Highland NHS Board 5 June 2012 Item 5.1(b) A QUALITY APPROACH TO STAFF HEALTH AND WELLBEING

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1 Highland NHS Board 5 June 2012 Item 5.1(b) A QUALITY APPROACH TO STAFF HEALTH AND WELLBEING Report by Cathy Steer, Head of Health Improvement, Pamela Cremin, Workforce Planning & Development Manager, Linda Rawlinson, Occupational Health Strategy and Development Manager and Bob Summers, Head of Health and Safety; on behalf of Anne Gent, Director of Human Resources and Dr Margaret Somerville, Director of Public Health The Board is asked to: Note the position in developing a quality approach to staff health and wellbeing. Endorse the approach and support the next steps section of the report. 1 Background and Summary 1.1 This paper aims to alert the Board to the approach we are developing to promote staff health and wellbeing that responds to national policy and supports the Boards strategic vision to provide Better Health, Better Care and Better Value through placing quality and innovation at the heart of what we do to support staff health and wellbeing. 1.2 A number of recent national policies set out the background and context to improving the health of our workforce: Safe and Well at Work2, NHS Health and Wellbeing3 and the new Health Promoting Health Service guidance (CEL (1) 2012)4, highlight not only the duty that we have as employers to promote safe and healthy working but also the importance of staff health and wellbeing to improving quality and efficiency. While there has been a lot of work to implement these individual policies, it is recognized that we need a more efficient approach to promoting the health and wellbeing of our staff through bringing together a number of strands of existing work and building on this through development of more creative and innovative approach. 1.3 NHS Highland Board is committed to improve the health of the Highland population and develop high quality healthcare services that deliver Better Health, Better Care, and Better Value to the people of Highland. The Boards Quality and Efficiency Framework aims to improve the patients experience and outcome of care whilst identifying and removing waste. There is considerable evidence to show that better quality and safer care is more efficient and delivers financial benefits. In order to deliver the requirements set out by the government in Better Health, Better Care: Action Plan1, and the Boards Quality and Efficiency Framework, the Board must ensure it has a committed, well prepared, dedicated and healthy workforce, working in a safe environment to respond to and deliver health care services now and in the future. 1.4 The development of NHS Highland Strategic Framework is based on the premise that the three components of Better Health, Better Care and Better Value are fundamentally linked, and that to ignore one at the expense of the others, or to only focus on one aspect will lead to failure. So, continued focus on health improvement and preventative measures will reduce the demand on health care services. 1 Scottish Government, Better Health, Better Care: Action Plan. Edinburgh: SGHD

2 1.5 Implementing the Strategic Framework is supported by a Board Vision that will require changes to working practices for all staff as consistent systems and pathways are developed, evolved and adopted. Ultimately it must mean that health needs continue to be met as the balance of need and resource becomes tighter. It will mean that the characteristics of service delivery in NHS Highland over the next five years will quickly evolve to be ones of: 1. promoting good health, self care and independence 2. high quality, integrated, equitable, needs and evidence-based, and cost effective 3. increasingly community based with hospital beds preserved for the most acutely ill and those with specialist needs 4. anticipatory care 5. run by healthy, flexible, well-motivated and well-trained staff working to their maximum potential and capability 6. using modern, flexible, efficient, green assets to maximum effect 7. with zero wastage and inefficiency across all services and no unnecessary overheads 2 What do we know about our staff? Age Profile and Analysis: NHS Highland Age Profile (Headcount) HC Percentage Grand Total < NHS Highland s workforce age profile reveals an ageing workforce with the majority of staff in the age group, closely followed by age group and age group. This will have significant impact for NHS Highland in the coming years in terms of an ageing workforce % (3,240 HC) of NHS Highland s workforce are over 50 years of age. Using the average retirement age projections, the percentages of our workforce that will still be with us in 5 years is 93%; in 10 years is 81%; and in 15 years is 69%. A third of NHS Highland s workforce will be eligible for retirement and can leave over the next 15 years; and in 20 years, 50% of the workforce will have reached retirement age. In the current economic climate, retirement rates may be unpredictable, with people choosing to work after retirement age, which will require a focus on the health of the ageing workforce. 2

3 NHS Highland Gender Profile Gender Transgender Male,, 0.08% 18.94% Male Female Transgender Female, 80.98% 81% of NHS Highland s workforce are female; of these 55% are working work part time. NHS Highland Staff Absence Profile In terms of staff sickness absence almost 350 whole time equivalents are lost to NHS Highland daily (Apr2010-Mar 2011), with 15% of this being due to absence associated with anxiety, depression and stress. However in absence reporting information reasons for absence reported as other forms the single most significant category. Detailed exploration of the other category will be required to provide us with a clear picture of what is happening with sickness absence. Our annual average sickness absence is showing promising signs of following a downward trend. Our annual average sickness absence for was 4.19%, a decrease from the previous year when it was 4.40%. The decrease is mainly due to long term sickness absence Sickness Absence between Apr 10 to Mar Sickness Absence associated with Anxiety, Depression & Stress Argyll and Bute CHP Corporate Services Breakdown of Staff sickness by Approx WTE lost due to a reason by Op Unit Mid Highland CHP 1.68 North Highland CHP WTE lost daily Unknown MSD's WTE (15% of Asthma total) Skin 1.81 Operational Support Services Raigmore Hospital South East Highland CHP Anxiety/stress/depression/other psychiatric illnesses Respiratory (colds / influenza) GI (D&V) 3

