The NIHR Policy Research Programme has awarded £1.5m in funding to 13 development award projects in work and health.
The Centre for Musculoskeletal Health and Work (CMHW): from research to impact
- Professor Gary Macfarlane, University of Aberdeen.
Musculoskeletal conditions, like back pain or arthritis, are amongst the most common causes in the UK of people being off work due to illness, or stopping work altogether. Evidence exists which shows how people with these conditions can be better supported to stay in work. However, often this evidence is not effectively translated into policies and programmes which lead to real-world benefits.
This project brings together people with musculoskeletal conditions and other stakeholders, such as healthcare workers, researchers and people working in government, to discuss how recently completed research might lead to important changes in workplace and healthcare practice. The Centre for Musculoskeletal Health and Work (CMHW) is a research collaboration between eight universities across the UK, and is funded by the Medical Research Council and the charity Versus Arthritis. CMHW’s research programme is focused on supporting patients with musculoskeletal conditions, their employers and healthcare professionals to enable them to stay in work as long as they wish to do so.
Our plan will bring together patients, policy makers, clinicians, charities, and employers, with experts in translating research into programmes, guidelines and policies, to decide which studies have the greatest potential to have the most impact.
National evaluation of workplace health and wellbeing initiatives that are free at the point of use for workplaces (WHISPAs)
- Dr Laura Kudrna, University of Birmingham.
The aim of the research is to create a national network of people who are involved in workplace health and wellbeing. Only people involved in workplace health and wellbeing initiatives that are free at the point of use for workplaces (WHISPAs) will be included. This means that participating workplaces do not need to pay anything. The national network will share ideas about what works to help improve health and wellbeing at work through participation in WHISPAs. It will create a new national group of diverse public contributors. We will ask people if and how they think we should do more research about workplaces in the future. Many people spend a significant portion of their life at work. Workplaces are a good place to give people advice and support for their health and wellness. There are many initiatives that aim to improve employee health and wellbeing, such as flexible working or meditation classes. However, existing initiatives have some challenges:
- Initiatives are delivered differently at local levels and learning is not always shared.
- Public involvement generally tends to be with patients. However, workplaces do not only employ patients, and a greater diversity of perspectives is needed.
- There is little relevant evidence on what works well to improve workplace health and wellbeing.
We will address these challenges by creating a new national network, listening to contributors about what diversity means, and finding out what people know to make meaningful changes.
Sustaining employability for older employees with chronic musculoskeletal disorders: JOINTWORKS Network
- Dr Glykeria Skamagki and Professor Afroditi Stathi, University of Birmingham.
This team is setting up a group called the JOINTWORKS Network. This group will include older workers with chronic musculoskeletal disorders, researchers, employers and healthcare professionals. Together, we aim to understand the challenges that older workers with chronic musculoskeletal disorders face and come up with ways to overcome them.
They will use a method called "system-mapping" to understand how support for workers with chronic musculoskeletal disorders can best work in the workplace. They will ask people from a range of working environments to share their views and knowledge in group discussions. We will look at how different systems (workplaces) operate, what are the challenges, what needs to change, what might get in the way of changes and what solutions might work. They aim to find 2-3 “best fit” solutions that could potentially make a difference.
Understanding needs and co-developing a workplace intervention to support healthy lifestyle behaviours in young adults
- Dr Eleanor Winpenny, University of Cambridge.
Young adulthood (age 16-24) is a time in life when many people put on weight. It’s also a time when people’s diet, exercise, and sleep tends to get worse. These changes in weight and behaviours can have both short- and long-term health consequences in terms of heart disease, hypertension and diabetes as well as deteriorating mental health. Not only are these distressing for individuals and their families, but they are also costly to the NHS and the wider economy.
It is known that people’s diet, exercise and sleep is strongly influenced by the type of places that people work, for example by working hours, food available in the workplace, or colleagues. Although the move from full-time education into work is one of the major changes that happens to young adults, researchers have rarely examined which types of workplaces have the greatest impact on diet, exercise, sleep and ultimately weight, or how workplaces could provide a more supportive environment for young adults to prevent them gaining weight. In this project the team’s aim is to find out:
- The groups of young people and types of workplaces which are likely to benefit most from interventions to promote better diet, exercise and sleep patterns.
- What employers and decision makers in Government and other agencies could do to support better diet, exercise and sleep patterns and reduce the risks of obesity among young adults who making the important change from full time education into the workplace for the first time.
