CCGs represent a fresh start, not just for what and how services are commissioned, but also for how the wellbeing of staff is supported. They take over in a system not renowned for its sympathetic occupational health, but they have the chance to improve both staff welfare and by default, the reputation of the NHS as an employer.
In the midst of all the turmoil, it might seem like just one more thing to do. Dr Charles Alessi, Interim Chair of the NHS Clinical Commissioners, has highlighted that this forthcoming year will be a particularly challenging one for CCGs, already having to make ‘tough choices on prioritization’ and defining ”the need for changes in service delivery’ as well as supporting ‘transformation and service reconfiguration’. However it’s not as hard as it may seem as many CCGs are starting from a low base on staff welfare. On an international scale, the proportion of adults in England who are unable to work because of health problems is poor. Half of those in Scandinavia who suffer a major injury return to work. In Britain it is just one in six. When it comes to welfare, the claimant rate of sickness benefit in Scotland has fallen by 18% in the past ten years and in Wales by 22%. In England it has fallen by less than half of this, by a rate of 10%.
For most people, being forced out of work or being unable to find employment because of illness or disability is a personal disaster. It often sets them on a downhill path of benefit dependency and isolation from society, as well as on a downward spiral of more mental and physical health problems. It is of course these effects, on those forced out of work, which are of paramount importance in this debate. On a purely mercenary basis, it is also in the interest of CCGs, as employers, who are liable for sick pay, to ensure that those working for them are well supported to prevent illness. We can predict that the stress of the first year of implementation will be significant, so the more thought given to staff support now, the more likely they will have the resilience to survive the tumult.
There is plenty of evidence to show that employees who know they will be supported in sickness and in health will ultimately be much happier, off sick less and more productive. Much of this we have covered in our publications on health and work: Health, disease and unemployment and Working together, the latter looking at opportunities for CCGs working with Health and Wellbeing Boards. Our latest report looks at the progress in the Devolved Nations on work as a health outcome and one of the exemplars is the RCN in Wales, who showed that strong leadership in developing effective health strategies in the workplace is crucial and beneficial to all.
Further, in the post-Francis era, there will be a determined emphasis on the ‘softer’ skill sets are upheld by staff, that is, that they treat patients with the respect, dignity and care that they deserve. It is often joked that sickness gets little sympathy when you have a parent who is a doctor, so we don’t deny that this will be a challenge for some in the larger family of the CCG. But the public’s perspective is interesting: why should a nurse look after me well if they are obviously harassed, exhausted or obese, or I repeatedly have my appointment cancelled due to staff illness? And of course, as the public see the NHS as a ‘whole system’ (the NHS itself is working on that), they won’t differentiate between staff employed by the CCG and those employed by a contracted provider, for example a community nurse. There is therefore an opportunity for CCG’s to ensure providers have staff welfare provision in their contracts. Getting staff health right – proactive support and care – will reap dividends, and now CCGs have the power to lead the way.
Julia Manning is chief executive of 2020Health.org