Enhancing the Health of NHS Staff: eTHOS—a randomised controlled pilot trial of an employee health screening clinic for NHS staff compared with usual care to reduce absenteeism and presenteeism

Background
Staff sickness absence incurs high costs to the NHS and is associated with adverse patient outcomes. Mental and musculoskeletal ill-health are the main causes, with cardiovascular risk factors also common. We tested the feasibility of undertaking a definitive randomised controlled trial to assess the effectiveness and cost-effectiveness of a staff health screening clinic (SHSC) in reducing sickness absenteeism and presenteeism.

Methods
Individually randomised controlled pilot trial of a SHSC compared with usual care recruiting employees from four English NHS hospitals. Those in the intervention arm were assessed by a nurse using electronic database-driven screening for musculoskeletal, mental and cardiovascular health. Screen positives were given advice and/or referral to services according to UK guidelines. Three co-primary outcomes formed the stop-go criteria: recruitment, referrals, and attendance at referred services. Secondary outcomes included: generalisability, screening results, individual referrals required/attended, health behaviours, acceptability/feasibility of processes, indication of contamination, costs, health-related quality of life, self-reported and employee records of absenteeism. Process evaluation included interviews with participants, intervention delivery staff and service providers. Quantitative analyses used descriptive statistics with framework analysis for qualitative data. Due to the COVID-19 pandemic, follow-up was restricted to 6 months and acceptance of referral during the screening assessment used as proxy for attendance.

Results
Despite recruitment rates during the truncated timeframe indicating potential to reach target, the final proportion recruited of 314 consented/3788 invited (8.3%) was lower than anticipated, and those recruited were not fully representative of the hospital staff population. 236/314 were randomised. Of 118 allocated to the intervention arm, screening identified 57 (48.3%) eligible for referral, with 18 (31.6%) accepting the referral. Process evaluation demonstrated that the electronic database-driven screening intervention and data collection system was efficient, promoting good fidelity. The intervention could benefit from more personalisation, better understanding of local context, longer training, and better integration with referral services.

Conclusions
We have identified a clinical need and perceived benefit for a SHSC. Delivery was feasible and electronic data capture successful. The three stop-go criteria were red (recruitment), green (referral), and amber (attendance); therefore, the Trial Oversight Committee recommended that a full-scale trial should proceed, but with modifications to adapt to local context and adopt processes to engage better with underserved communities.