Paper 3 Health-promoting hospital environments Introduction A series of three briefing papers have been produced, summarising health improvement activity within hospital settings in NHSScotland, following the second year of the governance reporting for Health Promoting Health Service CEL(1) 2012 (the national policy for health improvement in secondary care). This series reflects information and data submitted by all NHS Boards on 30 April 2014. These briefings are: 1 Overview of HPHS CEL(1) delivery 2 Health improvement opportunities in clinical care 3 Hospital environments supporting health improvement Briefing Paper 3: This briefing paper provides an overview of NHS Boards CEL(1) delivery of actions relating to creating hospital environments that promote and support health improvement. Key findings and progress Year 2 reports provide evidence that efforts are being made to create and develop hospital environments that promote health improvement for staff, patients and visitors within all NHS Boards in Scotland. However, much action continues to be driven through individual strands of work related to specific topic areas, with varying success and evidence of impact. The majority of NHS Boards have now set smoke-free grounds target dates, aligned with the National Tobacco Control Strategy. Evidence of the NHS estate being used to promote the physical activity of staff, patients and visitors. Increase from Year One in the number of updated policies to support breastfeeding. 1
HPHS CEL(1) actions relating to the hospital environment and Year 2 findings The HPHS CEL(1) 2012 requires health improvement interventions to be delivered across the hospital setting through a range of approaches, creating a setting that supports healing and promotes health and wellbeing for staff, patients and visitors. As a significant employer in Scotland, the NHS workforce is a key stakeholder in the delivery of this agenda, as well as the NHS estate. All actions and requirements within the HPHS CEL(1) are evidence-based and those relating to the buildings, grounds and services are in place to improve and promote health and reduce harm, where possible. 18.1 Tobacco Tobacco actions relating to the hospital environment within CEL(1) 2012 aim to create smoke-free NHS buildings and grounds. This allows staff, patients and visitors to experience fresh-air outdoor space within the hospital site, protecting them from second-hand smoke. In line with the National Tobacco Control Strategy all hospital grounds are required to be smoke-free by March 2015. This will both protect patients, staff and visitors from exposure to second-hand smoke but also establishes the hospital as an exemplar public health environment a place for treatment, healing and improving health. All NHS Boards reported that they had tobacco policies in place, with many noting that their smoke-free policy has recently, or is currently, undergoing revisions or consultation. The majority of NHS Boards have now set smoke-free grounds target dates, aligned with the National Tobacco Control Strategy. Some NHS Boards are upholding the exception for mental health facilities, while others will also have smoke-free grounds in these settings. Many NHS Boards provided additional information regarding their policies and e-cigarettes. Most NHS Boards noted that widespread measures were being implemented to increase awareness of pending smoke-free grounds status, including staff engagement and ensuring compliance to current restrictions. Smoking cessation support for staff through local services was evident in most NHS Boards. 18.3 Breastfeeding Support for mothers returning to work to breastfeed is a requirement of the HPHS CEL(1). This can be achieved through the availability of private facilities for expressing and storing milk, flexible breaks during shifts and the policy being communicated in advance of maternity leave ending. A total of 14 out of 15 NHS Boards reported that organisational policies were in place to support breastfeeding mothers, which was an increase on Year 1 reports. 2
Mechanisms for communicating the support available varied, from general information available to all staff, to some NHS Boards including protocols for advising women before and after return to work from maternity leave. 18.4 Food and Health Access to affordable, healthy food and drink is an important prerequisite for a hospital environment that supports health and wellbeing. Catering and retail providers can strongly influence the food and drink consumption of their customers through the range products they offer. HPHS CEL(1) 2012 requires NHS Boards to achieve both the Healthy Living Award and the Healthy Living Programme in their catering and retail facilities. Finally, there is a requirement for healthy vending and partnership working with social enterprises and/or community co-ops to provide healthy, affordable produce. Most NHS Boards reported against all the required actions for food and health. There are now records of attainment of the Healthy Living Award and the Healthy Living Programme across NHS sites in Scotland. There were some inconsistencies in recording when local data was compared to national datasets but these can be confirmed locally. All NHS Boards are on track to attain healthyliving award standard level, for all facilities in their NHS sites by March 2015. A confusion of the two awards, their eligibility and criteria was apparent. This is being addressed at national level. An area for development is the lack of engagement with food co-ops or social enterprises selling healthy produce. There are many challenges in this HPHS CEL(1) 2012 requirement, one key challenge being that there are just a few NHS Boards who have food co-ops or social enterprises to work with. Most NHS Boards were able to describe the healthy vending in their sites, although some were still struggling to achieve this. Key challenges were working within private finance initiative (PFI) contracts and the availability of appropriate snacks from vending suppliers. 18.5 Healthy Working Lives The Healthy Working Lives (HWL) Award scheme is a requirement for all NHS Boards within CEL(1) 2012. This requires the implementation of a number of actions that support and promote staff and health wellbeing, recognised through the attainment of the HWL Award. Progressing through the stages of the Award, maintenance of what is already attained, monitoring sickness rates and capturing staff satisfaction are key components of the policy requirements. 3