4 The main presenting issues to Occupational Health are for stress/ mild to moderate depression and musculoskeletal disorders. From October 2011 to March 2012 Occupational Health has had 574 management referrals and 418 self referrals. Management referrals are predominately associated with sickness absence and self referrals are related to individuals who are at work but struggling. 3 What are we currently doing to support staff health and wellbeing? The good news is that there is currently a lot of activity to support staff health and wellbeing across NHS Highland. A range of services, initiatives and projects are available, but while there is evidence of good practice, there are concerns about the spread of such activity. The following section describes some of the work currently undertaken to promote health and wellbeing with our staff. 3.1 Healthy Working Lives NHS Highland is working towards achievement of the Healthy Working Lives award for all workplaces. This programme supports workplaces to complete a health needs assessment for staff, development of health promotion and safety initiatives and provides a framework for recording and assessing success. Currently 24 workplaces are registered with the HWL award scheme, covering 87% of our workforce. Although activity tends to vary over time, 11 of these workplaces have achieved the HWL Bronze award, 5 the Silver award and 4 the Gold award. The others are still working towards achieving the Bronze award. 3.2 Occupational Health Service (OHS) Occupational Health deliver a range of services to staff, including help with mild to moderate depression and anxiety disorders including trauma on four levels according to the needs of the employee. It is the only Health Board in Scotland to offer this service. In order of increasing intensity and specialisation these levels are: 1. Information and signposting to self help websites and resources.. 2. Educational Courses; CBT skills for stress and Compassionate Mind Training. 12 courses a year. 3. One to one Cognitive Behavioural Therapy (CBT) 4. One to one Eye Movement Desensitisation and reprocessing (EMDR) OHS provides both management and self referral access to physiotherapy via case management process to support musculoskeletal conditions. Employees are contacted by telephone within 48 hours where the physiotherapist will triage appropriately: 1. Directed to self help materials or discharged 2. Seen in OH given exercises 3. Seen in physiotherapy outpatients. In relation to managing sickness absence OHS provides regular case review meetings with managers and employees are continuously being offered effective and appropriate intervention as outlined above OHS is responsible for co-ordinating the annual Highland wide staff influenza programme. In 2011 Nurse leads assisted the delivery of the programme within CHP areas which resulted in a significant increase in uptake and the roll out of skin health surveillance programme has been undertaken as part of COSHH programme. OHS offers lifestyle support and advice for alcohol brief interventions, smoking cessation and weight management. 4

5 3.3 Health and Safety Among other things, the Health and Safety team within NHS Highland support several programmes of work that promote staff health and wellbeing, including training and support for dealing with violence and aggression in the workplace, support for preventing and dealing with incidents including slips, trips and falls, and supporting work in relation to recognising and managing work related stress. A recent workshop delivered to a group of NHS Highland managers introduced the recent Health and Safety Executive (HSE) Management Standards, which provide preventative guidance on best practice for employers in managing work-related stress. 3.4 Using an assets based approach to staff health and wellbeing an asset based approach is one which seeks to positively identify and mobilise the assets, capabilities and resources available to individuals and communities which could enable them to gain more control over their lives and circumstances. In this context the community can be defined as the workplace or team. The more familiar deficit approach to health and wellbeing focuses on the problems, needs and deficiencies in a community such as illness or health damaging behaviours. A recent review of asset based approaches grouped relevant assets into three levels: Individual assets e.g. resilience, commitment to learning, self esteem, sense of purpose. Community assets e.g. networks, social capital, community cohesion. Organisational assets e.g. environment, opportunities for volunteering and participation. The following table summarises the kind of shift in focus required to successfully implement this approach. Deficit Start with deficiencies and needs Respond to problems Provide services See staff as consumers Treat staff as passive Fix staff Implement programmes Asset Start with strengths Identify opportunities Invest in people See staff as co-producers with something to offer Help staff to take an active part in their own and their workplaces wellbeing Support staff to develop their potential See staff as the answer There are a number of off the shelf programmes that purport to take this approach such as the staffwel project that is currently being piloted in some areas of NHS Highland. 3.5 Health Promoting Health Service the recent guidance on developing a health promoting health service was issued in January of This guidance provides a framework that supports the NHS to be health promoting organisations through a number of key priority programmes of work. This framework is as applicable to staff as it is to patients and visitors to our premises and services and as such provides a platform for taking forward work to support our overall approach to staff health and well-being including: Achieving the Healthy Working Lives award (see above) Developing health promoting environments through provision of healthy food and taking a whole hospital approach to healthy eating through catering strategies and support for the national Healthy Living Award. Providing support for healthy lifestyle through delivering alcohol brief interventions and smoking cessation support 5

