The first action included in HIA4, focused on staff wellbeing conversations, was for completion by October 2023. Delegates shared examples of good practice, including:

• Ensuring new managers are aware of the wellbeing services available to staff and how to signpost staff to these

• Adding wellbeing prompts to appraisal paperwork to encourage these conversations

• However, delegates noted that this needs to be underpinned by appropriate manager training to ensure they are confident and competent in holding these conversations

• There was also discussion about how to have these conversations with staff from different backgrounds, who might not be familiar or comfortable with language around mental health and wellbeing, particularly in the workplace

• Ensuring psychologically safe spaces for staff, driving wider organisational cultural change, ensuring board buy-in on the importance of tackling health inequalities, fostering strong staff networks and training staff on access to freedom to speak up (FTSU) guardians, particularly regarding reports microaggressions and incivility

• One attendee spoke of their organisation's purpose-built wellbeing hub, which offers accessible gym equipment, while another spoke about their health and wellbeing centre for staff. Another attendee spoke about the wellbeing gardens they have across all sites, as well as access to counsellors

• It was noted, however, that it is challenging for many organisations to offer wellbeing centres against the backdrop of severe financial pressures and/or if their estates do not have sufficient space for such a centre

• Others spoke about training mental health first aiders and recruiting a reasonable adjustment coordinator

• One attendee mentioned an app their organisation has utilised for frontline staff who might not have regular access to a computer at work and therefore might not be aware of signposting to services includes in other all staff communications.

Regarding the wider ambitions of HIA4, attendees spoke about work they are implementing to tackle staff health inequalities more broadly:

• Some spoke of targeted interventions to bring their local community back into/into their workforce, including targeted work with people who have experienced homelessness, care leavers, veterans and Gypsy, Roma and Traveller communities
• Others spoke of sending engagement teams into local schools and colleges, as well as working with the Department of Work and Pensions to support special educational needs and disabilities (SEND) schools with access to work
• One attendee shared how their organisation had offered a series of symposium events specifically tailored to inequalities experienced by their local communities – this is part of their organisation's wider Integrated Care System (ICS) working partnership, involving the local authority
• Others also spoke about offering staff health checks and/or MOTs, drop-ins and clinics, sports activities, weight management and blood pressure checks

• Many shared that there was a need for stronger data to help with targeting interventions, as well as a need to evaluate the success of any interventions made for their effectiveness. 
  
• Staff are patients and service users too, but it can be difficult to breakdown the assumption they are separate groups. It can be challenging to build consensus on where responsibility for tacking staff health inequalities sits within organisations as a result of this
  
• Organisational cultural change takes time and can be particularly challenging if an organisation is merging with another 
  
• Some boards are more diverse than others, as are some geographies. This can make it difficult to drive forward work around staff diversity and health inequalities 
  
• There is a need to ensure wider operational pressures do not overshadow work on staff health inequalities 
• Some attendees shared concerns about oversaturation of communications having a negative effect on staff engagement with the topic.   

• Some attendees felt that siloed working still needs to be overcome and underpinned by improved internal communication. Others felt that a lot of existing work already helps with tackling health inequalities, but there is a need to communicate this better and describe 'the how'
• Some attendees also shared that they felt their organisations are at the beginning of their journey on working to tackle staff health inequalities 
• Attendees felt that there is a need to better communicate that tackling workforce health inequalities is about existing staff as well as bringing staff into the organisation from the local community  
• The language around anchor institutions can be confusing, either because its meaning is not clear to all, or because its usage applies to services differently – for example, ambulance trusts work across regions including multiple partners  
• Some organisations shared how they are working in partnership with place-based colleagues, this includes delivering school talks, apprenticeships and community outreach locations in shopping centres to improve access to advice for seldom heard communities  
• There is an opportunity to diversify applications to healthcare careers through early intervention in schools 
• Housing is a key issue, and some are forming local relationships to start to address this   
• Data is patchy and it would be helpful to have access to more at place  
• One attendee mentioned their organisation's work to engage communities in service design and recruitment and attendees agreed it is important to work with staff who have close links to their community as this helps to build trust and foster engagement  
• One attendee spoke of their individual placement support team that helps local people access employment, particularly in areas with high levels of deprivation.