Mersey Care NHS Trust’s ‘Health and Wellbeing @ Work’ (H&W@W) is a dedicated NHS based Employee Support Programme (EAP) for our own Trust alongside other commissioning public and private sector organisations. As a NHS specialist Mental Health Trust we highly value supporting and aiming to enhance the Health and Wellbeing of our own staff and those of the organisations we partner. Provision of support services is paramount to the successful productivity of any organisation, and within the NHS ultimately patient care.
Our purpose is to keep employees healthy and well in work both mentally and physically to support them to do the jobs they do to the best of their ability and supporting them to have a good quality of life both in and outside of the workplace.
Mersey Care NHS Trust’s ‘Health and Wellbeing @ Work’ (H&W@W) is a dedicated NHS based Employee Support Programme (EAP) for our own Trust alongside other commissioning public and private sector organisations. As a NHS specialist Mental Health Trust we highly value supporting and aiming to enhance the Health and Wellbeing of our own staff and those of the organisations we partner. Provision of support services is paramount to the successful productivity of any organisation, and within the NHS ultimately patient care.
Our purpose is to keep employees healthy and well in work both mentally and physically to support them to do the jobs they do to the best of their ability and supporting them to have a good quality of life both in and outside of the workplace.
H&W@W is a growing service, historically operating within the North West of England and now working in partnership with Vivup and their Health and Wellbeing platform we are providing mental health support to employees within the NHS across England.
We have a partnership approach – ensuring that duel branding with the organisations we work with enable employees and colleagues to feel ownership with a psychological contract to the service and ensuing our provision dovetails in house and current support services to create a 360 degree model of health and wellbeing at work.
Historically Mersey Care NHS Foundation Trust (MCT) had internal Occupational Health (OH) and Staff Support Services, both separate as stand alone models. Following a service review in 2014 with benchmarking against both public and private sector organisations and investment from our Board, the stand alone services were re-structured, amalgamated, received investment and development to provide our staff with a 360 degree model of Health and Wellbeing at Work, supporting the mental and physical health and wellbeing of our workforce and our partner organisations.
As a Trust we strive to deliver ‘perfect patient care’, however we acknowledge that without our staff, our greatest asset, our ultimate delivery aims can not be achieved.To this end, the review and restructure looked to see how we could best support our staff with both mental and physical health issues, which are inextricably linked.
Within the Employee Assistance Provider (EAP) and OH industry sectors, services are often separate provisions with a resulting lack of dialogue and joint pathway of care and support for employees. As part of the review, we canvassed opinions of staff, managers and commissioners. We benchmarked against other organisations and recommended the creation of the new, dynamic, 24/7 serviceto support the mental and physical health and wellbeing of our staff.
The Health and Wellbeing @ Work service incorporates our NHS based Employee Assistance Provision, with 24/7 telephone help and advice line, Occupational Health Service (OH) and Physiotherapy provision, which includes a daily physiotherapy triage line for staff to gain immediate advice, information and support for Musculoskeletal issues.
In relation to specifically mental health, our EAP provides a full range of employee assistance and support 24 hours ad ay 7 days a week to over 45,000 staff within our own NHS Foundation Trust and our predominately NHS based partner organisations.
The service includes;
– 24/7 telephone help and advice line
– Telephone counselling and trauma support
– Face to face counselling with a range of theoretical models including CBT, EMDR, Solution focused counselling, person centered counselling, psychotherapy etc
– Critical Incident / Trauma Support
– Workplace Mediation
– Fitech stress testing
-Training packages, including mental health first aid and mental health awareness, stress management and resilience.
– Management consultancy
– Health and well-being days / events
– Counsellor drop ins
– On line Computerised Cognitive Behavioral Therapy packages
– Wellbeing Zone – physical health on line programme
Taking best practice from large commercial providers and internal services our EAP service has been developed to deliver all of the benefits to both, to staff and the organisation.
Research shows that good in house support for staff often results in higher usage rates, alongside expertise of delivery, as staff working within the service has extensive knowledge of the organisations, policies and processes. In-house staff are quickly able to engage with employees understanding roles and particular areas where staff may need increased support. Our EAP model offers comprehensive, targeted and proactive mental health support for our own staff and those of our external contracts.
As employees we bring our whole selves to work. We know there are inextricable links to long term mental health conditions impacting upon physical health and visa versa. Having access to both physical and mental health services within our own organisations, where staff has ease of access and feel quickly supported. Work roles and responsibilities are understood by the clinicians working within the team, makes such a difference to their support experiences when they need it most.
As an internal service we work closely with key stakeholders within our own Trust and our partner commissioning organisations. In MCT in particular the development of a centralised sickness absence team enables us to work closely with the team, as they identify areas with particular trends or hotspots. These include, stress, work related assaults, critical incidents / trauma support and musculoskeletal issues. The Health and Wellbeing @ Work (H&W@W) service sits within our Corporate Services Division, under a strong and committed Human Resources Director (HRD) and Deputy HRD with a dedicated focus on health and well-being within the Trust, fully supported by our Board and Chief Executive. For our own Trust having an in house provision enables us to be closely aligned to organizational strategy and policy development. Our current work with Professor Sydney Decker and our Just and Learning Culture has had a high priority health and wellbeing input as changing culture to a restorative and just one ultimately supports our staff and our patient care delivery models. The organizational embedding raises awareness, embeds Health and wellbeing at all levels of the organizational policy and process development and support s the change in our just and learning culture.
How do we make a difference?
Firstly – by being there and our Organisation investing in the Service for our Employees. This supports staff to feel valued and assists in recruitment, retention and wellbeing. Staff working within the H&W@W service, are a multidisciplinary team who all have the same focus. Keeping our employees ‘happy, healthy and here”. Whether staff enter the Health and Wellbeing at Work service via a mental health self referral or a physical issue, there are often other areas of the service that they may benefit from ands the team can signpost and advise. An example of this is an employee engaging in Physiotherapy may disclose feelings of depression and low mood, the Physiotherapist will provide immediate information (verbally and via wallet card giving contact details) to the staff member about how they can self refer into our EAP, and can do a referral if the employee would prefer.
