A 360 Degree Approach to Health and Wellbeing @ Work Mersey Care NHS Trust Amanda K Smith Head of Health and Wellbeing, Mersey Care NHS Foundation Trust (MCFT) Clare Hutchinson Counsellor MCFT
Operating environment Highest level of depression and anxiety (19.3%) in England (Avg 12%) Upper quartile new incidents of psychosis (31.4/100K) in England (Avg 24/100K)
Our Vision To become the leading organisation in the provision of mental health care, addiction services and learning disability care. Quality, recovery and wellbeing are at the heart of everything we do Inpatient, community mental health and learning disability, addiction management and acquired brain injury services covering the people of Liverpool, Sefton and Kirby. Secure mental health services for the North West of England, West Midlands and Wales One of 3 Mental Health Trusts in the country with High Secure Hospitals, Ashworth, Broadmoor and Rampton. Delivering Clinical Services at over 30 sites in Merseyside and Lancashire 5200 staff covering a population of 11 million.
Our Staff Investment; Board and Chief Executive support for Corporate Division, includes L&D, HR, Resourcing, Health and Wellbeing Strong leadership and support from HRD / DHRD, Head of Workforce and senior teams across the Trust. Leadership Forum development programme for staff bands 8 and above and development programme for managers all bands. Extensive training and development programme all bands across the Trust Peer Support Programme lived experience, recovery college model. Service users / Carers embedded at all levels within the Trust from recruitment to board. Health and Wellbeing strategy delivery of perfect staff care = perfect patient care Re-structure and development all areas of corporate services to meet organisational transition.
Key Stakeholders Health & Wellbeing @ Work Human Resources / CS team Board and strategic focus Mersey Care NHS Trust perfect patient care Divisional Areas Patients staff
360 Degree Model of Health & Wellbeing @ Work Centralised Sickness Team day 1 sickness absence referral, data collection, management support / compliance Employee Assistance Provision (EAP) 24/7 Human Resources Occupational Health Physiotherapy and daily triage line
Centralised Sickness Team Starting as a HSS model and cascaded through out the Trust since January 2015, the Sickness Team has introduced; Sickness Helpline for Managers and Staff Generic Email account - all communications Centralised database live data Individual electronic records for 5200 staff Monthly reports identifying hot spots / trends (for Surveillance, Heads of Division and Governance Committees) Guidance Notes policy etc Day One Health & Wellbeing @ Work referrals staff support and physiotherapy Monthly meetings with H&W@Work Lead (trends and target interventions) Robust system for Work Related Absence reviews Seamless system for processing TIA payments for staff (prior to half pay trigger dates) Management support to apply policy / procedures
Number of staff on Sickness Monitoring October 2014 to September 2015 Number of staff on Long Term Sickness monitoring Trust wide : Oct 14 to Sept 15 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Number of staff on Unsatisfactory Attendance monitoring Trust wide : Oct 14 to Sept 15 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15
Reasons for Absence Division 1 Division 2 13% 25% 46% 50% 25% 17% 12% 12% Anxiety / Stress (not work related) Musculoskeletal Gastrointestinal Other Anxiety / Stress (not work related) Musculoskeletal Gastrointestinal Other
On-going Activities Centralised Sickness Team Identifying hot spots / trends - Surveillance / Governance Committee - To inform H&W@Work (SS/OH & Physio) to provide preventative sessions Compliance rates for the completion of Return to Work forms Compilation of Fit Notes (electronic storage) Triangulation of sickness data with Bank usage and ER activity Timely prompts to Managers 1:1 / group training sessions Standard Operating Procedure (in conjunction with MIAA) Quality Kite Mark - sickness activity in ESR
Health and Wellbeing @ Work (H&W@W) Employee Assistance Provision staff support services Occupational Health Physiotherapy
Structure H&W@W Administration Teams Physiotherapy Occupational Health Manager Head of Health & Wellbeing @ Work Counsellors / Psychotherapis ts OH Nurses OH Physicians Covering over 32,000 NHS and private sector staff
Occupational Health Services Offering a full range of Occupational Health Services from our site bases in Liverpool and Lancashire. Management referrals Sickness absence assessment and management Rehabilitation following injury / prolonged sickness absence Ill health retirement assessment Pre-employment health screening Health surveillance Health Screening and Drug/ Alcohol screening Specialist physiotherapy and occupational rehabilitation Health Promotion Activities Needle stick and sharps management Immunisation and vaccination On site OH and Physiotherapy SEQOHS accredited Data analysis and KPI inform HR / Strategy / Investment and resourcing
Physiotherapy Services Referral via Occupational Health / Management and Self Referrals. Clinics 5 days a week 3 sites across Merseyside and Lancashire Flexible appointment times - from 8.00-6.30. Telephone advice / triage line for 1 hour a day 5 days a week all staff Developing Preventative infrastructure. Links with sickness absence co-ordination for all divisions. Links/referral system to active workforce and trusts health and wellbeing agenda. Physical activity champion. Deliver at health and wellbeing days. Preventative advice with any trend of issues in specific departments. Return to work analysis Data collection informing strategy and H&W agenda.
