Healthy Working Lives and Health Promoting Health Service Purpose of Report The purpose of this report is to outline proposals and a framework for taking forward work around Healthy Working Lives and Health Promoting Health Service across NHS Dumfries and Galloway. Background Healthy Working Lives (HWL) In 2003 NHS Dumfries and Galloway Acute Trust and the NHS Board were awarded Scotland s Health at Work (SHAW) silver accreditation. In April 2007 the Healthy Working Lives (HWL) programme replaced Scotland s Health at Work (SHAW) scheme. The HWL Award programme offers a clear evidence-based framework for improving health at work, relevant to the needs of employers and employees. Like the previous SHAW Award scheme the new HWL Award is based on undertaking activities on three levels (Bronze, Silver and Gold). Each level of the Award builds upon the previous level this should, in theory, lead to the establishment of actions which are sustainable in the long term. There are a number of key topics included within the Award programme: Identification and support for the health and safety needs of staff Promotion of topics such as healthy eating and physical activity Supporting staff attendance and reducing staff sickness Addressing mental health and wellbeing issues including stress Promoting wider community health and wellbeing Developing environmentally friendly good practice Developing support for employability Health Promoting Health Service (HPHS) Improving Health in Scotland The Challenge (SE 2003) identified key areas for health improvement, with an emphasis on the development of effective structures for delivery and an increased profile for health improvement. Delivering for Health (SE 2005) sets out the current vision for the NHS to improve the health of people in Scotland with a clear shift towards preventative approaches and more care in the community. This policy clearly acknowledges that health care makes an important contribution to health improvement. 1
The health service is a key area, where both as a service provider and an employer, there are opportunities to improve health. This includes the health of patients, staff and the wider community. The goal of the HPHS package is to support the development of a health promoting health service a service which prevents ill health as well as providing health care. Work can focus on patients, staff or the wider community. The ethos of the HPHS is about recognising and building upon good practice that is going on day to day in essence HPHS is about embedding health improvement practice as part of organisational culture. A national HPHS Network has been established in Scotland, made up of health promotion staff, clinical practitioners and others with a remit and interest in health improvement. The Network meets on a quarterly basis. There are also a number of Working Groups: Health improvement, food and retail in the NHS Health improvement, built environments and green space in the NHS Standards for Dental Health Promotion in Children s Hospitals Since 2005 Health Scotland has been funding some pilot sites to develop good practice examples of health improvement activities which reflect the ethos of the HPHS framework. World Health Organisation (WHO) Health Promoting Hospitals The Scottish HPHS Network is part of a wider WHO Health promoting Hospitals Project and Network. The WHO Health Promoting Hospital project is based on the Vienna Recommendations (1997) which build upon the general principles of the Budapest Declaration on Health Promoting Hospitals (1991). The WHO have recognised the need for standards for health promotion hospitals. Five core standards have been developed which define the responsibilities and activities concerning health promotion. The standards are mainly generic with a focus on patients, staff and organisational management. Individual sites with NHS Scotland (Dumfries and Galloway Royal Infirmary included) have become members of the WHO Network. Better Health, Better Health Care Better Health, Better Health Care (2007) is a significant step towards a Healthier Scotland and its three main components of health improvement, tackling health inequality and improving the quality of health care. Both HPHS and HWL can support action in terms of delivering Better Health, Better Health Care. Furthermore, a number of the HEAT targets relate to HPHS and HWL eg sickness absence rates and breastfeeding. 2
CEL Letter (March 2008) In March 2008 the Public Health and Wellbeing Directorate of the Scottish Government issued a letter asking Boards to implement specified health promoting actions on smoking, alcohol, breastfeeding, food and health and health at work, to support health improvement in the acute care setting and give an annual progress report on these in each of the next three years. The areas of action specified clearly link to National Performance Frameworks and a number of the HEAT Targets. A number of Performance Assessment measures have been identified against which Boards will be expected to report. Other related local policy A Healthy Understanding In 2007 NHS Dumfries and Galloway launched its Healthy Understanding Statement. The statement forms part of the NHS Better Health, Better Health Care Strategy and is essentially a statement detailing the expectations in terms of patient care between NHS Dumfries and Galloway and the public. It is felt that both the HWL and HPHS programmes could dovetail into the work that is currently being developed around Healthy Understanding. Local Health Partnership Strategic Reviews Each LHP has/is involved in undertaking a Strategic Review. As part of a wider health improvement programme and with links to NHS workforce planning and development there could be opportunities to include HWL and HPHS as part of LHP Strategic Reviews. Local Health Partnership Health Improvement Plans Health Improvement Actions Plans, linked to the wider strategic direction of the LHP, form the focus for health improvement work within each LHP. Work around health improvement and the workforce could feature in future plans. This work could also be extended into the wider community. Workforce Development Knowledge, Skills, Framework (KSF) Safer Patient Initiative National discussion There have been ongoing discussions between the Scottish Centre for Healthy Working Lives and the HPHS regarding joint working. It is likely that a statement will be released by NHS Health Scotland in the near future 3
