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Workplace Well-being


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Title: Workplace Well-being

Workplace Well-being Inequality ADPH
Conference May 2010
Dr Steve Boorman Director CR and Chief Medical
Adviser Royal Mail Group NHS Workforce HWB- Lead
Good Work
  • A tale of two post women!!
  • By way of context

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

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).

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

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

What is our overall goal?
  • Healthy engaged workforces in well-managed
  • A quality product
  • A high-performing resilient workforce
  • Enhanced productivity
  • Contributing to
  • A well- functioning society
  • UK plc

Why people are off work in the UK and many other
  • Two-thirds of sickness absence and long-term
    incapacity is due to mild and treatable
  • 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

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
  • Mental illness causes 46 of all sickness absence
    (average length of absence 28 days per case)

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

Unemployment rate by previous occupation
Long term conditionsSMR for 3 respiratory
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
Marmot - Two inter related aims!
  • Reduce the adversity of adverse working
  • Targeting interventions proportionately towards
    lower socio-economic groups

Prioritise active labour market programmes
  • Integrate unemployed in to work v passive income
  • 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
  • Evidence to date is mainly short term but is
    positive for disadvantaged groups (especially
    mental ill health now reflected in New Horizons

What is Good Work?Marmot highlighted ten key
  • Precariousness stable, risk of loss, safe
  • Individual control part of decision making
  • Work demands quality and quantity
  • Fair employment earnings and security from
  • Opportunities training, promotion, health,
  • Prevents social isolation, discrimination
  • 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

Creating better work!
  • Risk assessment physical and chemical risk
  • 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

Vital few
  • Creating good work
  • Psychosocial and physical work environment
  • 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

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!

HWB and organisational performanceThe Case for
Correlation between HWB performance and outcomes
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

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

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

Time periods beyond 2020
  • Use of Active labour market programmes to achieve
    timely interventions and reduce long term
  • 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
  • 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

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

1 Source NHS Chief Executives annual report