Health and wellbeing conversations

Guidance for line managers on carrying out safe and effective health and wellbeing conversations with staff.

12 March 2024

Wellbeing conversations guidance

The NHS People Plan asks that all NHS staff have a health and wellbeing conversation, and are supported to develop a personalised wellbeing plan, from September 2020.

Furthermore, the Long Term Workforce Plan has emphasised the importance of retaining our valued NHS workforce. Employers should be looking at their wellbeing offer and critically evaluating the experience of staff through all stages of their careers. A positive staff experience and a rounded support offer are vital to encouraging staff to remain in the workplace.

Here are some ideas for things you might consider to ensure that quality health and wellbeing conversations and plans that best meet the needs of our diverse workforce are embedded within your organisation.

NHS England has previously delivered a national training programme for line managers aimed at supporting colleagues in having safe and effective wellbeing conversations. This programme has now ended and has been evaluated to understand how managers have used the training to support their teams. Although this training is now closed, there are many other support options available here

Who will hold the conversation?

In most cases, a health and wellbeing conversation may be held by a line manager or supervisor, but in some cases staff might want to have this confidential discussion with someone else. Whilst the main intention is for line managers to hold wellbeing conversations with their colleagues, we would encourage everyone within the team to support one another by regularly checking in.

Consider who else might have the skills, confidence and expertise to hold a sensitive conversation with colleagues – for example, mental health first aiders, members of your HR/OD function, other line managers in the same department, staff network leads, freedom to speak up guardians or wellbeing champions. It is also important to note that it is line managers who can make and implement changes for their staff so it is vital that line managers are kept informed to provide the appropriate support for their colleague.

Embedding conversations for all staff

Health and wellbeing conversations should be held regularly and could be incorporated into existing processes, such as one-to-ones, appraisals or job planning discussions. Alternatively, you could think about developing a new stand-alone process. Consider how any actions to support your colleague will be recorded from the conversation, either using existing paperwork/systems or using a personal wellbeing plan.

Support and training for hosting the conversation

Providing the right support to those hosting the conversations is important. You need to ensure the discussions are sensitive, open and valuable to staff members. Here are some elements to consider in your approach:

Guidance – line managers or facilitators will need guidance on what the health and wellbeing conversation should cover, what it shouldn’t cover, rules around confidentiality and safeguarding and to set the expectations of their role in the conversation and any follow up actions.

Skills - many people will already have the listening skills, emotional intelligence and sensitivity needed for this conversation, but others may need more support to feel confident having these conversations. See our web page on training for line managers.

Signposting – consider what additional information and signposting details would be useful. These conversations may cover a broad range of work-related and personal issues, can you provide signposting to support for potential topics? See our support available for NHS staff web page for an outline of free national support services for staff.

Support – it’s important that line managers/conversation facilitators know where they can go for support. In particular, you should consider what support mechanisms you have in place if it’s necessary to break the confidentiality of the conversation due to safeguarding concerns.

Support and information for staff

Staff members may also be nervous about discussing their personal health and wellbeing with others. You might want to consider the following in your approach:

Communications – how can you build trust and confidence in your workforce that these conversations are to support their wellbeing?

Diversity and inclusion - how can you understand more about your colleagues and are there any culturally appropriate approaches you may need to consider?

Guidance – as with facilitators, staff members should be given clear guidance as to what to expect from the conversation, the types of topics they will discuss, the confidentiality of the conversation and what happens after the conversation.

  • Improving the wellbeing of our NHS people is a long term culture change and we are committed to supporting NHS organisations to implement wellbeing conversations through the co-design of resources and shared learning. The following resources have been developed by NHS England in partnership with NHS Employers:


  • North Cumbria Integrated Care NHS Foundation Trust

    North Cumbria Integrated Care NHS Foundation Trust has replaced its annual appraisal with quarterly discussions between managers and staff, covering a range of topics including wellbeing, learning and development and performance. For each quarterly discussion, managers are given prompts to discuss elements of wellbeing with their staff members. For example, a discussion about the things which have a positive or negative impact on their wellbeing, and identify things that would improve their wellbeing.

    Warrington and Halton Teaching Hospitals NHS Foundation Trust

    Warrington and Halton Teaching Hospitals NHS Foundation Trust has developed a check-in meeting process for managers to support staff through the pandemic. This discussion focuses on recognising the contribution of staff during the COVID-19 pandemic, explores their physical and mental health, and any support the staff member needs. The trust has developed a manager template (PDF) and detailed manager guidance (PDF) to support this process.

