Chartered Institute of Personnel Directors
Scotland Annual Conference
Glasgow, 5 March 2015
Improving Health
in our Workplaces
Dame Carol Black
Expert Adviser on Health and Work
Department of Health and Public Health England
Principal, Newnham College Cambridge
CBI : GETTING BETTER 2014
Workplace Health as a Business Issue
“ The working world is getting ever more
complex, with flexibility and globalisation
beginning to break down the barriers of
what we are used to.
In the UK, we need to compete on the
quality of what we do – and that makes
staff performance and productivity vital.
And workplace health is essential to both
of those key factors. ”
Sponsor: Medicash
Neil Carberry
CBI director of employment & skills
What prevents us from working –
or from working well and feeling good ?
• Common mental health problems
• Musculo-skeletal problems
• The quality of work and the workplace
- organisation of work
- managerial behaviour and leadership
- absence of ‘good work’
• Other important reasons
- long-term conditions – mental and physical
- psychosocial/ home-related problems
- lack of education and/or skills.
Common Mental Health Problems :
What and Why
• Stress, anxiety, mild depression
- high prevalence across populations
- little or no objective disease or impairment
- most episodes settle rapidly, though symptoms
often persist or recur
- essentially whole people, should be manageable.
• These symptoms are often an expression of, or
reaction to, poor work, poor workplaces, and/or
poor leaders or managers.
• Health interventions such as drugs, EAPs, CBT etc
may help BUT not address the real root problem(s).
Mental Health and Work
Globally, a growing realisation that :
• Mental ill-health among working-age people is a priority
challenge for the labour market and social policies …
OECD 2011
• .... an issue neglected too long – with widespread fears and stigma.
• Employment opportunities for people with mental ill-health are low,
many of those who are employed struggle in their jobs, and
disability caused by mental ill-health is frequent and rising.
• The costs of mental ill-health, for individuals, employers and society, are
very large. (The ILO estimates the cost conservatively at 3 to 4% of
Gross Domestic Product in the EU).
Governments recognise - this situation is not sustainable.
Measures of productivity loss
and mental ill health
Percentage of workers with various productivity losses in past 4
weeks due to a mental health problem :
Source: OECD calculations based on Eurobarometer Survey of 21 countries 2005
Well-being and Engagement
• Approximately 25% of the variation in reported levels of employee
productivity is predicted by a combination of:
- psychological well-being
- perceived commitment of the organisation to the employee
- access to appropriate resources, and
- good communication.
Donald et al, 2005
• Robertson and Cooper have shown that the top driver for employee
engagement is the extent to which employees believe that their
senior management has a sincere interest in their well-being.
• High levels of staff engagement are not sustainable unless well-being is
maintained, through good work and good workplaces.
• Engagement without well-being can lead to a burned-out workforce.
The Bottom Line
•
Mental illness costs employers about £ 28 billion
per year:
- prevention and early identification of problems
should save employers at least 30%, or £ 8 bn a
year.
•
November 2009 NICE
guidance presents the
business case.
NICE Costing tool available at www.nice.org.uk/PH22
- calculates the overall cost of mental health in the
workplace (all aspects) and potential savings
- calculates that for a company with 1,000
employees, mental ill health costs about
£835,000 per year
- reduction by 30%, through taking simple steps,
would save £250,000 per annum
Key players :
workers’ health and productivity
Health professionals
(Primary and secondary care)
Public Health (professionals,
local councils)
Employers
Non-governmental
bodies and charities
Employees
(Patients)
OH professionals
Trade Unions
Governments to make policy, initiate, support,
encourage, and where necessary legislate.
The crucial interfaces
The interfaces, between patient/employee,
health professionals and employer,
need to satisfy all parties.
Essential ingredients:
• well-informed, work-knowledgeable
health professionals
• employers that create good work
and good workplaces
• employees well, and engaged.
Essential Enablers
of Health, Wellbeing and Resilience
• Early appropriate intervention by
health professionals
• Good work and workplaces
• Proactive ‘reformed’ OH
• Staff engagement
• Empowering leadership
• Supportive managers
• Promotion of health and wellbeing
• Integration of Health, Safety, OH and
Wellbeing programmes
• Attention to positive mental health and resilience
All the above also improve safety and patient care.
Early action by health professionals
• Understanding by all health professionals of the social
determinants of health
• Proper use of the electronic Fit Note, with more use of
“.. may be fit to work if ..”
(current usage about 15% of written Notes)
• Return to work regarded as a desirable clinical outcome,
and measured as such by the clinical regulator
• Full use of the new Fit for Work Service, available in
Scotland through the NHS.
