Co-creating a Healthier NHS

CONTEXT
Research has widely demonstrated the impact that stress at work can have on individual health. For example work stress is related to heart disease, poorer immune system functioning and increased likelihood of developing symptoms of depression. It is the number one cause of long term sickness absence (greater than four weeks), and number two cause of short-term sickness absence, in the UK. Stress not only impacts the individual but also the organisation that they work for. For example, for every individual employed in the UK an average of 7.5 days are lost due to stress sickness absence, with that number increasing to nearly 11 days in the healthcare sector. Indeed, on average, NHS employees take more than 15 days off per year due to stress - twice the national average - with stress sickness absence levels increasing by 37% over the past 3 years. Tackling stress in the NHS is therefore such an important task that it has recently become linked to amounts of funding NHS Trusts receive each year.

AIMS AND OBJECTIVES
The main aim of this project is to design a series of stress management interventions to reduce sickness absence in three large NHS Trusts. The interventions will be co-designed with employees using a Participatory Action Research methodology. Through a series of individual interviews, focus groups, and meetings with dedicated wellbeing groups across three participating NHS Trusts, we will design interventions and a wellbeing toolkit for the improvement of stress awareness and communication which will be presented through a smartphone app. An app has been chosen for its ability to be easily accessed and distributed across a wide range and large number of individuals, and because it means information can be disseminated quickly to a wide range of NHS employees.

The first of three research objectives is to co-design (alongside NHS employees), distribute, and evaluate a wellbeing toolkit for NHS staff. The toolkit will provide understanding of how to spot and what to do about the signs of work stress in self and others. The second objective is to co-design NHS-specific interventions for the improvement of working conditions. These everyday stressors significantly contribute to the experience of work stress, and thus interventions which are aimed at these stressors are highly sought after. We will therefore co-design, implement and evaluate interventions delivered by the smartphone app for the improvement of these everyday stressors. Finally, NHS organisations consist of an administrative 'hub' organisation which service numerous satellite sites (i.e. hospitals, care centres). This leads to issues with communication of wellbeing initiatives being adequately communicated across the whole organisation. This project will therefore help to disseminate this information widely across participating organisations via the smartphone application, and thus determine best practice to ensure this reach is substantial.

APPLICATIONS: THE NHS AND BEYOND
There are clear applications for this project, from an individual employee to a wider NHS organisational perspective. Fewer individuals will be affected by stress at work, meaning that individual health will be improved in the short-to-medium term. Organisationally we aim for there to be fewer days lost due to work stress, meaning improved productivity over the short term and reduced sickness absence costs over the long term. Moving beyond the presented project, we will look to expand to a wider proportion of the NHS and other healthcare organisations. The project will also improve public knowledge of the effects of stress at work through public engagement events such as media appearances and dissemination, organisational and policy-maker understanding through an NHS staff wellbeing conference, and academic understanding via a wide range of journal and conference publications

The NHS employs the largest number of public sector workers in the UK, accounting for nearly 30% of all public-sector employment. We seek to work with employees within three large NHS Trusts in England (c.2000 employees) to develop a new stress awareness and management intervention which is tailorable for all employees in the organisations. The project will, therefore, benefit users by improving mental health and quality of life. Participating organisations will benefit from improved productivity and reduced sickness absence, and thus there is potential for this to lead to improved healthcare provided for NHS users. There will be an important knowledge sharing element to the project as it brings together academics and users of the research to make decisions and evaluate outcomes.

In order to widen the impact of the study beyond the three participating NHS Trusts, we will hold an NHS employer's conference at which the approach taken and findings of this project will be discussed. Senior NHS England management, and those responsible for NHS employee wellbeing, will attend and contribute to the conference and thus have the ability to interact with and find out about the outcomes of this research. We will therefore have influence on policy at the local NHS Trust level, as well as wider NHS management. The project has been discussed with Laura Wilkes, head of the NHS England Healthy Workforce Programme. Wilkes has confirmed the NHS's interest in the project and potential wider take up across the NHS (see attached). Wilkes will also be invited to contribute to the NHS employers conference on staff wellbeing at the end of the project.