wants to think out loud with, especially if that individual fears that their current, temporary feelings may affect their future prospects for promotion.

In a health service where staff do not always feel valued, the importance of listening and believing a person's story is crucial, and this represents a turning point for many people.

Results Sickness absence rates fell from 6. 1 per cent to 2. 6 per cent over two years, although it is not realistic to assume a causal link between the pilot project and the reduction at such an early stage in the scheme's life.

Uptake of service: So far 105 people, representing 17 per cent of the area's workforce and some staff from outside the area, have sought support. Ten teams have requested help with mediation or with team-building.

Issues raised by staff: 49 per cent were workrelated; 22 per cent were primarily personal; 9 per cent were primarily health-related; 20 per cent were a combination of the above.

Uptake of the service was distributed across all grades and all occupational groups, in both the community and mental health directorates, with a surprisingly high number of relatively senior staff - team leaders and ward managers - seeking support on their own behalf. This may be an indication of the isolation felt and the lack of support available for people carrying heavy responsibilities.

Administrative and clerical staff were also disproportionately over-represented, and perhaps this is unsurprising in view of their place within the organisational culture. Their challenging and often unpredictable frontline role as the first point of contact with the general public in busy health centres can be easily overlooked, especially if they are performing well, and their lack of freedom to move away from a desk is markedly different from the day-to-day mobility of the average community practitioner or manager.

To evaluate the benefits of the scheme, staff who sought support were asked to complete anonymised questionnaires. Responses have been positive, with staff remarking on the benefits of being able to speak openly with someone about work, help in focusing, and a general sense of being valued. Some said that had the service not been available they would have gone off sick or left the job altogether.

The importance of the relationship between coordinator and managers cannot be over emphasised.

A high level of mutual trust and an awareness of the nature of the support available have a real impact on the quality of the support that can be offered, especially where there exists a need for advocacy or liaison between an individual and their manager.

Without these, the service risks being little more than a dustbin for disenchanted staff. The service, though useful, would be without the opportunity to make a strategic difference to workplace health or to future organisational practice.

Thus, it is not only its links with the organisation that differentiates the service from a counselling service, but also the boundaries it has power to draw around time and space, and its potential for liaison with other colleagues or managers in order to make immediate changes in the workplace. Perhaps the most unexpected outcome of the pilot project has been its shift from one-toone support, to the embedding of this work in organisation development and in policies and practice related to workplace health. It is a shift that now places equal value on both the individual support service and its place in the bigger picture.

It is the link with organisational development which marks out the future direction of the service.

Over the course of the pilot stage, a number of themes have emerged, relating to performance management and the need for staff to feel listened to and valued. It is important that the organisation resists the temptation to 'pathologise' the individual who is raising concerns about the way they are managed or supported at work, and acknowledges where it is failing its staff. Such recognition is a mark of the strength, rather than the weakness, of an organisation.

Future developments include rolling out the pilot service across the entire trust, something many respondents called for in their feedback. A trustwide commitment to the support service will play a major part in the policies and procedures currently being strengthened and developed to meet the Improving Working Lives standard and in making the trust's vision of workplace health a positive and sustainable reality.