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Promoting wellbeing

Jennifer Trueland talks to physiotherapists who are improving the wellbeing of NHS staff and helping others back into work.

File 117195
Physios cut sickness rates and promote wellbeing

It’s just as well that Steve Shore is a firm believer in the adage that work is good for you because he is, in his own words, ‘incredibly busy’.

The occupational health specialist physiotherapist at Lancashire Teaching Hospitals NHS Foundation Trust has found that the service he helped set up – aimed at helping NHS staff to get back to work, or to stay in work without going off sick – has really struck a chord.

The service offers a fast-track to treatment for employees of the trust, providing advice and treatment as appropriate. But it goes further, in using workplace assessments to ensure that members of staff don’t get to the point where they need help in the first place.

‘I think that staff like the service because it makes them feel more supported,’ says Mr Shore, who has been a physiotherapist for around 20 years.

‘It has also saved money for the trust in terms of lost working days and sickness absence.

For me, it’s a satisfying area to work in because you’re helping people stay in work, and we know that work is good for you: among other things being busy keeps you stimulated, and also makes money.’

Healthy staff deliver better care

It’s an exciting time for the occupational health physiotherapy specialty, in the NHS and elsewhere.

Over the coming months and years, more NHS bodies are likely to consider setting up occupational health physiotherapy services similar to that already deployed in Lancashire.

A number of external policy drivers are pushing health services in that direction, as is the fiscal imperative of saving money on the staff absence bill.

At the end of April, NHS chief executives pledged their commitment to improving the health and wellbeing of staff who work in healthcare at a meeting convened by NHS Employers and Dame Carol Black, co-author of the seminal report on sickness absence Health at Work: An independent review of sickness absence.

She told the meeting that the benefits of strong health and wellbeing programmes in the NHS go far beyond the individual.

‘Staff whose wellbeing and health is well supported deliver better care and are more resilient and better engaged with their role. At a time when the NHS is striving to make the absolute most of its resources, getting this right is crucial.’

Key role for physiotherapy in national programme

Of course, sickness absence isn’t confined to the NHS workforce – and the government has made it clear that it sees physiotherapy having an important role in keeping the nation in work.

In its response to the report authored by Dame Carol and by David Frost (mentioned above) the government announced in January the setting up of a new independent assessment and advisory service aimed at getting people back to work and away from long-term sickness benefits.

Fitness for Work: the government response to ‘Health at Work – an independent review of sickness absence’, describes the proposed health and work assessment and advisory service as employing physiotherapists, as well as occupational health nurses, occupational therapists, occupational physicians and others.

The report anticipates the need for more healthcare professional providing services in this field, including up to 1,300 full time equivalent roles providing interventions such as physiotherapy, talking therapies and workplace mediation.

Fresh opportunities available

Léonie Dawson, a CSP professional adviser who is an occupational physiotherapist by background, agrees that it’s an interesting time with lots of opportunities.

‘We don’t know exactly what the independent advisory service will look like yet, but in theory it’s a good thing, and physiotherapy is seen as key.’

Jenny Nissler is another occupational health physiotherapist and leads on the CSP’s Occupational Health Physiotherapy works document (see: CSP website and search for physio works occupational).

She says the links between ‘good work’ and health are well-known – and that physiotherapy has an important part to play in getting people back to work in the health service as well as in the general workforce.

But both women urge aspiring occupational health physiotherapists to complete postgraduate professional development in the area, and suggest learning more about the Association of Chartered Physiotherapists in Occupational Health and Ergonomics, the professional network.

While the Lancashire trust is far from being the only NHS organisation to provide such a service to staff, it is seen as a good example; indeed, Mr Shore says other trusts have been inspired by it when setting up their own services.

Having spent some years in industry – and having a deep interest in ergonomics and medical law – he has used his experience to create a service which he believes is ‘quite unique’ in the NHS.

‘We use a biopsychosocial approach, which means we are not just looking at the physical – we use a flagging system, so if someone says something about their manager, or about something that’s happening at home, or how they feel about work, then it’s flagged up. The idea is to get to the root cause of what’s going on.’

Repetitive strain injuries

Although most referrals are clinical staff, administrative staff often present too, with issues relating to repetitive strain injuries. ‘It’s mainly backs, necks and shoulders,’ Mr Shore says, adding that there are also a lot of ‘stress’ issues, which he and his colleagues deal with using a cognitive behaviour therapy approach.

He uses the usual occupational health processes, such as functional testing of ability – particularly useful if someone has been off sick for a while – by analysing the job demands and comparing them to what the employee is able to do.

The service also offers redeployment functional testing: if a staff member is unable to do his or her current job, another post in the trust might be manageable and allow the person to stay in work. Functional testing of prospective employees who have indicated muscoloskeletal (MSK) issues in their application is also part of his role, as is ‘work hardening’ – getting people ready to make the return to work.

This is part of a wider set of wellbeing initiatives at the trust, which include a range of exercise classes (from box fit and Zumba to Pilates and belly dancing!) and a diet club which rewards the ‘biggest loser’ – in terms of weight, that is.