- The types of changes employers can make to workplaces that are likely to be the most feasible, offer the best value for money, and lead to sustained changes in diet, physical activity and sleep among young adults transitioning into the workforce.
Prediction of Older Workers disEngagement and their Retention in the UK (POWER)
- Professor Ewan Macdonald, University of Glasgow.
Dr Simon Walker, University of Glasgow
Older workers (50+) within the UK are undervalued, under-supported, and increasingly driven out of employment (HoCL, 2023). Typically, 50% of the UK workforce leave employment between 50 and 64, resulting in the loss of skills and experience for the employment sector, and financial stability for the individuals (ONS, 2014). Older workers leave their jobs for many reasons but health is commonly a key issue that is frequently categorised wrongly as 'unfitness for employment' despite options for adjustments. As the older jobless face the economic and causal ill health strain of unemployment, burdens are also placed upon the state for financial and medical care; while businesses and employers are faced with the dilemma of hiring/training new staff. Evidence suggests that many older workers can keep working by transferring to similar roles, retraining, or having their hours reduced (TUC, 2017). Through Occupational Health support these skills and roles need not be lost, particularly as the pension age rises and people live longer, enabling workers aged 50+ to continue to work effectively reinforced by interventions and adjustments. This research aims to identify if it is possible to identify older workers at risk of losing their jobs to help them to stay in work if they choose. The project will have three parts.
- We will use literature reviews to identify risk factors for job loss in working people aged 50-64 years.
- We will develop a large and diverse network to find ways that occupational health can reduce risk factors. This will include stakeholder workshops with employers, policy makers, health staff and members of the public to prioritise key issues such as health, retirement, job satisfaction, to see what can prevent or support these issues. One important part of this work will be to identify ways that occupational health might help to reduce job loss in people over fifty.
- The third part the team will identify whether existing databases can be used to assess if occupational health does reduce risk factors for job loss for older people.
What health and wellbeing services do SMEs in the manufacturing industry require and could these be delivered by a large enterprise partner?
- Dr Georgia Ntani, Southampton General Hospital
- Professor Ira Madan, Guy's and St Thomas' NHS Foundation Trust
Work is good for a person’s health. It gives people financial security, a sense of worth and confidence. Poor health may prevent people from working their normal hours, or to the best of their ability, or being able to work at all. Employees and employers can benefit from access to health and wellbeing services (HWS) at work. Such services can address employees’ health needs quickly and work adjustments can help people remain at work. They can also help prevent common illnesses and injuries like musculoskeletal problems or poor mental health. Keeping workers healthy and at work is vital for the national economy and for reducing health inequalities.
Few small and medium size enterprises (SMEs) have access to HWS. Attempts to encourage them to buy in services for their workers have largely been unsuccessful. There is little information on why this is the case. The Government is piloting a scheme to subsidise SMEs to buy HWS. There are challenges for this scheme beyond cost e.g. SMEs may still be reluctant to buy services from an independent provider, or may not know what providers offer. Another issue is that the needs of SMEs may not be the same as large employers. Approximately 77% of SMEs are part of a supply chain, providing goods and services to larger enterprise partners, and so often look for sector-specific support. In this context, our project will explore if HWS could be supplied from larger, enterprise partner organisations that SMEs are familiar with and trust.
We will review previous and current schemes that encourage SMEs to buy HWS, what type of health services SMEs in the manufacturing sector would like, and whether these can be provided by their large enterprise partner.
- Part 1 - We will search policy documents and other sources to understand what has been tried before to encourage SMEs to buy in HWS, what worked and what didn’t, and what the obstacles to SMEs buying in services were.
- Part 2 - We will interview employees and managers from three SMEs in the manufacturing sector with the same large enterprise partner. We will ask if they wish to have access to HWS, and, if so, their preferred type of services and method of delivery.
- Part 3: Based on findings from part 1 and 2 and with our expert stakeholder and patient/public’s group input, we will develop a plan to test the feasibility of delivering bespoke HWS. The plan will be adapted from the large enterprise partner to several of its supply chain SMEs in the manufacturing sector.
Our expert stakeholder and patient/public group will assist with part 1, help develop the questions for part 2 and assist us in interpreting the findings.
A Work And Health Research Data (AWAHRD) Platform
- Professor Martie van Tongeren, The University of Manchester
- Dr Evangelia Demou, University of Glasgow
What is this project about? Employment can have an important impact on our physical as well as mental health. It provides support, income, purpose and structure to the day and being out of work or the threat of unemployment can lead to poor physical and mental health. Moreover, poor working conditions can also be a cause of mental and physical ill-health, such as stress and lung diseases.
