Health Works in Scotland Glasgow 7 October 2010

Health Works in Scotland Glasgow 7 October 2010 Health, Work, Well-being: a national perspective Dame Carol Black National Director for Health and Work

What is our overall goal? Healthy, engaged workforces Well-managed organisations • A high-performing, resilient workforce • Enhanced productivity Contributing to: • A well-functioning society • Better economic performance

Population trends and working life For a flourishing society we need the maximum number of productive years from as many of the population as possible. We need the ratio of earners and wealth-generators to dependants (children, pensioners, unemployed) to be as high as possible. Childhood Working life Retirement On current predictions, the future population will be composed of longer survivors, with more long term conditions.

Impact of Lifestyle on Health and Work 100% Ideal Lifeline Typical Lifeline HEALTH Optimal Health Declining Health Poor Health Progressive and chronic disability 0% 0 10 20 30 What is healthy aging in the 21 st century? Westendorp RGJ Am J Clin Nut, Vol. 83, No. 2, 404 S-409 (2006) 40 50 AGE 60 70 80 90

Costs of working-age ill-health Financial • Overall costs of working-age ill-health in UK exceed £ 100 billion per year • Around 172 million working days were lost to sickness absence in 2007, at a cost to the economy of over £ 13 billion (CBI) Social “If people are not healthy enough to work – or are inadequately supported through ill health to make a return to work possible – it is not just the individual or the business which is affected. The bottom line is often the impact on his or her family and children. ” Lane Lecture, University of Manchester, November 2007 Worklessness is a greater risk to health than many ‘killer’ diseases.

Consequences of the problem § It reinforces and perpetuates patterns of poverty and social exclusion § Blights communities and stunts prospects of tomorrow’s working age population § Hinders progress towards higher economic growth and greater social justice § Unsustainable cost to the economy Not just the worker or business is affected, but often the family and children. Children in workless households suffer higher rates of psychiatric disorder. 1. Working for a Healthier Tomorrow, Dame Carol Black, 17 March 2008 Working for a Healthier Tomorrow, Carol Black, 17 March 2008

Inactive and young • In 2006, just as in 1997, almost a fifth of those aged 16 to 24 were not in employment, education or training – currently this is 1. 4 million young inactive. • Male joblessness and single motherhood correlate strikingly. In Liverpool male unemployment rose from 12% in 1971 to 30% in 2001; over the same three decades the proportion of families headed by a single parent rose from 11% to 45%. “The taxpayer has become the father” - one in four UK mothers is single. “The men have no role. The State has helped create a class of jobless serial boyfriends who prey on single mothers on benefits. ” “Those men need a chance, not a benefits system that undermines them. ” Camilla Cavendish, Opinion, The Times, 28 May 2010

The crux • Enabling people to be in work which is productive and contributes to the global competitiveness of the UK is a health issue. “The scale of the number on Incapacity Benefits represents an historic failure of healthcare and employment support to address the needs of the working-age population. ” Working for a Healthier Tomorrow (Black 2008) • Tackling this requires close cross-government working, involving several departments of state.

Why people are off work in the UK and many other countries • Two-thirds of sickness absence and longterm incapacity is due to mild and treatable conditions, often with inappropriate ‘medicalisation’: • 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) • Cardio-respiratory and other chronic diseases • Poor retention in the workplace of those with disabilities or chronic disease ‘Causes of the causes’?

The changes required An understanding by all of us: the public, government, employers, trade unions, heath professionals, education and training professionals, that: Work is generally good for health (Of course, the work needs to be ‘good work’. ) This requires a change in culture, approach and processes. For example, the old ‘sick note’, particularly when repeated, could be very bad advocacy for long-term health, well-being and self-esteem.

Health, Work and Well-being Initiatives Fit Note Use from 6 April 2010 11 ‘Fit for Work’ service trials Live 2009 -2011 Public sector exemplar: Boorman review of NHS staff health in Recommendations England included in NHS Operating Framework 2010/11 National Standards for provision of OH services Published Jan 2010 Council for Health and Work Established 2009 Regional co-ordinators of health, work and well-being Live 2009 -2011 Education and training initiatives for GPs and secondary care professionals Live 2009 -2011 Working our way to better mental health: a framework for action Published Dec 2009 Occupational Health Adviceline for SMEs Live 2009 -2011 Challenge Fund for Small and Medium Enterprises Live 2009 -2011 Free interactive Workplace Wellbeing Tool Launched 2010 All intended to help maximise health work and wellbeing.

