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NHS bids to tackle health of its own staff

It is one of the world's biggest experiments in workplace wellness.

It has a floor space that would cover the City of London 10 times over. It involves no fewer than a million people. And at its heart is mechanism to financially rewarded employers for improving the wellness of their staff. At stake is a cool £450m.

And the force behind this experiment? A giant US health insurer with an actuarial eye on claims? A monster multinational trying to retain and engage staff? A Google or Facebook intent on creative disruption?

No. The trailblazer is the NHS. Through a mixture of design, happenstance and a crushing need to improve productivity, NHS England has quietly launched a 'corporate' wellness initiative of an ambition and scale that only a handful of countries let alone corporates could dream of.

It could change the face of workplace wellness and usher in a new approach to public health more generally. It may even herald a new era in which positive lifestyle choices are given commercial value; where we all as citizens are financially incentivised to move more and eat less.

Much-needed NHS workplace health initiative

The initiative falls under the Commissioning for Quality and Innovation (CQUIN) scheme, which rewards NHS bodies which go the extra mile for their staff with extra cash. In the past, the targets have been clinical but this year a new national "staff health and wellbeing" indicator has been introduced for the first time. 

The scheme gives substance to NHS chief executive Simon Steven's heartfelt rhetoric on prevention and is simple in concept: 

  • Improve staff health and wellness in order to mitigate the estimated £2.4 billion (£1 in every £40 of the the NHS budget) that is lost each year through staff absence
  • Record outcomes through the proxy of the NHS Staff Survey or, alternatively, via peer review
  • Bag your share of the £450m in rewards if targets are hit  

Why it could work

From a behavioural economist's point-of-view the scheme has a lot going for it. The evidence on the power of financial incentives is strong, especially when framed as money you stand to lose. The target areas - physical activity, nutrition and flu vaccination - are also smart, creating change where it's most likely to have impact. 

The challenge will be in implementation. The evidence from the corporate sector is that most staff wellness schemes stumble on the twin hurdles of inclusivity and engagement. Offer pilates classes, sports days or anything else that smacks of Lycra and you will only attract the sporty 10% who need it least. Make it outdoors and you ignore the fact that 90% of our time is spent inside. Rely on the staff intranet site to let people know of its existence and you’ll find it never scales. 

The trick is to adopt universally visible schemes that are evidence-based, work indoors and - most important of all - avoid the need for special skills and Lycra. 

The CQUIN briefing guidance gets it right by focusing attention on schemes which build "physical activity into working hours and reduce sedentary behaviour". There is also a wealth of evidence showing how well incentives can work in promoting healthy behaviour change - and its right for the NHS to use them. 

So Stevens should be applauded. The new measure is brave and innovative and it plays perfectly to the NHS's needs around staff retention and productivity. If it works it could be a game-changer, not just for the NHS but for the use of financial incentives in preventative health more widely. 

One day all British employers may be rewarded for implementing evidence based staff wellness schemes - perhaps through tax breaks.

Want to tackle staff wellbeing?

StepJockey can help you take advantage of the opportunity CQUIN presents to your NHS organisation.

Get in touch today

Image credit: Air ambulance by Barry Skeates on Flickr Creative Commons. Licence CC2.0.

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