Cambridge and Peterborough NHS Foundation Trust (CPFT) are undertaking a number of activities to improve staff mental health and wellbeing at work. These include: - the establishment of a new Staff Wellbeing Service - Wearing 2 Hats - Staff Health and Wellbeing Strategy 2019-2022 - Schwartz Rounds - mindfulness groups The broad range of activities that CPFT is offering to support the mental wellbeing of staff demonstrate the Trust’s commitment to enabling staff to build resilience and maintain a good level of mental health. It is important to CPFT to provide a good experience of working for the Trust and ensuring that staff feel able to meet the demands of working within health and social care.
Please briefly describe your project, group, team or service, outlining what you do and why it makes a difference.
Cambridge and Peterborough NHS Foundation Trust (CPFT) are undertaking a number of activities to improve staff mental health and wellbeing at work. These include: – the establishment of a new Staff Wellbeing Service – Wearing 2 Hats – Staff Health and Wellbeing Strategy 2019-2022 – Schwartz Rounds – mindfulness groups The broad range of activities that CPFT is offering to support the mental wellbeing of staff demonstrate the Trust’s commitment to enabling staff to build resilience and maintain a good level of mental health. It is important to CPFT to provide a good experience of working for the Trust and ensuring that staff feel able to meet the demands of working within health and social care. The Health and Wellbeing Strategy covers the next three years and defies the Trust’s long-term goals to improve the health of our workforce and build resilience. It includes goals around leadership and management, data and communication and healthy working environments as well as goals to improve health interventions around mental health, musculoskeletal and healthy lifestyles. The Staff Wellbeing Service was permanently established in 2019 after a successful pilot project looking at improving access to musculoskeletal physiotherapy services. The aim of the Staff Wellbeing Service is to provide support to staff around both physical and mental health concerns, ensuring that our staff remain well at work.
The longer term aims of the service are to reduce presenteeism and sickness absence through using a coaching and enabling approach. Wearing 2 Hats is an established group within CPFT that seeks to 1) support staff with long term conditions (both mental and physical), 2) support staff who care for loved ones with health challenges, 3) enable managers to support staff members with lived experience and 4) support the organisation through establishing a culture that is compassionate and caring. Wearing 2 Hats has two components – business meetings, where staff with lived experience can influence Trust policy and procedures and a peer support element, run separately from the business meetings, where staff can receive and offer support to each other, as required. Schwartz Rounds are a multidisciplinary forum designed for staff to come together once a month to discuss and reflect on the emotional and social challenges associated with working in healthcare. Rounds provide a confidential space to reflect on and share experiences. Evidence suggests that people attending Schwartz Rounds regularly report feeling less stressed and less socially isolated. The Schwartz Round project invites staff from across the Trust to join together, further enhancing integration by providing insight into the different roles within the organisation and enhancing understanding of the scope of services that we offer. Schwartz Rounds celebrate the commonalities in what we do, reflecting on caring for people and the impact of this has on staff. Because our Trust works across four localities we rotate the venues for the Rounds geographically to help staff to be able to attend with minimal travelling.
The first Round was held in April 2019. Rounds are open to all CPFT staff, clinical and non clinical. Mindfulness groups are run on an 8 week rolling basis across the Trust. Our Mindfulness programmes are tailored to the needs of busy NHS staff working at all levels of the Trust. It combines cognitive neuroscience with mindfulness and practical strategies for developing resilience and maintaining well-being, both in the workplace and at home.This is a course suitable for all staff at every level in any role within the organisation. CPFT is an integrated Trust providing both mental and physical health, community and inpatient services across Cambridgeshire and into parts of Norfolk and Northamptonshire. We support a population of just under a million people and employ nearly 4,000 staff. Our biggest bases are at the Cavell Centre, Peterborough, and Fulbourn Hospital, Cambridge, but our staff are based in more than 50 locations. This presents a challenge in supporting the mental health and general wellbeing of such a diverse staff group. In order to meet this challenges, events and wellbeing activities as described above are run in a variety of locations and at varying times to try and capture as many staff as possible. The Staff Wellbeing Service reaches out to staff and will flex to meet at a time and place suitable for the staff member.
What makes your service stand out from others?
