Intended for healthcare professionals

Rapid response to:


Improving workplace health in the NHS

BMJ 2020; 368 doi: (Published 09 March 2020) Cite this as: BMJ 2020;368:m850

Rapid Response:

Health promoting hospitals – back to the future!

Dear Editor
We fully agree with Majeed and Asanati, NHS workplaces should aim to be centres of excellence for workplace health promotion so that there will be rich benefits for patients, staff and local communities.(1) The health service should not be just about curing illness, there are far bigger health dividends to be claimed as a large employer, a major landowner, and a substantial purchaser of goods and services.(2) However this will need a paradigm shift in the way we think about hospitals.

Over 30 years ago the World Health Organization’s described such radical ideas in the Ottawa Charter.(3,4) This seminal document of the new public health has been influential in guiding the development of the settings approach to health promotion. Throughout the world, examples of a wide range of settings can now be found including health promoting schools; health promoting workplaces; and health promoting hospitals.(5,6)

In order to become a health-promoting setting, those involved should undertake the commitment to three conditions:
(1) creation of a healthy working environment
(2) integrating health promotion into daily activities
(3) reaching out into the community.(6)
It is crucial that health promoting hospitals should not just be for the benefit of the patients but also for staff, visitors and community members.

The workplace can have a powerful effect on the health of employees. There is growing evidence about the costs of ill-health to organisations and the benefits of creating a healthy workplace.(7-12) Throughout the country there are examples of hospitals that do promote healthy eating, tackle musculoskeletal disorders, organise exercise and relaxation classes, and help people to quit smoking. However, this health promotion is usually on a small scale, rather than as a systematic and comprehensive programme.

A recent review has investigated the effective factors in implementation and development of health promoting hospitals.(13) Three of the factors that were key to success were, the participation and support of hospital leaders, assessing the needs of patients and staff in order to enable and empower them, and having specific and skilled personnel for health promotion programmes.

Public health specialists could initiate and support health promoting hospitals. Their core skills of needs assessment, programme planning, communication, leadership and systems thinking, are ideal for this type of activity. Public health departments would need adequate resources for them to undertake this work and there would need to be significant national commitment.(14-16)

Hospitals are health promotion “sleeping giants” in our local communities and have a substantial amount of resources. It is now time for re-orienting our health services and creating health promoting hospitals. We believe this will bring far bigger health dividends for patients, staff and the local communities.

1) Majeed A and Asanati K. Improving workplace health in the NHS. BMJ 2020;368:m850

2) Middleton J. Managing public health – health dividends and good corporate citizenship. Int. J. Management Concepts and Philosophy 2010;( 2): 154-176.

3) World Health Organization. Ottawa Charter for Health Promotion. Copenhagen: World Health Organization, 1986.

4) Thompson S R, Watson M C, and Tilford S. The Ottawa Charter 30 years on: still an important standard for health promotion. International Journal of Health Promotion and Education. 2018,56(2), 73-84.

5) Baric L. Health Promotion and Health Education in Practice. Module 2. The organisational model. Altrincham: Barns Publications, 1994.

6) Watson, M. Going for gold: the health promoting general practice. Quality in Primary Care. 2008; 16:177-185.

7) Tones K and Tilford S. Health promotion: effectiveness, efficiency and equity. Cheltenham: Nelson Thornes, 2001.

8) Faculty of Public Health and the Faculty of Occupational Medicine. Creating a healthy workplace: A guide for occupational safety and health professionals and employers. London: Faculty of Public Health, 2006.

9) IOSH. Working well. Guidance on promoting health and wellbeing at work. Wigston: IOSH, 2015.

10) Royal College of Physicians of London. Work and wellbeing in the NHS: why staff health matters to patient care. 2015.

11) National Institute for Health and Care Excellence. Workplace health: long-term sickness absence and capability to work. NICE guideline NG146. 2019.

12) General Medical Council. The state of medical education and practice in the UK. 2019.

13) Yaghoubi M, Karamali M, Bahadori M, Effective factors in implementation and development of health promoting hospitals: a systematic review, Health Promotion International. 2019, 34(4): 811–823.

14) Watson M C and Lloyd J. Raiding the public health budget. Action is needed to tackle current public health threats BMJ 2014;348:g2721

15) Watson M C and Lloyd J, 2016. Need for increased investment in public health BMJ 2016;352:i761.

16) Watson M C and Thompson S, 2018. Government must get serious about prevention. BMJ 2018;360:k1279.

Competing interests: No competing interests

12 March 2020
Michael Craig Watson
Trustee, Institute of Health Promotion and Education.
Dr John Lloyd, Honorary Vice President, Institute of Health Promotion and Education.
Institute of Health Promotion and Education, PO Box 7409, Lichfield WS14 4LS, UK.