The need to improve employee health and wellbeing is great. But are the benefits to the NHS worth the required investment? Carol Black explains why they must be.
What is not in dispute is that workplace environments and management culture have a major impact on employees’ health and wellbeing. But what is often not seriously considered, or attended to, is what impact poor employee health and wellbeing have on business and productivity - what impact does it have on patient care and outcomes?
The case was clearly made by Dr Steven Boorman’s review, NHS Health and Wellbeing, published in 2009. His findings show, that while excellent practice does exist, there are great variations between NHS organisations.
The interim report showed clear links between staff health and wellbeing and the three dimensions of service quality - patient safety, patient experience and the effectiveness of patient care.
It showed there was a relationship between staff health and wellbeing and performance on such key issues as patient satisfaction, Annual Health Check ratings and MRSA rates and set out a strong business case for investing in staff health and wellbeing.
He found that organisations that made this a priority performed better, with “improved patient satisfaction, stronger quality scores, better outcomes, higher levels of staff retention and lower rates of sickness absence.” Key is not to see this as a separate initiative but as integral to enabling the NHS to meet the quality and productivity challenges it faces - through a “focus on innovation and prevention.”
The report argued that the NHS can reduce rates of sickness absence by a third, and in doing so would save 3.4 million working days a year - which translates to an extra 14,900 full-time equivalent staff. This would lead to an estimated annual direct cost saving of £555 million for the NHS.
The NHS Constitution makes it clear that all staff in the NHS have the right to health and safe working conditions. As Dr Boorman so aptly put it “the cobbler’s children do not deserve bad shoes!”
Indeed, NHS bodies, along with many other public sector organisations, are ideally placed to lead the way in improving staff health. They need to be showing leadership on health improvement and promoting healthy lifestyles amongst staff.
This is important because, firstly, it’s the right thing for an employer to do; but secondly, it improves productivity - a healthier, fitter and more engaged workforce means better patient care; and thirdly, it also allows staff to speak more convincingly about health improvement to their patients. And not just their patients, but with their families, friends and wider community contacts. NHS staff touch the lives of millions of people every day and have a significant opportunity to influence by example.
What I want is for all chief executives to consider signing up to as many of the Responsibility Deal (RD) pledges - from the health at work and physical activity networks - that they feel they can commit to. I believe we have developed a number of flexible and pragmatic pledges, highly appropriate and achievable to the NHS.
For example, one of the pledges recognises the importance of measuring and publishing sickness absence rates. As well as encouraging the inclusion in annual reports or on websites of a dedicated section on the health and wellbeing of employees.
But sickness absence is not the whole picture. “Presenteeism” - being at work but not being able to function to maximum capacity, whether due, for example, to the work environment, poor managerial relations or unsupported health issues - is often a greater problem.
In the 21st century, occupational health shouldn’t just be about supporting staff who have declared health problems, it should also be about safeguarding and promoting the health and wellbeing of all staff.
We must reach further and strengthen the preventive function of occupational health - helping to keep staff healthy, engaged and content.
Another of the RD pledges, therefore, is specifically about bought in occupational health services. This pledge asks employers to use only occupational health service providers that meet the OH standards developed by the Faculty of Occupational Medicine, and that are accredited or are in the process of being accredited. And if the service is provided in-house, employers can ensure that they formally apply for accreditation.
Working in health we are all too well aware of the impact of long-term conditions on the service and the wider economy. But this also presents us as employers with a major challenge, as we are faced with a growing number of our workforce with such conditions. This means employers will need to gain experience in the management of staff living and working with obesity, heart disease, diabetes and treated cancers.
We have developed two guides that provide advice to employers and employees in managing long-term conditions. They take a common sense approach that reflects the least to be expected in a trusting and respectful line manager/employee relationship.
The guides aim to help keep people in work and, those on long-term sickness, to return to work. Although chronic conditions last many years, in most instances being in work can actually help to reduce their impact and improve outcomes.
The specific pledge we’ve developed is about embedding the principles of these guides within HR procedures, to ensure that those with chronic conditions at work are managed in the best way possible with reasonable flexibilities and workplace adjustments. The principles in these guides can supplement existing HR practices and provide employees and their line managers with practical solutions that can benefit them both.
We are also keen that employers do all they can to encourage staff to stop smoking. So another pledge is about facilitating on-site stop smoking services or by encouraging staff to attend local services during working time without loss of pay.
Another key aspect of the RD is about how we can better shape the environment to enable and encourage healthier lifestyle choices. Another pledge sets out how organisations can implement some basic measures for healthier eating at work - improving what’s on offer in staff restaurants and cafes, vending machines and catered buffets.
And all NHS organisation should consider how they can encourage their staff to be physically active. There are a number of appropriate pledges, such as promoting more active travel - walking and cycling - and increasing physical activity in the workplace, whether through modifying the environment, promoting workplace champions or removing barriers to physical activity during the working day.
I believe that these RD pledges offer a simple and pragmatic way for organisations to structure and deliver their approach to workplace health. They provide a vehicle that will help organisations get to where they need to go.
As the NHS Operating Framework says “staff continue to be our most vital resource” and steps must be taken to improve staff health. Since the launch of the RD last March, sign up from the NHS remains low. We have more energy company partners, which seem to take staff health and wellbeing very seriously. We are obviously keen to improve this. Not only will it help to achieve the Boorman ambition of reducing sickness, but the knock on towards improved productivity also means going some way in contributing towards meeting the QIPP challenge.
So, if NHS chief executives are asking, “can we afford to invest in this area of work?” - my response would be, can you afford not to?