1. Health and Work Development Unit 2011 Implementing NICE public health guidance for the workplace: Implementation and audit action planning toolkit

2. C. Local results benchmarked against the national average

3. The purpose of this section is to help you to: review your performance in the national audit against the national benchmark identify areas of success in implementation of the NICE recommendations audited identify recommendations that are not fully met.

4. What was the aim of the audit? To improve NHS staff health and wellbeing by measuring the extent and quality of the implementation of the relevant NICE workplace guidance by NHS trusts in England.

5. What did the audit cover? This was a national organisational audit. The audit questions reflect evidence-based guidance from NICE covering: Managing long-term sickness absence and incapacity for work (www.nice.org.uk/PH19)www.nice.org.uk/PH19 Promoting physical activity in the workplace (www.nice.org.uk/PH13)www.nice.org.uk/PH13 Promoting mental wellbeing through productive and healthy working conditions (www.nice.org.uk/PH22)www.nice.org.uk/PH22 Workplace interventions to promote smoking cessation (www.nice.org.uk/PH5)www.nice.org.uk/PH5 Obesity: guidance on the prevention, identification, assessment and management of overweight and obesity in adults and children (www.nice.org.uk/CG43). Note: section 4 addresses the workplace.www.nice.org.uk/CG43 Promoting and creating built or natural environments that encourage and support physical activity (www.nice.org.uk/PH8).www.nice.org.uk/PH8

6. The next set of slides presents your results against the national benchmark. You may choose not to use all of these slides if you already know which areas of the audit you need to focus on. As you work through this section please identify the areas where you have done well and the areas where you think improvement can be made. Note these on the example tables that can be found on slides 72 and 73. You will be asked to prioritise these areas before action planning.

7. Question 1.6 Within the last three years, has the trust done a needs assessment to inform an organisational approach to: National (282 trusts)Your trust Yes% 1.6.1 Obesity8129 1.6.2 Smoking14150 1.6.3 Physical activity11039 1.6.4 Long-term sickness absence20874 1.6.5 Promoting mental wellbeing17462 Development of policies to promote staff health and wellbeing

8. Question 1.8 Has the trust involved staff in planning and designing an organisational approach to: National (282 trusts)Your trust Yes% Obesity9433 Smoking cessation18064 Promoting physical activity16358 Building site design13146 Long-term sickness absence20272 Promoting mental wellbeing19469

9. Interventions to combat staff obesity NICE CG43: Obesity: guidance on the prevention, identification, assessment and management of overweight and obesity in adults and children: In their role as employers, NHS organisations should set an example in developing public health policies to prevent and manage obesity by following existing guidance and (in England) the local obesity strategy. Workplaces should provide opportunities for staff to eat a healthy diet…through active and continuous promotion of healthy choices in restaurants, hospitality, vending machines and shops for staff and clients, in line with existing Food Standards Agency guidance. Question 2.2 Does the trust actively promote healthy food choices, for example using signs, pricing and positioning of products to encourage healthy choices in: National (282 trusts)Your trust Yes% Vending machines9032 Shops for staff and clients8631 Hospitality14250 Staff restaurant17361

10. Interventions to combat staff obesity Question 2.3National (282 trusts)Your trust Number% 2.3 Does the trust offer overweight and obese staff multi-component interventions that address all three aspects of behaviour above? 8631 2.3.1 If yes, is the person providing the programme trained in obesity management? 64/8674 NICE CG43: Obesity: guidance on the prevention, identification, assessment and management of overweight and obesity in adults and children: Weight management programmes should include behaviour change strategies to increase people’s physical activity levels or decrease inactivity, improve eating behaviour and the quality of the person’s diet and reduce energy intake.

11. Interventions to promote physical activity among staff NICE PH13: Promoting physical activity in the workplace Encourage employees to walk, cycle or use another mode of transport involving physical activity to travel part or all of the way to and from work (for example, by developing a travel plan). Help employees to be physically active during the working day by: where possible, encouraging them to move around more at work (for example, by walking to external meetings) putting up signs at strategic points and distributing written information to encourage them to use the stairs rather than lifts if they can providing information about walking and cycling routes and encouraging them to take short walks during work breaks encouraging them to set goals on how far they walk and cycle and to monitor the distances they cover.

