NHS chief executives should be 'held to account' for improving staff health

As expected, the forum’s worksteam on the “public’s health” has called for clinicians to broach health and wellbeing issues with patients at every opportunity, to “make every contact count”.

But the review group warned the NHS must first “put its own house in order”.

Their report recommended trusts should design and implement strategies for improving the physical and mental health of staff, a move previously recommended by the Boorman review of NHS health and wellbeing in November 2009.

The future forum highlighted that this and the other suggestions made by Boorman were yet to be fully implemented by many NHS organisations.  It said that in future chief executives should be expected to report to the board annually on progress made on improving staff health and wellbeing.

The report also noted that the quality of occupational health services for NHS staff was currently “variable” and said it should be accredited.

It added that managers should be trained to support the health and wellbeing of their staff, and made to “account for doing so in their performance appraisals” – though it admitted success was also dependent on the attitudes of staff themselves. 

The report stated: “We have heard that progress will only be made if NHS leaders are accountable for helping to improve the health and wellbeing of their staff. 

“However, we were also told that the impact of NHS leaders can have is dependent on the input and commitment of their staff, and we would encourage the workforce to acknowledge their own responsibility.”

Workstream co-chair Ash Soni, pharmacist and clinical network lead for NHS Lambeth, told HSJ chief executives must demonstrate “what is being done and how it will help”. 

“The evidence is that actually improving the health and wellbeing of the workforce actually reduces costs by helping staff to be better valued and more productive. Therefore the challenge is more about how to hold organisations to account for not implementing,” he said. 

NHS Confederation deputy policy director Jo Webber told HSJ: “We know there is a really powerful case for focusing on NHS staff wellbeing. It makes for a better and more productive workforce and higher morale in difficult times. Boards are in the best place to make sure that organisations tackle these issues.”

Other recommendations made by the group included changing the NHS Constitution to “emphasise” workers’ responsibility to use every contact with patients to improve their health and wellbeing, “whatever their specialty or the purpose of the contact”.

It said managers needed to identify whether staff needed training in this area and proposed that universal training in public health could be provided in the same way as is currently done for child safeguarding.

In addition, the group said NHS commissioners should use “contracts and incentives” to encourage providers to improve health and wellbeing, and reduce health inequalities. For example, it said clinical commissioning groups should explore the use of “local tariff flexibilities” to promote healthy living and called for changes to the GP contract’s quality and outcomes framework to reward successful public health intervention.

Workstream member Charles Alessi, Kingston GP and chair of the National Association of Primary Care, thought such incentives were best delivered at CCG level. He said: “The CCG is after all the sum of the constituent parts and the parts are the GP practices – they are the building blocks that make up the CCGs.” 

However, he added that taking a population approach was “essential” to improving public health and, as a result, he would support changing QOF to make it more focused on interventions – but only within a population context.

Faculty of Public Health president Lindsey Davies said she supported the “every contact counts” initiative but with caveats. “We don’t want healthcare professionals to be telling off ill people,” she said.

Professor Davies told HSJ there were lots of “great ideas” included in the report, which was an encouraging start. But she said: “There are huge question marks about how this is going to be taken forward.”

She noted for example that implementation was likely to rely on the “goodwill” of organisations “to get on and do it”, highlighting Boorman as an example of where this had not properly occurred. She added: “It would be great for all those providing NHS services to be accredited on occupational health.”

In its response to the forum’s recommendations on public health, the government said today it will seek to ensure they were “acted on in full, so that preventing poor health and promoting healthy living become an integral part of the way the NHS conducts its business”.

It said it would consider adding a “new responsibility for healthcare professionals to promote healthy living through their daily contact with patients” to the NHS constitution. It said it would hold a consultation on the idea in autumn 2012, as part of its next update to the constitution, and backed the use of appraisals to “incentivise employees to take advantage of every contact with patients”.

Regarding improving the health and wellbeing of the NHS workforce, the government reiterated commitments on the issue in the NHS constitution and the 2012-13 operating framework, adding that it would continue to implement recommendations from the Boorman review. It also said the forum had provided a “valuable renewed focus” on the need for trusts to develop health and wellbeing strategies for their staff, and it would be publishing “detailed guidance” on this “over the next year”. However, it made no mentioned of holding chief executives to account for progress in this area.

The government, however, agreed that CQUIN should be used to incentivise local service providers to focus on improving the public’s health and said using local tariff flexibilities had its “full support”. It added that work had started on strengthening the public health elements of the QOF, with at least 15 per cent of the value of the current framework devoted to evidence-based public health and primary prevention indicators from 2013.