Jonathan Sheppard Clinical Specialist Physiotherapist (OH)

1. Staff Physiotherapy Service Reducing staff sickness at Ashford & St Peter’s NHS Foundation Trust Jonathan SheppardClinical Specialist Physiotherapist (OH)

2. Employee’s • An important part of our responsibility to our employees is providing them with resources to lead healthier lives. “Good health is important to all of us”

3. Performance AND Health and well being • Psychological • Musculoskeletal • Disease • Sense of ‘wellbeing’ • Happy • Supported • Sound decision making • Able to manage self • Coping with changes • Good morale • Improved productivity • Hitting targets • Good patient experience

4. NHS loses 10 million working days a year to sickness: • 46% Musculoskeletal disorders (MSDs) (Boorman 2009) • Staff off work for 6 months have 50% chance of returning • Staff off work for 12 months have a 30% chance of returning (Waddell, 2000)

5. Work ‘work should be comfortable when we are well and accommodating when we are ill or injured’ Norton Hadler (1997)

6. What is the good of treating a condition and then sending them back to the conditions that made them sick?

7. Prevention better than cure…. Vs Reducing the risks to health

8. Physiotherapy • Assess and treat specific conditions • Devise rehabilitation programmes to address areas of underlying weakness • Help staff to self-mange long-term conditions • Employee • Employer • Give appropriate ergonomic advice • Assists Occupational Health Advisors with return to work advice

9. Physiotherapy • Physiotherapy can: • reduce sick leave by preventing and treating the source of pain • enable staff to work on full normal duties through rehabilitation • ensure alternative or modified duties are appropriate and time limited • deliver a cost-effective service.

10. Ashford & St Peters NHS Foundation Trust

11. Delivering our vision

12. To recruit, retain and develop a high performing workforce – Trust Objective 2 • Align service improvement with workforce planning and job design • Ensure mandatory training and professional development activities meet patient experience and outcome priorities • Embed Living our Values and Leadership & Management Framework • Continue to improve staff loyalty and experience so that staff are inspired, proud ambassadors of our Foundation Trust • Continue to improve the health, safety and wellbeing of staff

13. Continue to improve the health, safety and wellbeing of staff • Provide a dedicated Occupational Health Service to support the management of illness and prompt rehabilitation to include a Physiotherapy service • Promote active and healthy lifestyles • Hold monthly focused health promotion events • Deliver a high uptake of the seasonal influenza vaccine

14. Occupational Health Physiotherapy Service

15. Background to the OH Physiotherapy Post • Historic Picture of Physiotherapy in OH • Previous pathway into main out-patients • Previous attempts to get Physio involved • ‘Good to Great’ – Leadership programme • NHS Constitution & NICE Guidelines • Health & Well-being agenda • 2007-Working for a Healthier Tomorrow (Dame Carol Black) • 2008-Improving Health and Work –Changing Lives (DH) • 2009-Review of NHS Staff Wellbeing (Steve Boorman)

16. Aims & Objectives • Assess the effect on staff sickness from MSD by the provision of an OH Physiotherapy service • Reduce the number of sick days and time lost due to MSD • Work with Occupational Health to fast-track return to work • To raise the awareness of the Health & Well-being agenda across the Trust

17. Outline of service • Additional funding provided by ASPH for one year trial • Managed by Occupational Health but professionally accountable to Physiotherapy manager • Cross-site clinics • Drop-in clinics • Usage of Physiotherapy equipment and rehabilitation and Hydrotherapy classes • Use of outcome measures • Visual Analogue Scale (VAS) • Discharge questionnaire

18. Service Delivery • Post filled with a band 7 Clinical Specialist Physiotherapist • Referral Process • Self Referral • Occupational Health Adviser’s • GP / Consultants • Links with other departments • Physiotherapy • Moving and Handling

19. Number of Staff seen • 449 staff seen in the year long trial • 56% clinical, Non-clinical 44% • 45% Nursing, Midwifery and Health Care Assistants • Average wait of 12 days compared with 85 days in the main department