12. Question 3.5 Does the trust help staff to be physically active during the working day by: National (282 trusts)Your trust Number% Encouraging staff to walk or cycle to external meetings14953 Encouraging staff to use the stairs rather than lifts e.g. by putting up signs at strategic points and distributing written information 13448 Providing information about walking and cycling routes to and from work 14752 Providing information about walking and cycling routes around the worksite 14250 Encouraging staff to take short walks during work breaks e.g. providing information about lunchtime walks 17361 Encouraging staff to use local leisure facilities23182 Encouraging staff to set goals on how far they walk and cycle and monitor the distances they cover 10337 Interventions to promote physical activity among staff

13. Question 4.2-4.3National (282 trusts)Your trust Number% 4.2 Does the trust publicise smoking cessation services for staff? 26494 4.2.1 If yes to 4.2, does this publicity include: Where services are available258/26498 How to access these services262/26499 The type of help available256/26497 When services are available236/26489 4.3 Does the trust provide access to stop smoking support (either on-site or through arrangements with another local service)? 26895 Interventions to promote & encourage smoking cessation among staff NICE PH5: Workplace interventions to promote smoking cessation Publicise the interventions identified in this guidance and make information on local stop smoking support services widely available at work. This information should include details on the type of help available, when and where, and how to access the services.

14. Question 4.4National (282 trusts)Your trust Number% Does the trust policy allow staff to attend smoking cessation services during working hours without loss of pay? 17963 NICE PH5: Workplace interventions to promote smoking cessation Allow staff to attend smoking cessation services during working hours without loss of pay. Interventions to promote & encourage smoking cessation among staff

15. Sickness absence management NICE PH19: Management of long-term sickness absence and incapacity for work Within 12 weeks (ideally between 2 and 6 weeks) of a person starting sickness absence (or following recurring episodes of short- or long-term sickness absence) ensure that initial enquiries are undertaken in conjunction with the employee. The aim is to: determine the reason for the sickness and their prognosis for returning to work (that is, how likely it is that they will return to work) and if they have any perceived (or actual) barriers to returning to work (including the need for workplace adjustments) decide on the options for returning to work and jointly agree what, if any, action is required to prepare for this.

16. Sickness absence management Question 5.1National (282 trusts)Your trust Number% 5.1.2 Does the (sickness absence) policy require managers to contact staff whose sickness absence continues beyond a week or so, for an initial enquiry to discuss their health and work? 26895 5.1.2.1 Does the policy give a trigger for when this should be done? Yes at 2 weeks (or less)112/26842 Yes by 3 weeks15/2686 Yes by 4 weeks97/26836 Yes by 5 weeks1/2680.4 Yes by 6 weeks1/2680.4 Yes, later than 6 weeks2/2681 No40/26815

17. Sickness absence management NICE PH19: Management of long-term sickness and incapacity for work Within 12 weeks (ideally between 2 and 6 weeks) of a person starting sickness absence (or following recurring episodes of short- or long-term sickness absence) ensure that initial enquiries are undertaken in conjunction with the employee. The aim is to: determine the reason for the sickness and their prognosis for returning to work (that is, how likely it is that they will return to work) and if they have any perceived (or actual) barriers to returning to work (including the need for workplace adjustments) decide on the options for returning to work and jointly agree what, if any, action is required to prepare for this.

18. Question 5.1.2.2National (282 trusts)Your trust Number% Does the sickness absence policy (or accompanying guidance) ask managers to explore in this initial enquiry: The reasons for sickness absence263/26898 Whether the staff member has received appropriate treatment 225/26884 When the staff member thinks that he/she will be back at work 259/26897 Any perceived (or actual) barriers to returning to work (including the need for workplace adjustments) 241/26890 The potential need for a referral to OH257/26896 The options for returning to work and what, if any, action is required to prepare for this 248/26893 Sickness absence management

19. Return to work: long term sickness absence NICE PH19: Management of long-term sickness absence and incapacity for work If a return-to-work plan is needed it should determine the level, type and frequency of interventions and services needed, including any psychological support. A return-to-work plan could also identify if any of the following is required: a gradual return to the original job using staged increases in hours and days worked (for example, starting with shorter hours and/or less days and gradually increasing them) a return to partial duties of the original job or temporary/permanent redeployment to another job.