What makes the CPFT staff wellbeing offering stand out from others is the diverse range of services/activities that are provided. The positive actions taken to support staff mental health are initiated and acted upon from the “top down” e.g. the Staff Wellbeing Strategy 2019-2022 and the “bottom up” e.g. Wearing 2 Hats. These varied approaches ensure that there is something for staff to be involved in, should they wish, at all levels of the organisation. It also ensures that the culture of supporting staff wellbeing is clearly set. Staff can be involved in these services as active participants and/or in receipt of support. For example: Xx is employed by CPFT as an administrator. She also has depression. Xx attends Wearing 2 Hats, in addition to her role as an administrator. Her line manager is supportive of her attending Wearing 2 Hats as xx brings information about best practice in managing staff with mental health and long term conditions back to her team. As part of this she is involved in work around reviewing sickness absence policies and guidance. She also attends the peer support element and finds this useful when she is having challenging times but also enjoys being able to support other staff in the Trust. XX experiences some back pain so refers herself to the Staff Wellbeing Service. She has a telephone conversation with the occupational therapist there who agrees to come to her workplace and assess the environment. They also discuss the interplay between mental and physical wellbeing, and xx notes that her back is worse when her mood drops, which she had not previously been aware of. The occupational therapist supports xx to develop strategies to manage her back pain and refers on to musculoskeletal physiotherapy. The occupational therapist also signposts xx to the counselling service which is part of the CPFT employee assistance programme. The combination of these measures supports xx to remain in work and avoid a period of sickness absence.
How do you ensure an effective, safe, compassionate and sustainable workforce?
The staff who work in the various strands of CPFT’s approach to staff wellbeing come from diverse backgrounds (HR, occupational and physio therapy, peer work, psychology, chaplaincy) and are each supported through their substantive team. Some of these staff have substantive roles specifically to support staff (such as the Staff Wellbeing Service), others see this as one part of their role (such as those who run Schwartz Rounds) and other aspects staff do in addition to their core role (such as Wearing 2 Hats). We are each enabled to provide activities that support staff wellbeing through our substantive roles, and work collaboratively from our different perspectives to provide a package of activities that support staff mental health and physical wellbeing.
Who is in your team?
Staff Health and Wellbeing Strategy – Emma Byrom, Workforce Development Manger and Elaine Bailey, Associate Director for People Services Staff Wellbeing Service – Annelies Franklin, Staff Wellbeing Lead (occupational therapist) B7 0.6WTE, Jo St Pierre, occupational therapist B6 1.0WTE, Jo Wallis, physiotherapist B6 0.4WTE Schwartz Rounds –Dr Anna Forrest, consultant clinical psychologist, John Nicholson (chaplaincy), Debbie Brown, clinical director Wearing 2 Hats – Sharon Gilfoyle, Head of Inclusion Mindfulness – Jo St Pierre, occupational therapist B6 and Lyn Eldred, nurse B6. Both are employed elsewhere in the Trust and their line manager supports being release for 4 hours a week to run mindfulness groups
How do you work with the wider system?
The various strands of the CPFT approach to improving staff mental wellbeing work with the wider system in the following ways: Staff Wellbeing Service – links with other local staff wellbeing services to co-deliver where possible through the Cambridge Biomedical Campus Wellbeing network. Wearing 2 Hats – The forum and the peer support group are committed to sharing the learning with the rest of the organisation and its wider partners. There are now a number of staff support groups within Mental Health Trusts and we feel we need to be sharing the work of all of these to wider NHS organisations and mental health services. We are also part of a health and wellbeing network group (Cambridge Biomedical Campus Wellbeing Network) in Cambridge, whereby documents, posters and leaflets about the group have been shared with other NHS, third sector (Mind) and Private organisations. We have also been working with other public sector organisations including the Police, Fire and Rescue, Ambulance, and the Councils to see if we can work more closely together to support our staff with their own long term conditions. Schwartz Rounds the Rounds are run by CPFT staff for CPFT staff. We have had support from the Schwartz team at Cambridge University Hospitals to attend one of their rounds and to learn from their experience of running rounds.
Do you use co-production approaches?
The services as described are for staff who are employed by CPFT. As such, co-production in the traditional sense was not strictly appropriate for these services. However staff, as the users of these services, have been consulted in their development.
Do you share your work with others? If so, please tell us how.
Staff Wellbeing Service – this is a new service, and as such has not yet had the opportunity to formally share our learning and development. We do however collaborate with other, similar services through the Royal College of Occupational Therapists specialist section for work, and the Cambridge Biomedical Campus Wellbeing Network. We are seeking to build local networks, for example, to offer yoga groups to staff from CPFT jointly with other local NHS services. Wearing 2 Hats – W2H has increased its profile on social media with anti-stigma campaigns and sharing publications such as the staff stories book. The excellent work of W2H has also been shared at the House of Commons in 2019. W2H also shares good practice through the mental wellbeing of staff special interest group of the Positive Practice Collaborative. Schwartz Rounds – Rounds only started running in April 2019 but we are collecting data to evaluate the impact of these which will be shared.