From a staff perspective we are able to refer within the team to our doctors, nurses, physiotherapists, complimentary therapists and counsellors / psychotherapists to support staffs individual requirements within the areas causing concern. This aligned approach enables employees coming into the service to receive a full range of support options with highly trained clinical staff. We work hard to always maintain confidentially and clinicians do not have dialogue without staff consent. The 3 services are managed as 3 clinical divisions of the Health and Wellbeing @ Work Service.
For staff entering our service, choice, confidentiality, access 24/7 and seeing clinicians who have working knowledge and understanding of the workplace as well as experience outside of such, enables them to feel immediately heard, understood and supported. Feedback for all of our services is positive, with staff feedback being actively sought both electronically, via our website and in paper format. Our 24/7 helpline that sits within the EAP element of the service is staffed by our own Counsellors and Psychotherapists. Our teams NHS specialist knowledge, understanding of procedures such as safeguarding and trust policies support the immediate intervention, reducing anxiety and providing support mechanisms.. Employees accessing our EAP evenings and weekends have often fed back that this has been very supportive at a time when other areas of the organisation are not traditionally available to offer advice and support.
Feedback – taken from feedback forms within H&W@W
“I want to thank the Nurse I saw in OH, she listened and reported back to my manager who was able to ensure I received the support needed to help me stay in work with my back condition. The Physiotherapist treated my symptoms and the exercises they emailed helped me to keep movement each day – thanks”
“I can’t thank the team enough; from the admin staff who took my first call to the counsellor I saw for my sessions, I feel lucky to have access to this within my workplace”
“Having EMDR (eye movement desensitisation and reprocessing) has changed my life; I’ve carried that around for over 20 years and cannot believe how much better I feel”
“The OH Nurse recommended I access some Counselling, I probably wouldn’t have done it myself, the counsellor really helped me to see there was a way forward, he listened and supported me to make changes, and I’m back in work, thank you”
“I’ve accessed counselling and physiotherapy in the last 3 months both were hard and painful at times however I feel like a new person and been able to stay in work – thank you.”
“I had reservations about seeking support, the counselor on the helpline was able to immediately provide me with information that reduced my anxiety and I felt more able to manage the rest of the situation. I dint need to see someone face to face as the on-line Cognitive behavioral Therapy programme meant I could do the work in my own time between my caring responsibilities”
What makes your service stand out from others?
Our 360 degree model of health and wellbeing enabling employees to have a dedicated provision to meet both physical and mental health support needs ensures our model stands out. The service is wholly run form an internal NHS perspective and as such clinical standards of excellence which we expect and strive to deliver to our patients and service users is provided for our employees who are the corner stone of our Trust.
Our Health and wellbeing offer is comprehensive and offers a complete support for our employees (and our partner organisations who commission services) to have both physical and mental health needs met. The service is progressive and is influenced by and influences our people strategy, leadership strategy, sickness absence reduction plans and the wider key strategic aims of the organisation across our footprint. Our internal location (rather than services being commissioned by external commercial providers as with many NHS organisations) enables us to have a voice, presence and add value to our purpose and strategy, vision and values and ensure our employee physical and mental health support needs are visible and supported from board to floor. Our recent Health needs Assessment and recommendations have gone to Board to enhance and identify key drivers and development needs and opportunities for the future.
Health and Wellbeing forms a key part of our work within the development of our Just and Learning Culture with H&W being the policy holder for our ‘supporting colleagues policy’ ( copy attached). The strong and cohesive whole Trust endorsement of our Just and Learning Culture, H&W@W and the ability to inform key strategic organisational aims enables our H&W provision to indeed be a unique offer to our employees and our Trust and something of which we as a Trust are proud and other Trusts keen to be a part of. We stand out from the Employee Support Sector and from other organisations with internal offers with the comprehensive nature of our 360 model offer, our proactive and preventative approach and our passion to ensure health and Wellbeing is embedded within our Values and Culture and supports our J&L journey which is changing organizational culture and the working lives of our employees. MCFT understands that employees, who are supported to live better, work better and are supported to be happy, healthy and here – to support our patients and deliver the care we strive for each and every day.
We have been proud to have been asked to present our model at the NEC for the national health and wellbeing at Work conference, to the Royal College of Psychiatrists and British Psychological Society and recently at the Institute of Directors. Our training is delivered across the country by Clinicians and subject experts to external contracts and other commissioning organisations including the Disclosure and Baring services in Darlington and Liverpool to all front facing managers, Clinical Commissioning groups and Trusts across the country. Our Clinical and Operational leads are seen as subject matter experts in the UK and sit upon various Expert Boards including The Employee Assistance Providers Association (EAPA), The National Resilience and Trauma Expert Reference Group and are working on research initiatives within the employee support sector with The Institute of Employment Studies.
Our reputational standing within the field of mental health support for employees has meant we are now the preferred provider partner to Vivup – who provide a range of employee benefits to NHS Trusts across the UK. This is a great accolade for the H&W service as this partnership could have been with any multinational EAP in the country, however our expertise, passion for employee mental health support and clinical excellence enabled us to work within this partnership, enhancing the opportunities for other NHS trusts to benefit form the support and the generation of any income from this to directly benefit our employees and our patients and service users. We feel this makes us not only stand out but to shine. Finally we make a difference to our own employees and those we support via our external contracts. Please see some of the comments we are proud to receive in feedback at question one.
As a Mental Health Clinician, the importance of linking mental and physical health is becoming more evident with moves in NHS settings to join services to see patients within a holistic framework incorporating their mental and physical health and wellbeing.
