Last reviewed 13 June 2017
Do you look forward to going to work? Jef Smith looks at the new National Institute for Health and Care Excellence (NICE) Quality Standard on Healthy Workplaces.
Several factors will contribute to how each of us responds to that question, the content of the workload, relationships with colleagues, and the competence of management prominent among them. One other important consideration, however, is the environment in which you make your contribution.
Employees’ health and wellbeing at work contribute significantly to an organisation’s productivity, as numerous statistics demonstrate. The number of days lost to sickness is around 27 million annually for England, Scotland and Wales, and the Health and Safety Executive (HSE) reports that the total for cases of work-related stress, depression or anxiety now approaches half a million. Any cuts in these figures, which are largely attributable to eminently treatable conditions such as stress and back pain, would clearly pay enormous dividends. It is very appropriate, therefore, that the NICE should have been working on how this issue specifically affects health and social care settings.
What is wellbeing?
We need at the outset to define some key terms. Health, pretty obviously, refers to one’s physical and mental condition. Wellbeing is rather more complicated, defined by NICE as “the subjective state of being healthy, happy, contented, comfortable and satisfied with one’s quality of life”. It is worth pausing to take in that list of adjectives, overlapping certainly but corporately presenting a rounded picture of a good place to be. How many of us could honestly say that we look forward to going to work expecting it to make us feel “happy, contented, comfortable and satisfied”? How many bosses can confidently answer that challenge positively on behalf of their workers?
Mental wellbeing, NICE goes on to suggest, includes self-esteem, the ability to socialise, the capacity to cope in the face of adversity, the development of one’s potential, the satisfaction which comes from working productively and creatively, the building of strong and positive relationships with others, and the opportunity to contribute to the community. Again, it is challenging for employers to ask themselves how or what they offer their staff measures up to that demanding list.
Of course, as Professor Gillian Leng, NICE’s Deputy Chief Executive and Health and Social Care Director, has said: “Every workplace is different and the relationship between management and employee wellbeing is a complex one,” but she went on to insist that, “there are some basic principles that should be applied by all employers, directors and line managers” and that “these include ensuring the right policies and managements practices are in place”. Her comments were made in the course of the launch in March of NICE’s quality standard relating to healthy workplaces.
The intended audiences for NICE quality standards include commissioners, providers, practitioners and regulators, and although they are not legally binding, the fact that they have powerful government support gives them significant authority. The Care Quality Commission certainly takes them into account in the course of inspections so home care agencies should also take them seriously.
NICE’s quality standard for healthy workplaces was produced under its public health programme of activity, so it covers both health and social care environments. This means that it lacks some degree of specificity to social care settings, but this by no means invalidates its advice. A more significant criticism in my eyes is that NICE’s Quality Standards Advisory Committees include very few people with specific knowledge of social care — lots of doctors, nurses and other NHS personnel, a scattering of academics and local authority commissioners, but almost no care providers.
The quality standard consists of four statements headed respectively making health and wellbeing an organisational priority, role of online managers, identifying and managing stress, and employee involvement in decision-making.
The first priority, therefore, according to NICE is for all providers to have a senior manager responsible for staff health and wellbeing, leading on policy initiatives, supporting line managers and the employers, and actively demonstrating the organisation’s commitment. Such a person in an agency employing 50 or more people should usually be a member of the executive team or at least someone with enough clout to be able to speak directly to them with confidence that they will be listened to. In smaller organisations, the owner or the agency’s manager could take on the role. Their main working tool will be a health and wellbeing strategy or plan and the responsible person needs to ensure that health and wellbeing are included in all other relevant policies and communication.
Responsibility, however, cannot end there. The second statement calls for it to be built into the role of all line managers, incorporated into their job descriptions, and prominent in their performance reviews. This demands adequate time, training and resources, but the paybacks make such an investment well worthwhile. Where health and wellbeing feature consistently in the priorities of line managers, this statement claims, “employees feel valued, content and able to discuss any concerns before they reach a crisis point”. This, it goes on to promise, “can also improve productivity”.
The third statement is even more demanding, requiring managers to be “trained to recognise and support” staff who are experiencing stress. Managers need of course to be in regular contact with their subordinates, both on a day-to-day basis and through structured supervision sessions, a requirement even more important in the domiciliary care business where front-line staff are routinely operating away from base. This is a costly demand but the standard quotes research evidence showing a reduction of symptoms capable of escalating into illness and absence, so the expense of those close relationships is eminently justifiable. Remedial action where stress is identified could include making changes to how the work is carried out or a temporary reduction in the workload. Such in-house measures have to be supplemented by access to occupational health and other sources of external support, and managers need to be knowledgeable about the resources available in their area.
The fourth statement covers the potentially much broader issue of employee involvement in decision-making. Well done, such practices have benefits all round; the organisation gains from insights from people closely involved in front-line delivery, and the staff feel valued and motivated. What the statement rather heavily calls “staff engagement forums”, a term it uses to include “small team meetings, working groups, the appointment of wellbeing champions, use of digital media, suggestion schemes or attitude surveys”, should both feature in the regular operation of the agency and be included in organisational plans and published reports. Staff also need feedback on how their views have been used. Could anything be more motivating than seeing your suggestion for improving a service put into operation?
Imagination and determination
NICE’s work is inevitably at a fairly high level of generalisation. It will require imagination and determination on the part of a care agency’s managers to apply it locally by devising operational solutions to their own workplace health and wellbeing issues. Some cases of front-line worker stress in domiciliary care are well known — brief and rushed visits, unpaid travel time, and of course increasingly demanding clients — and every agency needs to address these. The concept of a healthy workplace also requires some adaptation for domiciliary care to the fact that staff characteristically deliver service not from an agency-located base but in service users’ own homes where there is much less control over the working environment. This is a problem shared, of course, with other community-based health service staff so perhaps NICE could give it some dedicated attention.
Despite these specifics, home care agencies also have some qualities in common with other care providing bodies such as residential homes and day centres. Managers in all settings can profitably ask themselves questions like are recurrent causes of disaffection in the workforce being treated seriously with remedial action seen to be taken, and are changes over time in the problems clients present demanding new skills from front-line workers and, therefore, new forms of support and training?
For a care agency to offer manifestly healthy working conditions will naturally help both recruitment and retention of staff. Staffing is a major worry for most providers and the situation is likely to get tougher over the next few years as further controls on immigration are implemented. However, working conditions are by no means the whole story. In early May, the organisation NHS Providers reported that health service staff are quitting their posts because supermarkets’ wages for shelf stackers are higher. In social care, employers have been making precisely that point for many years. Low pay trumps pretty nearly every other source of workforce dissatisfaction.