Why is this project needed? It is difficult to find out if efforts to improve the health of workers or help their return-to-work after periods of sickness or unemployment are effective. Existing health datasets, such as those held by GPs or the data that hospitals collect, are often used in health research. However, these health datasets rarely hold information on employment and on the types of jobs people have. This means that it is very difficult to study how work affects people's health, how health impacts their ability to work and if measures to assist people to stay in or return-to-work are effective. Understanding these issues can benefit both workers and employers. Therefore, it is essential that we improve the data on work that is collected and link these data with existing health records to conduct high quality research in the areas of work and health.
How will this work? This project will look to improve on the ways how work and health data can successfully be used in research. We will review, collect and combine existing datasets that contain information on work, such as job type, workplace risks, as well as datasets with information on health outcomes. We will capitalise and build on recent work that brings together over 20 long-term UK studies that have collected data on people's health and wellbeing, some containing employment and job information, and most already linked to health records. We will explore how data from these and other studies can be linked to sources that provide more detailed information on work, such as data collected for tax and benefit purposes.
Who will deliver this project? Researchers from the Universities of Manchester, Glasgow, Bristol, Edinburgh and King’s College London will deliver the project. They will work with members of the public, workers, employers and organisations such as the Health and Safety Executive and the Office for National Statistics.
How will this make a difference? We will develop an important data resource for work and health research in the UK that can be used to measure the effect of policies and other interventions on the health of the UK workforce. This will have long-term benefits to workers, their families, employers and society.
Self-management support to enhance work-health balance in people with long-term health conditions and disabilities
- Dr David Maidment, Loughborough University
This award will look at how workers with long-term health problems and disabilities, including cancer, arthritis, hearing loss, and poor mental health, can be supported to self-manage at work. Self-management describes the actions people take to help them stay well. For example, taking medication, exercising, or getting help from friends or family when required. Our aim is to carry-out workshops and other activities to understand how employers can support self-management to improve health and quality of working life. This information will be used to develop a larger funding bid for the NIHR Research Collaboration Award scheme.
There are 13 million workers in the UK with long-term health problems or disabilities. To help people stay well at work, the UK government and professional groups want employers to support workers to self-manage their health. Yet, there is no specific advice for employers to help them achieve this goal. Our own research has shown that workers want employers to provide self-management support, but they do not receive it. This is because employers do not know about self-management or how to offer it.
We have developed a guide (or model) that outlines how workplaces can offer self-management support. The model was co-developed with employers and workers with long-term health problems. The model includes key areas of self-management support, such as how workers can tell their employers about their health needs and how employers can be prepared to meet these needs. This model now needs to be turned into tools, such as web- or paper-based information resources, to help people with long-term health problems and disabilities self-manage their health so that they can maintain or improve their work-health balance.#
Through workshops, we will bring together different groups of researchers, employers, civil servants, healthcare professionals, and workers. These workshops will help us work-out the best ways to turn our model into tools that can help improve workplace self-management. These workshops will also help us bring together a team of people who will work together on the Research Collaboration Award.
The research team will include 12 workers with diverse lived experiences who have different long-term health problems or disabilities. This will make sure the research meets their needs and is easily understood by everyone. They will be involved in all parts of the research project, including writing reports, leading workshops, and planning the future funding bid. We will share a report from our project, including how employers can best offer self-management support with other workers, employers, the government, professional groups, and researchers. This work will also inform our NIHR Research Collaboration Award, which will involve projects that aim to develop and assess workplace self-management support tools.
Improving economic activity in the North of England: A levelling up priority
- Professor Paul Crawshaw, Teesside University
- Mr Scott Lloyd, Middlesbrough Borough Council
Our project focuses on getting people with health problems who live in poorer areas back into jobs. This will make these areas healthier and wealthier. We are interested in the North of England where there are increased levels of health problems and poverty. There are also lower levels of people with jobs in these areas. Higher levels of health problems are often linked to where we live and where we work.
There are benefits to having a job both for people and their families and for local communities and economies. The UK government has made helping people to get a job a priority. They are particularly keen to help people living in poorer areas and people with health problems. This is often called levelling up. We don’t know exactly how to do this. There are ways that can help people with health problems into jobs, but we don’t know how well these work in poorer areas.
