Frequently Asked Questions
Background to the Boorman Review
Why did you choose to review health and well-being of staff in the NHS?
The Department of Health and the NHS took the important step of commissioning this review as part of their response to Dame Carol Black’s report of employee health and well-being across the UK workforce.
Supporting staff health and well-being has been a long term priority for the NHS and the Department of Health, with recent initiatives such as ‘Improving Working Lives’. The NHS Constitution pledged that staff in the NHS could expect well-designed and rewarding jobs; personal development and access to appropriate training; opportunities to keep themselves healthy and safe; and engagement staff in decisions that affect them and the services they provide.
What was the business case for improving health and well-being in the NHS?
The focus of the review was on improving the health of the NHS workforce, helping to prevent people from becoming sick and having to take time off work; and, where sickness does occur, helping to ensure that NHS staff can remain in or swiftly return to work.
The review has found that improvements to staff health and well-being will save money and improve patient care: the NHS loses 10.3m working days annually due to sickness absence alone, costing £1.7bn per year. A reduction of a third would mean an extra 3.4m working days a year, and annual direct cost savings of over half a billion pounds (£555m).
Staff ill health is also a serious barrier to the provision of consistently high quality patient care. 80% of staff believe that the state of their health affects patient care, and evidence set out in the report shows that better overall trust performance occurs alongside higher levels of staff health and well-being.
It is also in the Service’s interest to remain as attractive an employer as possible, recruiting and retaining committed and talented staff. To do this, it must ensure that it safeguards the health and well-being of its employees.
Was the whole NHS organisation behind the review?
The promotion and improvement of health and well-being of NHS staff has been a long-term objective for the Department of Health and the NHS employing organisations. It is widely understood that the health and well-being of the workforce makes a major contribution to the delivery of high quality health care. The review was therefore an important initiative for the DH and NHS and was carried out in consultation with employers and staff in the NHS.
Who is Steve Boorman and why was he asked to lead the independent review?
Steve Boorman is Director of Corporate Responsibility and Chief Medical Adviser to Royal Mail Group, and an experienced consultant in occupational health. Steve has worked in Royal Mail for eighteen years, leading its occupational health and welfare team up to its outsourcing in 2002. As Chief Medical Adviser he has had responsibility for developing occupational health approaches across a diverse, widespread and complex business, which has included working actively on absence reduction and substantially changing Royal Mail’s occupational health and welfare provision in recent years, supporting changes to make the business “a Great Place to Work”. He was also involved in redesigning the organisation’s ill health retirement scheme, and improving opportunities for rehabilitation. Outside his responsibilities at Royal Mail Steve Boorman is an active contributor to the wider health and well-being agenda, is widely published, and presents nationally and internationally on workplace health and well-being.
Due to his breadth of experience within Royal Mail in the field of occupational health, Steve was commissioned by the Department of Health and NHS to take on the role of leading the independent review.
Collecting evidence
How did you engage with staff in the run up to the Final Report?
A number of mechanisms were used to ensure breadth and depth of evidence. A staff survey was undertaken, submissions of evidence were provided by a number of trusts, independent NHS experts and other external stakeholders. Dr. Boorman also undertook a number of workshops across the country where he could hear directly about experiences of occupational health. During the whole process, best practice case studies were identified.
The evidence collation, analysis and interpretation were conducted by an independent research team from the Work Foundation, RAND Europe and Aston Business School.
The review engaged with a wide range of NHS stakeholders through the Call for Evidence and the staff perception research. It also shared key outputs as they were developed with expert and stakeholder groups. The evidence gathering and assurance processes ensured that the NHS was properly represented in the development of the interim and final report. The processes of engagement continued throughout the summer and early autumn when stakeholders were given further opportunities to contribute their thoughts on the interim report.
Following up the publication of the Interim Report on August 19, the review held feedback and discussion events in all 10 SHA regions, engaging directly with over 1000 staff. We also engaged extensively with staff through the communications channels on the Review website, where we were able to give tailored responses to the many insightful questions and suggestions we received. On top of this, we were sent many more examples of best practice, which were subsequently passed to the Work Foundation and have significantly informed the Final Report.
Do you think that the responses to the staff survey and the Call for Evidence can justifiably be said to represent the views of NHS staff as a whole?
The findings of the interim report are based on evidence gathered from across the NHS and its stakeholders; through the answers of over 200 experts and Trusts across the NHS who responded to the Call for Evidence, through over 11,000 responses to the staff perception survey; through engagement with staff and managers at workshops across the country, and information on best practice drawn from a comprehensive literature review, and stakeholder submisssions.