20. FTE Days off sick Days lost per employee No. of episodes Average length of sickness Without With physio physio 5714 4030 1.73 1.23 781 697 7.3 5.7 Staff sickness

21. Comparing Staff Sickness Levels 29% reduction comparing year on year

22. Specific conditions seen

23. Cost Savings • Indirect costs of MSD sickness • Productivity • Turnover of staff • Staff morale • Reduced bank staff usage shows saving of £60,344 • Return of £2 for every £1 spent

24. Outcome measures • Average reduction in pain of 80% • 77% of staff seen did not have time off work • 52% reported Physiotherapy intervention was the direct reason for not having time off • 68% of staff indicated they saved time by not having to take time off to visit their GP for a referral • 71% of staff more active following Physiotherapy treatment

25. Time saved by not visiting GP

26. MDT Working with OH Advisors • Timely referrals • Appropriate training • Return to work advice • Appropriate risk assessments

27. Health & Wellbeing • Prevention / Education • Back pain workshops • Desk-based exercises video • http://trustnet/docsdata/occhealth/exercises.html#h • Exercises on ‘Trustnet’ • Information resource on common conditions on ‘Trustnet • Calendar of events • Workout at work (CSP) Gym Ball sessions • Chair Pilates

28. Top Tips • Self referral is key • Understand MSD sickness • Understand the ‘in-direct’ costs of MSD sickness • Embrace Health & Well-being with direct support from the Executive team & partnership working

29. Staff-side Reps • Does your Trust have a Health & wellbeing strategy? • Be proactive in discussing Health & wellbeing with your organisation • Have ‘Health & wellbeing’ as a regular agenda item on your meetings with management • Explain and understand the link between staff morale and improved Health & wellbeing • Work with Occupational Health not against them

30. Building a business case with OH • Compare your current levels of sickness with nationwide statistics • Use evidence to show the effect of a specific OH Physio • Explain the need for a specialised physio in occupational health and NOT just a ‘fast-track’ service • Finance directors are interested in potential savings only so focus on these

31. Take Home Message • OH Physiotherapy proven to reduce staff sickness • Staff are being asked to do more with less so need support • NICE's public health guidance – “The NHS should do more to improve the health and wellbeing of its workforce” (Jan, 2012)

32. ‘The bigger picture’ • 30 minutes specific Physiotherapy treatment per week • Specific exercise 4 times a week for 1 hour • Approximately 56 hours sleep per week What about the other 107 ½ hours in the week??

33. I am happy to answer any questions or queries Sheppard J: 2013: Trust Physiotherapy: Occupational Health at Work; (5): 25-28 Jonathan Sheppard – Clinical Specialist Physiotherapist (Occupational Health) jonathan.sheppard@asph.nhs.uk

34. Further Information • Audit Commission (2011). Managing Sickness Absence in the NHS: Health Briefing from: www.audit-commission.gov.uk/SiteCollectionDocuments/AuditCommissionReports/NationalStudies/20110210managingsicknessabsence.pdf Accessed: 26/01/12 • Baker P (2011). Costs and benefits of managing musculoskeletal disorders and return to work. Journal of Association of Chartered Physiotherapists in Occupational Health and Ergonomics. Vol 15.3. pp. 14-16 • Boorman S. (2009).NHS Health and Well-being review: Final report. London, Department of Health. • Department of Health (2011). Healthy Staff, Better Care for Patients: Realignment of Occupational Health Services to the NHS in England. London, Department of Health. • Department of Health (2011). NHS Health & Well-being Improvement Framework. London, Department of Health. • Department of Health (2011). The Operating Framework for the NHS in England 2012/13. London, Department of Health. • Waddell G, Burton AK. Occupational health guidelines for the management of low back pain at work – evidence review. London: Faculty of Occupational Medicine, 2000 • Zigenfus G.C., Yin J., Giang G.M. (2000). Effectiveness of early physical therapy in the treatment of acute low back musculoskeletal disorders. Journal of Occupational and Environmental Medicine, 42 (1), pp. 35-39, 1076-2752.