Investors in People Health and Wellbeing Seminar London, 25 March 2015

Dame Carol Black

Expert Adviser on Health and WorkDepartment of Health and Public Health England

Principal, Newnham College Cambridge

Health and Wellbeing in the working environment

Content – What is new or developing ?

• Awareness of impact of demographics

• Importance of ‘good work’ and good workplaces

• Mental Health and resilience

• Staff Engagement and its relationship to wellbeing

• Role of the manager : NICE Guidance

• Sedentary workers• Integration of services

• Sector-specific activity, e.g. NHS, railways

Work, health and society

Society needs the maximum number of productive years from as many people as possible. Those not working depend on others.

The ratio of earners and wealth-generators to dependants (children, pensioners, unemployed) needs to be as high as possible.

Childhood Working life Retirement

Being sufficiently healthy is a condition for work, and maximising disability-free life as a proportion of total life is therefore a desirable goal for individuals, health professionals and society.

Fuller working lives A Framework for Action, DWP June 2014

Life expectancy is increasing – by 2030 those over 65 will increase by 50% and those over 85 will double. One third of children born today will live to be 100.

•both a huge opportunity and a huge challenge for Government, impacting on every aspect of society. But compared with 50 years ago, people exit the labour market earlier.

• Of those between 50 and state pension age, 28% are out of work

- of these 25% have retired, and 60% see another job as unlikely.

•Over 50% of adults have already stopped working by the year before they reach state pension age ...

…. many are sick, disabled or carers, or have given up looking for work

The world of work is changing

• The industrial landscape is changing, and a knowledge-based economy has emerged

• Globalisation of labour markets, leading to a work-anywhere culture

• Transferable skills needed, with flexibility, upskilling, lifelong education and training

• Female employment projected to increase, reaching 47.5 % of the total in 2020 UK

• Many people wanting or having to work after 65 • Fewer permanent ‘core’ staff, with out-sourcing

and zero-hours contract work

• Concept of ‘good work’ and good workplaces

The pattern of damage at work is changing.

Mental ill-health is increasing.

Good Employment : Essential characteristics

Good work Good workplaces

• Stable and safe• Individual control • Fair work demands

• Flexible arrangements• Opportunities training,promotion• Promotes Health and Wellbeing • Prevents isolation, discrimination

• Shares information• Reintegrates sick /disabled if

possible

• Visible senior leadership

• Appropriately trained managers

• Integration of OHS with health promotion and

illness prevention

• Monitoring & measurement

• Empowering employees to care for their own health

• Enabling staff engagement

What prevents us from working – or from working well ?

• 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 Care Systems

Mental Health Services in most countries often:

• do not help with employment issues, do not partner with employers – are not ‘joined up’

• leave health care and employment services separate

• do not include employment among care quality indicators

• neglect common mental health conditions (CMDs) and provide few services for them

• leave healthcare professionals believing that work is neither a realistic aim nor beneficial for people with mental ill-health

• provide sparse evidence on Mental Health and connection with work.

• Government, directly and through arms-length bodies : - Health and Safety Executive (HSE) - Acas (Advisory Conciliation and Arbitration Service) - Special health authorities e.g. NICE

• Employers - public, private, large, medium, small

• Health Professionals - and their organisations e.g. RCPsych

• NGOs - e.g. MIND, Tomorrow’s People, Comic Relief, MHFA

Mental Health and Work : UK Progress

Government Initiatives supporting Mental Health in the Workplace

• Mandates – to NHS, local government, etc.

• “No health without mental health” cross-Dept strategy

• “Time to change” National Anti-Stigma Campaign • Public Health Responsibility Deal (Department of Health) Health at Work Network, Mental Health pledge

• Achieving Better Access by 2020

• Chief Medical Officer’s Annual Report 2014

• Closing the Gap: Priorities for essential change in MH

“New data shows public attitudes towards mental illness have improved significantly – with the biggest one-year

improvement in the last decade taking place in 2013.”

“However, there is still more work to be done to end life-limiting stigma and discrimination.”

says Time to Change, the mental health anti-stigma programme run by Mind and Rethink Mental Illness, funded by DH, Comic Relief, Big Lottery.

Survey first conducted by TNS in 1993, additional analysis since 2003 by the Institute of Psychiatry, King’s College London.

Since Time to Change began in 2011, an estimated 2m people, 4.8% of the population, have improved attitudes towards people with mental illness.

Public Attitudes to Mental Health Time to Change, October 2014

Survey questions: What do the general public think about the one-in-four people who have a mental illness?