Pathology Reporting linking into Sickness Absence Team/HR/OH
Full EAP- Embedded within the Clinical Excellence of an NHS Mental Health Trust, we offer a Full EAP Provision to our own staff and our external partners. 24/7 telephone help and advice line and counselling Swift access to psychological support and counselling Wellbeing and promotion Critical Incident / Incident Support Service Workplace Mediation Organisational and Management Consultancy Service Bespoke training packages Stress management and Training Individual Fitech stress testing Life Coaching Advice, Information and Signposting Drug and Alcohol specialists referral pathways Eating Disorders Cognitive Behavioural Therapy (CBT) Solution Focussed Therapy Established referral pathways as NHS provider Psychotherapy Person Centred Therapies Eye Movement Desensitisation & Reprocessing (EMDR trauma) Integrative approaches IPT Interpersonal psychotherapy Academic excellence, professional accreditation, research led.
Service Evaluation EAP use Clinical / progress analysis -COREnet core 10 at TA, 34 at first and last session and 10 on a session to session basis Commenced using WOS 5 for workplace specific ROI data at assessment, conclusion and 60 days after therapy ending Client feedback form- - quantative and qualitative data electronically and paper based. Physiotherapy pathology &clinical outcomes, sessional attendance and client feedback Occupational Health KPI s in relation to SEQOSH plus organisational monthly reporting and sample analysis of management referrals for reporting quality. Clinical audit. Accreditation / Affiliation RCPsych / BPS/ SEQOSH/ EAPA / BACP/ RCN
EAP Statistical Data complimenting Sickness Absence Team importance of collaboration with all stakeholders 180 160 140 120 100 80 60 40 20 0 Pre Counselling Post Counselling On sick leave or absent from work Work function satisfactory Work functioning as normal Work functioning impaired Work functioning severely impaired Total
Workplace Mediation via EAP Our services includes access to qualified and experienced workplace mediators. Embedded within HR policy to enable swift resolution of workplace issues, reducing sickness absence and presenteeism. Mediation is a process whereby two parties in disagreement aim to work out a mutually acceptable way forward with the assistance of a third party mediator. Mediation is a useful alternative to grievance procedures as it enables staff to seek resolution by acknowledging another's perspective and re-frame the dialogue to move forward to a positive working partnership. Mediation is not arbitration or conciliation but is offered as independent and confidential dispute resolution.
Individual and Organisational Incident Support and Critical Incident De-Briefing / EMDR Staff in all workplaces can sometimes face difficult and unpredictable situations. Our team includes psychological specialists trained and experienced to assist those involved with traumatic incidents or events within the workplace or outside of such. Everyone is affected differently by Trauma, and symptoms can be psychological and physical. Having access to specialist NHS trauma specialists enable organisations, managers and individuals to refer to our Incident Support Service. This supports overall wellbeing and assists management and organisational duty of care responsibilities. Outside of the NHS organisation and individual trauma or difficult events management with high profile individuals or organisations can be managed confidentially and professionally with staff experienced in the management of high profile mental ill heath, addiction and trauma. Eye Movement Desentisation Reprogramming we find is a positive trauma treatment and used within our EAP effectively.
Stress Management and Prevention Staff health and wellbeing is of paramount importance to all organisations. By working alongside our own Trust and external contract organisations as a partner service, understanding cultures, values and the challenges staff undertake on a day to day basis enables our team to offer staff on site access to health and wellbeing advice, information and support. Health and Wellbeing @ Work can offer staff regular stress checks via our computerised Fitech system. Stress and Its management. This means that staff scoring highly are provided with the right advice and support at the time, helping to identify stressors and access immediate and appropriate support. Reducing sickness absence and presenteeism. For organisations and teams the identification and solution focussed support from specialists helps keep staff within the workplace whilst dealing with the problems identified.
