Dartford and Gravesham NHS Trust (DGT) is one of the largest hospital trusts in Kent, serving a population of around 500,000. DGT has 3,311 employees who provide a wide range of services. Over the last year, the trust has focused on creating a streamlined multi-disciplinary approach to the overall wellbeing of its staff. This streamlining happened by merging the occupational health (OH) and the health and wellbeing teams, which led to the newly formed health and wellness team.
Key outcomes and benefits
- A deeper understanding of what the health and wellness and occupational health job roles entail, and how working collaboratively provides proactive and preventative care for staff.
- A well-rounded health and wellness offer and a strategic approach to recruitment in the team to reflect staff needs.
- Sickness absence rates due to work-related stress and anxiety in the trust has more than halved to 0.5 per cent. The trust is in the top quartile of organisations for all health and wellness elements in the NHS Staff Survey.
What the organisation faced
DGT had two teams, occupational health (OH) and health and wellbeing (HWB), that were working independently to produce initiatives to best support staff experience. Both teams sat under the same directorate, but the idea of merging the teams was as a results of the impact of the COVID-19 pandemic.
Previously OH led on health and wellbeing initiatives, however, this changed as the pandemic took hold. Their focus had to shift to sickness management and COVID-19 initiatives. At the same time, a culture shift was happening nationally with health and wellbeing becoming increasingly higher on the priority list as trusts were forced to reassess how they were supporting staff.
As national initiatives grew, it was recognised that staff needed support from both teams. The impact of working separately meant there was a potential duplication of work, and staff who were seeking support weren’t given the full scope of what the trust could offer. The teams weren’t aligned with each other, and staff were increasingly wary of OH due to the connotations there was with HR. For example, if they were to approach the OH team, there was concern that this would be recorded and relayed back to the line manager, whereas the HWB team felt they were very trusted with the staff due to staff not having to access wellbeing services via HR.
Both teams had growing offers which were focused on different aspects of health. For example, the HWB team started to look at weight-management programmes. However, it was identified that this work might be enhanced by the inclusion of an OH perspective.
On top of this, OH referrals for staff mainly came from managers’ referrals, which in turn meant the outcomes and information from the OH meeting was not confidential to individuals. This created potential barriers for staff who didn’t feel comfortable to approach their managers and could have resulted in staff, worried about seeking the much-needed support, falling under the radar of the teams and potentially leaving their role at a time when retention is incredibly important.
What the organisation did
The decision to merge the two teams together allowed DGT to develop and deliver a multi-disciplinary approach to staff health and wellbeing. The first step to merging the teams was to really understand what the individual teams did. The quality improvement team was brought in to develop a functional matrix to find out exactly what people did in their daily roles, and to highlight any duplication of work between the two teams. This matrix demonstrated gaps within the team, meaning the trust could identify what was needed and begin to shape a well-rounded health and wellbeing offer.
It was also felt that the title health and wellbeing no longer best advertised what they did. Feedback from staff highlighted the term wellbeing was being overused. Health and wellness was adopted as this best demonstrated what the two teams delivered. The role of OH continues to be incredibly important, and this has not been diminished throughout this change. The outcome is now that the team can deliver a highly engaged, supportive wellness strategy for staff.
To be able to support individuals from the two teams throughout the process, the trust planned away days to build strong relationships to unify and create bonds. This enabled the organisation to understand where staff may need further support as the teams were merging and listen to how individuals were feeling.
Results and benefits
The health and wellness team still has several months to go before any quantitative evaluation can be examined however, qualitative data is positive. DGT has successfully created a health and wellness team that is supporting staff to stay well through a multi-disciplinary approach.
The trust joined forces with the reset health programme, a weight loss initiative, to transform the health and wellbeing of frontline NHS staff over the course of the COVID-19 pandemic. Since September 2020, they on-boarded a total of 246 members of staff onto the programme across five cohorts. The aim was to create a healthier workforce, and support those looking to develop a healthier lifestyle. The results show that both the mental and physical health of staff has improved, key findings include:
- more than 20 per cent increase in the proportion of members reporting no anxiety after 12 weeks
- more than 30 per cent increase in the proportion of members reporting no depression after 12 weeks
- approximately 30 per cent increase in the proportion of members reporting a reduction in binge eating
- an average of 10 kg (10 per cent body weight) lost per person after one year.
Since the merge of the two teams, the trust has seen a reduction in work-related stress and anxiety sickness rates against previous trust figures. As of September 2022 it sits at 0.5 per cent. This is compared with September 2021, when the work-related stress and anxiety sickness rate was at 1 per cent. The trust is also in the top quartile in most modal hospital indicators. Although this isn’t the only way to measure success and measure wellbeing, this is a strong indicator that centralising staff wellness has worked.
Since forming the new health and wellness team, the team has been more transparent about how staff can approach it confidentially rather than through a managerial referral. One of the many benefits of creating the health and wellness team has been the ability to offer options other than occupational health. For example, staff can refer themselves directly to the mental health teams in the trust. The team also actively promotes support systems that are outside of the trust, such as the Samaritans.
The feedback that the team has received confirms the positive impact the newly-formed team has had. Staff are aware that the self-referral process is confidential, and they can offer staff pathways to support both within and out of the trust. Staff have reported feeling more comfortable approaching the health and wellness team with this knowledge. Managers are still able to refer staff however this isn’t a confidential route. A priority for the team is making sure staff feel safe and comfortable when using their services.
With the prospect of the two teams merging, people felt uncomfortable with sharing their work without feeling threatened. The trust responded to their concerns by planning team development days which created safe spaces to help people open up and work through their differences/challenges.
The team operates in-team development days once a quarter, where they have an environment where they feel safe to engage in open and honest conversations.
The health and wellness team is aiming to change the culture within the trust with support from the trust board to ensure that staff health and wellness is seen equally important as patient care. One of the ways it has done this is through rostering in self-care time. This time is used for staff to attend reflexology appointments or any other initiatives that are available through the team. Another way it has encouraged this is through a retreat. Teams are encouraged to attend a local retreat where they practice forest bathing, mind work and other activities. This has been trailed with clinical teams and is approached in the same way as annual leave: planned in advance. What has been key to making this work is a change in mindset and understanding the value this adds to staff experience at the trust. The retreat will be rolled out to wider staff, with the aim to be available to everyone.
- Ensure your ethos is clear and you can articulate to the teams why merging the teams is important.
- Combine the team together, don’t just hand them over. Plan for away days and dedicate the time needed to build these relationships.
- Listen to what your staff want from the health and wellness team.
- Use your quality and improvement team to formulate a matrix to truly understand individual roles.