•6% rise in willingness “to continue a relationship with a friend with a mental health problem” (82 to 88%, change 2009 to 2013)

•7% rise in willingness “to work with someone with a mental health problem” (69 to 76%)

•5% rises in willingness “to live near..” (72 to 77%) and “to live with .. ” (57 to 62%) someone with a mental health problem

More people now acknowledge that they know someone with an MH problem (rise 58 to 64%) but attitudes in employment are lagging .. - still nearly half (49%) would feel uncomfortable talking to an employer about their own mental health.

Public Attitudes to Mental Health Time to Change, October 2014

The Political Landscape

• Nick Clegg announced on 3 October 2014 :

People with depression should from April 2015 begin ‘talking therapies’ within 18 weeks.

and on 19 January 2015 he announced: A ‘zero suicide’ ambition for the NHS.

• Ed Milliband on 19 January 2015 launched his Party’s plans on mental health “The Mentally Healthy Society” :

“Mental Health starts in our workplaces, schools and communities. We need a MH strategy outside as well as inside the NHS.”

Wellbeing, Mental Health and Engagement

• Wellbeing includes our psychological state

• High levels of staff engagement are not sustainable without wellbeing.

• Engagement without wellbeing can lead to a burned-out workforce.

•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 wellbeing. •Approximately 25% of the variation in reported levels of employee productivity is predicted by a combination of: - psychological wellbeing - perceived commitment of the organisation to the employee - access to appropriate resources, and - good communication.

Donald et al, 2005

IPA . Meeting the challenge Joe Dromey 2014

NHS Managers : Engagement, wellbeing and health

Employee engagement

Communication, senior managers and staff (%)

Engagement and communication at acute trusts (NHS Staff Survey 2013)

4.0

3.6

3.3

Staff engagement and overall patient experience

Improving NHS Care by Engaging Staff & Devolving Decision-Making Panel Review, chair C.Ham 2014

Engagement at Serco

Contracts with higher levels of engagement lose fewer staff members to attrition, so carry less of this cost.

(Evidenced across 47 matched contracts suitable for analysis, in three Divisions).

Contracts with lower engagement levels have more Lost Time Incidents, reducing productivity and raising operating costs.

Rate-of-change of engagement is also important, increase lowering LTI rates.

Staff turnover pa

Lost Time Incidents (per year, per 100,000 staff)

Engagement and Disengagement

Lack of motivation and sub-optimal health cause UK workers to work below peak productivity, holding back potential growth. Study of 5000 workers

•About half of people do not go above and beyond at work because they think it won’t be acknowledged or rewarded.

•Over a third of teams are experiencing extra stress and pressure due to staff ill health and absences •One in four staff admit they don’t want to win new business as it will only mean more work for them. •Failure to unlock employees’ ‘discretionary effort’ costs businesses dearly, cutting a potential £6 billion – equivalent to 0.4 per cent of GDP – from the UK economy in 2012.

BUPA/Centre for Economics and Business Research, December 2013

Train your Managers

• Good line management is key to good workplace health.

• 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

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%)

Promote health and wellbeing.

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.

Re-integration into Work : Cancer

• 109,000 working-age UK people diagnosed with cancer each year

• 775,000 working-age UK people have had a cancer diagnosis

• Research shows that cancer patients want to work … but

… long term cancer survivors are 1.4 times more likely to be unemployed.

• One in four survivors say their cancer prevents them working in their

preferred occupation

• The average fall in household income for a family of working age with cancer is 50%...

. . . and 17% lose their home.

MacMillan Cancer Support

- change in culture is needed.

Cancer is becoming a long term condition

Source: Maddams J, Utley M, Møller H. Projections of cancer prevalence in the United Kingdom, 2010-2040. Br J Cancer 2012; 107: 1195-1202.

The number of UK people living with cancer is set to double by 2030

Predicted numbers:

2010 2 million

2020 3 million

2030 4 million(with over 2.5 m diagnosed over five years earlier)

NICE: Public Health Draft Guideline

Workplace policy and management practices to improve the health and wellbeing of employees

• makes recommendations, focussed on organisational culture and the role of line managers

• for employers, managers and employees, and those working in Occupational Health, health and safety, Trade Unions etc.

Aims to: • promote supportive leadership and help line managers achieve it

• explore the positive and negative effects organisational culture can have on workpeople’s health and wellbeing

• provide a business case and economic modelling for managers.

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.”

Gains in health wellbeing, fitness for duty

Absence of illness or injury incidents

Illness/injury incidents

Gains in company performance

Cost minimisation

Loss Control

Organisational Health and Safety

Strategic, integrated

Harm MinimisationCompliance, systems,

culture

Integration : Total Worker Health

Slide courtesy of Anne-Marie Feyer and Niki Ellis

Expanded Expanded value chain value chain goes beyond goes beyond absence of absence of injuryinjury

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

• 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 .

Sedentary workers

Welcome to a new dawn

In Scandinavia 90% of office workers have sit-stand desks, in Britain 1%. On average British people sit for 8.9 hours each day, 70% of that at work.