20. National (282 trusts)Your trust Number% 5.1.3 Does the policy require development of a return to work plan agreed between the manager and the employee? 27497 5.1.3.1 If yes, does the policy specify that managers must consider, with the employee (taking account of any OH advice), the need for: A gradual return to the original job by increasing the hours and days worked over a period of time 273/27499 A return to some of the duties of the original job 272/27499 A move to another job within the organisation (on a temporary or permanent basis) 269/27498 Return to work: long term sickness absence

21. Case management: long term sickness absence NICE PH19: Management of long-term sickness absence and incapacity for work There is evidence…that a case management approach (in which sick-listed employees are interviewed by a person or team who can direct health and occupational services to help the interviewee back to work) is effective at helping people return to work. A case manager will: Keep everyone’s attention on the end point of a return to effective work Monitor absence data in real time Co-ordinate any required assessments Prompt and track actions Timetable actions to eliminate delays between milestones Initiate formal interventions Provide periodic reports to stakeholders

22. National (282 trusts)Your trust Number% 5.2 Does the trust use case managers for the more complex cases of long-term sickness absence? 18164 5.2.2 Does the case manager: Monitor absence data in real time145/18180 Co-ordinate any required assessments177/18198 Timetable actions to eliminate delays between milestones 162/18190 Initiate formal interventions175/18197 Prompt and track actions172/18195 Provide periodic reports to stakeholders161/18189 Case management: long term sickness absence

23. Sickness absence monitoring Question 5.3National (282 trusts)Your trust Number% Does the trust record absence data in real time (e.g. through ESR self-service)? Yes fully9433 Yes partially7727 No11139 NICE PH19: Management of long-term sickness absence and incapacity for work Within 12 weeks (ideally between 2 and 6 weeks) of a person starting sickness absence (or following recurring episodes of short- or long-term sickness absence) ensure that initial enquiries are undertaken in conjunction with the employee.

24. Question 5.7. Does the trust provide: National (282 trusts)Your trust Number% 5.7.3 Psychological therapies for its staff25289 5.7.3.1 If yes, are these provided by: Qualified psychologists146/25258 Counsellors trained in CBT approach217/25286 OH staff trained in CBT approach89/25235 Other staff trained in CBT approach48/25219 Management of staff on long term sickness absence NICE PH19: Management of long-term sickness absence and incapacity for work Ensure psychological interventions and services are evidence-based. Also ensure they are delivered by suitably trained and experienced practitioners. These may be health professionals (such as physicians, nurses or others specialising in occupational health, rehabilitation or ergonomics); social workers; clinical or occupational psychologists; specialist counsellors or therapists.

25. Promoting mental wellbeing NICE PH22: Promoting mental wellbeing through productive and healthy working conditions Establish mechanisms for providing support and advice on developing and implementing organisation-wide approaches to promoting mental wellbeing. These could include tools and approaches for risk assessment, human resources management and management training and development. Ensure that managers are able to identify and respond with sensitivity to employees’ emotional concerns, and symptoms of mental health problems. Ensure that managers understand when it is necessary to refer an employee to occupational health services or other sources of help and support.

26. Question 6.5 - 6.7National (282 trusts)Your trust Number% 6.5 Does the trust provide training for line managers on how to promote and protect employee mental wellbeing? 17863 6.5.1 If yes, is this training mandatory for all line managers? 33/17819 6.6 Does the trust provide training to ensure line managers are able to identify and respond with sensitivity to employees’ emotional concerns, and symptoms of mental health problems? 16860 6.6.1 If yes, is this training mandatory for all line managers? 38/16823 6.7 Does the trust provide training to ensure that line managers understand when it is necessary to refer an employee to occupational health services or other sources of help and support? 25390 6.7.1 If yes, is this training mandatory for all line managers? 79/25331 Promoting mental wellbeing

27. How were trusts scored? HWDU created a summary score for each trust. This is derived from 39 standards divided into 6 domains. Five domains match a guidance topic and the sixth is an overarching board engagement domain. Please note: not all questions were included in the score. The questions chosen for inclusion were those that related directly to the recommendations laid out in NICE guidance. You can see which questions were included from the appendix of your report.

28. How can you use the domain scores? All trusts should be aiming to fully implement the guidance and reach 100% compliance. The domain scores may help to guide and prioritise activities.

29. DomainNational median (IQR) Your trust Board engagement83.3 (50, 100) Obesity (NICE CG43)25 (12.5, 37.5) Physical activity (NICE PH13) and building site design (NICE PH8) 50 (37.5, 62.5) Smoking cessation75 (62.5, 100) Long-term sickness absence78.6 (64.3, 85.7) Promoting mental well-being63.6 (36.4, 81.2) Overall summary score60.2 (52.1, 69.8) Domain scores

30. The national picture

31. What did we do well and how can we publicise this within our organisation? PriorityArea of successAudit question 1 2 3 4

32. What areas do we need to improve? The information will feed directly into your action plan. PriorityArea for improvementAudit question 1 2 3 4