Although there is no one-size-fits-all approach to improving the wellbeing of your workforce, the evidence base on the most effective initiatives and approaches is constantly evolving and can provide a useful basis for reviewing your approach and making decisions as we know how important it is to retain our valued NHS workforce.
The Long Term Workforce Plan and the NHS People Promise explore how having a positive staff experience and a rounded support offer are vital to encouraging staff to remain in the workplace. The information provided below can support you in making informed choices to look after our NHS colleagues.
The evidence base can be useful across your health and wellbeing strategy, including to:
- build your business case and gain buy-in for change
- inform decision making and help focus your approach, including funding decisions
- guide your approach to evaluation and reviewing your strategy.
The workplace health and wellbeing evidence base is constantly growing and evolving – do you know about a key study we haven’t included here? Let us know by emailing us.
Overview of the health and wellbeing evidence base
NHS Employers commissioned the Institute of Employment Studies to undertake a rapid evidence review of the evidence base of health and wellbeing interventions used in healthcare and their implications for wellbeing outcomes. The key learning generated by this review is summarised below. You can find out more in the full Health and Wellbeing Interventions Rapid Evidence Review, published in October 2020.
- There is no single one-size-fits-all solution for workforce wellbeing. Interventions with good take-up and which led to positive wellbeing outcomes were those where healthcare staff had options as to which interventions they could engage with and suited their wellbeing needs.
- The quality and extent of the evidence base is variable and needs more attention. Organisations often use a broad range of interventions, focusing on both mental and physical wellbeing, treatment-based and prevention focused interventions. The extent to which these interventions are robustly evaluated is variable. Organisations should pay great attention to evaluating their approaches, including both wellbeing outcomes and process evaluation, and may find it useful to partner with research organisations to do this robustly.
- A whole-system approach to wellbeing should be considered alongside interventions. This includes a focus on the whole employment experience, including element such as workload, autonomy, employee voice and management processes.
Our eight elements of positive staff experience web page details the eight elements that are essential for creating, implementing and evaluating an effective staff experience strategy.
The below documents and reports have been influential in shaping thinking and approaches in health and wellbeing across the NHS. These may help you to develop and review your health and wellbeing approach.
Why workforce wellbeing matters
The evidence base for why workforce wellbeing matters is well established. You might want to refer to the learning from these reports, studies and evidence to build your case for making changes in your organisation:
- The Francis Inquiry into Mid Staffordshire NHS Foundation Trust revealed the fatal impact of disconnected and detached staff with poor mental wellbeing and a lack of empathy and emotion.
- There is well-established evidence base demonstrating that poor wellbeing is correlated with poorer patient outcomes, summarised in the Healthcare Staff Wellbeing, Burnout, and Patient Safety systematic review
- Better staff experience overall is linked to better wellbeing, lower turnover and lower sickness absence, as outlined by The Kings Fund, 2018.
- Poor mental health in the NHS equates to £1,794- £2,174 per employee per year, according to HEE’s Staff and Learners’ Mental Wellbeing Report, 2019 (PDF)
- Institute of employment studies report summary: Presenteeism: A review of current thinking
- Commissioned by The International Public Policy Observatory (IPPO), a rapid evidence review and economic analysis looks at the financial impact of poor NHS staff mental health and wellbeing, and what can be done to improve it.
- The Chartered Institute of Personnel and Development (CIPD) Health and wellbeing at work, 2022, annual survey exploring health, wellbeing and absence in UK workplaces
- Economics of mental wellbeing: A prospective study estimating associated productivity costs due to sickness absence from the workplace in Denmark. This study uses data from Denmark to explore how different levels of mental wellbeing influence productivity costs and to estimate associated productivity loss on a national level. Take a look at What Works Wellbeing blog with considerations the study’s methodology and key findings, and what the insights mean in the context of workplace wellbeing in the UK.
- Latest research from the University of Southampton has found long shifts combined with poor staffing levels and little choice in working patterns are likely to be behind nurses experiencing burnout and exhaustion.
- The Society of Occupational Medicine (SOM) has produced an evidence-based report calling for a new strategy to tackle burnout. Burnout in healthcare: risk factors and solutions recommends a series of primary, secondary, and tertiary interventions employers can take, aimed at protecting employees against burnout and supporting those returning from absence to do so safely.
- The value of Occupational Health and Human Resources in supporting mental health and wellbeing in the workplace is the latest report from Dr Kevin Teoh at the Society of Occupational Medicine (SOM) and aims to encourage more effective interventions to support employees and colleagues in managing their mental health.
