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Chartered Institute of Personnel Directors


Title: v Author: Simon Thornhill Last modified by: Kirsty Talbot Created Date: 7/11/2007 8:04:46 AM Document presentation format: On-screen Show (4:3) – PowerPoint PPT presentation

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Title: Chartered Institute of Personnel Directors

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
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.

Neil Carberry
CBI director of employment skills
Sponsor Medicash
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
  • - 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
  • - most episodes settle rapidly, though
    often persist or recur
  • - essentially whole people, should be
  • 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

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
  • .... 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
  • 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
  • Governments recognise - this situation is not

OECD 2011
Measures of productivity loss and mental
ill health
Percentage of workers with various productivity
losses in past 4 weeks due to a mental health
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
  • 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.
  • NICE Costing tool available at
  • 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

November 2009 NICE guidance presents the business
Key players workers health
and productivity
Health professionals (Primary and secondary care)
Public Health (professionals, local councils)
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
  • Essential ingredients
  • well-informed, work-knowledgeable health
  • employers that create good work
    and good workplaces
  • employees well, and engaged.

Essential Enablers of Health,
Wellbeing and Resilience
  • Early appropriate intervention by
  • 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
  • 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
  • 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.

Departmentfor 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
  • reduce the chances of people falling out-of-work
    and on to benefits
  • increase awarenesss of the benefits of working to
    a persons 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
  • 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
  • Does the service offer net economic benefits?

J.Brown et al, Scand J work Environ Health,
  • 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
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,
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 EASYs
    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
  • 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 HWB 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 well- being, 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
  • 99 confidence interval (CI) 0.49
  • empowering leadership at work
    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

Effect of Managers on Employee
  • 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
  • Intervention (measured at entry and 18 months
  • - 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
  • Managers should focus on
  • effective communication with the
    employee and other
    members of staff
  • awareness of the issues and the
    ability to
  • 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
  • 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
  • 7 rise in willingness to work with someone with
    a mental health problem (69 to 76)
  • Managers are crucial to successful

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
  • 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

Integration Total Worker Health
Gains in company performance
  • Gains in health wellbeing, fitness for duty

Organisational Health and Safety Strategic,
Cost minimisation
Absence of illness or injury incidents
Expanded value chain goes beyond absence of injury
Harm Minimisation Compliance, systems, culture
Loss Control
Illness/injury incidents
Slide courtesy of Anne-Marie Feyer and Niki Ellis
Health and Wellbeing Programmes
  • Depend on circumstances place, time,
  • Consult staff then design.
  • Mental Health Prevention 1st, 2nd and 3rd
  • - counselling, mediation, yoga, stress
    management, resilience training, mindfulness
  • Physical Health (also benefits mental
  • - 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
  • Overall organisational productivity depends
    critically on workers aggregate performance
  • - their contribution is essential to
  • 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
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
  • Works if
  • Goals aligned to business
  • Programme design is evidence-based
  • Evidence-based implementation
  • Ongoing evaluation
  • If only goal is to save money, maybe not worth it

Journal of Occupational and Environmental Medicine
Modified from Niki Ellis
The Kings 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
  • 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
  • Shared direction
  • Distributed leadership
  • Supportive styles
  • Transforming tools
  • Trustful culture
  • On Board agenda

The Kings Fund 2015