What outcome measures are collected, how do you use them and how do they demonstrate improvement?
Staff Wellbeing Service – to date, the service has been reviewed using PROMS and PREMS in the form of focus groups and individual questionnaires. The service is currently reviewing the type of outcome measures that are available in order to gather more robust data. The information gathered is summarised below: What difference did the service make? · Being referred to MSK PT made a difference. · Actually seeing someone face-to-face. · Equipment provided. · Service has been brilliant/fantastic. · Getting rid of my pain. · Feeling valued, felt positive getting MSK from private physio. · Active treatment intervention compared to NHS. Overall, how much do you feel your wellbeing has changed since you first came to the Staff Wellbeing Service? 1.1 Very much better 12% 1.2 Much better 41% 1.3 A little better 28% 1.4 No Change 16% 1.5 A little worse 3% 1.6 Much worse 0% 1.7 Very much worse 0% Overall, how much do you feel your Health has changed since you first came to the Staff Wellbeing Service? 1.1 Very much better 19% 1.2 Much better 34% 1.3 A little better 38% 1.4 No Change 9% 1.5 A little worse 0% Wearing 2 Hats – We believe it’s the change in culture, and qualitative feedback that we receive that indicates the real differences its making for our staff, and in turn our colleagues and service users.
Wearing 2 Hats is developing our culture and interactions so we are more supportive, better equipped and not afraid to have positive conversations about mental health and any other long term condition. Here are some of the quotes we have received from members of the Wearing 2 Hats group and those who have used the buddy system: • “I don’t know what I would have done without the support I received from staff member x (W2H) without this I would not be back on my recovery journey and be back at work.” • “I was fortunate to be involved in the W2H and peer support groups almost from the beginning and having them within the Trust has helped it to feel a lot more human and supportive than other Trusts I have worked for. It has given me the opportunity to support colleagues and be part of the setting up of a buddy system for those struggling with mental health issues at work and needing a confidential listening ear. I, in turn, have benefited from that listening ear and not felt the least bit stigmatised or disrespected for having the need. It has also exposed me to others in the organisation who really care about their colleagues and encouraged me that despite it being a huge organisation we can, little by little, influence it for the better.” • “It has offered such an opportunity at all levels for staff with mental health needs to be honest, ask for support when needed and for our opinions to matter.” • “Having a forum of W2H gives me, as a staff member, the valuable space to be a part of shaping the care for colleagues who live with their own mental health challenges.” • “I would also especially like to thank staff member X from the W2H initiative. If it wasn’t for her support I don’t know what I would have done. She is a true asset to CPFT.” • “I feel wearing Two hats is a brilliant portal for finding out more information on working and living with mental health within CPFT.” • “Its been great to get some feedback on our processes and policies from people who have been on the receiving end of them, some great changes have been made thanks to the Wearing 2 hats acting as a lobbying group as well as working in partnership with HR.” • “I am so thrilled that we have developed our W2H forum, I am able to be open and honest about my mental health challenges in a safe, welcoming and compassionate environment.” • “I have never felt able to disclose my mental health issues to my manager but with the support of the W2H forum I feel this is something that I will now try to do.” • “The stigma associated with mental health is enormous and I think this is even more so working in a mental health organisation.
The w2h forum is a brave step to rise our heads above the parapet and sing the praises of the courageous staff members who live with their own mental health challenges as well as working as professional in mental health services.” • “I am proud to be a member of w2h and I absolutely believe that I am a better and more compassionate manager / staff member because of my own challenges.” Schwartz Rounds- at the end of each Round evaluation forms are completed by each attendee asking them to rate the Round on a number of dimensions, including relevance to role, benefit to patients, intention to attend future rounds and the likelihood of them recommending rounds to others. We also collect information about those attending including which profession they are from, and how they heard about the rounds. Qualitative feedback is also sought. This is a selection of the comments from attendees from the first two Rounds: “A quietly powerful forum in which to listen and have time to reflect. I have the greatest respect for the panel members and my colleagues”. “Good to see these added to the menu of support options”. “It helped me reflect on own experience and that we are able to express our emotions”. “Out of the ordinary and much needed”.
Has your service been evaluated (by peer or academic review)?
How will you ensure that your service continues to deliver good mental health care?