Health and wellbeing in the NHS workforce
There has been a plethora of research, studies and reports outlining the state of health and wellbeing for the NHS workforce, and making recommendations for change and improvement. Here are three seminal reports exploring wellbeing in the NHS:
- NHS Health Education England NHS staff and learners' mental wellbeing report, February 2019 - This report, led by Commission Chair, Sir Kenneth Pearson, reinforces the importance of promoting and supporting the wellbeing of NHS staff and those learning in NHS settings. The report examines at what the NHS are doing currently, where there is excellence and where the NHS can aspire to excellence. Take a look at our dedicated web page which can help support you to implement some of the recommendations from this report.
- The Boorman Review, November 2009 (PDF) - The final report of the independent NHS Health & Well-being Review was published on 23 November 2009. The report reiterates the case for change, and provides a comprehensive set of recommendations for improvement in provision of health and wellbeing across the NHS.
- Thriving at work - The Stevenson/Farmer review of mental health of employers, October 2017 Following the request from the Prime Minister at the beginning of 2017, Paul Farmer and Dennis Stevenson undertook an independent review into how employers can better support the mental health of all people currently in employment including those with mental health problems or poor wellbeing to remain in and thrive through work. This extensive report includes recommendations employers can adopt regardless of their workplace type or size. Our dedicated web page can help support you to implement some of the recommendations from the report.
- Five-year workplace wellness intervention in the NHS, June 2013, shows improvements in health behaviours, reductions in sickness absence and improvements in job satisfaction and organisational commitment were observed following five years of a workplace wellness intervention for NHS employees. These findings suggest that health-promoting programmes should be embedded within NHS infrastructure.
- The annual NHS Staff Survey is one of the largest workforce surveys in the world and is carried out every year to improve staff experiences across the NHS.
Initiatives in practice
There are a broad range of preventative and treatment-based physical and mental health initiatives, although there is no single best approach.
Read section four of the IES report: Health and Wellbeing Interventions in Healthcare: A rapid evidence to find evidence specifically relating to interventions from the NHS.
Below we’ve also curated a set of research studies around common health and wellbeing themes to inform and guide your approach.
Research by the Institute for Employment Studies in 2020 evidenced the benefits of workplace counselling, including: reduced sickness absence, reduced presenteeism and improving retention. Read the study in full to find out more, including how workplace counselling can be evaluated and adapted for even greater impact.
- The National Institute for Health and Care Research (NIHR) has published a summary of their research showing that an intervention to encourage office workers to stand and move reduced their sitting time after one year.
- The National Institute for Health and Care Research (NIHR) has also produced eight research findings addressing key risk factors for poor health in later life and helping you stay healthy as you age. Some offer reassurance, for example, about the value of exercise or weight management programmes. Others highlight differences in risk between different groups of people. All studies had important and actionable findings.
- The Work Foundation carried out a systematic literature review examining the breadth of evidence on workplace-based lifestyle interventions, including weight-loss, physical activity, smoking and alcohol.
- The BMJ's Effectiveness of the Stand More AT (SMArT) Work intervention: cluster randomised controlled trial paper shows how successfully reducing sitting time over the short, medium and longer term resulted in positive changes in work related and psychological health.
- The Device-measured physical activity and cardiometabolic health: the Prospective Physical Activity, Sitting, and Sleep (ProPASS) consortium study, supported by the British Heart Foundation (BHF) and published in the European Heart Journal, is the first to assess how different movement patterns throughout the 24-hour day are linked to heart health. Replacing sitting with as little as a few minutes of moderate exercise a day tangibly improves heart health, according to research from UCL and the University of Sydney.
What is a good job?
The What Works Centre for Wellbeing have summarised the range and quality of evidence demonstrating a link between high quality roles and better workforce wellbeing. Read the full report to find out more about the evidence relating to each of these elements of job design:
- job security
- social connections
- training and development
- role clarity
- employee voice and workplace culture.
Research Proves Your Brain Needs Breaks, Microsoft, Worklab, 2021
This study of brain wave activity in 2021 confirmed what many people sense from experience, back-to-back virtual meetings are stressful. The research also points to a simple remedy—short breaks. The research showed three main takeaways.
- Breaks between meetings allow the brain to “reset,” reducing a cumulative build-up of stress across meetings.
- Back-to-back meetings can decrease your ability to focus and engage.
- Transitioning between meetings can be a source of high stress.
