Last week saw the publication of the NHS staff survey 2019. The results show more staff reporting work-related health problems such as musculoskeletal problems and stress compared to 2018, a continuation of the same trend since 2016. It is clear the NHS still needs to do much more to improve the health and wellbeing of its staff.

Duncan Selbie, Chief Executive of Public Health England, has previously said ‘…a job, home and a friend are the things that matter most to our health.’ It is widely recognised that employment is a key determinant of health. But evidence shows that poor quality work is even worse for health than being unemployed – in other words, bad work is worse for you than no work.

Last year we published a newsletter feature Improving the health and wellbeing of 1.6m NHS employees where we highlighted that as the UK’s largest employer, the NHS has the potential to influence the health and wellbeing of a significant proportion of the population.

The NHS as a ‘good employer’

The Interim NHS people plan, published in June 2019, has ‘Making the NHS the best place to work’ as its first theme. There is hope that the final plan, expected in the coming months, will build on this. However, there is still a long way to go.

In 2019, 40.3% of NHS staff reported feeling unwell from work-related stress. By comparison, work-related stress across the entire workforce has a prevalence of 1.8%. Indeed, 71% of those taking ill-health retirement in the NHS reported that their ill health was partly or completely work related.According to NHS digital and ONS figures, the NHS sickness absence rate, at 4.21%, is over twice that of the national average of 2%, and well above the public sector average of 2.7%. Despite these results, less than a third (29.3%) of NHS staff in England report that their employer takes positive action on health and wellbeing.

Focusing on lower paid NHS Staff

Staff earning less than £24,000 make up 40% of the NHS workforce. In the NHS workforce, we know that staff in lower paid positions have poorer health and, according to internal Health Foundation analysis, are more likely to have long-term health conditions than colleagues in higher paid posts.

In our recent work on NHS anchor institutions we describe how the NHS can begin to tackle poor health outcomes and health inequalities through:

  1. a greater focus on improvement of health and wellbeing of all staff
  2. fair pay and conditions, and
  3. professional development and career progression.

When we look across NHS occupations there are stark differences. For example, administrative and support staff are more likely to take longer to return to work after sickness absence than medical staff. Workplace interventions designed for one group such as hospital consultants, may not be appropriate for another, such as domestic staff. Indeed,  there is some evidence that workplace wellbeing programmes are predominantly used by staff in higher pay grades, whilst some of the lowest paid staff tend not to participate, potentially worsening health inequalities. In order to really address these inequalities, the NHS will need to better understand the issues and experiences of its lower paid staff, and design interventions with them in mind.

Being healthy and well is not only good for those lower paid staff on an individual, family and community level, it is good for patients and employers too.

What does it mean for patients?

The Boorman review makes it clear that staff health and wellbeing affects quality of care. This is no less true of lower paid staff. For example, higher rates of health care-associated infections have been linked to adverse employment conditions for cleaners. Lower paid staff are just as much part of the wider team, keeping patients safe and improving their hospital experience.

What does it mean for employers?

Studies across several sectors report that the health and welfare of staff influences their productivity. NHS digital data shows sickness rates for band 2 staff were 6.22%, more than four times that of band 9 staff at 1.26%.

However, productivity is more than simply attendance at work. There is growing recognition that productivity is driven by investment in people. At a time of unprecedented workforce shortages, perhaps we need to think of our workforce more as an asset to invest in, and less as a cost to minimise.

Policy changes such as the announcement of the government’s new immigration system mean that international recruitment of lower paid NHS staff may become more difficult, especially if there is a shortage of these staff in other sectors. There is ever mounting need for the NHS to invest meaningfully in the health and wellbeing of the lowest paid staff.

What next?

Our early scoping work has identified knowledge, policy and practice gaps on the health and wellbeing of lower paid NHS staff. We are therefore inviting proposals to work with us on an exciting new project. The closing date for applications is Monday 23 March.

Through drawing on evidence and consultation with this staff group, we hope to learn more about how the NHS can be a better employer and improve health and wellbeing of its lowest paid staff.

James De Boisanger (@JBoisanger) is Clinical Fellow at the Health Foundation.

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