Leading by Example? Why the mental
health and well-being of staff in Further
Education is a leadership issue
1 February 2011
Improving the Health and
Wellbeing of FE Staff
Dame Carol Black
National Director for Health and Work
Why invest in the health and
well-being of FE staff?
“The rewarding but difficult work of education can not be
carried out well by people who are stressed and tired,
but can be done well by staff with energy, commitment
and a positive outlook.”
- Well-being facilitator
• All staff are role models for students and can demonstrate how to lead a
healthy and balanced lifestyle
• Staff well-being may affect institutional performance (a study by
Birkbeck College in partnership with Work Life Support (2007) suggests
that there are links between average teacher well-being in schools and
pupil performance – 8% of variation in SAT scores show significant
correlation with staff well-being)
• Improved health and well-being can reduce absence and improve
retention of staff
The Boorman review
The Impact on Service Delivery and Outcomes
… over 80% of staff felt that their
health and well-being impacts
upon patient care, and virtually
none disagreed…
52.8%
60.0%
50.0%
40.0%
32.5%
30.0%
13.2%
20.0%
1.1%
10.0%
0.4%
0.0%
Strongly
Agree
Agree
Neither
Disagree Nor
Agree
… data correlation
also showed some
significant
relationships…
NHSHealthandWellbeing
The Boorman review
Disagree
Strongly
Disagree
… yet only 40% think that their
institution cares about their
health and well-being.
Trust A
Trust B
Trust C
Trust D
Absence Rate
4.21%
4.04%
4.58%
4.70%
Turnover Rate
10.5%
9.79%
11.65%
17.02%
Agency Spend
1.70%
2.96%
1.71%
4.57%
Patient Satisfaction
78.9
76.4
77.4
67.5
MRSA rate
0.65
0.88
1.56%
0.95%
Health Check – Quality
of Services
Excellent
Excellent
Weak
Fair
Health Check – Use of
Resources
Excellent
Excellent
Weak
Weak
Source: RAND Europe
What is our overall goal?
Healthy, engaged
workforces
Well-managed
organisations
• A high-performing, resilient
workforce
• Enhanced productivity
Contributing to:
• A well-functioning society
• Better economic performance
A new vision for health and work
A Review of the health of the working-age UK population, commissioned
in 2007 by the Secretaries of State for Health and for Work and Pensions.
Working for
a Healthier
Tomorrow
“At the heart of this Review is a recognition of,
and a concern to remedy, the human, social and
economic costs of impaired health and well-being
in relation to working life in Britain.
The aim is … to identify the factors that stand
in the way of good health and to elicit
interventions, including changes in attitudes,
behaviours and practices – as well as services –
that can help overcome them.”
Working for a healthier tomorrow, 2008
Prevent illness, promote health, intervene early,
improve the health of the workless.
Costs of working-age ill-health
Financial
Social
• Overall costs of working-age
ill-health in UK exceed £100
billion per year
“If people are not healthy enough
to work – or are inadequately
supported through ill health to
make a return to work possible –
it is not just the individual or the
business which is affected. The
bottom line is often the impact on
his or her family and children.”
• Around 172 million working
days were lost to sickness
absence in 2007, at a cost to
the economy of over £13
billion (CBI)
Black Report, 2008
Lane Lecture, University of
Manchester, November 2007
Factors that stand in the way
Culture beliefs and attitudes – needing change
• Misconceptions about health and work – e.g. “need to be 100% fit”
• Inappropriate ‘medicalisation’ of complex psycho-social problems
• Poor retention in work of those with disabilities or chronic disease
• Managerial attitudes, organisational behaviour, unable to make business case.
Inadequate systems
• Inflexible system of sickness certification – the ‘sick note’
• No pathways of rapid intervention to keep you in work or return you to it
• Health, work and well-being not part of training curricula or clinical practice
• Poorly-supported healthcare professionals. No OH advice for GPs.
Lack of Primary Care involvement
• Rehabilitation to work not a performance measure for responsible local health
bodies
• Configuration of Occupational Health services: no national standards.
Next generation
• Little attention to building mental and emotional resilience in our future workforce
Why are people off work?
• Two-thirds of sickness absence and longterm incapacity is due to mild and treatable
conditions, often with inappropriate
‘medicalisation’, needing vocational
rehabilitation:
• Depression, anxiety, stress-related
mental health problems (est. cost £28.3
bn in 2008)
• Musculoskeletal conditions – mild and
often soft tissue (est.cost £7 bn in 2007)
“ The art of medicine remains the art of identifying
the patient’s problem (which is something more
than diagnosing the disease) .”