requesting local NHS Boards look at ways in which work around HWL and HPHS can be integrated and taken forward at local level. In essence, each local NHS Board will be expected to register for the HWL programme, develop portfolio s leading to assessment for HWL Award accreditation and undertake specified action around smoking, alcohol, breastfeeding and food and health (see CEL Letter March 2008). Resource considerations It is acknowledged that there are resource implications, both in terms of staff time and budget, associated with developing actions around HWL and HPHS. Broadly speaking resource issues are linked to the following: Staff time in terms of co-ordinating and attending meetings Costs linked to possible events or sustainable actions It is difficult to indicate exact figures at present however it is anticipated that a Local Health Partnership should be able to achieve HWL Bronze and Silver Awards for a figure in the region of 2,000. As part of the Bronze Award organisations are required to undertake a Health Needs Assessment (HNA) and prepare an Action Plan, based on the findings of the HNA. It is at this particular point that more exact costings could be determined. It is suggested that early discussion takes place with the Director for Health Services regarding the possibility of utilising existing Staff Endowment Funds for the purpose of taking forward work around HWL/HPHS. Health Scotland have indicated that HPHS match funding to the value of 6,000 is available for NHS Dumfries and Galloway. Discussions have commenced with Health Scotland regarding the possibility of utilising this funding in conjunction with the HWL programme. With local match funding of 6,000 a budget of 12,000 would be available for work of this nature across Dumfries and Galloway. Human Resources and policy development An element of HWL involves action around policy (eg staff attendance, smoking, alcohol work-life balance etc). These policy issues will require to be addressed at corporate level within NHS Dumfries and Galloway and therefore it is felt that the resource implications associated with work of this nature will be minimal at local level. Policy development is, in the main, developed through Human Resources (HR and Workforce Strategy), Corporate Management Team and associated working groups. Proposal At local level in terms of taking forward work around Healthy Working Lives and Health Promoting Health Service it is suggested that discussions take 4
place around using the two programmes to enhance health improvement work within NHS Dumfries and Galloway. At a broad level the programmes can support the following: the development of an improved skills and knowledge base of staff the bringing about change in organisational policy and culture the achievement of improvements in health related outcomes In order to meet the above outcomes it is suggested that discussions around adopting the following model of working practice take place: Annandale & Eskdale LHP Nithsdale LHP Stewartry LHP Wigtownshire LHP *DGRI, CRH and Board Health Improvement Lead Workplace Health Improvement Officer - Workplace Evaluation & Reports to LHP Executive Committees and NHS Board Annual Review It is suggested that in order to manage and gain local ownership for both HWL and HPHS, local project groups are established within each of the Local Health Partnerships. The local Groups will co-ordinate and lead the work programme for HWL and HPHS. This model of work practice will require each of the 4 LHP s to register for Healthy Working Lives. A further group will require to be implemented covering DGRI and Crichton Hall sites, reflecting the size and dynamics of these two sites. In order to reflect the staff composition of the LHP the local working groups would require to be comprised of staff representatives from across the LHP (including GP representation). Given the health improvement focus of both HWL and HPHS it is suggested that the Health Improvement Team s within each locality could potentially coordinate and lead this work support to each LHP would be provided by the 5
Health Improvement Programme Lead Workplaces and the Health Improvement Officer Workplaces. Recommendations Colleagues are requested to consider and support the following recommendations: 1) With agreement and support from the Public Health Practitioners it is suggested that in the first instance meetings are arranged with the LHP Managers in order to discuss the feasibility of using the proposed model of HPHS and HWL within each LHP setting; 2) A proposal paper to be submitted to each LHP Management Team outlining the proposals and seeking support to develop work in this area; 3) Submission of a proposal paper to the Corporate Management Team seeking approval to progress HWL across NHS Dumfries and Galloway, with the LHP s and DGRI/CRH registering as individual sites as outlined in the model highlighted above; 4) Discussions to take place with the Director of Health Services in order to explore options around funding for future HWL and HPHS work. 6