I feel Mersey Care sits at the forefront of the Mental Health sector with recent CQC rating of good and a Chief Executive who is leading our trust to look at new and innovative ways to support patient’s mental and physical health and well-being.
Our Health and Wellbeing at Work provision is a way of taking this forward for our staff. Removing barriers to support with a 360 degree model and enabling a dialogue between staff, specialist clinical support and the organisation to put our staff first, enabling them to support our patients in the best way they can. Supporting staff to remain in work, healthy, happy and well, reducing sickness absence and presenteeism and having a positive impact on patient care across the NHS organisations we support.
A typical client journey – our 360 degree model makes a difference!
As an NHS Trust MCFT realise the importance of a holistic and person centered approach to patient care that enables patients to be seen as a whole person rather than one with an identity of having a mental or physical health issue as the stand alone issue. We know there is a high correlation of patients with long term physical health conditions developing a mental health condition and visa versa and the correlation between physical and mental health is inextricable. As a Trust we are fortunate with great leadership and drive to be able to offer the people of Liverpool a cohesive and such tailored approach. With the recent acquisition of Liverpool Community Health and prior to that South Sefton our Trust programme of a 360 degree model of health and wellbeing for patients is well underway.
Our approach to our employee health and wellbeing has established this 360 degree approach over the last 3 years. It makes people and business sense to enable our staff to access support and care pathways that see them as that one person with a variety of support needs at any one time, and for some of those times there will be an overlap where they may need to access more than one of those services to support colleagues to remain in work and well, or to return to work as soon as possible if they have been absent. This support to our staff has a direct impact on the care we offer to our patients and service users as if our employees are well they are able to support our patients and service users. The analogy of putting ones own oxygen mask on to enable us to help others is clear, especially within the NHS with current pressures at work, not withstanding the economic and social pressures on our employees.
So in practice what does this model look like and how is this experienced by our employees
X has worked for the NHS for 24 years. X worked whilst having a family and is proud of the fact that their sickness record is excellent and enjoys their role working within a ward based MH environment. X has been having some back pain for a period of time and has put it down to both age and being on their feet for much of the day. X’s manager notices their discomfort and suggests they contact the Physiotherapy daily triage line to get some advice. X reluctantly does so and speaks to one of the Physiotherapists within the Health and Wellbeing @ Work Service. They are provided with some immediate advice and booked in two days later for an assessment appointment. At the appointment the Physiotherapist is concerned in relation to X’s walking gait and feels there needs to be further assessment and writes to X’s GP to suggest a neurology assessment. In the meantime the topical pain is treated and supported.
X is seen by the neurologist and there are some concerns resulting in the diagnosis of a benign condition requiring surgery. X is worried and concerned and discloses this to the Physiotherapist, who suggests that some Psychological support maybe useful. Whilst in the department X refers themselves into our EAP staff support provision and receives a telephone assessment the next day. At the telephone assessment there is a risk assessment and full history taken during which time X discloses that they had been having relationship difficulties prior to this diagnosis and had been feeling very low in mood and although not suicidal had had thoughts of the family being better off without them. They were additionally concerned that the operation was going to mean time off work and they were concerned in relation to their job.
X was given an appointment within one of the Counsellors and had a choice of locations close to home or work. X chose to be seen nearer to home as the operation would mean they couldn’t drive for a period of time. The Counsellor at assessment also discussed with X that a self referral into Occupational Health (OH) maybe beneficial to get advice re the planned surgery and that HR support was also available. X contacted HR and was re-assured re the supporting attendance policy and self referred to OH and was seen by one of the Nurses
X was finding the Counselling support really useful as the counsellor understood not only their job but was also able to assist with the family difficulties supporting X to speak to their partner and discuss their perception of the problems. X had not felt able to do this previously fearing the outcome and that it would lead to further disagreement but with support from the counsellor to look at how that conversation may be facilitated and what needed to be discussed X was able to have the conversation and move things forward in a positive way. This meant X felt more supported going into the surgery and less anxious. X additionally found the on line CBT programme they were doing via the staff support service helpful and as the Counsellor had informed X they could do – X’s partner was using this too for their own anxiety.
X found being able to speak to OH prior to surgery had been supportive. OH made recommendations X’s Manager in relation to reasonable adjustment and phased return in preparation for X’s return. X felt supported both during recovery and their anxiety in relation to the job role and been managed and supported by the Health and Wellbeing Team and HR.
X continued to see the Counsellor whilst absent from work and used the Physiotherapy service to support the recovery process after surgery. X valued the fact that they could access the support all under one internal service, the speed at which this was arranged and the feeling of support that came from knowing that every health professional they saw both understood X’s job, how the operation and anxiety may affect this. X felt that their home situation had much improved as a result of accessing the Counselling support and communication between X and their partner had greatly improved.
Of course not all staff will access all of the services offered to our Employees at the same time, however there are many employees who benefit form the 360 approach with less complex support needs. The value of the NHS systems, policy and processes knowledge, the Clinical excellence and professionalism of the team and that importance of being able to access support for work and home related issues alongside Physical and mental health is something our Employees value and our Trust and Board is proud to provide. Our EAP now provides support to over 45,000 NHS and some private sector staff and this is growing as we now have external contracts across England. Within these contracts we are supporting other NHS Trusts to use there internal or outsourced OH and Physiotherapy to create their own 360 degree model for their own Employees with our support to do so.
At our recent SEQOSH inspection for Occupational Health the inspectors who spent a day on site both commended highly the cohesion of service team members and how the 3 services were able to work both individually and yet with dialogue between departments that existed under the Health and Wellbeing at Work umbrella. They commented that in their experience this was unusual and very positive and that they felt our 360 model was to be commended and was well led.