Sir Douglas Black – echoing Sir Robert Platt
Different problems need
different approaches
Symptoms: 2/3 of cases
Chronic conditions: 1/3 of cases
•
Often mild
•
•
Symptoms not ‘diseases’:
– back pain
– musculo-skeletal symptoms
– stress
– anxiety, mild depression
Examples
– chronic rheumatic diseases
– endogenous depression
– bipolar disorders, schizophrenia
– diabetes, cancer
•
Few investigations required
•
Diagnosed with relative ease
•
Intervention needs to be early,
often non-medical, good
vocational rehabilitation, regular
contact between employee and
employer.
•
Investigations more extensive
•
Diagnosis can be difficult
•
Treatment – good medicine, good flexible
employers, plus rehabilitation
Prevent chronicity
•
Prevent deterioration
•
– post-trauma disability
Health of teachers
Reported rates of occupational stress, depression or anxiety
are twice as high in the teaching profession than that for
all other occupations.
A National Association of Head Teachers (NAHT) survey
found that 40% of teachers reported having visited their
doctor with a stress-related problem in the previous year.
20% of teachers considered they drank too much and 15%
believed they were alcoholics.
The National Union of Teachers reports that
around half of teacher ill health retirements
take place for stress / psychiatric illnesses.
Costs of mental ill-health at work
Total cost to UK employers is estimated at £ 26 bn per year
(2006: Centre for Mental Health), including
£ 2.4 bn in replacing staff who leave because of mental illhealth
£ 8.4 bn in sickness absence (40% of the average 7 days
off sick per year is for mental health problems); but
£15.1 bn in reduced productivity at work. ‘Presenteeism’
loses 1.5 times the working time lost due to absence costs more as more common in higher-paid work
November 2009 NICE
guidance presents the
business case.
• www.nice.org.uk/PH22
NICE: If mental illness costs employers £ 28.3 billion per
annum in 2009:
- prevention and early identification of problems
should save employers at least 30%, i.e. £ 8 billion
each year
- for a 1,000 employee company annual costs could
be reduced by £250,000.
The old system, and
the need for early intervention
• Work-related health problems often
not life-threatening, but lifediminishing (MSDs and mental health
conditions)
• No clear pathways of vocational
rehabilitation or standards: treatment
all too often slow and inefficient, often
with a poor outcome for the patient
• GPs have no easy access to expert
help or OH advice, or vocational
rehabilitation
• Repeated Medical Certificates can
lead to worklessness
• Problems are often mild and treatable
GPs issued
‘sick note’
The workplace: findings of the
Black Review (2008)
• Poor understanding of relevance of Health, Work and Wellbeing
• Employers unaware of the business case for investing in health and
well-being
• Accessible and affordable sources of support and advice rarely
available for small and medium-sized companies (SMEs)
• Line managers’ behaviour crucial, but there is often little training
• Employers inflexible about necessary adjustments for those with
disabilities or chronic disease
• Often no policy on handling mental ill-health
• Often no sickness-absence policies to promote return to work
• Patchy Occupational Health services, of variable quality
• No national standards available to employers when they purchase
occupational health or well-being services
And yet, the workplace provides great potential for prevention & promotion
Health promotion and ill health
prevention in the workplace
Advantages of the workplace:
• a microcosm of society, as to age, gender, income, ethnicity
• powerful communication and education structures
• a culture of health at work can reinforce positive health behaviours
• good employer/employee relationships can sustain healthy behaviour
• infrastructure for measurement of health outcomes is often in place
• interventions can benefit employees, employers and the public purse
• families of employees extend impact further.
Promotion of health in the
workplace
The promotion of physical health
and fitness, and the prevention of
physical disease, are highlydesirable goals, often pursued by
companies.
But the promotion of positive
mental health and fitness is
done by too few companies.
Physical health influences mental
well-being.
