"Perhaps the biggest priority is addressing workforce issues in health and social care"

- Matthew Taylor, NHS Confederation chief executive in a recent BBC interview

What are the key staff health and wellbeing challenges in the NHS? How can and are they being addressed? What is the role of the board in this especially in the context of the new trust code of governance?

On Thursday 13 October, the Good Governance Institute (GGI) and Reset Health – a care provider and thought leader on employee wellbeing and long-term health conditions – convened a virtual panel discussion involving more than 40 healthcare senior leaders looking at one of the biggest challenges facing health and care services: staff health and wellbeing.

The purpose of the event was to explore, in the context of the new provider trust code of governance put out for consultation in the summer by NHS England, answers to the questions posed above and to look at:

• key challenges around staff health and wellbeing in the NHS
• opportunities and areas for experimentation and innovation
• new solutions and good practice happening across trusts and ICSs.

The discussion was chaired by GGI executive director Mark Butler and featured contributions from:

• Marie Burnham, Chair at South West Yorkshire Partnership NHS FT
• Leslieann Osborn, Director of Wellbeing and Engagement at Dartford and Gravesham NHS Trust
• Simon Hall, Principal Consultant at GGI
• Grant Harrison the Chief Strategy Officer and Co-Founder of Reset Health.

There was a lot of focus on practical solutions, outcome-driven approaches and ideas for innovation. Marie Burnham spoke about the quadruple aim approach at her trust and the development and flexibility of their evolving staff wellbeing offer. Leslieann Osborn spoke about the impact of the health and wellbeing work at her trust, which is using Reset’s services, which is in the top quartile for all health and wellness measures and has of the lowest sickness levels for work-related stress and anxiety at 0.2%.

Below is a summary of the key discussion points from the session, including more information about the work happening in Marie and Leslieann’s trusts as well as insight from Grant about the impact of Reset’s care model in different settings.

The scale of the NHS staff workforce challenge

Mark Butler introduced the session by setting the scene around the scale and significance of the NHS workforce challenge facing boards.

Quoting NHS Digital figures, Mark spoke about the significant rise in staff sickness and absence rates through the pandemic in 2020 at the start of the pandemic and these have stayed fairly high, with a number of trusts seeing absence rates of 10% and over, especially in the North East and Midlands. But also to their variable causes – aside from Covid-related absence, stress and depression, musculoskeletal and gastro are high contributors, with obesity and diabetes on the rise as well as long-Covid and sheer exhaustion.

Mark spoke about the substantial recruitment issue and the scale of vacancy rates across NHS regions with some, like London, standing at over 10%, and the associated challenge of retention. The disproportionate impact was also drawn to attention with higher rates of staff absence among the lowest paid NHS roles, which are also those most susceptible to the consequences of the cost-of-living crisis.

Mark also talked about the burning nature of the problem with its stark consequences as a strategic risk for health and care providers on a number of fronts:

• The significant cost of staff absence
• Its implications for service provision quality and safety
• The challenge it poses for operational planning.

Integrated care, market solutions such as Reset Health’s and the emphasis on staff wellbeing in the new trust code of governance create a landscape of opportunity.

GGI and Reset Health research on staff wellbeing and the new code of governance for providers

Simon Hall spoke next, starting by emphasising the importance of staff health and wellbeing. He said: “Healthier staff are happier, more productive and less likely to leave. A strong health and wellbeing offer and environment is also an increasingly strong recruitment draw and differentiator.”

Simon talked about the new code of governance for provider trusts put out for consultation by NHS England in May 2022 – the first revision since 2014, coinciding with the formal constitution of integrated care systems.

Simon then introduced the research that GGI and Reset Health have been doing on the new code and staff wellbeing, interviewing 14 trust chairs, chief executives, chief people officers and directors of governance and strategy. Centred around what the new code of governance for providers will mean for boards on staff wellbeing responsibilities set out in point 2.3:

"The board of directors should assess and monitor culture. Where it is not satisfied that policy, practices or behaviour throughout the business are aligned with the trust’s vision, values and strategy, it should seek assurance that management has taken corrective action. The annual report should explain the board’s activities and any action taken, and the trust’s approach to investing in, rewarding and promoting the wellbeing of its workforce."

Simon presented some of the key points from the research:

• He welcomed the focus that the new emphasis in the code brings but was sceptical about how much it would change board’s already do invest and report.
• Acknowledgement of the scale of the issue and the cost.
• The conditions are driving out lots of staff and making it increasingly hard to recruit.
• That Covid has put a renewed emphasis on staff health and wellbeing.
• It’s an increasingly complex picture and staff require increasingly tailored support.
• The cost-of-living crisis is a real threat and is exacerbating the challenges.
• There is a genuine desire and sense of intent to do more but this is constrained by financial pressures.
• There is a genuine desire and intent to do more to care for staff and improve their health.
• Generally pretty shallow understanding of staff sickness and absence on a number of boards.
• Lack of focus on the workforce challenges against other pressing issues.
• There are significant variations in how well equipped and engaged boards are to address the challenge –use of data, engagement on the issue, skills.
• Variability of board ownership and leadership on staff wellbeing.
• Evidence of some really good pockets of good practice and creative ways to fund staff health and wellbeing.