Health and Wellbeing @ Works 360 degree model ensures our employees have in house access to a range of Clinicians supporting them to be physically and mentally well at work. Our Clinicians offer a wide range of support services within the teams they work with and we are currently undertaking research with The Institute of Employment Studies looking at ROI of EAP, and internally in relation to staff pathways within the services. This will continue to enable us to make service improvements for our employees who in turn ensure we as employees offer the best care to our, patients and services users supporting our trust aims to provide perfect patient care.
How do you ensure an effective safe, compassionate and sustainable workforce?
As a growing service safe and effective practice, sustainability and compassion and inclusivity for our team are paramount to enable the team to support our employees to support our patients and service A 360 degree wheel that replicates our 360 degree model!
Our staff retention is high. People enjoy working in the team. A recent SEQOSH accreditation in April 2018 (safe, effective, quality Occupational Health service) highly commended the service both for its achievement of the SEQOSH standards (an industry kite mark and equivalent of a CQC inspection) and its well led leadership and 360 degree model. This was an excellent and unusual accolade and the positive comments in relation to the team’s multidisciplinary working and success of this was testament to the hard work and dedication of multidiscipline professionals and an understanding and value of each others role within the support we offer to our employees.
From a trust perspective, ensuring we have the right people in the right jobs with the right skills is vital to the success of our patient care. Our strategic focus and people plan consistently aim to forward and future proof the Trust and this is mirrored within the planning and modeling of the H&W@W service.
Our recent acquisitions of Calderstones NHS Trust (learning disability) and Liverpool Community Health (community services) have seen our workforce go from 4000 to 8000 over the last 4 years. It has additionally meant that the Trust focus of mental health has changed to that of community and mental health, a vision of our CEO and something that we feel will greatly benefit our patients and service users with a comprehensive and seamless delivery of support services supporting the whole person not just a proportional diagnostic element. This has meant that the skill mix of our colleagues has changed and will continue to evolve and develop for patient benefit as we further embed. Our experience as a Health and Wellbeing @ Work service and the positive feedback of the SEQOSH accreditation team supports the benefits for multidisciplinary working for mental and physical health services.
Our service accreditation supports and ensures our services within H&W are safe and effective. Occupational health is accredited by SEQOSH and our mental health EAP services was one of the first in the country and the only EAP to be accredited by ‘APPTS’ a joint accreditation via the Royal College of Psychiatrists and the British Psychological Society. Additionally all members of the multidisciplinary team are registered members of their relevant professional bodies, this includes The British Association of Counselling and Psychotherapy, Royal College of Nursing, College of Occupational Medicines and EAPA ( Employee Assistance Professionals Association) the professional association for EAP’s upon which our head of health and Wellbeing sits upon the Executive Board as Secretary.
Our journey as an organisation within our Just and learning Culture has been a year of challenges, hard work and positive outcomes. Reduction in disciplinary cases and suspensions throughout the trust are testimony as to the changes we have made as to how we work together as colleagues, managers and Executive when things do not go as expected for our staff, patients or service users. We look to learn from things when they don’t go as we thought they may to see ‘why / what’ went wrong rather than too. This learning is enabling us to move forward to change policy and practice creating an open and supportive culture for our staff. Catching ‘near misses’ and reporting how it happened and what we have learnt enables others to look at practice and ensure procedures that need to be reviewed are and staff are able to work in an inclusive caring professional and learning culture, not one where human error or a mistake has a culture of fear or reprisal. Two members of the senior team within H&W sit on the Committee, ensuring again that health and wellbeing of our employees has a clear defined and valued role in shaping our Trust and our services.
Within the H&W team our re-structure from external Occupational Health Physician led service to internal Nurse led under the H&W team umbrella ensure multidisciplinary learning and reflective practice within the team., The senior management team share an office and SMT meetings with the wider team management monthly enable dialogue, understanding and problem solving to be agreed, cascaded and feel inclusive to the service as a whole.
All team members are able to access training opportunities. Our administration staff is key to the overall running of the service and rotation within the teams ensures variation in workload, learning and no single point of failure. Often overlooked in Clinical teams, all administration has undertaken relevant and aspirational training this year and is supported to undertake training commensurate to both their roles currently and career aspirations.
Our Clinical team are supported with CPD training relevant to their professional bodies and supported with opportunities to work within projects and work both inside the Trust and externally. We are currently looking to deliver a national conference on the Menopause and this is being led by a member of the Counselling team with a keen interest in the mental health impact of the menopause and the impact of our staff with a high number of our employee demographic falling within this age group. As part of our Trust has secure MH facilities we do unfortunately have employees impacted by assaults. We have trained half of our Counsellors and Psychotherapist in EMDR (eye movement desentisation reprocessing) NICE guidelines approved treatment for Trauma and has had excellent clinical results;
“I have been carrying the Trauma of the assault for over 10 years and can’t believe the difference I felt after completing my EMDR – thank you so much”
Ensuring the teams keep up to date with new techniques is an important factor in us achieving our service accreditations and provide the professional services required under an NHS service. Our clinical supervision is provided in accordance with individual team member’s professional bodies i.e. BACP for therapists is 1.5 hours each month (this is provided externally and is in line with the individual practitioners theoretical training i.e. CBT / EMDR / person centered /etc
Our team are the key delivers of health and wellbeing to our employees. It is vital therefore that we as a team look after our own health and wellbeing. H&W team members requiring psychological support are supported to have this funded externally. For OH support they would be referred to another NHS provider at a convenient location to them. We are looking forward to a team ‘away’ day and are partaking off the Aston programme of team development. Additionally we have been selected to take part in ‘Perform at your Peak@ a pilot wellbeing imitative that helps to monitor and measure the wellbeing of staff and recommend a range of intervention and support to improve subsequent findings.
From a Trust perspective, we feel our 360 degree offer to our employees is second to none and details of some of this have been previously provided. Additionally we have a range of physical health programmes, seated massage sessions, couch to 5k, yoga etc and work in close partnership with Merseyside Sports Partnership and Sefton Active – there is of course cost to the organisation of these provisions but we see that as investment in health and ultimately wellbeing. The H&W@W team has entered an almost whole team Rounder’s team in the upcoming NHS Games. A fun and health team event that we are all looking forward to participating in!