UK Government Response 2013 to
Sickness Absence Review 2011
• Accepted a recommendation to introduce
a state-funded health and work
assessment and advisory service
[now Fit for Work: in Scotland NHS
delivered, as Fit for Work Scotland]
• The Service has been designed to
intervene in sickness absence at
the four-week point.
• On 1 January 2015 a recommended tax
exemption came in on medical treatment
recommended by Fit for Work or
employer-arranged OH services.
Department
for Work &
Pensions
Fitness for work: the
Government response
to ‘Health at work – an
independent review of
sickness absence’
Presented to Parliament by the Secretary of State
for Work and Pensions by Command of Her Majesty
January 2013
Fit for Work Scotland
… is being introduced to support a
reduction in the length of sickness
absence from work and reduce the
impact that absence has on individuals,
employers and the State.
The service aims to:
• support people to reduce the length of sickness absence
• reduce the chances of people falling out-of-work and on to benefits
• increase awarenesss of the benefits of working to a person’s health
• increase the positive actions taken by employers, employees and GPs
in contributing to a change in attitudes towards health and work.
Fit for Work Scotland : Why?
Currently in Scotland, each year :
• 130 million days are lost to sickness absence, costing economy £15 bn
• employers face bill of about £9 bn for lost production and sick pay
• individuals absent sick lose around £4 bn in earnings.
It is estimated that Fit for Scotland will :
• reduce employers’ sick pay costs by a third
• reduce cost of out-of-work benefits by a third, to £6 m per year
• increase Scottish tax and NI revenues by £10 m to £21 m per year
Early intervention: Scotland
EASY sickness absence service
Cost effectiveness study after four years (2008 to 2012),
NHS Lanarkshire compared with NHS in rest of Scotland
• Is the service effective in reducing sickness absence?
• Does the service offer net economic benefits?
J.Brown et al, Scand J work
Environ Health, on-line.
Easy Access to Support for You (EASY)
• Biopsychosocial approach to case management
• Line Manager immediately informs EASY call centre of the absence
• Centre aims to call employee on first day of absence (FDA)
• Reference to OH services on tenth day of absence
NHS sickness absence rates, 2007-12
Lanarkshire vs Rest of Scotland
Lanarks
EASY service, telephone early in absence,
provided in Lanarkshire only
(EASY = Early Access to Support for You)
Rest Scotland
J.Brown et al, Scand J work
Environ Health, on-line.
In 2009 Lanarkshire rates came below
those in rest of Scotland, for first time.
EASY evaluation - outcome
• Although sickness absence in NHS Lanarks was falling beforehand,
following EASY’s introduction absence reduced by 21%.
• Nonspecific tightening of sickness absence policies in rest of Scotland
NHS reduced sickness absence by about 9% in same period.
• There were commensurate economic benefits, cumulative from 2007 to
2012, greatest at the outset and diminishing over time.
• MSK and Mental Health problems accounted for 23 and 19% of days lost.
• Absences due to MSK problems reduced from 32 days on average in year
one to 20 days in year four – no significant change for other diseases
• By 2012 NHS Lanarks absence rates were close to those in rest of NHS
Scotland – so is EASY still producing economic benefit?
Good Workplaces
Key features common to those organisations which have achieved
success in promoting physical and mental health and well-being:
• Senior visible leadership
• Accountable appropriately-trained managers throughout the
organisation
• Integration of traditional Health and Safety with promotion of
Health and Wellbeing
• Monitoring and measurement to ensure continuous improvement
• Empowering and facilitating employees to care for
their own health
• Enabling staff engagement
Board Leadership :
National Health Service England
• Board level involvement will make the difference
• Where NHS Boards live the values they want to
achieve, staff will take those values seriously.
• A named board member responsible for H&WB and reviewing
progress every 6 months will drive this agenda forward.
Example: York Teaching Hospitals NHS FT
• Used board engagement to drive progress across the Trust
• Board visibly involved in events to promote better health and wellbeing, and communicated this to staff.
• Delivered sickness absence savings of £2.7m yearly, and 72%
reduction in long-term absence.
Leaders and back pain :
predictors not always ‘medical’
After adjustment for age, sex, skill level, back pain severity and
other potential confounders, the most consistent predictors
of back pain were:
• decision control at work
(lowest OR 0.68;
99% confidence interval (CI): 0.49 -0.95),
• empowering leadership at work
(lowest OR 0.59; 99% CI: 0.38-0.91)
• fair leadership at work
(lowest OR 0.54; 99% CI: 0.34-0.87)
Christensen JO, Knardahl S. 2012
Do not forget leadership and other psycho-social factors
Effect of Managers
on Employee Well-being
• A longitudinal interventional study (n = 188) in a large Danish local
government organisation, where poor social support, lack of role clarity and
lack of meaningful work were significant problems.
• Intervention (measured at entry and 18 months later) :
- improved team working with a degree of self-management
- Question: Did active middle management support for the
intervention mediate its impact on well-being etc. ?
