The issue

NHS England has some evidence to suggest those in Agenda for Change pay bands 1 to 4 (generally the lowest paid members of the NHS workforce) may face added barriers to accessing health and wellbeing support. The staff group, ‘support to clinical staff’, which mainly comprises staff in pay bands 1 to 4, had the highest sickness absence rate (7.2%) in January 2023. Understanding the health and wellbeing needs of this group of staff is essential in reducing absence and retaining vital skills and expertise.

What we did

We visited two NHS trusts where we listened to staff in 1:1 sessions with individuals and collated important health and wellbeing information from all staff in bands 1 to 4. We also conducted remote interviews with staff in these bands.

The open-ended interview questions related to the following themes: views about their job role, particular challenges, health and wellbeing, workplace support and career development. These themes follow the domains of the NHS health and wellbeing framework.

What we learnt

Using these two different methods allowed us to reflect on the most effective way of engaging this staff group. The in-person site visits were the most efficient as we were able to speak to a number of people in a short time period. However, there were practical issues which may have discouraged individuals from speaking freely. For example, conversations often happened in open wards as individuals were too busy to go somewhere more private. In addition, they were often encouraged by their line managers to talk to us which meant some were sceptical about how confidential the information was despite reassurances. This is an important consideration for this group given that they are often in junior roles and may feel less able to speak up, especially if it pertains to their line manager or senior leadership.

Remote interviews were a way of overcoming this issue as individuals often took these calls whilst working from home. However, it is worth recognising that staff such as healthcare assistants (band 3) might not have the option to work from home, and so this may have been a barrier to engaging in the research.

Considering a variety of ways to speak to people that can cater to individuals’ concerns and work patterns is important when conducting a service improvement piece like this.

The impact

The key observations were summarised and shared with key stakeholders including health and wellbeing professionals, managers and NHS trust leaders, allowing them to understand how to improve the health and wellbeing of this staff group and make adaptations to improve access to health and wellbeing support.

Recommendations included:

• Increasing the visibility of health and wellbeing initiatives to mitigate access barriers.
• Ensuring that staff across all grades and roles have access to high-quality wellbeing conversations.
• Increasing engagement with and listening to staff across all grades and roles.
• Using the expansion of the apprenticeship schemes and other roles such as nursing associates to improve the career progression pathways for staff in bands 2 and 3.
• Raising awareness and respect of band 1-4 roles and the integral support they provide for the NHS.
• Using the approaches outlined in this case study to gather insights from staff in bands 1 to 4 particularly, or any staff whose voices are not always heard through the data we routinely collect on staff wellbeing.