Governance and staff wellbeing

Marie, a former NHS acute trust chief executive and now chair of mental and community health trust, spoke about the new code of governance and the relationship between governance and staff wellbeing.

Alluding to one of Mark’s comments, Marie made the point that indeed the trust code of governance’s new emphasis on staff wellbeing investment was welcome, but this wasn’t anything that trusts weren’t already doing.

Marie spoke about the strength and importance of the ‘softer’ aspects of governance such as values and behaviours. She talked about how at SWYFT values and behaviours were a vital part of the organisation’s identity and genuinely a driver for a culture that had cultivated a sense of belonging and ‘one team’, which in turn had a tangible impact on staff wellbeing.

Marie also talked about All of Us, the trust’s staff wellbeing offer, which includes regular exercise sessions for staff, creative minds, where staff can take part in creative artwork, and things like support for holiday opportunities. Marie said that much of All of Us had been shaped by input from staff with channels in the organisation and governance structures set up so that the workforce had the opportunity to have a say about the kinds of support they felt would be most beneficial. This staff agency, for Marie, was essential: “It’s an important thing is for staff to have agency and be able to speak out about and shape the help they get. Our offer evolves and develops on this basis.”

Wrapping up, and acknowledging her trust still had some way to go, Marie concluded that overall SWYFT provided a culture where staff feel safe and connected to each other and a framework of support. She reflected on the challenge of retention and postulated that this is perhaps one area ICSs can help given the significant issue of trusts competing for and taking staff from each other.

A strategic approach to staff health and wellbeing

Next to speak was Leslieann, who gave some background on her trust as a medium-sized acute trust with about 4,500 employees. Leslieann took over responsibility for staff wellbeing in August 2020, having previously been in strategy roles, and her strategic approach to the workforce challenges has yielded some incredible results.

Talking about the trust’s strategy, Leslieann said: “Our strategy here is joy at work, and the health and wellness element is ensuring our staff are happy, healthy and heard.” She said her trust had adopted a holistic approach, merging the wellbeing and occupational health departments into a single staff health and wellness team.

She said Dartford and Gravesham had a weighing machine that gives staff their BMI and risk indices for conditions such as stroke and heart attacks. Leslieann contacted Reset Health when she realised that 10% of trust staff were at risk. The trust is currently on its sixth cohort of 50 staff members going through the Reset programme, which means around 300 staff have benefited from it.

The benefits of the programme are clear, she said. “It has reversed staff diabetes, it has reversed hypertension, it is improving their health. We are in the top quartile for all health and wellness measures on model hospital, and we now have probably one of the lowest sickness levels for work-related stress and anxiety. We're currently at 0.2% of our staff are off for stress related conditions.”

Leslieann said there was a strong focus on mental health support at the trust, with clinical psychologists and mental health support nurses on site. They have also looked at complementary therapies, including reflexology, Indian head massage and Reiki.

She said the programme had cost nearly a million pounds to deliver so far, adding: “If you're going to do it and do it seriously, you have to put staff wellbeing on par with patient care. It's got to be viewed as that important. We cannot deliver excellent patient care if we don't have staff that feel cared for, valued, healthy and happy.”

Leslieann said the trust has been exploring ways to develop the programme with Reset Health, as well as looking into ways to develop relationships with the local community and businesses – particularly with colleges and universities – exploring how to offer mutual support. She added that they were looking at possible commercial opportunities with local organisations, including Amazon and Tesla.

Thinking differently about staff wellbeing

Grant Harrison from Reset Health spoke about the importance of innovation in this space. He said Reset Health’s primary focus was on obesity and reversing type 2 diabetes, which they’re focusing on with a number of organisations including the NHS, Transport for London, National Rail, and HM Prison Service.

He said around half of the workforces Reset is working with are either overweight or living with obesity. And about one-seventh of people have type-2 diabetes, with 30% being pre-diabetic. He added: “We’ve found that they could reverse these conditions, generally without drugs and very cheaply. We’re seeing a metabolic impact, physical improvement, we’re seeing HbA1c improvements, and we’re also seeing anxiety and depression improvements.

“This mental wellbeing improvement is being picked up by clients who say to us: ‘We’d hoped we’d get a sickness absence benefit, but we didn’t realise we’d get a happier workforce’. If you can turn around these metabolic conditions within 12 weeks, as we are, and then continue to make improvements, people get really evangelical, and they start offering to mentor people in their own organisations.”

Grant said Reset was leveraging these mentors as part of the programme, paying them to advise others, which magnifies the impact of the doctors, nurses and Reset’s technology. He said: “We’ve realised that financial health is an important part of overall health and wellbeing so we’re extending the mentor rewards programme so that mentors who are helping other people can earn between £1,000 and £5,000 per month on top of their salaries.

“We’ve realised that metabolic health is best improved with a connected solution of clinicians and patients. Of the revenue we get in, we’re probably giving half of it back to mentors now because we’ve realised that mentors help to change behaviours and have a massive impact on people’s health. We see it as a sort of community of wellbeing and it makes a lot of sense for us, financially, to put our money where our mouth is.

“Our challenge as a business is finding organisations that say, first of all, ‘yes, health and wellbeing is important’, then identify the health and wellbeing problems that they have, and then say ‘actually, we’re going to spend some money on it’.”