The Northern Care Alliance NHS Foundation Trust (NCA) is a group of hospitals and community facilities in Greater Manchester with around 22,000 staff.
In 2022, in partnership with Manchester Metropolitan University, two bespoke surveys were designed to better understand the experiences and needs of NCA employees across a range of women’s health issues. One survey was aimed at all staff, and another targeted those with line manager responsibilities.
The findings, presented to the NCA in 2023, showed areas of strength but also areas for action. Regarding women’s health issues, positively, most managers felt motivated to provide support for the various conditions/experiences, and many indicated that they were aware of legislative entitlements. Further, many employees felt that their manager was willing to listen to their issues, and felt able to confide in colleagues. The majority also found work to be a useful distraction, a place of social support and an important part of their identity when navigating difficult health issues.
However, in line with research on women’s health issues in the workplace more broadly, the surveys found that more can be done to support staff affected by complex fertility journeys (including fertility treatment and pregnancy loss), menstrual health issues (including endometriosis) and menopause transition.
On the back of the research partnership, findings and recommendations, the NCA has introduced the following initiatives as part of the Well Women Strategy:
- a Well Women Strategy page on the NCA intranet, with a range of resources for line managers and colleagues and the development of training sessions for HR, managers and mental health champions.
- four new policies on fertility treatment, pregnancy loss, endometriosis and menstrual health.
- menopause advocates, who run menopause awareness sessions twice monthly.
- training and awareness-raising sessions delivered by external providers on fertility treatment (from Fertility Network UK) and pregnancy loss (from MIST Workshops), including sessions on male perspective, childlessness and LGBT+ issues
- endometriosis champions (trained by Endometriosis UK) delivering in-house awareness sessions.
- working with the NCA’s safeguarding team and domestic abuse specialist to develop training and awareness raising around domestic abuse and sexual violence.
- building on the work to develop a strategy for women’s health to gain commitment to a new Men’s Health Strategy, including input into an All-Party Parliamentary Group (APPG) paper on men’s health.
- endometriosis case studies collected and included in the new Wellbeing and Attendance Management Policy, which is a collaboration across the North West. This helps raise awareness of the strategy and project beyond the organisation.
- additional evaluation collated from all the awareness sessions to understand further gaps and support needs.
- utilising the local questions within the NCA Quarterly Pulse Survey to understand how many colleagues are aware of the Well Women Strategy and indirectly promoting the strategy.
The impact of personal adjustments
The following example has been collected by the NCA to show how suitable personal adjustments can be agreed for one of the featured health conditions:
“Ever since I started having periods they were extremely painful, and it only seemed to get worse as I got older. No one ever mentioned that it could be due to a disease, and I was just told that this is what period cramps felt like, despite none of my friends experiencing pain the same way. The GP prescribed painkillers and hormonal contraceptives to try and manage the pain but I wasn’t ever referred onwards to a gynaecologist. When I was 27, after 13 years of going to the GP about the pain I was experiencing, I finally had a laparoscopy and received a diagnosis of endometriosis. The surgeon removed what they found at the same time. Unfortunately, endometriosis is a chronic condition, and the tissue grows back. Now, my pain is much less, although it is getting worse as time goes on. I still have bad days, and that can be due to other symptoms too, like bloating and fatigue.
“Through discussion with my manager I’ve been able to put a Personal Work Adjustment Plan (PWAP) into place – this means that I can have flexible start/finish times when needed, as long as I still do my hours, and I am able to use a hot-water bottle at work if I need to. I also have days where, if I am not seeing patients, I will wear my own clothes instead of my uniform, which is helpful if the bloating is particularly bad that day.”
Highly Specialist Nurse
- Having a dedicated strategy is important, rather than treating specific health issues in isolation.
- Developing strong branding, with lots of communication to raise awareness and engagement.
- Using different channels and connecting to existing initiatives and groups.
- Being prepared to look inward, acknowledge potential issues (such as those around culture or processes) and learn.
- Engaging with independent researchers and actually listening to the findings.
- Making incremental changes and evaluation along the way.
- Using feedback from training sessions, eg pulse surveys.
- Acknowledging the mental health elements of women’s health issues as well as physical.
- Finding ways to encourage diverse voices. There was limited demographic diversity in the survey responses, so extra engagement work via staff forums/networks draws out additional voices and specific challenges.
- Considering implementation challenges and needs of different stakeholders. This includes valuable insights about time demands for line managers and how this might influence levels of support.
- Understanding the complexity of systems involved in such a large organisation (such as the challenges to adjust how things are logged in absence management systems).
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