Health and wellbeing guardians in integrated care boards

This appendix document sets out guidance to how the function of health and wellbeing guardians can be implemented in integrated care boards (ICBs), as a deliverable within the NHS people plan and supportive of the NHS people promise we are safe and healthy.

This implementation guidance should be adapted to the local organisation’s need and used as a starting point and be applied flexibly, rather than seen as a fixed mandate or set of requirements.

Context of integrated care systems and integrated care boards

At the time of publishing this updated guidance, the new statutory body arrangement of integrated care systems (ICSs), integrated care boards (ICBs) and integrated care partnerships (ICPs) has launched. More information can be found on the what are integrated care systems? page on the NHS England website.

ICSs have set out a people function guidance report, called building strong integrated care systems everywhere on the integrated care system people function. This outlines what is expected of ICBs in relation to people and workforce priorities.

The first of these priorities is to support the health and wellbeing of all staff. ICBs have a dual role to create a holistic health and wellbeing environment both for their internal ICB staff, but also for our NHS people within the services they are commissioning.

In addition to ICBs, there are also ICPs which fall under the umbrella of work within an ICS. ICPs are the statutory committee jointly formed between the NHS ICB and all upper-tier local authorities that fall within the ICS area. The ICP is responsible for producing an integrated care strategy on how to meet the health and wellbeing needs of the population within the ICS area.

Recommendations for health and wellbeing guardians in integrated care boards

In this new architecture of ICS, ICBs and ICPs, the following is recommended:

Integrated care boards

• Every ICB should put in place a health and wellbeing guardian to look after their internal NHS employees.
• This can follow a similar model to secondary care/provider organisations, where a non-executive director (NED) or lay member takes on this function.
• Their focus being to hold the ICB senior leadership team to account to ensure they are prioritising the health and wellbeing of all organisational employees.

The wider integrated care system and integrated care partnership

• Health and wellbeing guardians are an NHS policy area and therefore this only covers organisations that employ NHS staff. Therefore, health and wellbeing guardians are likely not suited to ICS or ICPs, who partner with wider public and wider sector health and care organisations.
• However, it is acknowledged that the health and wellbeing guardian function and/or its principles could be useful in the wider organisations and bodies connected with the ICS for example, in ICPs.
  • ICPs may wish to explore, adapt/adopt the function of the health and wellbeing guardian in an approach which uses local knowledge and information to shape how best this would fit within the local arrangement.
  • An ICP health and wellbeing guardian would act to represent strategically the needs of the entire workforce across the area and hold the ICP leaders to account for improving health and wellbeing of their staff.
  • This must be at local system leader discretion.

Integrated care board health and wellbeing guardian purpose, remit, and support

A suggested overview of how a health and wellbeing guardian function could be positioned within ICB healthcare organisations is detailed as follow.

Purpose of health and wellbeing guardians in integrated care boards

To seek assurance from, independently challenge, and hold to account the board/senior leadership team of their healthcare organisation for developing a compassionate and inclusive culture of health and wellbeing; to ensure that all employees are cared for and enabled to deliver high quality of care to patients and service users.

Remit of health and wellbeing guardians in integrated care boards

To champion the improvement of employee health and wellbeing, directly working with the board and senior leadership team, in addition to being closely aligned to the human resource (HR) director, and operationally supported by the occupational health and wellbeing lead, human resource and organisational development (HROD) leads, and/or other organisational guardians and/or key leaders.

Integrated care board organisation infrastructure and support for health and wellbeing guardians

As this is an assurance function, and not an operational doing role, health and wellbeing guardians require a team to support them with the operational aspects of improving employee health and wellbeing. Key support relationships are likely with:

• Board and executive team members, HR director, HROD team, and occupational health and wellbeing lead (or equivalents).
• Engaging with staff networks including a network on health and wellbeing champions, and where applicable, the chief nurse or senior registered nurse responsible for overseeing professional nurse advocates (PNA).
• Working with peer health and wellbeing guardians across their system to support each other and to influence improving health and wellbeing across the ICS, and nationally.
• Supported by the regional and national health and wellbeing guardian networks and community resources.

Within the context of an ICB, the chair and chief executive officer – with the support of the HR director (or equivalent) – should be responsible for appointing a health and wellbeing guardian.

The health and wellbeing guardian is ultimately responsible to the chair (or equivalent). When appointing a non-executive director (NED) health and wellbeing guardian, the NHS fit and proper person test framework for board members requirements should be adhered to.

Who should take on the function of a health and wellbeing guardian in integrated care boards?

A NED or an equivalent lay member who has the authority and influence to challenge the board and senior leaders and seek assurance that employee health and wellbeing is a priority and is continually improving.

Key skills of a health and wellbeing guardian in integrated care boards

• Is competent and confident to act as a critical friend to challenge the senior leadership team to take action to improve health and wellbeing.
• Ability to actively listen, appreciatively enquire, and robustly question the organisations leadership team.
  • By doing so, helping them to explore and mitigate the impact of their decisions on employee health and wellbeing and enact their corporate responsibility to improve the health and wellbeing of their employees.

