A rapid response

A high level of sickness absence in the nhs is due to MSK conditions, The Boorman review found.  One enterprising physio team set about addressing the issue – and earned a 2011 CSP Service Excellence Award. Christian Duffin reports

When members of a Salford physio team heard that about half of all sickness absence among NHS employees is due to a musculoskeletal (MSK) injury, they decided to act.

The finding was contained in the 2009 NHS Health and Well-being report, written by occupational health consultant Dr Steven Boorman.

He said NHS staff typically take 10.7 days each year off work due to sickness – about 10 per cent more than colleagues elsewhere in the public sector, and a startling 67 per cent more than private sector workers.

To tackle this problem, a group of physios set up the ‘Working Well’ programme, based originally within Salford Community Health and also involving the University of Salford.

The idea was to ensure NHS employees with MSK disorders had access to treatment from a specialist occupational physio case manager, enabling them to return to work or help them remain in work for longer.

Previously, these employees had endured lengthy waits for appointments through their GP.

‘We knew members of staff could have up to six weeks off work before gaining any treatment, which they had to get via their GP,’ said Working Well team leader Victoria Dickens, consultant physio at Salford Royal NHS Foundation Trust.

‘We also knew that a lack of specialist knowledge about MSK disorders within occupational health teams meant a “safety first” approach was used and that decisions around returning to work were delayed.’

Nearly 600 treated within months

The Working Well project started in February 2010 as a 12-month pilot funded by the charity The Health Foundation, through its Shine programme that awarded projects up to £75,000.

The Working Well team aimed to bring greater job satisfaction and mental well-being for employees affected by MSK disorders and to cut the costs to the NHS of providing backfill staff to cover absences.

A further aim was to improve efficiency and effectiveness of staff, and bring improved levels of care and patient satisfaction.

The project worked so well that the programme won the ‘Research into Practice’ category at the 2011 CSP Service Excellence Awards.

Ms Dickens could not provide detailed figures to show how many sick days were recovered, but said that the project created a saving of £25,461 in its first 12 months.

Up to the end of November 2011, 596 NHS employees had accessed the service.

The first stage of the programme involved tracking down NHS employees in the Salford area with MSK disorders, using human resources records and absenteeism data.

This enabled identification of departments or units where sickness rates were highest.

The process also involved liaison with the employees’ line managers, human resources managers and occupational health workers to devise ‘appropriate transitional work arrangements’ and advice on working practices.

The Working Well team put the message out in a variety of other ways. Ms Dickens explained: ‘We went to team meetings, put up posters and sent out flyers, and sent out notification in the email bulletins that went to staff.

This helped us pick up the people that were to go off work in the future.’

Using feedback to improve provision

It was difficult to engage some community staff, however, who did not always have access to computers or did not see posters because they were on the move so often.

‘We were marketing the service to colleagues who were working out and about in the community, and this was a challenge.

We soon learned that face to face contact with staff and managers was the most effective marketing approach.’   

The team found a huge range of injuries among their NHS colleagues: low back pain, neck and shoulder pain, hip and knee joint problems including arthritis, sprains, strains, fractures, repetitive strain injuries in the hand and wrist, and generalised aches and pains due to faulty posture or movement patterns.

Ms Dickens added: ‘Ninety per cent of staff we approached opted to take part in the service.

They came from across a range of areas and professions. We had estates and support staff, admin staff, district nurses and other clinicians.’

Data collection and analysis proved more laborious than first anticipated, however, and so the team had to allocate additional funding and time to this task.

An important part of the project was that NHS employees were given assessments and functional capacity checks within their workplace at one of three sites.

The clinics were held at times that suited employees, but it was tricky because of their multiple shift patterns and different locations.

The timings of clinics were reviewed through the initial 12 months, so that access to the service could be improved based on feedback from participants.

Ms Dickens said: ‘The employees were given quick access to treatment by a physiotherapist, or referral to a different physiotherapist or discipline for a specific intervention such as podiatry or counselling.

It had to be flexible so it could accommodate the varying hours of shift workers.

‘We had to liaise with GPs to facilitate an effective management of the return to work.’

Positive effect on morale

After the project had run for 12 months, the University of Salford reviewed progress.

Participants were asked to fill in questionnaires on their general health, and give an account of their psychological well-being.

They also had to give an idea of their job satisfaction.

Salford Royal NHS Foundation Trust could not supply exact figures, but the Working Well team says there was a ‘significant improvement’ between pre-intervention and discharge for all three measures.  

Some staff reported that they had joined slimming clubs, taken up exercise or been able to restart hobbies they had put on hold.

When someone who had been off sick returned to work this boosted colleagues’ morale because their workload returned to normal, she added.

Other regions have expressed interest and Ms Dickens hopes that the project will continue.

Christine Parker, a physio lecturer and team member, said: ‘Working Well gives staff the support they need to stay healthy and in work, which is crucial in these challenging economic times.’ fl

To download the NHS Health and Well-being report.

2012 CSP Awards

The deadline for this year’s Awards has passed. The winners will announced in November

Christian Duffin

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