Positive Workplaces
Key features common to those organisations which have achieved
success in promoting health and well-being:
• Senior visible leadership
• Accountable managers throughout the organisation
• Attention to both mental and physical health improvements
• Systems of monitoring and measurement to ensure continuous
improvement
• Empowering employees to care for their own health
• Fairness
• Flexible work
Health and well-being need to be embedded in every
aspect of an organisation’s structure and work
HSE Management Standards
The standards define a desirable set of conditions to work
towards:
• Demands which includes issues like workload, work patterns
• Control which is how much say the person has in the way they do
their work
• Support which includes encouragement and resources provided by
the organisation & line management
• Relationship includes promoting positive working to avoid conflict
• Role which ensures people are aware of their role in the
organisation and there is no conflict in roles
• Change covers how organisational change (large or small) is
managed and communicated by the organisation
http://www.hse.gov.uk/stress/standards/
Black Review:
Health, Work and Well-being Initiatives
Fit Note
In use from 6 April 2010
11 ‘Fit for Work’ service trials
Live 2009 -2011
Public sector exemplar: Boorman review of NHS staff health in Recommendations
England
included in NHS Operating
Framework 2010/11
National Standards for provision of OH services
Published Jan 2010
Council for Health and Work
Established 2009
Regional co-ordinators of health, work and well-being
Live 2009-2011
Education and training initiatives for GPs and secondary care
professionals
Live 2009-2011
Working our way to better mental health: a framework for action Published Dec 2009
Occupational Health Adviceline for SMEs
Live 2009-2011
Challenge Fund for Small and Medium Enterprises
Live 2009-2011
Free interactive Workplace Wellbeing Tool
Launched 2010
All intended to help maximise health, wellbeing and productivity.
From ‘sick note’ to ‘fit note’
Sick note:
• For the past eighty
years or more, a GP
assessed a person’s
health and ability to
work.
Fit note:
GPs share responsibility with employers:
• GP knows health condition and impact
• Employer knows job
Adjustments being made:
• The old form
required the doctor
to state whether or
not the patient could
work, and how long
they should refrain
from work if sick.
• Phased return to work
• Partial ability to work
was not considered.
• Practical adjustments in the
workplace.
• Part-time working
• Working from home
• Flexible start times
• Different tasks
Importance of Fit for Work
Service Pilots
• Identifying underlying
problems with rapid
referral
• One stop supported
approach
• Practical support in
non-medical areas
• OH input as required
These measures are to help people remain
in work or return to work more quickly
Leicester City & Leicestershire
Fit for Work Service
Vision
• Move management of sickness absence from the
medical model into vocational rehabilitation.
• Move vocational rehabilitation closer to mainstream
primary care.
Dr Rob Hampton, Clinical Lead
Commissioning Partnership
Advantages of Leicester
FFWS Model
Convenient for patients
• Contact within 24hrs
• First appointment within a week
• Mobile phone communications
• Choice of venue for consultation: 40
surgeries, 12 MAC sites, PCT, Council and
Provider premises
Helpful to GPs
• Ease of referral – no forms
• Musculoskeletal interventions funded
• Service signs Fit Notes
• Service provides audit data to GP practices
Interventions: proportion of clients
Musculoskeletal
15%
Psychological
Employer dialogue
30%
50%
Amended/Phased Return To Work
Alternative employment
Information and guidance
Referred to MACs (financial/family/legal)
40%
5%
20%
40%
JC Plus
5%
Leicester FfWS
Client: ‘Never gave up on me, helped with all problems.’
Occupational Health
Advice Helpline
• Provides SMEs and GPs with tailored occupational health
advice, by advisers with special training in Mental Health
• Majority of call are about sickness absence and attendance
management
• Increasing number about the fit note
• 90% of callers find it useful or very useful
WALES: Health at Work Advice Line Wales
ENGLAND: run in partnership with NHS Plus
SCOTLAND: Healthy Working Lives Advice
line
Workplace Well-being Tool
• Free on-line resource to help employers calculate
financial costs of employee ill-health to their
organisation
• Can be accessed at: www.workingforhealth.gov.uk
Mental Health:
how can savings be delivered?
• Awareness training for line managers,
to increase understanding of MH issues
and their ability to respond confidently
and rapidly, e.g. at the Centre for Mental
Health (one of many such courses).
• Prevention of directly-work-related MH
problems (around 15% of total) – e.g. by
providing mentally-healthy working
conditions and practices (see guidance by
UK Health and Safety Executive)
• Better access to help for employees, particularly to evidence-based
psychological help and support while carrying on working
• Effective rehabilitation for those who need to take time off, including
regular contact with the employee during periods of absence
Case study-EoN
•
E.ON is the world’s largest investor owned gas and electricity company
•
Approx 18000 employees in the UK, over 50 sites across UK
•
Reviewed their structure, implemented strategic Business Partner roles
•
Employed a specialist Case Manager and Communications Specialist
•
Aligned Health to the Business – commercial & customer focus
•
Made health relevant to the individual
EoN-Staff Roadshows &
innovative health promotion
• The number of new
cases & days lost
through mental health
related absence has
reduced by 25% since
launch
• Continuous reduction in
sickness absence over
2 years, approx £11.8m
cost savings
Case study: Airbus
• Commercial partnership between
a large company and an NHS
Trust.