Responsibilities of the health and wellbeing guardian

The health and wellbeing guardian achieves their responsibilities for advocating improving employee health and wellbeing by championing a health and wellbeing culture, seeking assurance, and holding the organisation to account, as follows. To achieve this, they will likely:

• attend the appropriate meetings with the board/senior leadership team/staff networks to champion health and wellbeing and hold organisational leaders to account
• work in collaboration with and be supported by leaders for the organisation who represent the HROD and occupational health and wellbeing, or equivalent functions to discharge their assurance function effectively
• participate in regional and national health and wellbeing guardian networks to offer peer support, share best practice, and influence the health and wellbeing agenda across their system/nationally.

A detailed overview of the key responsibilities for health and wellbeing guardians is provided as follows:

1. Championing a health and wellbeing culture

1.1 Creating a proactive and preventative health and wellbeing culture: Using their senior leadership position and influence to advocate for a preventive and inclusive health and wellbeing culture based on organisational interventions, that recognises how good employee health and wellbeing leads to high quality patient care.

1.2 A role model for health and wellbeing: Role modelling when advocating for improving employee health and wellbeing the leadership behaviours as defined in the NHS our leadership way. These behaviours of we are compassionate, we are curious and we are collaborative are underpinned by key principles expected of all leaders to demonstrate compassionate and inclusive behaviour towards our people.

1.3 Networking and influencing across boundaries: Network with peer health and wellbeing guardians and leaders through regional and national networks, to learn from each other and to influence NHS employee health and wellbeing strategy and policy as levers for improvement.

2. Seeking assurance

2.1 The organisation understands the diverse health and wellbeing needs of its employees: Ensure that the needs of all employees are inclusively and regularly reviewed using a variety of workforce, occupational health, engagement data and metrics. This may take the form of:

• seeking assurance that the organisation is regularly reviewing its NHS health and wellbeing framework diagnostic tool/assessment and workforce data (for example, the Wellbeing dashboard in model healthcare system)
• actively seeking out staff feedback/engagement through diverse networks that reach all employees, including adoption of an engaged network of health and wellbeing champions and, where applicable, professional nurse advocates (PNAs).

2.2 There is a holistic strategy for improving occupational health and wellbeing for all employees: Ensure that a holistic occupational health and wellbeing strategy is adopted across the organisation whereby employees receive proactive, preventative and compassionate support for their mental, psychological, physical, financial, cultural, and social health and wellbeing.

This is as outlined within the NHS health and wellbeing framework’s seven elements of health and wellbeing and supported through the NHS growing occupational health and wellbeing together strategy.

2.3 Senior leaders continually review and act on employee health and wellbeing data and metrics: Ensure that the senior leadership team has access to, monitors, regularly discusses and acts upon findings from workforce health and wellbeing data and metrics, to demonstrate that the health and wellbeing strategy and services provided are improving employee health and wellbeing.

2.4 There is an inclusive approach to providing occupational health and wellbeing services and support for all employees: Ensure that supportive occupational health and wellbeing services, initiatives and interventions are addressing and improving the health and wellbeing needs of employees.

Through effective analysis of relevant data, the organisation should be able to demonstrate that the different needs of various staff groups are being met and ensure that necessary support is provided with particular consideration to the nine protected groups under the Equality Act 2010.

3. Holding to account

3.1 All senior leadership decisions consider the impact on employee health and wellbeing: Ensure that employee health and wellbeing is proactively considered in all organisational decisions and actions at senior leader/board level.

Ensure that every decision made by the senior leadership team considers and mitigates impact on the health and wellbeing of all employees.

3.2 Occupational health and wellbeing are considered alongside other workforce, performance, quality and financial demands: Challenge the senior leadership team to ensure that the organisation is working with system leaders and regulators, to ensure that employee health and wellbeing is given equivalent weight to other key measures of organisational performance such as quality, finance and operations.

3.3 Work does not compromise the health and wellbeing of employees: Hold senior leaders to account to ensure that employees are not being compromised by the work they do and the environment they work in.

Ensure that when a never event, or an event that causes unexpected trauma/adversity, happens to an individual or team, the organisation is taking action to ensure that the people affected are supported and learning is captured and acted on.

In relation to the death by suicide of any member of staff, new national guidance for organisations is available in the NHS employee suicide: a postvention toolkit to help manage the impact and provide support document.

The health and wellbeing guardian is entitled to hold senior leaders to account to ensure they are implementing this guidance, but the health and wellbeing guardian is not expected to lead or report on any investigation findings.

3.4 There is an adequately funded/resourced occupational health and wellbeing service/offer: Drawing on the NHS growing occupational health (OH) and wellbeing together strategy, ensure that the organisation is providing adequate investment, resource, infrastructure, capacity, and capability in an integrated and multiprofessional OH and wellbeing support service that covers proactive and preventative interventions, through to responsive diagnostic and treatment services (for example, rapid access to physiotherapy and mental health services).

Leaders of this function should be working with and operationally supporting the health and wellbeing guardians to discharge their duties.

3.5 All leaders and managers are responsible for improving the health and wellbeing of their employees: Ensure the organisation empowers managers and leaders to look after the health and wellbeing of their teams to create a culture of wellbeing through wellbeing conversations, manager training, and team wellbeing development.

Managers and leaders are held to account to role model healthy leadership behaviours, to keep their teams safe and healthy, appreciating that a wellbeing culture is dependent upon good organisational leadership and management.