Workplace Well-being

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Workplace Well-being Inequality ADPH
Conference May 2010
Dr Steve Boorman Director CR and Chief Medical
Adviser Royal Mail Group NHS Workforce HWB- Lead
Reviewer
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Good Work

• A tale of two post women!!
• By way of context

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Marmot Priority Objective CCreate Fair
Employment Good Work For All

• Improve access to good jobs and reduce long-term
  unemployment across the social gradient
• Make it easier for people disadvantaged in the
  labour market to obtain and keep work
• Improve quality of jobs across the social gradient

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Health inequalities and work!

• Health inequalities result from social
  inequalities in the conditions in which people
  are born, grow, live, work and age
• Action taken to reduce health inequalities will
  have economic benefits in reducing losses from
  illness associated with health inequalities.
  These currently account for productivity losses
  (estimated 33bn/year), reduced tax revenue and
  higher welfare payments (up to 32bn/yr) and
  increased treatment costs (5.5bn/yr).

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Work as a harmful myth!

• Work widely perceived as noxious
• Health Risk smoking 10 packs of cigarettes per
  day (Ross 1995)
• Suicide in young men gt 6 months out of work is
  increased 40 x (Wessely, 2004)
• Suicide rate in general increased 6x in
  longer-term worklessness (Bartley et al, 2005)
• Health risk and life expectancy greater than many
  killer diseases (Waddell Aylward, 2005)
• Greater risk than most dangerous jobs
  (Construction/North Sea)
• Long term worklessness is one of the greatest
  known risks to public health

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Working For a Healthier Tomorrow

• Dame Carol Blacks appointment and review
• Ill health among working age population has
  equivalent cost of running a second NHS
• Work not seen as an important clinical outcome
• Consequences of worklessness on long term health
  of individual, and of family
• Black built on earlier work and Marmot accepts
  case that unemployment (particularly long term)
  impacts on physical and mental health
• Taken further Good Work protects health

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What is our overall goal?

• Healthy engaged workforces in well-managed
  organisations

• A quality product
• A high-performing resilient workforce
• Enhanced productivity

• Contributing to
• A well- functioning society
• UK plc

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Why people are off work in the UK and many other
countries

• Two-thirds of sickness absence and long-term
  incapacity is due to mild and treatable
  conditions
• 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)
• Poor retention in the workplace of those with
  disabilities or chronic disease
• Obesity and demographic shift are significant
  risk factors to exacerbate

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Mental health the facts

• 1 in 6 working age adults have symptoms
  associated with mental ill-health (e.g. sleep
  problems, fatigue, etc) which do not meet the
  criteria for diagnosis
• A further 1 in 6 working age adults experience
  diagnosable mental health problems (e.g.
  depression, anxiety, etc)
• An estimated 1-2 of the population have severe
  mental health problems (e.g. schizophrenia,
  bipolar disorder, etc)
• 44 of people on long-term health related
  benefits have a mental or behavioural disorder as
  primary conditions
• The Royal College of Psychiatrists Mental Health
  and Work (2008)
• 11.4 m days lost in 2008/09 due to
  stress/depression
• Mental illness causes 46 of all sickness absence
  (average length of absence 28 days per case)

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Mental health and work

• Being in work generally leads to good mental
  health, self-esteem 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 well-being 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

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Unemployment rate by previous occupation
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Long term conditionsSMR for 3 respiratory
diseases
TB Ca lung COPD
Long term conditions are more likely to be
work-limiting in poorer socio-economic groups
before retirement age
300 200 100
1 2 3n 3m 4 5 1 2 3m
3n 4 5 1 2 3m 3n 4 5
8.9 4.6 14.2
Ratio Unskilled manual professional
Source Office for National Statistics
SMR Standard Mortality Rate
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Marmot - Two inter related aims!