Research provides compelling evidence that sitting for more than 4 hours : - shuts down enzymes that burn harmful blood fats - reduces calorie burn and disrupts blood-sugar levels - increases insulin levels and blood pressure.

Prolonged sedentary working increases risk of heart disease, diabetes, etc.

Sedentary workers

• Australian studies show the ameliorating influence of workplace interventions to promote standing breaks and sit-stand adjustable work stations.

• These interventions led to improved health-risk markers, improved productivity quality and efficiency, and greater sense of collaboration among employees.

Healy G., Eakin EG et al, Preventive Medicine 2013

• These examples provide cost savings to both the health service and the employer, along with knock-on positive effects on the productive lives of others, e.g. carers.

Investors in People

The most important asset your organisation has is its people. The biggest asset they have is their health and wellbeing. It therefore makes good sense to look after it.

The IiP Health and Wellbeing Award recognises businesses that go the extra mile. How do your Health and Wellbeing practices stack up? Our 20 question test will help you compare against the very best.

Key features: - Explores the key enablers of healthy workplaces - Establishes how well your plans and policies are implemented - Develop your personal action planHow does it work? - Take 10 minutes to complete 20 questions - Results give a clear picture of how your organisation is performing - Download your personal Health and Wellbeing report

We know how to get the best from people.

Investors in People

Health and Wellbeing Framework :

Plan Do Review

Free Tools:

Health and Wellbeing

Benchmarking

Increasing Sector-specific Activity

Examples :

1. NHS

2. Construction

3. Railways

4. Police

5. Fire Service

6. Higher Education

RCP Audit of NHS Trusts on NICE Guidance

Summary of results, Rounds 1 and 2

Setting higher standards

6 NICE Guidances

Improvement in most areas in the 3 years between Round 1 and Round 2.

2010 2013

Board engagement

Obesity

Physical activity

Smoking cessation

Long-term sickness absence

Promoting mental wellbeing

Overall

Where there is clear NICE guidance we should be using it

Does the trust actively promote healthy food choices , for example using signs, pricing and positioning of products to encourage healthy choices in:

Round 1 Round 2

Vending machines34% 45%

Shops for staff and clients 34% 53%

Hospitality 51% 65%

Staff restaurant 77% 84%

2010 2013

62% evening 27% overnight

Does the trust offer overweight and obese staff interventions that address activity, eating behaviour and weight reduction ?

29% 38%

The National Health (NHS) Workforce

•Simon Stevens said in his inaugural address on 2 April 2014 :

“If like me you believe in a tax-funded NHS you’ll want the Health Service to play its part in growing our nation’s economy, precisely so that we can sustain public health services for generations to come.”

To do this, NHS employees will need to be healthy, both mentally and physically, have good well-being, and be fully engaged in their work towards improved outcomes for patients.

NHS Five Year Forward View October 2014

A healthier NHS workplace

“ We will establish with NHS Employers new incentives to ensure that the NHS sets a national example in the support it offers its own 1.3m staff to stay healthy, and serve as ‘health ambassadors’ in communities.”

•Only a third of Trusts offer support in keeping healthy weight – and 75% don’t offer healthy food to staff working at night.

•The NHS could reduce its sickness rate by a third – equivalent to adding 15,000 staff or a cost saving of £0.5 bn.

•The ‘offer’ by NHS England is now being worked up.

New vision for the Health and Wellbeing of Railway Employees

28 April 2014 the UK Rail Standards and Safety Board published their vision :

•A new website area on Health and Wellbeing

•Currently cost of sickness absence and presenteeism is reckoned at £790m yearly

•The ‘roadmap’ to better health aims to save at least £32m per year. Suggested ‘tools’ support different aspects of health promotion.

•“ GB railway is an industry where everyone takes responsibility for health and wellbeing and benefits from it.”

Office of Rail Regulation : Occupational Health Programme 2014-19

What we expect from the industry: • Excellence in health risk management, implementing strategies

e.g. exposure monitoring, health surveillance• Greater engagement with employees, e.g. signing PHRD pledges• Better efficiency and reduced costs due to work-related ill-health• Enabling improvements in competency, information, co-ordination.

Also:• Senior-level commitment to the above, driving

improvements in health and wellbeing• Better use of specialist resources, ergonomists, physiotherapists etc

‘Health’ is to be understood to cover three things:• Effect of work – adverse dust, noise, vibration, stress, MS risk• Fitness for work – safety-critical tasks, drug/alcohol, capability• General well-being – lifestyle, absence management, rehabilitation.

Railway Health and Wellbeing Roadmap

RSSB Rail Safety and Standards Board

A Watershed in Life and Work

Change is the law of life.

And those who look only to the past or present are certain to miss the future.

John F. Kennedy