Overall, CPFT has made a commitment to staff wellbeing through the establishment of the Staff Wellbeing Service, and the support given to Wearing 2 Hats, Schwartz Rounds and mindfulness groups. Staff Wellbeing Service – in 2019 CPFT made a commitment to provide ongoing funding to provide this service. In terms of continuing to deliver good mental health care, we are working with colleagues in-house and in other, more established services, to understand what a gold standard service for staff mental health would look like. We will then develop a plan for staff to access primary, secondary and tertiary mental health services, considering what we can do with current resource. Mindfulness – CPFT has made a commitment to this by training staff members in-house to offer this service to staff. Staff who facilitate this are supported by their line managers to take 4 hours a week out of their substantive roles to facilitate the group and/or take part in CPD activity. CPFT is looking at how this offering can be expanded in order to enable more staff to access mindfulness.
Wearing 2 Hats – The group has different leads for the different workstreams. Each workstream has input from other members of the group, this supports the group in being more sustainable. The Trust has recently re-launched the Diversity Network, who wish to provide the strategic direction, energy and momentum for promoting and maintaining equality and diversity across the Trust. This has bolstered the structure and also the support for the Wearing 2 Hats group. They champion the work of the Wearing 2 Hats group and again will support the sustainability of the group. The group has a terms of reference and has flexibility built in, so as we feel a workstream is completed we will move on to the next relevant thing, constantly asking for feedback and constantly moving the agenda forward. Schwartz Rounds – our initial contract with the Point of Care Foundation is for 2 years and this was funded by the Older Peoples and Community (OPAC) charitable fund. This has had support from the Chief Executive. Ongoing costs (venue hire and refreshments) are being covered by the OPAC directorate, but this may be reviewed depending on take up by staff from the other directorates. Our intention would be to fund some more training places for facilitators to help the sustainability of the Rounds in the future. The Trust is committed to delivering Schwartz Rounds within the organisation and supporting people to take part in these.
What aspects of your service would you share with people who want to learn from you?
The different parts of the CPFT staff wellbeing offering have encountered different challenges at different times. However there has been an overarching challenge of beginning this work in a culture where staff do not feel confident to share their mental health challenges with colleagues. As more people to share their challenges, and more services like W2H, Staff Wellbeing Service and Schwartz Rounds are established, the culture is slowly shifting. Staff Wellbeing Service – the challenges this service has faced include the following: · Our staff don’t all live (and work) in Cambridgeshire, so if the service were to continue this would need to be factored in, with additional Physiotherapists available in fringe counties. · Others would have liked more follow up sessions and more input from the Occupational Therapist. This is something that has been frustrating for the Service too, knowing this would be advantageous but not able to offer it due to resource constraints. · Some of the Physiotherapists used worked in a corporate way and not inline with NICE guidelines, i.e. not leaving long enough periods between physio sessions for exercises and then asking for additional treatment sessions at the end. · Some staff still don’t know the service exists and aren’t clear about what’s available. · Not enough resource to engage in more promotional work, self management training and mental health support. · Much of the Occupational Therapist’s time was spent completing administrative duties or workplace assessments which could be done by a more junior member of staff and enabling more occupational assessments and prevention work. Many of these challenges have been resolved by making the pilot service a substantively funded one.
A permanent manager with occupational therapy background has been appointed in order to develop the service to address staff wellbeing more holistically, with a specific focus on mental wellbeing. Wearing 2 Hats – Initially, a request was put out to see if staff wanted to come together in a forum to support each other or the organisation make improvements to the way staff are supported. Only 2 staff members came forward at this point so unfortunately we decided there was not enough support to make this work, so it went on the back burner. Subsequently we put this opportunity out to the organisation about 3 years ago and no-one came forward at all, so once again it was shelved. However more recently there seemed to be an appetite for staff to come together with the purpose of supporting each other, so we put out a request again and we had about 20 people contact us to say they would be interested. This continues to grow each time we meet and as more people ‘come out’ about their own challenges then it paves the way for other staff to do the same. I think in hindsight what we should have done years ago was brought the 2 people together to form a small group and then see if it would gain momentum as it has done this time. I think by not doing this we may have lost several years’ worth of positive work that we could have achieved. One of the challenges that we have encountered is for managers to provide protected time for staff to attend the forum, rather than it feeling as though this is luxury time out. With the increase in workloads and a shortage of resources staff feel under pressure to do more, and often this means that the support they need themselves gets neglected.