• Male-dominated environment with
7,500 employees.
• Marketed programme around
“well-being” and not “mental
health”, to avoid latter’s stigma.
• Mental Health First Aid courses to
Managers, Shop Stewards and
Apprentices.
• Encouraged the men to open up
and be more honest among
themselves.
Results
• Saved £1.7 million of direct
costs over 3 years
• Sickness absence fell by 3
to 4%
• social benefits: one
employee’s partner
approached a manager in
a local supermarket to say
the programme had
improved her life too.
Grimsby Institute:
Introduction
Grimsby Institute of
Further and Higher
Education has won many
awards for employee
health and well-being.
“
Our approach is determined by the desire to provide
customers (students and others) with the best possible
service. To achieve this, we need to employ excellent staff
who perform each day to their best. If they are not at
work, they cannot do this.
Grimsby Institute:
Key to success
Health and wellbeing strategy
aligned with:
• Institute mission, values
and business plans
• staffing procedures
• key business processes
• Health and wellbeing team who
work with other experts.
• Speedy & supportive interventions
to keep people at work or
accelerate returns to work.
• onsite catering
• Helping other organisations
understand the value of health and
wellbeing.
• charity fundraising
• Regular management training.
• sport and activity
• internal communications
• Extensive employee
communication.
• health and safety
• Measuring the impact.
• employee benefits
Grimsby Institute:
Results
Sickness absence:
Year
%age of Days /
days off person /
sick
year
2004/05
1.62%
3.60
2005/06
1.63%
3.60
2006/07
1.31%
3.23
2007/08
1.18%
2.61
2008/09
1.24%
2.74
• Level of accidents at work
dropped from 424 in
2004/05 to 253 in 2008/09
• Quality of observed
teaching has improved
• Size of the organisation
has grown (£17m in 2001
to £47m in 2010)
• Financial health improved
Improving the health and well-being
of University staff
‘Improving performance through
wellbeing and engagement’ : a two year
national project funded by HEFCE in
partnership with Scotland and Wales to
support institutions to enhance their
performance through their people.
60%
The project, led by the Universities of Leeds
and Glasgow in partnership with the a number
of Higher Education institutions, has so far
engaged 60% of HE institutions.
‘ Improving performance …
The project aims to:
• Develop a higher education specific business case for
employee wellbeing and engagement — showing what
aspects make the biggest impact on performance
• Support institutions to enhance their practice by
developing a bank of practical case studies and
resources
• Support learning and sharing across the sector by
developing an employee wellbeing network, supported
by regional meetings.
Recourse
Recourse (formerly CUSN – the
College and University Support
Network) is the charity established
by Teacher Support Network, in
partnership with UCU, to improve
the well-being and effectiveness
of all working in the adult, further
and higher education sectors.
• Recourse provides free and
confidential services to
those working in post-16
education.
• This includes serving,
former and retired staff and
their dependents plus
employees and former
employees of UCU, AUT
and Natfhe.
Recourse services
• 0808 802 03 04
– 24/7 Support Line providing practical, emotional and financial
support
– Run every day of the year by fully-trained counsellors and coaches
• www.recourse.org.uk
–
–
–
–
E-mail support from fully-trained counsellors and coaches
Web-based InfoCentre
Online self assessment tools
E-newsletter
• All of Recourse’s services are completely free and confidential, thanks
to the continuing donations of the UCU and over 15,000 of its
members
How Recourse can help
– Daniel’s story
Daniel, 30, got his first post as a
lecturer last year. He contacted
Recourse as he was struggling
with his workload.
Feeling anxious and pressured, his
work had begun to adversely
affect his sleep patterns and
short-term memory.
Firstly, Recourse’s coach
encouraged Daniel to seek
medical advice. He then helped
him to realise that he needed to
learn to manage his workload
more effectively and, most
importantly, say no when things
were getting on top of him.
Daniel’s state of mind had
improved significantly by the
end of the coaching programme
and he had more confidence
and better communication with
his Head of Department.
Mental health and work
• Being in work generally leads to good mental health, selfesteem and well-being
• Being out of work is associated with poor mental health,
increased likelihood of anxiety and depression, and increased
use of medication
• When people return to work their mental health and wellbeing generally improve
• Although work can pose a risk to mental health, the positive
effects far outweigh the risks
• People with mental health problems attach a high priority to
work, and work can be part of the recovery process
• Poor mental health associates with low earnings, social
exclusion, poorer physical health, child poverty, disrupted
education