6 3.6 Management of sickness absence Efforts have been made in recent years to put in place a number of mechanisms to manage sickness absence. Implementation of our Managing Sickness Absence policy and proactive work with Occupational Health to support staff is making a difference in relation to reducing long term sickness absence. 4 Next Steps It is recognised that the current activity to promote health and wellbeing with our staff is appropriate and valuable, but requires additional focus and drive to bring together the various strands of work in a way that will allow us to better build capacity and capability to realise the vision described above. In order to progress this, there are a number of issues that require further work and it is proposed that a small steering group of senior staff will provide strong leadership and visible support to this issue, taking forward a programme of work in partnership with staff side that will include: Development of information/data recording and reporting to provide a more accurate picture in relation to the health and wellbeing of our staff Activity mapping to understand the spread/reach of services/initiatives to support staff health and wellbeing Communicating the vision and benefits to operational units Ensuring that staff side representation and staff themselves are involved in shaping the development of our approach to staff health and well-being Build upon the activity already underway to create and support healthy environments for our staff including work in relation to violence and aggression, healthy eating through development of our Catering strategy etc Identifying clear routes of reporting and accountability and gain local ownership of this agenda Developing a dashboard of indicators to monitor and report on progress to very local levels. 5 Contribution to Board Objectives The Board Vision described through the triple aim of Better Health, Better Care and Better Value and the seven characteristics described under the Strategic Framework requires translation in to specific service strategies to support application and implementation. The Highland Quality Approach to Staff Health and Well Being aims to ensure that we promote good health and self care to our workforce, which will in turn ensure that the organisation is run by healthy, flexible, well-motivated and well-trained staff who are fit to work to their maximum potential and capability. This quality approach to staff health and well-being supports the Boards Quality and Efficiency Framework by: promoting a person centred approach to staff health ensuring a safe working environment providing effective support through consistent ways of working ensuring equity by applying this approach to all staff promoting efficiency by ensuring a healthy well-motivated workforce with reduced sickness absence providing support and interventions in a timely manner 6

7 6 Governance Implications Staff Governance One of the key standards of the NHS Scotland Staff Governance Standard requires NHS Boards to demonstrate that staff are provided with an improved and safe working environment, promoting the health and wellbeing of staff, patients and the wider community. The development of a Highland Quality Approach to Staff Health and Well Being is a key underpinning approach to the staff governance standard. Patient and Public Involvement The issue of employee wellbeing has become increasingly important to patients and the public in the last decade due to a number of factors. One of these is the high cost to the public purse of employee absence. In delivery of the Triple Aim, the Board ensures Better Health (of its staff), which in turn supports Better Care (for patients), the outcome of both are Better Value in terms of patient experience and efficient public expenditure. Clinical Governance An educated, trained and developed workforce is an integral part of clinical governance. Valuing the contribution that staff make to quality health care and continuing improvement, and the provision in workplaces of a culture of employee wellbeing practices are important to achieving better patient care. Financial Impact The Board recognises that they have a direct interest in creating an environment that helps people make healthy choices: because of corporate social responsibility and because a healthier, more engaged workforce makes good business sense. A motivated, healthy workforce is more likely to perform well. Employers and employees benefit through improved morale, reduced absenteeism, increased retention and improved productivity. 7 Risk Assessment Risk assessments have not formally been taken in line with this piece of work. However, it is evidenced above that whilst there is currently a lot of activity to support staff health and wellbeing across NHS Highland, there are concerns about the spread of such activity the development of a Highland Quality Approach to Staff Health and Well Being will minimise the risk that the work stream is not being implemented consistently across the Board. The Highland Quality Approach to Staff Health and Well-being will ensure that any implementation plans are prioritised using the agreed risk management assessment process. 8 Planning for Fairness This report outlines the approach to be taken to develop a Highland Quality Approach to Staff Health and Well-being and as such, does not require planning for fairness assessment at this stage. However, as the approach and any programs of work are developed and embedded, planning for fairness assessment will be undertaken. 7

8 9 Engagement and Communication The development of Highland Quality Approach to Staff Health is being developed through engagement with staff and with key individuals across various fora including the health and safety committee, and the staff governance committee. The approach has been discussed at the Boards Partnership forum where it was enthusiastically received by both management and staff side. As a result the Board partnership forum endorsed the approach and staff side is keen to get more engaged. A staff side representative has been put forward to be involved in progressing this work and will fully involved in taking this forward. A joined up approach in corporate services across human resources and public health functions is key to ensuring that stakeholders are engaged and supported to interact with the development of the approach. Cathy Steer Head of Health Improvement Bob Summers Head of Health and Safety Pamela Cremin Workforce Planning & Development Manager Linda Rawlinson Occupational Health Strategy & Development Manager Corporate Services 25 May