By promoting the Wearing 2 Hats forum through Senior Leadership group and through HR and Occupational health. The Wearing 2 Hats group is seen as part of the support network that keeps people well and at work. We have also added a Buddy scheme, which is an initiative that has evolved out of the Wearing Two Hats group and is designed to provide a listening ear to colleagues within the Trust who have their own mental health challenges and are in work but may be having a particularly bad day. Several colleagues, some of whom have their own lived experience and others who are “allies” (ie people who do not have lived experience but are passionate about this issue) have volunteered to become “buddies”. Our Organisation has changed considerably since the group started, having moved from a predominantly Mental health Trust to an Integrated Care Organisation. The language we use such as ‘Recovery’ is not as well understood by those in the physical health side of the Trust. So, more thought is needed when promoting who we are and what we can offer. It has also highlighted that we have other staff with lived experience of conditions such as; Diabetes, Irritable Bowel Syndrome, Cancer and Stroke, they also wear 2 hats. So we have opened up the groups remit further to support, represent and lobby on the issues of staff with any long term condition.
Another challenge was the number of staff who were keen to be updated but didn’t want to be seen as being involved, due to the Stigma associated with mental health. The number of staff feeling this way has reduced, with more now coming to the meetings and feeling comfortable in opening up to their managers and colleagues. Again, the engagement with Senior Leaders and the Anti-stigma campaign, along with the increasing numbers attending each meeting has highlighted that they are not alone. Schwartz Rounds- Rounds started in acute hospital and delivering them in the community is challenging. Rotating venues helps staff in different locations to access the Rounds, but means that there is less opportunity to build up a monthly following of regular attendees. Hopefully we will establish a regular following in each locality (which we will visit every 4 months). Rounds have helped staffed to understand each others roles more and to share experiences. They have started an honest and at times emotional discourse about the work we do and showed the importance of us acknowledging difficult emotions.
The following questions are an opportunity for you to provide further details on how you implement positive practice in your service delivery and how you ensure your service is advancing access and equalities. Answers to these questions will not influence how your PPiMH awards application is assessed, however any responses received may contribute to the potential inclusion of your service/team as a positive practice example within published guidance developed by NCCMH and NHS England.
How many people do you see?
Wearing 2 Hats – over 70 staff regularly access the forum Staff Wellbeing Service – 112 referrals Mar 2018-Jan 2019 (10 months) – note referrals are often made for back pain (or similar), and when SWBS discusses referral with the staff member the situation is often more complicated and the initial referral reason may be a symptom of stress or similar. Mindfulness – 8 week groups, 12 attendees per group, 4 times per year 2018-19 Schwartz Rounds – 65 staff have attended the first two Schwartz Rounds.
How do people access the service?
Staff Wellbeing Service – staff access the service by referring themselves, or their manager can refer, with the staff members consent. This is done by email. Staff are made aware of the confidentiality and disrecretion provided by the service to encourage referrals from those who may be unsure about sharing personal information. Appointments are offered at a location of the staff members choosing, not necessarily at their place of work, if that is what will support the individual to access the service. Referrals are triaged by either the physiotherapist or occupational therapist. Musculoskeletal issues are seen by the physiotherapist, and mental health or long term conditions by the occupational therapist. Schwartz Rounds – Staff do not have to book into the Rounds, they just turn up on the day. The Rounds are promoted through the directorate, in the Trust Staff News and through social media. We also have a dedicated web page with information about what the Rounds are, details for how to get involved and including the dates for future rounds. Mindfulness – staff can register their interest by emailing the facilitators. This is promoted in the Staff News. The group runs for 8 weeks at a time and the location is varied each 8 weeks to try and capture as many staff as possible in different areas.
How long do people wait to start receiving care?
Staff Wellbeing Service – referrals to the service are acknowledged and initial contact is made within 5 working days. Mindfulness – staff may have to wait until the next group begins in their area, usually no longer than 8 weeks
What is your service doing to identify mental health inequalities that exist in your local area?
Data is being collected about uptake of the Staff Wellbeing Service, Schwartz Rounds and Mindfulness groups provided by CPFT for their staff. It has been noted that the geographical diversity of the Trust area can disadvantage staff working in rural areas. The varied workplaces of CPFT staff can make it challenging for those who work in clinic or ward environments to access these wellbeing services. Ways of addressing these issues, such as staff wellbeing service running regular drop ins in rural areas are being considered.
Commissioner and providers
Commissioned by (e.g. name of local authority, CCG, NHS England): CPFT
Provided by (e.g. name of NHS trust) or your organisation: CPFT
Brief description of population (e.g. urban, age, socioeconomic status):
Collectively, the Staff Wellbeing Service, Schwartz Rounds and Wearing 2 Hats provide emotional and psychological support to the staff employed by CPFT. These services are available to all staff. CPFT covers both urban and rural areas, and our staff come from a wide variety of backgrounds.
Size of population and localities covered: 4000 staff covering the whole of Cambridgeshire.