As part of the structural review we have recruited staff with the right skills to deliver health and wellbeing, and mental health services to our staff. We revised the model to ensure it was embedded in all aspects of our Trust processes and procedures. The service works with staff, managers, and surveillance comities and at a senior strategic level. Whilst it is led clinically it reports into our DHRD, thus working closely with Corporate Services. We have standard operational processes and a clinical structure that is being supported and developed by our management and leadership program me.
All staff within the service are encouraged to develop personally and clinically and many of the team are enrolled on our management and leadership programme which moves throughout our bands via our strive (bands 5 and below), thrive (band 5 to 7) and drive (bands 8a and above) programme. As a trust we are committed to ensuring that all our staff are seen as leaders and that we support the potential development of staff who wish to progress both clinically and managerially ensuring our workforce have the skills and exercise to deliver. This, alongside the Aston Team development ensures that we have experienced staff in place to move forward or support management change / recruitment moving the service forward.
Our team works closely with employees within the Trust. These staff effectively become our service patients and peer workers. Being able to access support services and realising that with mental health any one of us may need support and intervention at any time reminds us as a team and the employees that access our services why the work that we do as a trust is so important to patients and service users of such. We are proud of our Trust approach to recruitment with a service user or carer being on every interview panel. This underlines our Trust ethos at the earliest opportunity at interview of the importance of lived experience as with mental health we are all each day on the continuum and for our employees our Health and Wellbeing team is there to support when its needed for any work or home related issues both mental and physical supporting our employees to deliver the best in patient care.
As part of the structural review we have recruited staff with the right skills to deliver health and wellbeing, and mental health services to our staff. We revised the model to ensure it was embedded in all aspects of our Trust processes and procedures. The service works with staff, managers, and surveillance comities and at a senior strategic level. Whilst it is led clinically it reports into our DHRD, thus working closely with Corporate Services. We have standard operational processes and a clinical structure that is being supported and developed by our management and leadership program me.
All staff within the service are encouraged to develop personally and clinically and many of the team are enrolled on our management and leadership programme which moves throughout our bands via our strive (bands 5 and below), thrive (band 5 to 7) and drive (bands 8a and above) programme. As a trust we are committed to ensuring that all our staff are seen as leaders and that we support the potential development of staff who wish to progress both clinically and managerially ensuring our workforce have the skills and exercise to deliver. This, alongside the Aston Team development ensures that we have experienced staff in place to move forward or support management change / recruitment moving the service forward.
Who is in your Team -Team Structure – please include bands / grades / wte
The Health and Wellbeing at Work service comes under Corporate Services and reports into Deputy HRD level.
The Service structure is as follows;
1 x Band 8b – Head of Health and Wellbeing and Clinical Lead
1 x band 8b – Occupational Health Manager
1 x band 8b – Staff Support / EAP – Health and Wellbeing Manager
1.06 x band 7 Nurses (OH)
1.0 x band 7 Senior Counsellors (job share)
0.8 X band 7 Snr Physiotherapist
1.0 x band 6 Physiotherapist
1.0 x band 6 OH Nurse
8.6 x band 6 Counsellors
1.0 band 4 Office Manager
1.0 band 4 administrator / stress management support
3.80 X band 2 administrators (across the department)
How do you work with the wider system?
Our service is embedded into every aspect of Practice and Policy within MCFT. With a key role in the development and delivery of our Just and Learning Culture, sitting on the committee and leading on our Ambassador recruitment. Embedded into HR policy and practice with regular meeting with HR advisors to provide soft intelligence and case management form an Occupational Health perspective.
Our training packages offered internally and externally enable us to work closely with Learning and Development. Our Operational lead for EAP has provided train the trainer training for our lead trainers within the OED to ensure that co-delivery of Resilience and Mental health Awareness comes from both clinical and training excellence. Both topics being supportive of employee mental health enabling early detection and recognition of mental health issues and the building of individual resilience to support our preventative approach.
This is mirrored both within our external contracts, other mental health services and agencies. This includes delivery of both services and training to local authorities, large government agencies (DBT) and Housing with a successful delivery of Trauma focused Compassionate Care to a large NW Housing Association and 3rdSector housing support staff. This uses our expertise as both a MH Trust and the expertise within the Health and Wellbeing at work service to support the wider community and a range of employees form all sectors. We know form an evidence base that the sooner we as individuals receive support and diagnosis for a mental health condition the better the recovery outcomes and delivery of these types of training packages within the wider community systems supports the reduction of stigma and the ability to support not only employees but family, friends and associates.
Do you use co-production approaches?
The Employee Assistance element by its very nature is a confidential service for employees and therefore not appropriate in relation to co-production approaches as often staff are presenting with family or relationship difficulties. Our OH service within the H&W service does enable families or carers to attend appointments if this is supportive for the employee. Our services service users ie employees are provided with electronic and paper feedback forms to enable feedback to both inform us of what is going well but additionally make service improvements where required. During our Service Accreditation process service users are invited to the department to speak confidentially with our accreditation panel as part of the accreditation process.
As a trust our services users and carers are at the heart of everything that we do.
Do you share your work with others?
Mersey Care NHS Trust are members of the positive practice network and our health and wellbeing team have contributed to some of the work streams this year. This gives us the opportunity to share good practice and to learn form others and we see it as a valuable and often innovative. Our CEO and senior Managers in the Trust have the upmost respect for our colleagues within the Positive practice team and MCFT membership is valued and celebrated. From the Health and Wellbeing Team perspective it has been refreshing to work with and organisation and network that refuse to tick the box and miss the point.