Future direction: challenges and opportunities • pressing economic issues • health, well-being, engagement, productivity • prevention and the workplace • Occupational Health • increased life expectancy, and work • long-term conditions (LTCs) and work • socio-economic status, poor fitness and physically-demanding jobs • common Mental Health problems • early-life building for a resilient future workforce • working together

The full cost of poor health for employers These apply only in the US 30% Medical care and pharmaceutical costs 70% Health-related Productivity Costs All these apply to the UK also Absenteeism Overtime Turnover Temporary Staffing Administrative Costs Replacement Training Off-Site Travel for Care Customer Dissatisfaction Variable Product Quality (adapted from R. Loeppke, US National Business Group for Health, Philadelphia 2009)

Workplace Disease-prevention and Wellness Programs Generate Savings “ There is growing interest in workplace disease prevention and wellness programs to improve health and reduce costs. In a critical meta-analysis of the literature on costs and savings associated with such programs, we found that medical costs fall by about $3. 27 for every dollar spent on wellness programs and that absenteeism costs fall by about $2. 73 for every dollar spent. Although further exploration of the mechanisms at work and broader applicability of the findings is needed, this return on investment suggests that the wider adoption of such programs could prove beneficial for budgets and productivity as well as health outcomes. (Katherine Baicker, David Cutler & Zirui Song, Health Affairs 29(2), 2010)

Workplace Well-being Tool • • • Free on-line resource to help employers calculate financial costs of employee ill-health to their organisation Can be accessed at: www. workingforhealth. gov. uk Since launch in March 2010, there have been over 8, 500 hits to the Welcome page, and over 2, 500 users have created a profile to permit use of the full range of the tool’s functions.

Case Study: British Gas Around 2, 500 employees, 90% office-based. Strategy of ‘Health and Well-being’ not ‘Health and Safety’ • Formed team of three FTE, to encourage employees to take interest, and responsibility for their own health. • Classes, fitness sessions – aiming for more fun at work – familyinclusive. • Consulting employees, not dictating Outcome over two years: • 12% reduction in staff absence • 25% reduction in staff turnover • increased employee engagement and commitment

Making the business case: SMEs Chess Telecoms: – – free fruit and mineral water, on-site massages and health checks, health insurance and flu jabs over 20% of employees now cycling to work, company providing showers to encourage more on to their bikes Absence management monitored monthly Long-term employees receive loyalty points to buy extra holidays, increase their level of health care, put more money into their pension Rise in sales and profits over the last 3 years with an increase in profitability of 51% 08 -09 to 09/10 attributed to healthy workplace initiatives (Anne Binnie, Chess Telecoms HR & Compliance Director) Challenge Fund: a Scottish winner

Positive Workplaces Key features common to those organisations which have achieved success in promoting health and well-being: • Senior visible leadership • Accountable managers throughout the organisation • Systems of monitoring and measurement to ensure continuous improvement • Empowering employees to care for their own health • Attention to both mental and physical health improvements • Fairness • Flexible work

The economic challenge and the workplace The truth is that we are in very different economic times, and the future for the health, well-being, productivity and performance of our working population is not sustainable unless we are all able to work radically and pull together in times of austerity to create a better whole for us all. “ We have to create the right political and business environment that will allow entrepreneurial spirit and value wealth-generation by businesses – but through the untapped potential of the large numbers of now-partly-disengaged but potentially-actually-working population. ” Head of productivity and wellness, Large corporation, June 2010

Macleod Review: Engaging for Success 2009 Organisations with engaged employees tend to: • Have employees who have a real sense of where they are trying to get to • Have managers engaged at the front line; managers who offer clarity about what’s expected and give lots of appreciation • Have well organised work – it is hard to be engaged if work is badly organised • Have congruity between values and actions

Employers: their role Ideally: • see ‘Health and Work’ as a core business provision, that can improve productivity and ‘quality of product’ • understand the issues, with well trained managers • make use of the OH Adviceline • make use of DWP’s Workplace Wellbeing tool • make appropriate use of the Fit Note • engage with the Fit for Work service • are flexible to those with Long Term Conditions • know of the Government’s ‘Access to Work’ scheme • understand the Equality Act

Occupational Health in the UK • Occupational Health services reflect the historical view of ‘industrial medicine’ as a benefit to employers which should be financed by them. (However, currently only 30% of employees have access to OH via their employer. ) • A new model has to be put in place to reflect the current profile of employment in Britain. • It requires new partnerships and new ways of working across traditional boundaries. Occupational Health must make a greater contribution to the health of the national economy. “ If we are to change fundamentally the way we support the health of working age people, then we have to address a number of challenges which face Occupational Health as it is currently configured. ” Working for a healthier tomorrow (2008)

Common Mental Health problems The chief health problem of working age in the UK - and at any age mental health problems may compound physical disorders. Prevalence of mental health conditions requiring treatment increased from 14. 1% of the adult UK population in 1993 to 16. 4% in 2007 (ONS survey) Mental health problems were cited by 40% of claimants for Incapacity Benefit in 2006 compared to 26% in 1996. People with mental health problems do not have to be entirely free of symptoms to remain in or return to work successfully, but there are barriers to be overcome. Evidence on the effectiveness of health and employment interventions is currently not as strong as we could wish, and we depend on reinforcing accepted best practice to promote mental wellbeing and restore working life.