All NHS Boards demonstrated attainment of the Healthy Working Lives Award. NHS Boards work on a whole NHS Board, whole-site, or cluster of units basis to achieve the different levels of the award. A wide range of activities and initiatives were reported to promote the health and wellbeing of staff. Analysis and reporting from staff survey results show that some NHS Boards reported a consistent trend of decreased satisfaction by staff with their workplace and employer. 18.7 Physical Activity HPHS CEL(1) 2012 requires NHS Boards to provide active travel workplace schemes, and initiatives to be physically active within the hospital site, through collaboration with local organisations. Hospitals are required to use promotional and motivational resources in order to share key messages on the benefits of physical activity and encourage staff and visitors to make more active choices. This may include information about green or active travel in advance of appointments, and/or the provision of secure bike storage for those cycling to work. Many hospital sites with gardens and greenspace can be used by the wider community and are particularly beneficial to long-stay and mental health patients. The majority of NHS Boards had many measures in place to inform and engage staff in physical activity, for example, staff intranet, newsletters, incentive schemes, 23½ Hours, stair walking posters, site maps of the hospital estate and greenspace, local leisure information. Many of these were targeted at patients and visitors as well as staff. There was an increase in reporting on active travel. Many NHS Boards were implementing activities that covered active travel, including: on site and between site travel; walking maps; public transport and green travel; and step count challenges. Barriers to implementing both physical activity and active travel interventions included the position of sites and geography, particularly in island and remote locations. Good practice examples There are many positive examples of action to improve the hospital environment and promote health and wellbeing of patients, visitors and staff evidenced in the Year 2 Annual Report submissions. Some selected examples include: Smoke-free grounds NHS Western Isles set out to improve the health of the individuals and local communities they serve by taking a lead in becoming smoke-free in all NHS premises and grounds, promoting healthier and safer environments. A 4
comprehensive tobacco strategy with clear guidance on its implementation was developed, working with the Chief Executive and local authority. Working towards a target of 30 November 2013, the process involved extensive communication of the final countdown including staff open days in the hospital, events, banners, posters, business cards, advertisements in local media and use of the staff intranet and public-facing website. A smoke-free site is now implemented, and this work has also raised the profile of the smoking cessation services available. Absence management NHS Lanarkshire reduced their annual sickness absence rate with support from their in-house absence management service. EASY (Easy Access to Support for You) is part of NHS Lanarkshire s occupational health service and supports all staff from the first day of absence until they return to work. NHS Lanarkshire staff have direct access to this accredited occupational health service, which includes consultant physicians, advisors, case managers, health and safety specialists and an occupational therapist. The service can also refer staff onward to physiotherapy, counselling and clinical psychology. The service works closely with line managers, HR and Staff-Side representatives to ensure the earliest healthy return to work for staff. Partnership and greenspace Through partnership working with the Forestry Commission Scotland, the Braveheart charity, schools within Larbert and local authority planning partners, the greenspace at Forth Valley Royal Hospital has been revitalised. This project aimed to create a space for a range of physical activity opportunities, as well as encouraging staff and visitors to use the grounds for therapy and relaxation. An evaluation by the Forestry Commission showed benefits for both the staff and the community. Summary Action to create hospital environments that promote health and wellbeing is a core component of the HPHS CEL(1) 2012. There is evidence of efforts being made to fulfil these requirements at local level. Key areas of activity shown within Year 2 reports include collaborations with local authorities and third sector organisations to support physical activity and greenspace. Action towards smoke-free grounds and premises was also demonstrated, with most Boards setting smoke-free target dates. Whilst the progress that has been made through the contribution of HPHS CEL(1) 2012 has been evidenced across various elements of the physical environment, the 5
inconsistent provision of healthy options within catering, retail and vending outlets within hospital settings continues to be an ongoing challenge within the majority of NHS Boards. Efforts continue to be driven by individual strands of work, related to specific topic areas, with varying success and impact. In order to fully achieve the HPHS requirements, a more cohesive and collaborative approach is required by NHS Boards by utilising staff expertise, valuing their workforce and harnessing opportunities within their sites. For more information on HPHS please contact the national team at NHS Health Scotland by emailing: nhs.healthscotland-hphsadmin@nhs.net 5151 12/2014 NHS Health Scotland 2014 6