Our Operational Manager within Health and Wellbeing leads on the Regional NHS Network for NHS H&W leads and additionally sits on the National Expert reference Group for Resilience and Trauma. Our Head of Head of Health and Wellbeing sits as Secretary on the Executive Board of EAPA, is a Service reviewer for The Royal College of Psychiatrists APPTs accreditation Programme and works along Salford University as an Honorary Associate. Our Occupational Health lead sits within Cheshire and Merseyside Occupational health Forum where good practice and process is shared across the region. Alongside the wealth of sharing within these learning networks. Our Heads role on the EAPA Executive Board involves her regularly writing articles in relation to employee health and wellbeing, clinical standards and topical mental health issues for national press and EAPA standards for the industry.
Our website provides a wide variety of supportive information and downloadable CBT workbooks;
additionally all Employees accessing the health and wellbeing @ work service are provided with details of our on line Cognitive Behavioral Health Programme, our Physical health programme ‘The Wellbeing Zone’ and our webs site details. (See links attached).
Covering 45,000 NHS staff ensures that we share good practice of all that we do as a Mental Health trust with other NHS bodies with which we work in partnership We have recently introduced across the EAP service ‘silver cloud’ on line computerised cognitive behavioral therapy programme, giving staff access to CBT support at any time of the day or night to support our 24/7 telephone help and advice line.
We attend staff and board events to promote services and share our experiences of what works for staff mental health and wellbeing.
Sitting on the EAPA executive enables our Head of Health and Wellbeing to share across the industry good practice within the field of mental health and wellbeing on behalf of Mersey Care NHS Foundation Trust. Additionally she can share within our own trust and our partner’s good practice and new ideas within the world of employee mental health and well-being from across the world as EAPA UK is part of EAPA worldwide and international organisation representing best practice across the world in employee mental health and wellbeing.
As mentioned our OH manger sits upon the OH North West forum, sharing good practice for employee health and wellbeing and we have excellent working partnerships with NHS Trusts within the North West, and NHS Employers. We are represented at all levels with NHS Employers and attend relevant health and wellbeing events, seminars and conferences. I recently delivered a presentation at the Health and Wellbeing Exhibition at the NEC in Birmingham (March 2016) on our 360 degree model of health and wellbeing for staff which received excellent feedback and positive interest for other trusts looking to replicate the model. We are currently working with a local trust to replicate for them our sickness absence model to enable them to coordinate this within the services we offer them and their internal management of sickness absence.
What outcome measures are collated, how do you use them and how do the demonstrate improvement?
The Service uses two outcome measurement programmes. Core net within the EAP provision and COHORT within OH. Both systems enable our services to collect data in relation to client presentation, risk assessment, and KPI’s for reporting on service level agreements, waiting times etc.
For our mental health support EAP provision all data collected by Corenet is confidential and reporting back to our own Trust and external partners is none identifying and provides the service, our clients themselves and commissioners with reliable data. Core net offers:
There are over 30 measures that CORE Net supports, including sector and diagnosis specific measures. Summary charts provide instant visual summaries of a client’s progress, displayed alongside clinical cut-offs to help therapists assess severity levels. Clients, therapists and supervisors can all see and comment on the progress of therapy.
Outcome data can be collected by the client inputting directly onto the system side-by-side with the therapist, prior to the session in waiting room, or the client can be emailed an invitation, prior to attending the session, to complete their outcome measures on-line on a securely.
The system enables all clinical or contact notes in a single record and highlights critical case notes to ensure colleagues are aware of an important instructions or information about the client.
• Flags Simplify case management, by identifying client’s records that require attention, for routine case management, care pathway monitoring or administrative house keeping. There is an ever expanding range of flags available and services can request their own tailor made flags.
• Risk Management the system has built in Risk Flag to support and document existing risk management protocols.
• Data Quality CORE Net provides our service with immediate visual feedback to help keep on top of required data completion for KPIs, data for client presentation etc
• Attachments Clinicians are able to documents from their computer to a clients file. This means all documents can be scanned and attached.
• Reports The system enables us to provide reporting relating to client presentation, themes and trends, protected characteristics, KPI reporting etc to our own Trust and external contracts.
Cohort for OH also enables similar reporting capabilities and is used to support KPI data and ratings.
Demonstrable improvement includes;
ü To commissioners relating to sickness absence and clinical change via Workplace outcome suites
ü To individual clients relating to clinical presentation improvement on a session to session basis
ü To therapists who can measure their individual client improvement rates via the appraisal measures
ü For mangers to review clinical outcome data for individual therapists ensuring quality and consistency across the service
ü KPI scores for contract and host trust reporting
Has your service academic review?
Our EAP service is reviewed and Accredited by Appts – a combined accreditation by the Royal College of Psychiatrists and The British Psychological Society. Our health and wellbeing EAP was one of the first in the country to be successful and the only EAP to have gained this accreditation. This ensures that we are providing Clinical and Professional Excellence for our clients and service users and is backed by CCQI.
Our OH provision is accredited by SEQOSH (safe effective quality occupational health service). Our recent 5 year re-validation assessors commented on the excellence and working partnership of our 360 degree model and that the service was ‘well led’.
Our services have been evaluated by the royal College of Psychiatrist as part of the accreditation process for mental Health services. We were involved in the first tranche of this process and achieved accreditation with excellent feedback on the service as a whole, waiting times, range of therapeutic intervention and were highly commended.
Our OH services (which include mental health support both sat directly within such with a dedicated counsellor and referral process to the EAP element) are accredited by SEQOSH yearly. This looks at Clinical standards, KPI’s and reporting, all which have improved following service re-structure and this combines with new clinical management programs and the staffing structure.
We work closely with HR and the whole of corporate services and looking to measure retune on investment around sickness absence, staff engagement and staff reporting via the staff survey and the friends and family test.
New initiatives are evaluated. We are two months into a 12 month programme of seated acupressure sessions delivered to staff in work on the ward areas. Feedback is positive and we are currently evaluating the initial staff feedback forms for stress reduction and resilience scoring. Again we will be monitoring sickness absence figures on the delivery areas to evaluate impact.
