ghp September 2015 | 63 health and social care The Five Year Forward View is an initiative developed in 2014 by NHS England which sets out how the health service needs to change, arguing for a more engaged relationship with patients, carers and citizens in order to ensure the NHS is capable of promoting wellbeing and preventing ill-health in our modern society. The forward view examines numerous aspects of the NHS with regards to how it will have to adapt to cope with future challenges. Changes to models of care moving forward are an integral part of the concept, with Warden explaining that these changes will have an impact on NHS staff and that NHS employers is working to support the staff as they look towards implementing these changes. “Our role with regards to implementation of the Five Year Forward View is examine how the workforce needs to shift to support the delivery of the new models of care. This means looking at whether staff need to do perform slightly different roles, whether ad- ditional training is required, whether staff need to work across different boundaries or work in new teams etc. We are helping employers within the NHS to think about these workforce implications of the Five Year Forward View and then helping them put the required actions in place so that the workforce is fit to deliver the models of care outlined in the Forward View.” Warden works primarily within the education and shape of workforces within the health service, and finds that projects beginning now with regards to the Forward View often focus on examining whether new job roles are required, which means Trusts are examining the possibility of new training for staff, with possibilities such as adding new competencies onto roles so existing staff can perform a slightly broader role and do more tasks within their job. Staff experience is also a vital issue which NHS Employers is working with Trusts to address, so that employees working within the health service can be more positive and open to change, as well as reducing stress related staff absences within the service, which is an issue Warden feels is important and needs to be addressed moving forward. “The NHS is an inherently stressful environment to work in, which is part of the challenge staff face and part of the reason many of them chose to work there in the first place. When you add this to the challenges being faced by the service at the moment such as financial challenges, increased demand and the changes to how the service delivers being outlined by the Forward View then it increases the stress in the working environment. “As a result of this what we are seeing, what Trusts are telling us, is that sickness absence which is attributed to stress is on the increase. We need to keep the NHS workforce healthy so what we are doing to help this is looking at how we can support NHS organisations to make the changes which are happening within the organisation as stress less as possible and acknowledg- ing that any type of change will be stressful for the staff. “We are also working with NHS Trusts to analyse how they can support people who are unwell and help them get back into the workplace. It is about creating an environment where people don’t feel that they have to be off work sick with stress but if they do chose to take time off for stress related sickness, then we have to facilitate their return to work as quickly. Evidence shows that the longer someone is off work sick the harder it will be for them to return to work. “As the NHS invests a lot of money and time hiring highly qualified staff they are keen to have them in work supporting the service ad helping patients. This is why supporting people who are off sick and creating an environment to reduce stress related sickness is very important to the health service.” The Government’s constant efficiency strategies for the NHS also contributes to stress in the health ser- vice, Warden adds. “Messages are coming through that the NHS has to be more efficient, that it has to change the way it is doing things, and this is challenging on number of different lev- els and puts staff under a variety of different pressures.” A particular challenge NHS employers have is around opening up a dialogue among staff around mental health issues, with problems often being exacerbated by stress. NHS Employers is supporting the health ser- vice to ensure that line managers and senior staff feel competent enough to deal with mental health issues and staff feel comfortable with having these conver- sations. Warden stressed that these conversations are vital to ensuring staff do not become so ill that they have to take time off work. “There is still quite a stigma around mental health, both in the NHS and in society as a whole. This is one of the major challenges that we have found and we are working with employers within the NHS, with Trusts and other organisations to support staff in the NHS to start talking about their emotional wellbeing and the stress of working within the organisation.” Some key ways to reduce this include supporting line managers so they can support the staff working under them and improving the health of the overall NHS staff. Simon Stevens, chief executive of NHS England, has recently announced a health plan for NHS staff to reduce levels of absence. By creating a healthier workforce the NHS will be better placed to deliver the best possible patient care as well as reducing costly sickness absence, which recent figures from HSCIC put at 4.72% in January this year. Change of the sort proposed by the Five Year Forward View will cause a great many issues for the NHS in the future but with active engagement with staff the changes will run smoother and cause fewer problems. We spoke to Ruth Warden, Assistant Director of Employment Services at NHS Employers about how the NHS can support staff through the changes inherent in the implementation of the five year forward view.