• Results :
- structural equation modelling showed that active middle-manager
involvement, as perceived by employees, correlated with job satisfaction
and well-being.
K. Neilsen. National Research Centre for the Working Environment, Denmark
Train your Managers
• Good line management is key to employee Wellbeing.
•
Managers should focus on:
– effective communication with the
employee and other members of staff
– awareness of the issues and the
ability to empathise
– developing open culture with employees feeling
able to discuss their problems.
• Learning about mental health enables managers to judge when
they need to refer employees to outside help.
• There are many sources of advice and good training courses.
Re-integration into Work :
after Mental Ill-health
OECD Report 2011 :
• Globally, employment opportunities for people with
mental ill-health are low, many of those who are
employed struggle in their jobs, and disability caused
by mental ill-health is frequent and rising.
Time to Change, survey of the public,
October 2014
• 7% rise in willingness “to work with
someone with a mental health
problem” (69 to 76%)
Managers are crucial to successful
re-integration.
Integration : Total Worker Health
•
Traditionally, workplace Health and Safety has been separated from
Health Promotion.
•
NIOSH (National Institute for Occupational Safety and Health, USA)
is now emphasising Total Worker Health :
“ Growing evidence supports the effectiveness of combining these
efforts through workplace interventions that integrate health
protection and health promotion. ”
“ Integrating health protection and promotion will create synergy,
enhance overall health and wellbeing of the workforce, and
decrease the likelihood of workplace injury and illnesses.”
“ Having a psychologically-healthy workplace and having a profitable
and sustainable business are linked.”
Integration : Total Worker Health
Gains in health
wellbeing,
fitness for duty
Organisational Health and
Safety
Strategic, integrated
Cost
minimisation
Absence of
illness or injury
incidents
Harm Minimisation
Compliance, systems,
culture
Illness/injury
incidents
Gains in
company
performance
Expanded value
chain goes
beyond absence
of injury
Loss
Control
Slide courtesy of Anne-Marie Feyer and Niki Ellis
Health and Wellbeing Programmes
Depend on circumstances – place, time, organisation
• Consult staff – then design.
• Mental Health : Prevention 1st, 2nd and 3rd !
- counselling, mediation, yoga, stress management,
resilience training, mindfulness
• Physical Health : (also benefits mental resilience)
- health assessments, running clubs, discount on
gym membership, fit bug, smoking cessation,
dietary changes in canteens, Well Point,
physiotherapy, pilates, reflexology, etc.
• Lifestyle : - make the most of money, well done letters,
flexible retirement policies, lifewise flexible working,
reading clubs, choirs, garden allotments .
The gradient in health and motivation
in workplaces
• Overall organisational productivity depends
critically on workers’ aggregate performance
- their contribution is essential to success.
• In particular, there is a need to understand the
degree of linkage, in typical pyramid-shaped
organisations, between, on average, poorer
health (mental and physical) and lower
motivation and engagement at work.
• Recognition of this needs to be properly
factored in to management thinking about
health to enhance productivity
Top management
Usually
declining
income
and health
Workforce, many more at the
foot, is not uniform in health,
wellbeing or motivation
Heart Age and Health Inequalities
A simple online tool to find out your estimated
Heart Age based on input of personal information
on risk factors.
Factory Site :
Marketing Site :
Inequalities
of health !
0 Heart Age above actual
0
Proportion of people in sample with heart ages in different ranges
above their actual age – very different distributions at the two sites.
+
Do Workplace Wellness
Programs Work?
Johns Hopkins study, JOEM, September 2014
- considering programmes in the US system.
Best and promising practice:
• Health education
• Supportive social and physical environments
• Integration with HR, infrastructure and
environmental health and safety
• Links between HP and related programmes
e.g. EAP
Journal of Occupational and
Works if:
Environmental Medicine
• Goals aligned to business
• Programme design is evidence-based
• Evidence-based implementation
Modified from
• Ongoing evaluation
Niki Ellis
If only goal is to save money, maybe not worth it
The King’s Fund 2015 :
NHS Staff Engagement
• NHS providers with high levels of staff
engagement tend to have lower levels of
patient mortality, make better use of
resources, and deliver stronger financial
performance.
(West and Dawson 2012)
• Engaged staff are more likely to have the
emotional resources to show empathy and
compassion, despite the pressures they
work under.
• So Trusts with more engaged staff tend to have higher patient
satisfaction, with more patients reporting that they were
treated well.
(Review of Staff Engagement and Empowerment in NHS, 2014)
Six building blocks for a highly
engaged workforce
• Shared direction
• Distributed leadership
• Supportive styles
• Transforming tools
• Trustful culture
• On Board agenda
The King’s
Fund 2015