We report 3 monthly to MCT and our external contracts poking at usage rates, pressuring issues and demographics. This is evaluated by our equality and diversity lead and we address any inconsistencies in relation to such. An area of improvement has been in male usage uptake, as historically men access mental health support less frequently than women. Our promotion and publicity, as well as taking services to the wards and other target interventions have improved the male take up rate of services across our own trust and external contracts.
Our Core net clinical system evaluates usage rates and session by session clinical improvement. We can also evaluate session attendance rate, average sessions delivered, methodology and clinical improvement. All of which are evaluated on a clinician by clinician basis by our service lead.
Reporting enables our Board to evaluate on a quarterly basis the value to staff and the trust; this is underpinned by staff qualitative data taken form customer feedback forms and evaluation. All of which are positive with staff choosing to recommend the EAP to other employees and returning to the service when requiring further support.
How will you ensure that your service contributors to deliver good MH care?
We work with a wide range of commissioners across many industry sectors. This enables us to promote positive mental health messages through service delivery and training. We work closely with commissioners to ensure they receive the service they need for their employees – our service users. It’s a tailored rather than one size fits all approach. Ongoing funding will be via continued growth, with any surplus going back into the Trust to support patient care.
Our sustainability and people plan ensures that the service can continue to deliver if management were to change. We have re-designed the service to enable us to support newly qualified staff to have clear career pathway and for our non qualified staff to seek the training they have for aspirational movement to do so.
What aspects of your service would you share with people who want to learn form you?
We do and would be happy to share any aspects of our service with any interested party. We have presented at RCP, NEC, and IOD etc and are happy to share. We value our membership of the Positive Practice Collaborative.
How many people do you see?
The service has 3 services under the Health and Wellbeing at Work umbrella. Our OH and Physiotherapy service provide services to our own host Trust of 8,000. During an employee journey all employees will see our OH service. At the start of their employment for OH clearance, for any required immunisations and vaccinations and for sickness absence management. Our Trust does enable our employees to self refer into the OH service as we see OH as a supportive intervention.
Our psychological health EAP currently provides services to our own host Trust and our external contracts. Currently the service support over 45,000 mainly NHS employees but has additional contracts with both public and private sector employees. On average we will see around 4% of the organisational employees for face to face 121 counselling / psychotherapy support. The service works to a 6 session solution focussed model however clients requiring more specialist intervention for EMDR / CBT will require additional sessions. Not all employees contacting the service will require face to face support and 2 contracts are for telephone counselling and on line support with access to on line CBT, our informative website and physical health wellbeing zone programme.
On average we offer 258 appointments per week and 13,000 face to face appointments per year. Additionally all clients entering into the service will receive a telephone assessment (½ hour) and access to on line CBT etc
How do people access the service?
Access into our EAP is via self referral primarily. Some of our contracts we accept referral via Occupational Health. For all contracts we work closely with OH to try to replicate the internal 360 degree model we have that is so successful within MCFT. We provide the OH department with ‘referral packs’ which include a letter of introduction, an information wallet card and service leaflet detailing what is available to the employee.
All staff receives information about the range of services and support that are offered by H&W@W at induction. The wallet card is laminated card to enable them to keep it and it details EAP / OH and Physiotherapy triage line. (See copy attached). Additionally the service is promoted across the organisation via banners, posters, regular health and wellbeing events and our just and learning culture events. Using the information provided by our clinical reporting tools we are able to target additional support to areas where there is a high level of reported stress/ anxiety / organisational change etc and we can additionally provide ‘Fitech stress testing’ a computerised and facilitated stress testing system which identifies causation factors and the facilitator will signpost to appropriate support services. Employees additionally access the service following attendance on courses, following trauma events etc. Our supporting colleague’s policy has a tool kit for managers to enable them to contact the service if there is an incident within the Trust. Our Head of health and wellbeing will then write out / email all employees affected to offer support and fast track access to the H&W@W services and Psychological support.
There are regular articles in our weekly communications to all employees across the Trust and the interdepartmental referral system ie clients in physiotherapy who would benefit from psychological support works well. Please see below for a typical client journey within MCFT.
As an NHS Trust MCFT realise the importance of a holistic and person centered approach to patient care that enables patients to be seen as a whole person rather than one with an identity of having a mental or physical health issue as the stand alone issue. We know there is a high correlation of patients with long term physical health conditions developing a mental health condition and visa versa and the correlation between physical and mental health is inextricable. As a Trust we are fortunate with great leadership and drive to be able to offer the people of Liverpool a cohesive and such tailored approach. With the recent acquisition of Liverpool Community Health and prior to that South Sefton our Trust programme of a 360 degree model of health and wellbeing for patients is well underway.
Our approach to our employee health and wellbeing has established this 360 degree approach over the last 3 years. It makes people and business sense to enable our staff to access support and care pathways that see them as that one person with a variety of support needs at any one time, and for some of those times there will be an overlap where they may need to access more than one of those services to support colleagues to remain in work and well, or to return to work as soon as possible if they have been absent. This support to our staff has a direct impact on the care we offer to our patients and service users as if our employees are well they are able to support our patients and service users. The analogy of putting ones owns oxygen mask on to enable us to help others is clear, especially within the NHS with current pressures at work,not withstanding the economic and social pressures on our employees.
So in practice what does this model look like and how is this experienced by our employees.
X has worked for the NHS for 24 years. X worked whilst having a family and is proud of the fact that their sickness record is excellent and enjoys their role working within a ward based MH environment. X has been having some back pain for a period of time and has put it down to both age and being on their feet for much of the day. X’s manager notices their discomfort and suggests they contact the Physiotherapy daily triage line to get some advice. X reluctantly does so and speaks to one of the Physiotherapists within the Health and Wellbeing @ Work Service. They are provided with some immediate advice and booked in two days later for an assessment appointment. At the appointment the Physiotherapist is concerned in relation to X’s walking gait and feels there needs to be further assessment and writes to X’s GP to suggest a neurology assessment. In the meantime the topical pain is treated and supported.
