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West Dorset General Hospitals NHS Trust has been issued with an improvement notice by the Health and Safety Executive (HSE) as it did not have a work related stress policy or a risk assessment of work related stressors. The improvement notice is about systems of work, and does not, in any way, suggest that staff in Dorset County Hospital are more stressed than in any other public sector organisation.

The Trust has been working closely with the HSE and staff representatives to understand the reasons for work place stress, and plan to develop a survey in conjunction with a local university. Whilst Trust staff already have access to occupational health and counsellor services, it will now also be using the management standards developed by the HSE, as a way to begin to tackle work-related stress.

This note is to draw the attention of senior managers and Improving Working Lives leads to the Department of Health position on organisational stress, and the role of Improving Working Lives in addressing it, as reported to the Public Accounts Committee by Sir Nigel Crisp in June this year. It is also to remind you of the need for all NHS employers to have in place a policy on work related stress supported by written risk assessments of work related stressors.

Background and the role of Improving Working Lives

Through Improving Working Lives we are working towards providing a better working environment for staff, one in which many of the causes of workplace stress have been removed. Through IWL we have seen the introduction of team based self rostering, annual hours arrangements, carers support and career breaks, childcare support is being rolled out, reduced hours options are becoming available, and we are changing the long hours culture.

We are giving staff the freedom to manage their own work life balance, to be in control. And being in control is a major contributor to reducing stress levels.

We are committed to providing healthy workplaces. Access to occupational health services is now the norm rather than the exception that it was just a few years ago, health and safety management is improving and so are the buildings that NHS staff work in. The zero tolerance zone campaign is enabling staff to address the issues of violence and aggression in the workplace, another major cause of stress, and to see the perpetrators of that violence face the consequences of their actions.

Improving Working Lives was not introduced specifically to tackle workplace stress; the aims of IWL are far wider than that. However, the actions we are taking to tackle the working environment mean that we are addressing the causes of stress, rather than focussing on alleviating the symptoms.

The Partnership on the Health of the NHS Workforce, set up by Frank Dobson in 1997 specifically to look at the mental health of NHS staff, made ten recommendations in what they called ' a comprehensive and integrated staff health improvement plan based on the relevant scientific literature'.

Through Improving Working Lives, better training opportunities, the healthy workplace project and the zero tolerance zone initiative amongst others we have now put nine of those ten recommendations in place. Later this year we shall be publishing the first ever-strategic occupational health and safety plan for the NHS. This will meet the tenth recommendation.

The plan will draw together into a coherent strategy all of the work referred to above and set out how implementation of these linked policies can benefit staff, patients and the service. Not only will it allow NHS managers and staff to see the reasoning behind the work it will allow them to become even more involved in making the NHS a better and less stressful place for their colleagues and themselves to work in. And by improving their working lives, and reducing the stress of working in the NHS, they will contribute to providing a better and more efficient service for patients and their families.

The Department of Health is working closely with colleagues in the Health and Safety Executive and the NHS in the development of the new Occupational Health and Safety Strategy and on identifying ways of reducing organisational stress in the NHS.

• Improving working lives

Recognised causes of stress

NHS managers considering the formulation of a new policy on managing organisational stress and on the assessment of risk may wish to consider the causes identified below.

The latest piece of research into the major recognised causes of stress in the NHS workplace, verified by staff including nurses (Prof Isobel Allen, Policy Studies Institute), junior doctors and consultants, are listed below:

Health and safety legislation

Section 2 of the Health and Safety at Work etc Act 1974 imposes a duty of care on all employers and the Management of Health and Safety at Work Regulations 1992 (amended 1999) require all employers to undertake adequate risk assessments.

Further information on the HSE management standards for work related stress can be found on the Health and Safety Executive (HSE) website.

• HSE Management Standards (opens new window)