Nurse health and wellbeing should be 'core principle' for NHS trusts
Trusts should be held to account for improving the health and wellbeing of their workforce, the NHS Future Forum has recommended.
The forum was originally set up by the government to advise on changes to the health bill but was then given a second set of health areas to investigate. These were education and training; integrated health; information and the public’s health. Reports on its findings were published today.
The forum’s worksteam on the “public’s health” has called for clinicians to broach health and wellbeing issues with patients at every opportunity, so that they “make every contact count”.
However, the review group warned that the NHS must first “put its own house in order” before healthcare professionals could be expected to try and improve the health and wellbeing of their patients.
Their report recommended that trusts should design and implement strategies for improving the physical and mental health of staff, a move previously recommended by the Boorman review of NHS health and wellbeing in November 2009.
However, the future forum highlighted that this and the other suggestions made by Boorman were yet to be fully implemented by many NHS organisations. It said that in future chief executives should be expected to report to the board annually on progress made on improving staff health and wellbeing and that supporting staff to improve their health and wellbeing should be a “core principle” of every NHS organisation.
The report also noted that the quality of occupational health services for NHS staff was currently “variable” and recommended that in future it should be accredited.
It added that managers should be trained to support the health and wellbeing of their staff – though it admitted success was also dependent on the attitude of staff themselves.
The report stated: “We have heard that progress will only be made if NHS leaders are accountable for helping to improve the health and wellbeing of their staff. However, we were also told that the impact of NHS leaders can have is dependent on the input and commitment of their staff, and we would encourage the workforce to acknowledge their own responsibility.”
Workstream co-chair Ash Soni, pharmacist and clinical network lead for NHS Lambeth, told Nursing Times: “The evidence is that actually improving the health and wellbeing of the workforce actually reduces costs by helping staff to be better valued and more productive.”
As stated above, the other major recommendation made by the group was to make “every contact count” between a health professional and a patient. This it said would mean clinicians at an individual level would have to “reassess how they use their time with the public”.
It said the NHS constitution should be changed to “emphasise” staff responsibility to use every contact with patients to improve their health and wellbeing, “whatever their specialty or the purpose of the contact”.
The report stated: “Simply put, they should aim with every contact to offer advice and support to maintain or improve a person’s mental and physical health and wellbeing, which might mean looking outside their initial symptom or concern. This was a clear message in our engagement, and the public expects it.”
However, the report noted that some clinicians may need further training in areas such as nutrition and obesity, and proposed that in future universal training in public health could be provided in the same way as currently done for child safeguarding.
Mr Soni said: “The ability of staff to act as advocates must not be underestimated. There are going to be some education and training requirements to support making every contact count by helping develop the right skills where necessary.”
The workstream said health visitors and practice nurses were among the groups that had told them they were “enthusiastic” about broadening their health wellbeing responsibilities.
Faculty of Public Health president Lindsey Davies said she supported the “every contact counts” initiative but with caveats.
“We don’t want healthcare professionals to be telling off ill people,” she said. “Professionals do need to think holistically about the needs of the person in front of them.”
Royal College of Nursing chief executive and general secretary Peter Carter said: “The RCN recognises that nurses have a crucial role to play in preventing problems from developing in the first place, and intervening early before major damage is done.
“However, messages alone will not work, it will need strong leadership to evoke a cultural change to the way that the NHS has previously been seen.”
He added: “Equally, the right services must be in place to refer patients onto, with specialist staff to support lifestyle changes. With more than 56,000 posts at risk in the NHS and nurses who tell us every day that low staffing levels mean they can’t do as much for their patients as they would wish, the government must act fast to boost the public health workforce.”
In its response to the forum’s recommendations on public health, the government said today it will seek to ensure they were “acted on in full, so that preventing poor health and promoting healthy living become an integral part of the way the NHS conducts its business”.
It said it would consider adding a “new responsibility for healthcare professionals to promote healthy living through their daily contact with patients” to the NHS constitution. It said it would hold a consultation on the idea in autumn 2012, as part of its next update to the constitution.
The government also said it backed a proposal for using appraisals to “incentivise” employees to take advantage of every contact with patients. “The use of appraisals with specific measures on making every contact count is a practical step that employers could reasonably consider taking,” it said.
Regarding improving the health and wellbeing of the NHS workforce, the government reiterated commitments on the issue in the NHS constitution and the 2012-13 operating framework, adding that it would continue to implement recommendations from the Boorman review.
It also said the forum had provided a “valuable renewed focus” on the need for trusts to develop health and wellbeing strategies for their staff, and it would be publishing “detailed guidance” on this “over the next year”.
Summary of main recommendations on public health:
- Every healthcare professional should use every contact with an individual to maintain or improve their mental and physical health and wellbeing where possible, whatever their specialty or the purpose of the contact
- Health Education England, Public Health England and the NHS Commissioning Board should build a coalition with professional bodies to agree a programme of action for making every contact count
- NHS organisations should design and implement a strategy for improving staff mental and physical health and wellbeing. They should report annually on their progress against this strategy and hold their chief executive, or other senior responsible officer or partner, to account against it
- All providers of NHS‐funded care should build the prevention of poor health and promotion of healthy living into their day‐to‐day business. NHS commissioners should ensure providers of NHS‐funded care redesign their business in this way, using contracts and incentives to encourage providers to improve health and wellbeing and reduce health inequalities
- NHS commissioners and providers of NHS‐funded care should use partnerships with other local services to improve the health and wellbeing of communities that the NHS locally finds difficult to reach, providing training where appropriate
- Healthcare professionals, NHS commissioners and providers of NHS‐funded care should share learning about improving the public’s health and wellbeing and reducing health inequalities, and seek to learn from others