X is seen by the neurologist and there are some concerns resulting in the diagnosis of a benign condition requiring surgery. X is worried and concerned and discloses this to the Physiotherapist, who suggests that some Psychological support maybe useful. Whilst in the department X refers themselves into our EAP staff support provision and receives a telephone assessment the next day. At the telephone assessment there is a risk assessment and full history taken during which time X discloses that they had been having relationship difficulties prior to this diagnosis and had been feeling very low in mood and although not suicidal had had thoughts of the family being better off without them. They were additionally concerned that the operation was going to mean time off work and they were concerned in relation to their job.
X was given an appointment within one of the Counsellors and had a choice of locations close to home or work. X chose to be seen nearer to home as the operation would mean they couldn’t drive for a period of time. The Counsellor at assessment also discussed with X that a self referral into Occupational Health (OH) maybe beneficial to get advice re the planned surgery and that HR support was also available. X contacted HR and was re-assured re the supporting attendance policy and self referred to OH and was seen by one of the Nurses.
X was finding the Counselling support really useful as the counsellor understood not only their job but was also able to assist with the family difficulties supporting X to speak to their partner and discuss their perception of the problems. X had not felt able to do this previously fearing the outcome and that it would lead to further disagreement but with support from the counsellor to look at how that conversation may be facilitated and what needed to be discussed X was able to have the conversation and move things forward in a positive way. This meant X felt more supported going into the surgery and less anxious. X additionally found the on line CBT programme they were doing via the staff support service helpful and as the Counsellor had informed X they could do – X’s partner was using this too for their own anxiety.
X found being able to speak to OH prior to surgery had been supportive OH made recommendations X’s Manager in relation to reasonable adjustment and phased return in preparation for X’s return. X felt supported both during recovery and their anxiety in relation to the job role and been managed and supported by the Health and Wellbeing Team and HR.
X continued to see the Counsellor whilst absent from work and used the Physiotherapy service to support the recovery process after surgery. X valued the fact that they could access the support all under one internal service, the speed at which this was arranged and the feeling of support that came from knowing that every health professional they saw both understood X’s job, how the operation and anxiety may affect this. X felt that their home situation had much improved as a result of accessing the Counselling support and communication between X and their partner had greatly improved.
Of course not all staff will access all of the services offered to our Employees at the same time, however there are many employees who benefit form the 360 approach with less complex support needs. The value of the NHS systems, policy and processes knowledge, the Clinical excellence and professionalism of the team and that importance of being able to access support for work and home related issues alongside Physical and mental health is something our Employees value and our Trust and Board is proud to provide. Our EAP now provides support to over 45,000 NHS and some private sector staff and this is growing as we now have external contracts across England. Within these contracts we are supporting other NHS Trusts to use there internal or outsourced OH and Physiotherapy to create their own 360 degree model for their own Employees with our support to do so.
At our recent SEQOSH inspection for Occupational Health the inspectors who spent a day on site both commended highly the cohesion of service team members and how the 3 services were able to work both individually and yet with dialogue between departments that existed under the Health and Wellbeing at Work umbrella. They commented that in their experience this was unusual and very positive and that they felt our 360 model was to be commended and was well led.
Health and Wellbeing @ Works 360 degree model ensures our employees have in house access to a range of Clinicians supporting them to be physically and mentally well at work. Our Clinicians offer a wide range of support services within the teams they work with and we are currently undertaking research with The Institute of Employment Studies looking at ROI of EAP, and internally in relation to staff pathways within the services. This will continue to enable us to make service improvements for our employees who in turn ensure we as employees offer the best care to our, patients and services users supporting our trust aims to provide perfect patient care.
Clients with specialist needs can be accommodated across the full range of access to service clinics. Offering over 14 locations ensures employees can be seen close to home or work. We have arranged taxis for clients with mobility or physical health difficulties. Additionally on occasion we have conducted home visits for clients who are very unwell, have a poor prognosis or have been involved in a work place incident / Trauma.
Our referral process for the EAP includes all clients that contact the service has an immediate telephone assessment with a counselor or alternatively one within 5 days at a time to suit the client (we operate 24/7). Clients a risk assessed and medication and relevant information taken. Presenting issues and concerns are discussed and the client is then triaged to either a face to face appointment with a male or female counsellor at a location of their choice, signposted to other relevant support services and given details for our on line resources and information. Clients requiring immediate intervention are either seen at the next available appointment where appropriate or triaged to appropriate crisis management services in their geographical area.
How long do people wait to start receiving care?
All clients accessing the EAP service will receive a telephone assessment with a counsellor within 5 days. This is subject to client availability. Clients with urgent needs can be seen within 24 hours and the wait between referral and 1stface to face appointment KPI is 15 working days. Clients who are happy to be seen at a number of locations will be offered an appointment quicker than one asking for Friday afternoon with a male therapist. Clients are advised of this at point of contact with the service and encouraged to give as many location choices that they can easily travel to / attend. All clients can access support form a counsellor 24/7 via our telephone support line.
Demand for employee EAP support services is rising as waits for psychological support can vary considerably throughout the country.
How do you ensure you provide timely access?
The service has a team of experienced and dedicated multidisciplinary professionals. All referrals are subject to service SOPs and all triage is via appropriate experienced clinicians. Risk assessment and priority is part of the initial assessment process within the various processes within the Health and Wellbeing @ Work department. We would be happy to share these with any interested parties but are numerous given the size, teams and processes for the service.
Staffing levels are constantly reviewed and the staffing has increased in line with the services growth and geographical spread. Our OH department do struggle to recruit appropriately trained clinical specialist OH Nurses as there is a national shortage.
