Overview of this updated guidance

This updated guidance defines the function of a health and wellbeing guardian and explains how to implement them in different healthcare settings, as a deliverable within the NHS people plan and supportive of the NHS people promise ‘we are safe and healthy’.

This updated edition of the guidance has been simplified and enhanced based on feedback and evaluation (see Appendix 1).

It now includes supporting appendices to enable flexible and local implementation in different healthcare contexts including:

• integrated care boards (ICBs) (see Appendix 2)
• provider trusts (see Appendix 3)
• primary care (see Appendix 4).

It also provides guidance for those who support the health and wellbeing guardian strategically and operationally, such as human resource (HR) directors and occupational health (OH) and wellbeing teams (see Appendix 5).

Background to health and wellbeing guardians

The health and wellbeing guardian is an essential leadership function that is designed to provide assurance that the organisation is providing a safe and healthy place to work for all healthcare employees, which in turn enables them to provide the best care for patients and service users.

Health and wellbeing guardians originated from the recommendations within the NHS staff and learners’ mental wellbeing report (2019). This report identified inequalities and an inconsistent approach to supporting the health and wellbeing of healthcare employees and trainees across many healthcare organisations and recommended the function of a wellbeing guardian to address this.

The previous term of wellbeing guardian has been evolved to now become health and wellbeing guardian. This decision has been made based on feedback from wellbeing guardians that the title needed to reflect the full breadth of both health and wellbeing aspects of what the function covers.

This change is in alignment with the original intention set out in the people plan 2020/21, outlining the function to “look at the organisation’s activities from a health and wellbeing perspective and act as a critical friend, while being clear that the primary responsibility for our people’s health and wellbeing lies with chief executive officers or other accountable officers”.

The health and wellbeing guardians’ function was subsequently adopted as national NHS policy within the NHS people plan and launched with initial guidance in January 2021. It was further endorsed as part of the 2021 review for Enhanced board oversight: a new approach to non-executive director champion roles.

At the time of publishing this updated guidance, early evaluation demonstrated that 96% of NHS provider trusts have adopted the function of a health and wellbeing guardian, however more work is required to increase adoption across wider healthcare settings such as ICBs and primary care. The network of health and wellbeing guardians have been supported through a variety of community development offers and regional networks.

A full evaluation of the first two years of the health and wellbeing guardian have informed this updated guidance document (see Appendix 1).

Why? Importance of health and wellbeing guardians

The NHS people plan commits to looking after all our diverse healthcare people, to ensure that they are safe and healthy. Evidence unanimously supports that caring for our healthcare employees, leads to significantly improved patient experience and outcomes (NHS health and wellbeing framework, 2021).

The NHS growing occupational health and wellbeing together (2022) strategy acts as our roadmap to improve occupational health and wellbeing services for our healthcare employees.

It identifies the importance of establishing the health and wellbeing of staff as a strategic priority at senior leadership level given the strong links to delivering the NHS people promise to improve staff experience and retention, and the importance of the health and wellbeing guardian function to achieve this.

Health and wellbeing guardians will ensure that all healthcare employers are creating a culture of wellbeing, looking after their employees, and enabling them to deliver high quality care to patients and service users.

They achieve this by seeking assurance that the organisation and senior leadership team are prioritising employee health and wellbeing and are supported by a well-resourced and needs-driven occupational health and wellbeing service as part of a preventive approach based on organisational interventions.

What? Defining the health and wellbeing guardian function

“A health and wellbeing guardian is a senior healthcare leader that seeks assurance, independently challenges, and holds the senior leadership team of a healthcare organisation to account 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 care to patients and service users”.

The organisational contexts in which health and wellbeing guardians sit vary across healthcare settings (see appendices 2, 3, and 4). However, the fundamental intention and responsibilities outlined within this guidance should remain consistent. The overarching commonalities for the function of the health and wellbeing guardian are:

• Seeking assurance that employee health and wellbeing is being prioritised by the organisation’s senior leadership/board as part of the strategic agenda, and health and wellbeing is improving.
• Challenging and holding the board and senior leadership team to account to fulfil their corporate responsibility to improve the health and wellbeing of their employees and ensure that organisational decisions do not have a negative impact on employee health and wellbeing.
• Is operationally supported to discharge their assurance duties by appropriate operational leaders within the organisation, likely to include the HR director, HR organisational development team and occupational health and wellbeing team. In primary care, this is likely to include the practice manager and members of the primary care network.