The service runs alongside traditional physiotherapy at the trust – while it uses the same equipment, there is no sense that staff are ‘jumping the queue’ to the detriment of other patients.

‘The NHS is one of the biggest employers locally, and I hope that people would be pleased that we are looking after our staff – because our staff are the people who will be looking after them,’ he adds.fl  see Fit enough for patients

Are you thinking of working in occupational health?

The Association of Chartered Physiotherapists in Occupational Health and Ergonomics (ACPOHE) is a CSP-endorsed professional network.

It has developed a competency framework and registered membership.

Members of ACPOHE can find the competency framework in the members’ zone at: ACPOHE

Registered membership is available via three routes: completion of a relevant postgraduate course, completion of four ACPOHE courses and evaluation of a case study, or completion and evaluation of two case studies.

The ACPOHE competency framework enables physiotherapists working in occupational health to map their level of knowledge, skills and experience against the framework.

The mapping can be used to support job opportunities, but also as a tool for continuing professional development and helping to identify leaning needs.

A vocational approach

Physiotherapy is a key element in a vocational rehabilitation service covering Scotland’s second largest health board area.

Working Health Services Lothian has been running for four years, and is there to help people who are either off sick or struggling at work, with any health condition.

The criteria are that they live or work in the Lothian region, and that they work for a small to medium sized company (up to 250 employees) or are self-employed.

Clients refer themselves, or can be referred by their GP, or by NHS 24 (Scotland’s telephone-based help and advice service, and gateway to care out-of-hours, which has recently started offering a direct referral service for musculoskeletal (MSK) problems).

Crucially, referral does not come through the employer, marking the service out from occupational health.

According to Jyotsna Rai, specialist physiotherapist with the service, physiotherapy is a key part of the multidisciplinary team (which also includes an occupational therapist (OT), counsellor, case manager and administrative staff).

‘Physiotherapy is a crucial part of the team, because many people present with MSK problems.

‘It’s a very satisfying job, because you feel you’re really helping people who are struggling,’ she says. ‘We get really good, positive feedback. It’s rapid referral – we don’t have a waiting list – so can help people stay in work, or get back to work, and help them avoid going on benefits.’

The programme, which is funded by the Scottish Government, and is part the UK government’s Fit to Work initiative, uses a biopsychosocial and case management approach.

This means the team considers not just physical barriers to an individual returning or staying in work, but also the mental health and social barriers.

Every patient enrolled is assigned a case manager, who gains an in-depth knowledge of the individual’s condition, and is then referred to the appropriate person in the multidisciplinary team.

The physiotherapy role involves providing treatment for the condition, offering ergonomic and postural advice to facilitate return to work, and, in cases where someone is already at work, help to modify their work environment to reduce discomfort and help them stay at work.

‘If the individual is off sick, once it is ascertained that the patient is bio-mechanically stable, the OT or physiotherapist can undertake a functional capacity evaluation to provide an indication of the patient’s level of function,’ says Ms Rai.

‘This informs the therapist and the employer about the patient’s safety in returning to work. The patient doesn’t have to be 100 per cent fit to return to work – they can return with modifications,’ she adds.

Workplace assessments are also undertaken in conjunction with occupational therapy as appropriate.

‘If during the physiotherapy sessions, any mental health issues arise that are preventing an individual’s return to work, the patient is referred to see either the counsellor or the mental health occupational therapist,’ she says.

Of the service’s recorded exit data, 93 per cent of clients have remained in, or returned to work from sickness absence, on completion of the programme.


Health and safety issues

There are some very good occupational physiotherapy initiatives in the NHS.

But, the CSP recently surveyed NHS acute mental health and community trusts in England and found that out of the 70 per cent that responded, more than one third (37 per cent) did not have a strategy in place to improve the health and wellbeing of their staff.

The survey also identified 20 trusts that don’t provide physiotherapy services to staff through occupational health services.

If you know your employer should be doing more, or you are not certain what is being done to improve your health and wellbeing, talk to your CSP safety rep.

He or she will know the answers or can find out. If you don’t have a safety rep, organise with your workmates to elect somebody to take on this important role.  

An accredited CSP safety rep is vital to promoting good health, safety and wellbeing practices at your workplace.

They achieve this through their legal rights to do inspections, be consulted on employers’ risk assessments and any significant change that affects your health, safety and wellbeing.

Safety reps support CSP members by:

  • Surveying them to identify the main health, safety and wellbeing issues and then representing these concerns directly to management
  • Advocating on their behalf to get direct access to occupational health provided physiotherapy
  • Inspecting work premises for potential hazards and then working with managers to risk assess effective solutions.  
  • Reviewing accident and sickness absence records to uncover trends and raise awareness of problems
  • Educating members about their health and safety rights
  • Body mapping members – a process that identifies work practices and other factors behind members’ musculoskeletal disorders – the main cause of NHS staff sickness absences
  • Participating on the joint union and management health and safety committee to help create the best health and wellbeing strategy

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