• Reduce the adversity of adverse working
  conditions
• Targeting interventions proportionately towards
  lower socio-economic groups

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Prioritise active labour market programmes

• Integrate unemployed in to work v passive income
  support
• Create jobs, offer employers subsidy to offer
  employment opportunities and grants for start ups
• Support for retraining and reintegration
  improving occupational mobility for unemployed
• Improving job matching programmes to increase
  success rate of at risk groups such as long term
  unemployed
• Evidence to date is mainly short term but is
  positive for disadvantaged groups (especially
  mental ill health now reflected in New Horizons

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What is Good Work?Marmot highlighted ten key
components

• Precariousness stable, risk of loss, safe
• Individual control part of decision making
• Work demands quality and quantity
• Fair employment earnings and security from
  employer
• Opportunities training, promotion, health,
  growth
• Prevents social isolation, discrimination
  violence
• Share information, participate in decision making
• collective bargaining, justice if conflicts
• Work/life balance
• Reintegrates sick or disabled wherever possible
• Promotes HWB psychological needs self efficacy,
  self esteem, belonging and meaningfulness
• Both physical and psychosocial environments
  critical

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Creating better work!

• Risk assessment physical and chemical risk
  factors
• Shift work work time factors (eg breaks,
  working hours, time control, flexibility)
• Improving psychosocial workplace risk factors
• These are largely intuitive and already subject
  to law

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Vital few

• Creating good work
• Psychosocial and physical work environment
  critical
• Lack of reward and lack of control stress risk
  factor and worse for lower socio economic groups
• Work environment change combined with positive
  health promotion beneficial in creating health
  promoting work
• Preventative and rehabilitation approaches need
  improvement to create health promoting work

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Leadership and Staff EngagementIs HWB Important?

• Although 80 of NHS staff felt their HWB impacted
  on quality of patient care, only 40 believed
  their employer cared!
• We also found over 65 of staff reported coming
  to work in last month feeling ill enough to
  consider taking time off!

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HWB and organisational performanceThe Case for
Change
Correlation between HWB performance and outcomes
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LSE Research headlines (Value of Rude Health -
Independent evaluation)

• gt227 mil saving over 3 years, 46mil investment
• Small depot - impact equivalent to 14 extra
  parcels or 2700 a day on PL
• Direct link to Q of S and sales
• Maps our initiatives to our attendance
  improvement flight path ie HWB interventions
  did reduce SA
• Since savings continued and attendance now 40
  improved on base line

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Time periods 2011 - 2015

• Develop Active labour market programmes
• Improve quality of work across social gradient,
  adhere to legislation and equality guidance and
  ensure compliance with stress management and
  well-being promotion at work
• Improve security and flexibility of employment
  via increased flexibility around retirement age,
  and encouraging employers to adapt jobs to
  accommodate especially lone parents, carers and
  those with physical and mental health problems

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Time periods 2016-2020

• Widen use of Active labour market programmes to
  intervene early decrease long term unemployment
• Improve implementation of quality of work across
  social gradient, increase job security in
  employment contracts and employers adhering to
  equality legislation and extending stress
  management and active HWB programmes
• Extend security and flexibility of employment via
  continued flexibility around retirement age, and
  continuing efforts for employers to adapt jobs
  to accommodate especially lone parents, carers
  and those with physical and mental health
  problems

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Time periods beyond 2020

• Use of Active labour market programmes to achieve
  timely interventions and reduce long term
  unemployment
• Improve quality of work across social gradient,
  building in job security to employment contracts
  and monitoring employers adhere to legislation
  and equality guidance and monitor compliance with
  stress management and well-being promotion at
  work
• Continue to achieve flexibility of employment via
  a tax benefits system that promotes flexible
  working and ensuring jobs are suitable for lone
  parents, carers and those with physical and
  mental health problems

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Why Health and Well-being in the NHS?We tried to
articulate a case for change seeking higher
priority for staff health
Healthy workforce essential for the NHS to meet
21st Century challenges and deliver Lord Darzis
vision of High Quality Care for All

• Rising demand driven by demographics and
  increasing expectations
• Imperative to deliver better quality care
• 20bn savings1 can only be delivered by a healthy
  and productive workforce
• Innovative approaches required to address
  additional pressures on staff
• Keeping communities well needs prevention as a
  key workforce skill

NHS Constitution gives legal rights to
NHS cornerstone of Government response to Dame
Carol Black

• NHS should be an exemplar of workplace health
• Improving staff health can improve the health of
  the general population

• Patients and public quality of care
• Staff rewarding jobs in a healthy and safe
  environment

1 Source NHS Chief Executives annual report
2008/09