How? The key responsibilities of health and wellbeing guardians

A health and wellbeing guardian achieves their responsibilities for advocating for and improving employee health and wellbeing by championing a health and wellbeing culture, seeking assurance, and holding the organisation to account in several ways as outlined in the sections detailed below.

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 Leadership Academy’s 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 (eg the wellbeing dashboard in model healthcare system)
• actively seeking out staff feedback/engagement through diverse networks that reach all employees
• adopting an engaged network of health and wellbeing champions and, where applicable, professional nurse advocates.

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 the organisation is working with system leaders and regulators. This will ensure 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 takes action to ensure that the people affected are supported and learning is captured and acted upon.

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 and wellbeing together strategy, ensure the organisation is providing adequate investment, resource, infrastructure, capacity, and capability in an integrated and multiprofessional occupational health and wellbeing support service.

This should cover proactive and preventative interventions through to responsive diagnostic and treatment services (eg 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.

Who? Suitability to take on this leadership function

Appointed to the function of a health and wellbeing guardian should be a very senior and independent leader (ie board level/equivalent) who is well positioned to take on these duties in their leadership capacity (ie does not need to be a health and wellbeing specialist).

This senior healthcare leader who takes on the function of a health and wellbeing guardian needs to be in an influential position to provide challenge and a degree of independence in holding the organisation to account and is therefore likely to be someone in a lay member or non-executive director (NED) role.

Evaluation has shown that this implementation guidance needs to take account of different healthcare settings across the NHS. Therefore, this 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.

Within the context of an integrated care board or provider organisation, the chair and chief executive officer (CEO), with the support of the human resources 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).

Due to the diverse and complex landscape of primary care organisations, the local context will determine the suitability of the need to appoint a health and wellbeing guardian. A range of models for how this can work within a primary care context are offered for consideration in Appendix 4.

When appointing a NED health and wellbeing guardian, the NHS fit and proper person test framework for board members requirements should be adhered to.

For anyone appointing a health and wellbeing guardian in any organisational context, the person taking on the health and wellbeing guardian function should ideally meet the following criteria:

• Be independent of the operational running of the organisation.
• Be in a senior position to hold to account the senior leadership team/board.
• Be motivated and influential, and therefore able to bring about change.
• Take on this responsibility as part of a naturally aligned and/or existing portfolio.

Within most large healthcare organisational settings such as NHS provider trusts, NEDs or lay member equivalents are ideally positioned to take on this function due to their independent and assurance roles.

For smaller healthcare organisations such as those across primary care networks who may not have such roles, it will likely come down to local knowledge and information on the best person to take on this function.

Considering who should not take on this function is equally important. While flexibility is important, this guidance does not advocate that the function of a health and wellbeing guardian should be taken on by an existing senior officer, such as an executive director or operational manager.

The Health and Safety Executive outlines the legal duty to ensure the health, safety, and wellbeing of employees is firmly held by the CEO or equivalent, in any organisation. As such, this legal duty cannot be abrogated (ie revoked) by the CEO, nor can it be delegated to any other member of their team.

A health and wellbeing guardian is therefore not suited to a CEO, or equivalent, or someone who undertakes operational activities that support the CEO with these corporate duties (eg HR director or primary care network clinical director).

Further guidance is available for organisational leaders who operationally support the health and wellbeing guardian in Appendix 5 (eg HR organisational development, occupational health and wellbeing) and there is guidance for how the entire senior leadership team/board members can support the health and wellbeing guardian.

Where? Health and wellbeing guardians across healthcare settings

It is expected that all large healthcare organisations adopt the function of the health and wellbeing guardian in a flexible way that is right for their organisational context. This includes integrated care boards (see Appendix 2) and NHS provider organisations (see Appendix 3).

In addition to this, guidance has been provided for how the health and wellbeing guardian function may be suitable and add value in smaller healthcare organisations, such as across primary care (see Appendix 4). Detailed below is a list of the healthcare settings/organisations in which health and wellbeing guardians can be implemented and add value.

Healthcare settings for implementing health and wellbeing guardians

Integrated care systems

• integrated care systems

Provider organisations

• acute and foundation trusts
• ambulance service trusts
• community health trusts
• mental health trusts.

Primary care

• large primary care organisations (ie federations)
• primary care networks
• local committees:
  • medical
  • dental
  • optometry
  • pharmacy
• local practices (eg medical, dental, optometry and pharmacy) may be too small to implement a health and wellbeing guardian. In these cases, the health and wellbeing champion model is recommended as an alternative.