Seeking wellness in the NHS: despite negative reporting and some significant omissions, the Boorman Review has raised important issues about the health and wellbeing of NHS staff.
Subject: Medical personnel (Health aspects)
Medical personnel (Surveys)
Occupational health and safety (Surveys)
Occupational health and safety (Management)
Author: Munday, Dave
Pub Date: 10/01/2009
Publication: Name: Community Practitioner Publisher: Ten Alps Publishing Audience: Academic Format: Magazine/Journal Subject: Health; Health care industry Copyright: COPYRIGHT 2009 Ten Alps Publishing ISSN: 1462-2815
Issue: Date: Oct, 2009 Source Volume: 82 Source Issue: 10
Topic: Event Code: 280 Personnel administration; 200 Management dynamics Computer Subject: Company personnel management; Company business management
Product: Product Code: 8010000 Medical Personnel; 8000500 Employee Health & Safety NAICS Code: 62 Health Care and Social Assistance
Organization: Government Agency: United Kingdom. National Health Service
Geographic: Geographic Scope: United Kingdom Geographic Code: 4EUUK United Kingdom
Accession Number: 209163268
Full Text: In August, Dr Steven Boorman launched the interim report from the NHS health and wellbeing review in England. There was much in the news about the review and how NHS staff are ill more than most other workers, overweight and smoking too much. To discount the report from these headlines would be a mistake, since there is much to be commended within its 104 pages.

The overarching point made in the report is that 'staff health and wellbeing needs to be seen as central to the NHS and recognised as a crucial issue at board level as much as at ward level'. This point alone identifies a weakness of the work to date, and Unite's submission to the review welcomed 'the recognition that there have been lower levels of staff engagement in the "staff perceptions survey" from community staff and support service workers'. Although not entirely focused on acute hospitals, the report does have the feel of being weighted toward that organisational model.

According to the report, NHS staff have relatively high levels of sickness absence--on average 10.7 days a year, higher than across the public sector (9.7 days) or the private sector (6.4 days). It is highlighted that even though these levels of sickness absence are reducing, they are not reducing as significantly as in other organisations. There are also repeated claims about how much money could be saved by improving on these levels, enough to fund an increase of 14 900 whole-time equivalent staff if levels of sickness absence were reduced by one-third (an estimated annual direct cost saving of 555 million [pound sterling]).

As part of the background work to the report, a staff survey was commissioned, and this and other evidence found that:

* Respondents reported high levels of presenteeism, with many reporting that they come to work when they feel sufficiently unwell to justify staying at home

* Many staff reported significant levels of stress

* Many staff did not believe that senior managers or their organisation take a positive interest in their health and wellbeing

* Most staff believed that their state of health affects patient care. Although helpful to have a new survey conducted with over 11 000 responses from NHS staff, it is unsurprising to hear these outcomes. We have seen similar results in the annual NHS staff survey and as reported last month in this journal.

Recommendations of the report

The report makes 42 recommendations with sensible approaches that may well help to improve the health and wellbeing of NHS staff. However, in Unite's submission to the review, we highlighted the marketisation and privatisation drive within the NHS, which we believe is counterproductive to better health and wellbeing.

We witnessed one example of this recently when supporting members in a London trust. The report recommends that the long hours culture--where staff repeatedly work over contracted hours--needs to be tackled, with evidence that it increases higher sickness absence rates and has a negative effect on staff perceptions of how much managers care, which again negatively affects staff sickness absence. In this specific trust, the manager was asked what efforts were being made to reduce the level at which community practitioners worked unpaid overtime (in the previous NHS staff survey this was reported at 80% of staff). The trust responded that all staff in the NHS are expected to work more than the time they are paid for--it is unsurprising that it was facing a real and persistent recruitment problem.


Omissions from the report

Throughout the report there are a few areas where there is a lack of information or apparent understanding. Although it discusses the importance of engaging staff via trade unions and professional organisations, and also of involvement with both the NHS Staff Council and its health and safety subgroup--the Partnership for Occupational Safety and Health in Healthcare (POSHH)--there is no mention of Improving Working Lives (IWL).

This is surprising, since Unite raising the importance of IWL at previous consultation events, within its submission and also at the POSHH group, and IWL has more recently been re-endorsed by the NHS Staff Council. Having raised this issue at a POSHH group, Unite was pleased to hear that NHS Employers is still committed to IWL and expects it to be one of the delivery mechanisms of the final recommendations.

It is also unfortunate that the report does not discuss the role of the NHS in supporting staff who suffer from domestic abuse, and this issue will be pursued by Unite.

Actions for members locally

The first response from Unite members working in the NHS should be to request information from their human resources department about how the interim report is being acted on locally. One strong recommendation of the report is that a senior executive director should take the lead on wellbeing. This commitment alone would demonstrate how serious the organisation is on improving the health and wellbeing of its staff.

Local safety representatives should take the time to at least read the recommendations in the report to ensure they have a grasp of the information. If members have any questions locally, they should direct these to a local representative.


(1) NHS Health and Wellbeing: the Boorman Review. Interim report. Available at: (accessed 14 September 2009).

(2) Unite. Unite response to the NHS Health and Wellbeing 'Boorman Review'. Available at: Unite_response_to_Boorman_Review_Call_for_Evidence_July_09.pdf (accessed 14 September 2009).

Dave Munday

Unite Health Sector professional officer
Gale Copyright: Copyright 2009 Gale, Cengage Learning. All rights reserved.