Health and Wellbeing Framework can be used at system-level

A Healthier Future used NHS England and NHS Improvement’s workforce Health and Wellbeing Framework across an entire Integrated Care System

What we’ve done

Who we are

‘A Healthier Future’ is the Integrated Care System (ICS) covering Hertfordshire and West Essex in the east of England. We have a combined health and care workforce of 56,000 staff serving a population of 1.5 million people.

The system includes three clinical commissioning groups with over 140 GP surgeries and around 30 primary care networks; 2 county councils; 13 district councils; 3 hospital trusts; 4 community and mental health trusts; 1 ambulance trust; 2 health and wellbeing boards; 2 Healthwatch organisations and hundreds of voluntary and independent groups.

What we did

Our ICS started using the Health and Wellbeing Framework in November 2021. Over a five-month period, about 80% of our health and care organisations used the Framework’s diagnostic tool to identify areas for development.

We ringfenced one person’s time to work on this for about 15 hours per week. Our dedicated lead met virtually with each health and wellbeing lead from individual organisations to discuss key questions from the diagnostic tool. It took 2-3 hours per organisation to briefly talk through around 60 questions.

We then contacted the leads from staff networks to get their perspective about some of the questions and the health and wellbeing support available. We used staff survey data to triangulate, so there was a three-pronged approach to gaining feedback and evidence.

We provided each organisation with a spreadsheet summarising their own data, plus a summary report highlighting positives and potential gaps. We also created a report drawing out themes across the whole ICS. We presented the report to health and wellbeing leads and other stakeholders.

This helped us identify gaps and plan next steps. Each health and wellbeing lead is now self-nominating to take forward a priority area on behalf of the whole system.

What we’ve achieved so far

  • Using the diagnostic tool provided a sense of where we were doing well, areas of overlap and gaps. Instead of taking a siloed approach, we’re now thinking about workforce health and wellbeing at a system-level, with a joined-up ethos.
  • Using the Health and Wellbeing Framework supports joint working. We are developing workstreams to take actions forward, particularly looking at how to evaluate the impacts of wellbeing initiatives. This is helping us gain economies of scale rather than duplicating across organisations.
  • Most organisations did not have an up-to-date workforce Health and Wellbeing Strategy, so we are developing an ICS-wide strategy. Individual organisations can then adapt this for their own staff, which is another example of working at system-level for economies of scale.
  • We are championing use of the Framework by others. We have presented our approach at national meetings and supported other areas that contact us for advice.

“The diagnostic tool showcased our successes and helped us work in a more joined up way. Wellbeing leads are enthusiastic about what they are doing individually. We’re building on that to benefit the whole system.” – ICS representative

What we’ve learnt so far

  • Including partners from all sectors worked well. We launched the Framework at a meeting of all organisations’ Health and Wellbeing and Occupational Health Leads so everyone heard the same message and had an open forum to ask questions. It helped to have senior leadership involved to remind people of the benefits and encourage participation. Some people were concerned that this was an ‘NHS Framework’ so it may not apply to them, but we found that councils and other partners were usually happy to engage. This helped to paint a more complete picture of workforce wellbeing across the whole system and reinforced the culture of ‘system first’.
  • It helped to have someone with ringfenced time driving the use of the diagnostic tool. Without a ringfenced lead, the tool may not be completed consistently, and it may be harder for individual organisations to prioritise using it. It worked well to have someone asking health and wellbeing leads questions and then completing the tool based on their answers. This approach may get less detailed information, but it is enough to identify strengths and gaps.
  • Presenting information in a simple way makes it more applicable. The diagnostic tool contains a lot of information so can look overwhelming at first. We reformatted the tool to focus on key areas and extracted questions to ask health and wellbeing leads. That way leads did not need to input information into a spreadsheet. It helped to get feedback from multiple people and triangulate with the staff survey and other data. This overcomes some of the subjectivity of the diagnostic tool. We then presented the results as short reports that were useful for individual organisations as well as system-wide themes. We focused on using the diagnostic tool as a step in our journey, rather than an end in itself.