Cheshire and Wirral Partnership NHS Trust - stress case study

Who are they?

Cheshire and Wirral Partnership NHS Foundation Trust provides mental health services for children, adults and older people, as well as learning disability and drug and alcohol services. It is also contracted to deliver community services throughout Western Cheshire under the title Community Care Western Cheshire (CCWC).

No of employees:

The Trust has approximately 3500 employees over 75 sites throughout Cheshire and Wirral, including hospitals, wards, resource centres, supported housing and out-reach teams.

Business Sector:

Health

What had they done when we last saw them?

We last visited the trust in 2006 to understand their approach to managing work-related stress. The trust had adopted the Management Standards approach using the indicator tool to identify hotspots. The trust had two Acas advisors, whose main role was to train staff to become facilitators for the focus groups. In total they ran 33 focus groups.

Following the focus groups, facilitators presented staff’s views to an action-planning sub-group, containing senior staff from each area of the Trust, using this information the sub group looked at the stressors (demands, control, role, relationships, support and change) and identified three priority issues from each stressor. This data was reviewed and an action plan was developed, identifying the key actions to be implemented for each stressor. The steering group then monitored this.

The Trust had some implementation issues regarding the levels of resource needed, project planning, the management structure and financial issue as well as overcoming staff reluctance to take part. These problems almost caused the collapse of the project and it needed management support at executive level to endorse the project and encourage staff to take part.

What has happened since?

As a mental health trust, the organisation is aware of the need to be able to recognise and address work related stress, and the repercussions of failing to tackle it. Prolonged exposure to stress has been shown to lead to mental conditions such as anxiety or depression. For this reason the Trust continued to review the results of actions taken and tackled new areas of potential risk as they arose. They have also adapted the project as new initiatives came on line. These are some of the further issues, actions and solutions they have faced:

• The focus groups produced lots of information based on comments from staff which led to updates in the action plan – the process of improvement is ongoing and not all actions are yet complete.
• They have clarified issues of conflicting actions such as increasing the use of video conferencing for communication which overlaps with other issues such as reduction in environmental emissions and cutting down on travel costs. A new system has provided cameras on computers to allow meetings between managers/staff. This is working well, has helped managers and staff to reduce driving time and given them more time to focus on other things
• Data gathering and communication have expanded within in the Trust. For example there is now a questions and answer facility on the intranet via the Chief Executive’s blog. All staff, except some domestic staff, have access to the intranet and those staff who don’t have access are supplied with paper copies of documents such as the indicator tool
• When major changes are ongoing they have set up phone numbers for people to ask about rumours; this helped to maintain the messages of the project and helped to clarify issues, even though it only lasts a short time it is well received by staff.
• The Trust has conducted a further review using the indicator tool which fed it into the health safety and welfare group and workforce and organisational development sub committee. This data is now being used with data gathered through work on sickness absence trends, national staff survey, turnover and stability.
• In 2009 the Trust decided to start a specific stress management project and developed an action plan specific to stress - managers wanted more guidance and this was developed. This guidance also looked at attendance management. It looked at HSE guidance which promotes early intervention and engagement with employees. Working with OH and staff support (counselling) it developed a system to address stress as early as possible. This new service started in January 2011.
• Changes to sickness absence systems include action if someone calls in sick identifying the cause as stress. There is an immediate examination of why and what can be done to help. All managers are being trained on this approach.
• Implementation of solutions for hotspots started in June 2010 to see if the changes have dealt with the issues. The hotspots were identified by looking at teams of more than five members where absence exceeded 10% a month. These teams are monitored and colour coded, if a team is highlighted as red (higher absence rate) there is HR intervention; this may be as simple clarifying that the team manager is aware of issue and asking what is being done to manage the absence. There is no set solution imposed and actions taken by managers varied.
• The average length of sickness absence due to stress has reduced and the overall sickness absence rate has gone from 7% in 2008 to 5% in 2010.
• The Trust has also employed an external organisation to help build a ‘mental toughness’ model – which is called Resilience Plus

Challenges

The Boorman Report and the closing of PCTs under the review of the NHS have presented various challenges which required action to assess the impact on staff. The Trust

• Has set up a task and finish group to look at the Boorman report and they would like the group to champion the indicator tool. Clearly change is one of the six areas identified within the Management Standards and it would be beneficial to assess the impact as early as possible
• Has gained 900 people under the ‘Transforming Community Services’ initiative. They plan to use the experience they have gained and the lessons they have learned when integrating these new people. At the moment they are aware of potential issues and the need to consider how the change will be received.
• Identified that it was sometimes hard to get staff on board.

What worked particularly well?

Measuring data:

The trust has expanded the sources it uses in decision making and:

• Has sixteen core wellbeing aspects (turnover, retirement, sickness absence) which it uses to measure progress. Staff have to give a medical reason for their absence, prior to this there was an option to identify ‘other’ which hindered good analysis, this option is no longer available. This did not identify additional stress problems.
• Presents to the board quarterly, to look at the figures for each of the six service lines and board members take responsibility if their area has high sickness absence rates.
• Every period of sickness absence now results in return to work interview and a trigger point has been identified that generates an automatic formal investigation.

Promotion:

Steps have been taken to promote both the policy and the benefits of tackling stress. Specifically, promotion has taken place to address the stigma of mental illness. Volunteers, including some senior managers, who had suffered from some mental condition agreed to take part in an informal buddy system for those who were experiencing problems. In a Poster campaign, they acknowledged they had suffered from a mental illness and supplied their telephone number for other staff who could call them for support. 36% of people acknowledged in a survey, that they had suffered or were suffering from a mental illness.

Training:

New training regimes have been implemented in the trust:

• The key action has been the introduction of mandatory training – all levels of staff have to attend. The training provides information on stress and staff support but also looks at learning and development and encourages employees to ‘look after yourself’. In the training stress has been grouped into a general wellbeing training which has removed some of the stigma of stress and allowed for wider solutions to help staff cope with stress whether it is work related or not.
• A management training programme is in place which includes a half day focusing on stress and resilience. The training is reviewed and refreshed yearly
• A system for providing support and ‘on the job’ training for managers conducting return to work interviews is in place. HR provides support at the first meetings managers conduct and then encourage managers to conduct them without that support. However, managers can still seek advice and guidance from HR outside such meetings.

Following implementation of these new services, the Trust carried out a review asking managers what they thought of it – their view was that the improvements were useful but there needed to be some kind of improved communication. In response, the Trust has created a leaflet about the Stress policy, a copy of which is provided to everyone in the trust and its occupational health service.

The Future

As a mental health trust, the organisation is aware that it cannot rest on the positives it has achieved but it needs to ensure it continues to recognise and address work related stress, to minimise the impact stress may have on its staff especially any psychosocial problems such as anxiety and depression.

For this reason the Trust will maintain and regularly review its policy and will aim to tackle the challenges identified above. They are fully aware that the process of improvement is ongoing and they still have to review the action plan since not all actions are yet complete.