Our Award will review whether ways to get people with health problems back into work in areas of poverty are effective. We will work on three smaller projects and then bring all of the learning together to create a new intervention that will help people get back to work. First, we will do a review to identify all research that has been published in scientific journals and reports and ask what this can tell us about what works in areas of poverty. We will also talk to people who have led projects so that we can learn from them and understand what the barriers were to getting people back to work when they had health problems and what might help. We will also speak to two organisations, as case studies, that support people back into work to understand what works and what does not.
We will use all of the learning from these three projects for a fourth project. The fourth project will ask people who we talked to earlier and members of the public to help us create an intervention that can help people get back to work. This is the overall aim of our Award. We will identify what can work in helping people who are in poorer health get back into jobs in poorer areas. We hope to test this as part of a much larger project that could last up to three years and really make a difference. We will use methods that encourage us all to work together and value everyones experiences. If we involve the people who are most affected by not having a job and the those who support them, we hope to contribute to the design of projects and new policies that really work for people.
Developing a National Centre for Working Age Health
- Professor Gwenllian Wynne-Jones, Keele University
Many more people are reporting long-term absence from work due to sickness, with the biggest rise in the younger age groups. Once people are on long-term sickness absence, they risk not being able to get back to work. It is important then to ensure that appropriate support to work is available throughout a person’s life.
We also know that some groups of people may need more specific support, for example.
- Younger and older workers
- Ethnic minority groups
- Those living in remote and rural communities
- People with rare diseases
- Those working in jobs at high risk of traumatic events
- People whose work status may lead to poor mental or physical health
To look at health and work across people’s lives we propose to bring together three research groups from Keele, Aberdeen and London to create a National Centre for Working Age Health. Through this grant we will look at the evidence around health and work in the specific groups above. We plan to do this through four work packages, each addressing different things.
Work package 1 will look at the research that has already been done to see what is known and if or where there are gaps in our understanding of the impact of health on work and vice versa. This will highlight the key questions we need to answer. We will also look at research that the team have previously done to see whether we can adapt interventions and resources to use in different settings, for example training managers to better support workers on sick leave.
Work package 2 will look at data that has already been collected to see how we can best use this to answer some of the questions found in work package 1.
Work package 3 will bring together people who have an interest in health and work and will include employed and unemployed people with health conditions that impact their work as well as employers and other professionals. This group is known as a Patient and Public Involvement and Engagement or PPIE group. We will invite this group to give their views of our plans throughout this grant and to work with us to co-produce an application(s) for the next round of funding the NIHR Research Collaboration grants.
Work package 4 will formally bring our team together by outlining how the National Centre for Working Age Health will be set up. We will set out the structure of this Centre and use the information from work packages 1 to 3 to create a programme of research guided by PPIE input.
Building towards a vision of Work-Health Expert Research Collaboration (WHERC)
- Professor Adam Whitworth, University of Strathclyde
The UK’s work-health landscape presents a series of significant challenges that frustrate individual’s work aspirations, restrict business’s ability to recruit and prosper, and involve significant costs for government. We contend however that a separate UK work-health problem lies in the relatively limited and fragmented nature of the UK work-health research environment itself when set against the scale of the UK’s work-health challenges or other health research areas.
In response, this network proposal brings together leading work-health scholars to explore together and with PPI partners ten UK policy and research priorities in order to develop a larger future programme of applied work-health research together and with wider partners. The ten priorities are: work/health inequalities; workplace accommodations; integrating phases of work-health research and policy; programme form and effect; fair work; gap analysis and evidence reviews; economic appraisal; PPI methodologies; integrating methods and evidence; and growing early career researcher capabilities.
To explore needs develop research-policy priorities across these themes our network brings together leading academic expertise across a range of key research and policy areas alongside disabled people, partner disabled people’s organisations (Breakthrough UK, Speakup Self Advocacy Rotherham, Astriid, Chronic Illness Inclusion), policy stakeholders and business organisations as equal PPI partners. Across our ten month network we run four two-day development events and monthly digital discussion sessions to develop priority questions within each theme and to explore connections between themes.
Our project Steering Group is made up of our partner disabled people’s organisations and key policy partners. It will meet four times during the network to ensure that our programme of work developed maximises its potential value to policy makers and disabled people.
EDI Smart-Dash: Supporting health organisations to develop a more inclusive working environment.