The research also includes strategies/tips for making breaks successful—and beating meeting fatigue
Using quality improvement to deliver a systematic organisational approach to enjoying work in healthcare shares learning from East London NHS Foundation Trust’s programme which supported their colleagues to apply their quality improvement skills to try and understand what matters to their staff and what contributes to good days at work. The programme started in the trust in 2017 with 86 teams, clinical and non-clinical, from the organisation, and is based on the Institute for Healthcare Improvement’s (IHI) joy in work framework which provides an evidence-based approach to tackling the complex issue of staff experience using improvement science.
Enjoying Work Collaborative 38 teams from 16 healthcare organisations in England and Wales took part in this quality improvement (QI) programme in 2021-22 to understand and improve the experience, wellbeing and joy of staff. The results showed an improvement across the three outcome measures:
- A 50 per cent improvement in the percentage of people who have enjoyed being at work frequently
- A 41 per cent improvement in the percentage of people who are experiencing no symptoms of burnout
- An 38 per cent improvement in the percentage of people who are extremely likely to recommend their team as a place to work
- ACAS Work adjustments for mental health: a review of the evidence and guidance on making workplace adjustments for employees with mental health conditions.
- Mental health burden for NHS healthcare staff during the COVID-19 pandemic: First results of a longitudinal survey. This study was conducted and performed in collaboration between psychological researchers at the University of Sheffield and NHS staff working at the Sheffield Teaching Hospital NHS Trust. By understanding who may be most at risk of severe mental health difficulties during the COVID-19 pandemic, preventative measures could be implemented to develop a more robust workforce when future pandemics arise. Read the study for more information.
- What works to improve mental wellbeing in the UK: insights from WEMWBS. This review looked at 209 studies using the WEMWBS scales to evaluate the effects of interventions delivered across public, voluntary and private sectors. The broad themes for the studies were psychological, social, arts/culture and health promotion, with over half reporting statistically significant improvements in mental wellbeing post intervention.
- What could make a difference to the mental health of UK doctors? A new study commissioned and funded by the Louise Tebboth Foundation has revealed that UK doctors are at greater risk of work-related stress, burnout and depression and anxiety than the general population. The report, published in conjunction with the Society for Occupational Medicine, finds the incidence of mental health problems among doctors is increasing alongside growing demands and diminishing resources in the healthcare sector.
Mental Health First Aid
The evidence base on the effectiveness of Mental Health First Aid in organisations is mixed and conflicting.
- The Health and Safety Executive (HSE) research outlines that there is little evidence for the impact of MHFA on users of the service, but does have an impact on those trained as mental health first aiders.
- The Institute of Employment Studies (IES) point out the mixed evidence and caution against using MHFA as a solo approach, and that many other training and awareness raising approaches are effective in workplaces.
- The Institute for Occupational Safety and Health (IOSH) examined international examples of MHFA in contrast to other mental health awareness or intervention approaches. The research outlines the potential benefits and pitfalls of implementing MHFA in workplaces, and makes practical recommendations for organisations. As an output of this study, IOSH have developed practical tools for organisations to improve the implementation of MHFA alongside other approaches, including:
- Mental health first aiders: workplace considerations
- Mental health in the workplace: benchmarking questions
A realist informed mixed-methods evaluation of Schwartz Center Rounds® in England, 2018 - this report highlights that Schwartz Rounds offer a safe, reflective space for staff to share stories with their peers about their work and its impact on them. Interestingly, the report shows that there was no change in staff engagement scores of participants, but poor psychological wellbeing reduced significantly. Take a look at the report in more detail for the full findings.
Workplace Health Expert Committee (WHEC) is a scientific and medical expert committee whose purpose is to consider the evidence linking workplace hazards to ill health. WHEC's reports cover evidence reviews and position papers giving their independent expert opinion on key topics for workplace health.
Evidence from the What Works Centre for Wellbeing highlights the importance of organisational culture in achieving improved wellbeing outcomes. Read the report What works for health and wellbeing in the workplace? to find out more.
Research undertaken by the University of Central Lancashire (UCLan) and commissioned by CMP and the Healthcare People Management Association (HPMA) provides detailed analysis of the position of state of employment relations in the NHS across the UK in the aftermath of the COVID-19 pandemic and into a 'new normal' for people management.
The Society of Occupational Medicine (SOM) published their Organisational interventions to support staff wellbeing: Case studies and learnings from the NHS report. It looks at the most effective measures to support staff wellbeing in the NHS. The report was carried out by researchers working across Birkbeck, University of London, University of Nottingham and University of Sheffield, and includes current literature reviews, practitioner interviews, and in-depth case studies on this topic.
Read our summary of the Society of Occupational Medicine's report on effective interventions to support staff wellbeing in the NHS.