    Wirral Community Health and Care NHS Foundation Trust

    Wirral Community Health and Care NHS Foundation Trust has embedded health and wellbeing conversations into its annual appraisal process. The appraisal conversation template (PDF) guides staff and managers through a range of topics relating to wellbeing, including work-life balance, the team culture, and any actions or areas for improvement.

    Lancashire and South Cumbria NHS Foundation Trust

    Lancashire and South Cumbria NHS Foundation Trust designed and developed a conversation workbook which would sit alongside and complement its current system, with the aim of ensuring meaningful wellbeing conversations took place during staff appraisals.

    Northern Care Alliance NHS Group

    Northern Care Alliance NHS Group explored various inclusive and compassionate ways to empower its staff to confidently discuss how they are feeling, through information conversations with their colleagues or during a confidential, wellbeing conversation with their line manager.

    Staffordshire and Stoke-On-Trent CCGs

    Staffordshire and Stoke-On-Trent CCGs explored how to use wellbeing conversations to support colleagues to work from home in a safe and ergonomically suitable environment, where necessary reasonable adjustments had been made.

    University Hospitals of Derby and Burton NHS Foundation Trust

    University Hospitals of Derby and Burton NHS Foundation Trust has created a health and wellbeing plan (PDF) that underpins the wellbeing conversation. The trust has shared this plan with its staff forum, wellbeing networks, executive colleagues and board wellbeing guardians who have all contributed to the plan. The plan has been launched with inclusion in organisational development work and will be embedded in appraisal, induction and leadership training.

    • Ensure you have a confidential space to hold the conversation – whether it’s taking place in person or virtually.
    • Give yourself enough time for the discussion, and make it clear you can have a follow-up conversation if needed.
    • Prepare by reading your organisation’s guidance and help the staff member prepare by ensuring they do the same.
    • Think about open questions you could ask as part of the discussion. You might want to consider some of the following:
      - How is your general wellbeing at the moment?
      - What is having a positive effect on your wellbeing at work?
      - What is having a negative effect on your wellbeing at work?
      - What would improve this?
      - Do you have any personal health and wellbeing goals that we can support you with?
      - Are there any issues inside or outside of work that have an impact on your health and wellbeing that you would like to talk about?
    • Wrap up the meeting by summarising any actions, reassuring the staff member of confidentiality and re-iterating any signposting.
    • Seek support yourself if you need any support for your own wellbeing.
  • Health and wellbeing leads from NHS trusts collaboratively worked on creating a personal wellbeing plan template (Word) that organisations can easily use if they do not have one of their own. This editable template allows you to include your own organisation logo and local sources of support and signposting such as your Occupational Health details for example.

    Mind's wellness action plan – Mind has developed a template to guide managers and staff through discussions about mental health, to help them identify specific challenges and actions to improve wellbeing.

Building health and wellbeing into everyday conversations

In addition to implementing health and wellbeing conversations and plans in response to the NHS People Plan, line managers, teams and colleagues should regularly openly discuss wellbeing. This section outlines a few different ways wellbeing can be build into everyday conversations.

  • Positive relationships and culture within teams support and foster a positive staff experience. When managers make time for and listen to their staff, this makes a difference to the team’s wellbeing and also to the patient experience. Managers could work with their team in a range of ways.

    • Regularly update the team on organisational or departmental health and wellbeing initiatives and support mechanisms – such as counselling, EAP services, coaching and staff networks
    • Open up a discussion with the team. For example, ask 'how can we work together to support the health and wellbeing of the team more effectively?'
    • Be aware of what’s going on in the team. Are you aware of team members that are showing signs of stress? Do you understand the health and wellbeing needs of your team?
    • Enable staff members to take time out of their day, for example, to access support or take part in wellbeing interventions.
    • Role model healthy behaviours, including taking breaks, staying hydrated and having something to eat.
  • The way a manager responds when staff call in sick can make a difference to how they feel about work. It could even affect the length of this absence and future absences. Compassionate and effective return to work meetings shows employees that their absence was noticed, that they were missed, and that the employer wants to take the time to find out how they are. They also show that effectively managing sickness absence is a priority for the employee’s wellbeing. Key questions managers could ask staff could be:

    • What’s the reason for the absence?
    • How long do you think you’re likely to be off?
    • Is there any work you’ve been doing that needs to be picked up while you’re off?
    • Is there anything else that may be affecting your wellbeing at the moment?
    • How is your general wellbeing now following your recent absence?
    • Are there any issues inside or outside of work that have an impact on your health and wellbeing that you would like to talk about?

    Find out more about managing conversations around sickness absence in our sickness absence toolkit.