- Professor ROSALIND SEARLE, University of Glasgow
- Professor Roberta Fida, Aston University
The National Health Service (NHS) is one of the most diverse workplaces in the world in terms of its workforce and the communities served. Building and maintaining an ethnic inclusive work environment is central for staff to feel valued, accepted regardless of their background, and able to thrive. Diversity improves healthcare access for historically marginalised groups, increases trust, and the quality of patient care. Despite prior NHS initiatives, staff, especially from diverse ethnic backgrounds, report experiences of bullying and discrimination from other staff and patients. There is little real-time system that supports the assessment, monitoring, and development of more inclusive workplaces.
Our aims are: i) to understand how NHS hospitals currently assess and deal with staff equality, diversity, and inclusion (EDI), and the challenges they experience and ii) to undertake preliminary work to develop (in a second stage) a ‘smart’ information tool supporting NHS workplaces to diagnose the problems they face, identify effective changes to make and how to make them.
This project involves two workpackages. The first involves speaking to experts in the NHS and Human Resource professionals to understand views and experiences in relation to EDI in the workplace and their suggestions for any improvements. We will examine workplaces’ approaches, the solutions they try and how these are received from the groups they are designed to help. The second workpackage identifies the quality and level of evidence available on EDI interventions. We will combine these insights to determine the architecture of our ‘smart’ NHS information tool for automating data collection and analysis and identifying the most effective interventions for their workplace. We will also build a team for its delivery in the next stage of this project.
This project has been developed in collaboration with several ethnic minority staff associations and with hospitals’ HR professionals and EDI leads. Members of these groups will be part of our steering group and they will be involved in all the stages of the project. We will also engage with different ethnic group staff members to understand their experiences of workplace’s equality, diversity, and inclusion and NHS current approaches. This includes understanding the direct impact of policies and interventions. We explore community tensions and how they are experienced by those from different ethnic groups to identify potential data gaps.
After completing this work, we will better understand how to build and maintain more inclusive workplaces that are able to support and care for patients and staff. We will produce reports for the participating hospitals with good practices and their data map, and a summary report and data map for the NHS. We also develop the second stage project application.
Business Framework for Health: a system change approach to improve health through work and workplaces
- Ms Tina Woods, Business For Health CIC
- Mrs Elizabeth Bachrad, Business For Health CIC
We need new solutions to improve the health and wealth of the nation. Our programme will identify how businesses can help people stay healthy and well in work and return to work optimally after illness- thus benefiting the entire workforce at all levels of health and wellbeing. We propose to develop and test measures and methods that will produce evidence-based guidance for business and government, leading to the development of interventions that can be tested and evaluated at scale in the next stage of research. Increased investment in workforce health has the potential to improve population health and reduce the burden on health and care while improving economic growth.
In February 2020, the All Party Parliamentary Group (APPG) for Longevity addressed ageing demographics, prevention and health promotion by publishing the Health of the Nation Strategy¹, setting out key recommendations to meet the government goal of five more years of healthy life expectancy by 2035 while minimising health inequalities. Business for Health (B4H) was formed in response to target improvement in workforce health through business investment and engagement. B4H published a Business Framework for Health² in 2021 with update³ in 2023, and engaged with Cambridge Public Health to understand how their ‘Improving Improvement toolkit’4 could be used together to advance system-level change in improving health outcomes. The scoping work identified three key needs and gaps: (1) businesses want evidence-based guidance on investing in workforce health sustainably (2) a whole-systems approach is required for research and evaluation to generate an evidence base (3) there are no validated whole-systems methods.
In partnership with Cambridge Public Health and their Design Systems group, we will undertake an iterative programme of work using a co-designed mixed methods approach to develop measures and methods to meet the needs and gaps identified. This will include a series of workshops to: (1) co-adapt and co-refine methods taken from a whole-systems engineering framework (2) co-refine and co-test B4H’s measurement framework (3) develop and test the utility of an improvement practice for aligning different perspectives on needs and gaps through a "do-tank" and "think-tank".
B4H hosted two workshops with stakeholders from private, public and third sector (including employers and employees from AXA Health, Institute for Health Equity, Reckitt, and NHS England) to provide an understanding of the diverse views needed for the planned work. Our PPIE advisory group will co-create materials for the workshops, feedback on findings, support dissemination, and help to develop the PPIE workstream for subsequent research.
Our partners will be instrumental in sharing findings, including knowledge transfer through publications, events, and policy recommendations. With refined frameworks and methods/measures we will test and validate their utility at scale in subsequent research.