The responses to the demographic questions in the staff survey indicate that it covered a representative sub-set of the entire NHS workforce in relation to the age, gender, ethnicity and occupational group of the respondents.
Do you feel enough NHS staff got the opportunity to share their views with you?
We are deeply proud of the extensive staff consultation that informed this Review. Since the call for evidence was launched in April, we have received hundreds of responses from NHS organisations across the country. We have spoken to over a thousand staff at a series of discussion events, and our staff perception survey received 11,000 responses. And for many months we have engaged with staff through the interactive channels on our website, giving us the opportunity to respond directly to their questions and concerns.
The Final Report has also benefited greatly from the two month consultation phase that followed the release of the Interim Report. This gave us a chance to present our initial recommendations to staff across the country, and ensure that they were as practical and realistic as possible. This process served to validate and prioritise the findings and recommendations contained in the Interim Report and we have seen overwhelming agreement that a greater support for staff health and well-being is imperative to deliver the quality and productivity challenge.
What happened at the regional/SHA consultation events in August and September 2009?
At each event, Dr Boorman set out his vision and findings, before running extensive question and answer sessions. Attendees then participated in a series of workshops run by staff and service leaders from across the region. These sessions focused on key health and well-being issues and gave attendees an opportunity to debate the report’s recommendations.
The event series also saw keynote presentations from a range of high-profile experts in the fields of health, work and well-being. Speakers included NHS Chief Executive David Nicholson, National Director for Health and Work, Dame Carol Black, Work Foundation Executive Vice-Chair Will Hutton, Unison Head of Health Karen Jennings and HSE board member Sayeed Khan.
Who was invited to attend them?
The events were open to all who wished to attend them, although senior leaders in each SHA region were invited personally. Many attendees worked in occupational health and human resource functions across the service, and their level of knowledge and experience of the field was conducive to insightful and productive debate. The enthusiasm and creative thinking of all attendees was greatly appreciated by the Review team, and their feedback incredibly valuable in delivering the Final Report.
Is the base of evidence fairly representative of the wide range of different staff groups across the NHS?
The responses to the demographic questions in the staff survey indicate that it covered a representative sub-set of the entire NHS workforce in relation to the age, gender, ethnicity and occupational group of the respondents. The pattern of responses was consistent with that found in NHS’s own national, annual staff survey. Responses to the Call for Evidence were received from trusts across the country and each Strategic Health Authority region was well represented.
The developing evidence base was continually shared with the project based stakeholder groups to ensure it was representative, and additional material sought where gaps were identified.
Have you seen a positive response to the review among NHS stakeholders and staff?
We have seen an overwhelmingly positive response to the review from staff, employers and other major stakeholders. Senior leadership in both the NHS and DH engaged with the review at an early stage and continue to be key advocates for its findings and recommendations, with David Nicholson personally supporting the launch of the Interim Report and encouraging senior leadership to participate the in the engagement events..
The high level of participation in the review - with over 200 responses to the Call for Evidence and over 11,000 responses to the staff perception survey – is evidence in itself that NHS staff and stakeholders are fully engaged with the review and its aim of investigating current staff perceptions of health and well-being, alongside current occupational health provision. This level of engagement has sustained itself since the publication of the Interim Report, with over a thousand staff attending our regional roadshow events.
The Final Report
Why is the final report shorter than the interim report? How does this Final Report differ from the Interim Report?
The Interim Report presents an extensive range of findings and evidence. It seeks to examine in detail the complex questions that must be considered when assessing NHS health and well-being provision. It is a thorough and comprehensive assessment of the state of current provision, and offers a business case for change and a set of initial recommendations.
The Final Report represents a distillation of the key findings and recommendations of the Review. These have been tailored to reflect the valuable feedback we received during the extensive consultation process that followed the publication of the Interim Report. It is a powerful call to action, and seeks to set out its key recommendations in as straightforward and concise a form as possible. In doing so, it clearly and compellingly illustrates the case for change.
How much did you collaborate with the Department of Health to produce the final recommendations?
The Department of Health has been supportive of the Review at every stage of the process, whilst recognising and respecting its independent status. The Department has given the Review the support it has needed to consult as widely as possible, and this has been invaluable in producing the Final Report. The Department is also devoting considerable internal resources to ensuring the recommendations are considered for implementation as swiftly and effectively as possible.
