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Background
As the only dedicated children’s hospital trust in the north of England, Sheffield Children’s NHS Foundation Trust provides a vitally important range of services for its users, including integrated healthcare for children and young people, community and mental health care and acute and specialist services.
Providing timely access to treatment and good continuity of care is a crucial part of the Trust’s commitment to providing a high-quality standard of service, so maintaining a stable, healthy team is fundamentally important.
With many roles within the hospital environment having a physical element, the avoidance of musculoskeletal disorders amongst its employees was of paramount importance to the Trust. Acute musculoskeletal pain can affect almost anyone, so it is important that any employee suffering an acute musculoskeletal condition receives treatment quickly to stop the condition becoming chronic, and medical evidence indicates that one of the most effective ways of achieving this is through early physiotherapy intervention.
The Sheffield Children’s NHS Foundation Trust (SCH) offers its staff access to a variety of services to safeguard their health and wellbeing but wanted to expand the provision to include access to a flexible physiotherapy service that would enable employees to recover more quickly and safely from musculoskeletal injuries and conditions that required treatment. As a result, SCH turned to occupational physiotherapy provider Physio Med to provide its innovative, blended physiotherapy service.
Brief
The Sheffield Children’s NHS Foundation Trust is one of the biggest employers in South Yorkshire, employing circa 3,000 staff.
It has established a dedicated Health & Wellbeing group, which is available to all employees, to identify and implement initiatives to help them improve their physical, mental and financial wellbeing. The physical health service includes access to a variety of exercise classes and discounts at local gyms, while a fitness initiative - ‘Move More’ - has also been set up to encourage employees to stay active at work by taking part in step counting competitions.
With many of the job roles within the Trust being physically demanding as a result of the nature of the services on offer, some employees were susceptible to musculoskeletal disorders (MSDs), resulting in sickness absence or reduced productivity. As a result, the Trust decided to add fast-track access to an effective occupational physiotherapy provision as part of the wider health and wellbeing strategy it offers to staff.
With access to NHS physiotherapy via GP referral taking up to 14 weeks (National Survey, 2015), employees suffering from MSDs were often working at reduced levels of productivity while waiting to access treatment, or absent from work entirely for extended periods. As a result, the Trust decided it needed to find a way to support its employees in quickly accessing quality physiotherapy treatment in order to:
- Reduce MSD-related employee discomfort and pain levels
- Minimise associated absence and facilitate an early return to work
- Improve productivity
- Reduce the risk of further absence due to the recurrence of MSDs
Solution
In February 2017, Physio Med began working with the SCH to implement a blended model of physiotherapy services which provides fast-track access to treatment, in order to support staff health and wellbeing, improve productivity and reduce sickness absence.
Employees suffering a musculoskeletal injury or disorder are first referred to Physio Med by their managers and then contacted by a member of the Physio Med team for a telephone triage, within as little as two hours and a maximum of four, to ensure they are appropriate for treatment.
All appropriate referrals then receive an initial assessment within a maximum of three days, with acute conditions going through Physio Med’s award-winning Physiotherapy Advice Line (PAL) service and chronic injuries being referred directly to the face-to-face (F2F) service via Physio Med’s network of clinics.
The PAL initial assessments are carried out over the phone by a Senior Chartered Physiotherapist and comprise a series of evidence-based clinical questions and a series of movements designed to facilitate diagnosis. The employee is then advised on the best way to self-manage the condition and assist the physical healing process. This includes:
- An individually tailored progressive exercise programme created by the physiotherapist to speed up healing, communicated via comprehensive videoexercise files, and accessed via a computer, smartphone or tablet
- Appropriate advice regarding their work station, lifestyle, medication, posture and methods of symptomatic relief
- Realistic advice on modifying the working day to accommodate the injury.
Employees referred directly for F2F treatment receive an appointment within an average of 2.6 days at one of Physio Med’s network of 780 hand-picked practices. Because they have a large number of practices to choose from, employees can select the one most convenient for them, allowing them to use their time more effectively and helping to improve productivity levels.
Outcome
In a 12-month period, from February 2017 to January 2018, a total of 93 cases were progressed by Physio Med, with 77% being treated via the PAL service and 23% with chronic conditions being routed directly for F2F treatment. Initial PAL assessment appointments took place within an average of just 1.8 working days of the triage call, while initial F2F assessment appointments took place within 2.9 working days.
At the point of referral, 19.4% of the employees referred were absent from work due to their condition, while the remaining 80.6% were at work with pain and therefore operating at reduced productivity levels and highlighting the hidden cost of presenteeism.
Employees discharged from the F2F service received an average of 5.2 sessions each, including the initial assessment.
Of the 84 employees discharged from the service, only 2 remained off work following treatment and there was a reported average pain reduction of 57.5% (from 6.6/10 to 2.8/10). There was also a reported improvement in productivity and function in real terms of 34% (from 53% to 87%), equating to 1.7 days pp/pw working a five-day week and resulting in an overall increase of 64%.
97.6% of the 84 employees successfully discharged from the service returned to work following treatment, representing 82 employees successfully rehabilitated back into the workplace.
In financial terms, and based on the average daily cost of a Trust employee being £100.00, the service has delivered impressive returns. The improved productivity and function multiplied by the days saved in not waiting to access NHS treatment delivered a total estimated saving of £198,492 over the 12-month period – which equates to an ROI figure of 13.3:1
Physio Med also reports back to the Trust on a host of criteria – including anatomical injury site, referring locations and job roles – identifying trends to help the Trust put practices and measures in place to reduce future injuries and issues.
Jane Clawson, Deputy Director of Human Resources and Organisational Development at SCH, said: “We value the wellbeing of our staff and want them to be well taken care of. By providing them with an occupational physiotherapy provision which lets them receive advice over the phone within hours of reporting a problem and provides access to treatment centres close to home or work, we’ve reduced MSD-related sickness absence and helped staff return to full health – and return to work – sooner.
“The Physio Med model also works well for us financially, as we only pay for what we use and have no overheads, which has helped us make our budget go further. Physio Med has been helpful from the outset in helping us control our costs by suggesting we use management referral in the first instance and limiting the number of treatment sessions per employee. The support we have received overall has been excellent.”