Mental Health at Work: the business case • At any time, one UK worker in five will be experiencing mental distress, depression, or problems relating to stress. • Total cost to UK employers is estimated at £ 26 bn per year (2006), including: • £ 2. 4 bn in replacing staff who leave because of mental ill-health; • £ 8. 4 bn in sickness absence (40% of the average 7 days off sick per year is for mental health problems); but • £ 15. 1 bn in reduced productivity at work. ‘Presenteeism’ loses 1. 5 times the working time lost due to absence, and costs more because more common among higher-paid staff. Centre for Mental Health, 2010

Common long-term conditions Common chronic disorders – rheumatic diseases, cardiovascular and respiratory conditions, diabetes, treated cancers – do not deny the possibility of fulfilling work or an extended working life. They require: • good clinical care and Vocational Rehabilitation • flexibility and adaptation in the workplace. Increasing prevalence of chronic disorders appears inevitable with an ageing population and ‘lifestyle factors’. If managed effectively, disability can be minimised and disease progress delayed - thus extending working life and reducing the load on health and care services.

Lifestyle trends It is likely that by 2025 40% of adults will be obese, and the number of people living and working with chronic conditions will rise steadily, affecting morale, competitiveness, profitability. In an increasingly competitive global economy, only the healthiest businesses will prosper. Companies that invest to support employees’ health will be fitter to survive. Retire at 68? Three-quarters of us will be too ill to even work that long. . . February 11, 2010

The UK epidemic of obesity: BMI-related diseases Predicted UK rates per 100, 000 (National Heart Forum): 2006 2030 2050 Arthritis 603 649 695 Breast cancer 792 827 823 Colorectal cancer 275 349 375 Diabetes 2869 4908 7072 Coronary heart disease 1944 2471 3139 Hypertension 5510 6851 7877 Stroke 792 1050 887 The risk factors, of poor diet, physical inactivity, high alcohol consumption and smoking, provide a clear focus for action for all.

MSDs in the UK and Europe • By some margin the most commonly-reported cause of work-related ill-health in the UK. • Affected about 1 m people in 2005 -06, twice as many as suffered from ‘stress’. • Responsible for 9. 5 m lost working days in 2005 -06, on average 17. 3 days per sufferer. • Cost to UK society estimated to be £ 5. 7 bn in 199596, equivalent to £ 8 bn in 2010 prices each year. Musculoskeletal Disorders and Labour Market Participation, The Work Foundation, 2009 • MSDs account for about half of all work-related disorders in EU countries, costing between 0. 5% and 2 % of GDP. • Unemployment rates are three times higher among people with MSD than in general population. Musculoskeletal Disorders in the European Workforce, The Work Foundation, 2009

Rheumatoid Arthritis and Work • Employees with RA average 40 days sick leave per year, but those in work who respond to treatment take only 16 days sick leave annually. • The wider costs to the economy of sick leave and work-related disability (lost employment) due to RA amount to an estimated £ 1. 8 bn per year • Employers were inflexible in making adjustments • Little coherence in links between NHS and organisations commissioned by the Dept of Work and Pensions (DWP) to get people back to work • 56% of hospitals were aware of these DWP schemes, but: - 33% of these did not give information about schemes to those with RA - only 12% of GPs gave information about continuing in employment to those newly diagnosed - only 20% of those with RA considered that they received sufficient information about employment issues. National Audit Office. Services for People with Rheumatoid Arthritis, July 2009

Cancer and work Cancer is becoming a long term condition. • • 109, 000 working-age people are diagnosed with cancer in the UK each year 775, 000 people of working age in the UK have had a cancer diagnosis Long term cancer survivors are 1. 4 times more likely to be unemployed yet… … research shows that cancer patients want to work One in four long term cancer survivors say their cancer is preventing 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 Mac. Millan Cancer Support

Return after cancer: employer support is variable The problem: • Only 50% of patients are offered flexible working arrangements • 80% of employers were unaware that cancer is covered by the Disability Discrimination Act (now the Equality Act) The solutions: Macmillan Cancer Support • published an expert workshop report on getting the message out to employers • published a ‘Self-employment and Cancer’ booklet • produced with the TUC a learning programme for trade union reps • are running a pilot Vocational Rehabilitation programme for recovering patients

Early life : building resilience for our future workforce To increase the life chances of young people : • Improve support in education • Encourage supportive parenting and relationships • Provide early and co-ordinated intervention Four recent Reports address this: Foresight, Mental Capital and Wellbeing; the Black Review Working for a Healthier Tomorrow; Working our way to better mental health: a framework for action; and the Marmot Review. “In order to give every child and young person the best possible chance to thrive, families carers and health and education systems must act together to promote wellbeing and foster skills for resilience. ”

Work “No other technique for the conduct of life attaches the individual so firmly to reality as laying emphasis on work: for work at least gives one a secure place in a portion of reality, in the human community. ” Sigmund Freud The product of work contributes to health, wellbeing and economic & social stability.