Client Journey 1. John has been having issues at home in his relationship. He has been finding coming into work difficult, has had a number of short term absences with viral and MSK issues and his team are finding him snappy. He hits the trigger point for a management referral to OH. John attends OH and sees a nurse practitioner, they explore his absence history and she recommends some physiotherapy intervention for the MSK issues and books an appointment that week. She also provides John with a pack giving details of the EAP scheme, explains its confidentiality and makes a note of this offer in Johns OH notes. The OH nurse writes a report to Johns LM, copied to HR and the centralised sickness team. John self refers into the staff support service and accesses support, he informs his LM to enable him to attend in work time to avoid additional pressures at home. He is assessed at point of contact for risk and presenting issues and offered an appointment within 15 days with a counsellor / psychotherapist meeting his presentation requirements and geographical location preference.
Client journey 2. Sarah has been off work following a debilitating health condition, she has good sickness absence history and has seen OH twice whilst absent. Her health condition will make it difficult to return to the type of ward she worked on, her manager (who she feels isn't supportive) says there are no alternatives. OH recommend a return to work in a less physical environment. Sarahs HR business advisor is off on maternity leave and she wants to come back to work but feels unable. As part of the health and wellbeing offering Sarah is offered the opportunity to access a case conference, with all key stakeholders invited alongside her union representative if she wishes. HR / OH / Sickness Team / LM / Union ( counsellor if counsellor / client feel appropriate and it is disclosed by Sarah she is within the service )and Sarah meet to discuss her support needs and options. HR are aware of a staff member looking to move to a HSS environment and this post would be suitable for Sarah. Its not for 3 months. LM agree to phased return and reasonable adjustment, supported by HR and OH. Sarah is able to return to work and then make a permanent move to meet health requirements.
Learning, Benefits, Outcomes of a 360 degree Model. Working partnership with key stakeholders both for internal (MCT) and external contracts A unique NHS model of EAP / OH/ Physiotherapy backed by the clinical expertise of an NHS Mental Health Foundation Trust A one stop shop for staff enabling co-hessian, seamless delivery of services and a dialogue where supportive to the individual Confidentiality maintained client consent / agreement for any inter disciplinary dialogue Management overview Head of Health and Wellbeing - am able to look at Trust as a whole and external contracts and provide clinical and data analysis in addition to soft intelligence useful to support areas facing difficulties / challenges LM of service into EDHR / DHR. Head of service sits upon senior management team, EDHR sits upon Trust Board. Staff and managers value all services under one umbrella supports interdisciplinary dialogue and client care for mental and physical health and wellbeing at work.
Learning, Benefits, Outcomes of a 360 degree Model. Sickness team live data analysis enables targeted interventions and proactive supportive measures for MSK and Stress two of our highest causes of sickness absence. OH / SSS/ Physiotherapy seen as one team requires clear boundaries re confidentiality. Administration teams are separate, supported by administration manager over all teams. Model now almost 2 years old, has had new clinical systems across departments within the service, web site development, downloadable applications for physical health revitalise and mental health silver cloud on line CCBT. Employees access service at numerous locations across Merseyside and Lancashire, supporting access in work or whilst absent. Need of service staff to understand roles, boundaries and clinical requirements of each others services ie OH understanding clinical boundaries of counselling. Positive impact of all services under one umbrella plus the challenges this has brought clear pathway for mental and physical health support for staff with preventative strategies and promotion and publicity of services across contracts.
Next steps. Continued evaluation of model feedback from service users, managers and our own Trust at all levels. ROI always difficult to measure EAPA survey on-going measurement / cost analysis Process mapping different for different trusts / organisations to comply with policy and procedure individual to them ie private sector compared to NHS Positive feedback - from our own organisation and partner customers building upon model, graduated expansion with a focus on meeting organisational need and client support. SOP s for each service / organisation Continued need for IT development and expansion of clinical systems, reporting and evaluation methodology Increase in offer to staff of a range of physical and mental health interventions as both inextricably linked.
Thank You Any Questions? amanda.smith@merseycare.nhs.uk clare.hutchinson@merseycare.nhs.uk 0151 330 8099 07971 419004