Healthy Wealthy and Working 2 nd February 2011

Healthy Wealthy and Working 2 nd February 2011 Progress and Priorities in 2011 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 People with mental health conditions must be part of this goal.

A new vision for health and work A Review of the health of the working-age UK population, commissioned in 2007 by the Secretaries of State for Health and for Work and Pensions. Working for a Healthier Tomorrow “At the heart of this Review is a recognition of, and a concern to remedy, the human, social and economic costs of impaired health and well-being in relation to working life in Britain. The aim is … to identify the factors that stand in the way of good health and to elicit interventions, including changes in attitudes, behaviours and practices – as well as services – that can help overcome them. ” Working for a healthier tomorrow, 2008 Prevent illness, promote health, intervene early, improve the health of the workless.

Factors that stand in the way Culture beliefs and attitudes – needing change • Misconceptions about health and work – e. g. “need to be 100% fit” • Inappropriate ‘medicalisation’ of complex psycho-social problems • Poor retention in work of those with disabilities or chronic disease • Managerial attitudes, organisational behaviour, unable to make business case. Inadequate systems • Inflexible system of sickness certification – the ‘sick note’ • No pathways of rapid intervention to keep you in work or return you to it • Health, work and well-being not part of training curricula or clinical practice • Poorly-supported healthcare professionals. No OH advice for GPs. Lack of Primary Care involvement • Rehabilitation to work not a performance measure for responsible local health bodies • Configuration of Occupational Health services: no national standards. Next generation • Little attention to building mental and emotional resilience in our future workforce

Why are people off work? • Two-thirds of sickness absence and longterm incapacity is due to mild and treatable conditions, often with inappropriate ‘medicalisation’, needing vocational rehabilitation: • 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) “ The art of medicine remains the art of identifying the patient’s problem (which is something more than diagnosing the disease). ” Sir Douglas Black – echoing Sir Robert Platt

Fit for Work Service Pilot: Case Study, ‘George’ Problem • 50 year old man, working alone as a catalogue distributor • Presented with musculo-skeletal problems & pain • Assessment identified: anxiety; long term psychological issues dating back to childhood; previous gambling and alcohol addiction • Had caring responsibilities in family causing stress at home & financial difficulties due to inability to work usual hours • Poor relations with employer Little of this is strictly medical! Action • Referral to Physiotherapy • Referral to local Council for Alcohol counselling and support • Identified carer’s support, referral completed • Given information on Citizens Advice Bureau for benefit review • Encouraged to attend Alcoholics and Gamblers Anonymous • Motivational support from Case Manager at regular review calls

Fit for Work Service Pilot: Case Study, ‘George’ Results • Client improved from Physiotherapy • Citizens Advice provided help and information • Client continued counselling and attendance with Alcoholics’ and Gamblers’ Anonymous • Case Manager provided regular review, motivation, self-help materials, and ensured client was progressing Outcome • Increased productivity at work • Client promoted to manager, doing less physical duties • Caring responsibility now reduced, which has improved relationship between client and partner Without Fit for Work, the outcome could easily have been the Benefit system

Different problems need different approaches Symptoms: 2/3 of cases Chronic conditions: 1/3 of cases • Often mild • • Symptoms not ‘diseases’: – back pain – musculo-skeletal symptoms – stress – anxiety, mild depression – chronic rheumatic diseases – endogenous depression – bipolar disorders, schizophrenia – diabetes, cancer • Few investigations required • Diagnosed with relative ease • Intervention needs to be early, • often non-medical, good • vocational rehabilitation, regular contact between employee and • employer. • Prevent chronicity Examples – post-trauma disability • Investigations more extensive Diagnosis can be difficult Treatment – good medicine, good flexible employers, plus rehabilitation Prevent deterioration

Mac. Millan Cancer Support 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. Employers are sometimes not flexible in making adjustments to permit return to work. Mac. Millan Cancer Support

Rheumatoid Arthritis and Work • 50% of UK adults with RA are of working age. • 75% are diagnosed when of working age • 33% of people with RA will have stopped working within 2 years. • Earlier diagnosis and appropriate treatment mean better retention in work. • Increasing from 10% to 20% the number of people treated within 3 months of symptoms would increase NHS costs in England by £ 11 million over 5 years BUT could result in £ 31 million gain for the economy due to reduced sick leave and workrelated disability. National Audit Office Report 2009 Public Accounts Select Committee 2010

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 (government) 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 they received sufficient information about employment issues.

Promoting health improvements in the workplace Advantages of the workplace: • a microcosm of society, as to age, gender, income, ethnicity • powerful communication and education structures • a culture of health at work can reinforce positive health behaviours • good employer/employee relationships can sustain healthy behaviour • infrastructure for measurement of health outcomes is often in place • interventions can benefit employees, employers and the public purse • families of employees extend impact further.

UK Employment Statistics 2010 • Total employment 28. 9 million, of which 6. 1 m (21%) are in the public sector. • Of the 22. 8 m in the private sector, 9. 2 m (40%) are in large companies (with more than 250 employees). • Of the other 13. 6 m (60%), working in SMEs: - 11. 0 m (81%) work in Small companies (less than 50 employees) - 3. 9 m working alone; - 3. 8 m in companies with 1 to 9 employees; and - 3. 3 m in companies with 10 to 49 employees - 2. 6 m (19%) work in Medium-sized companies (50 to 249 staff). • Note: There are 3. 1 m sole proprietorships, of which 10% have employees; 0. 45 m partnerships, of which 38% have employees; and 1. 3 m companies, of which 58% have employees. Source: BIS and ONS

Occupational Health in the UK • 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. • The profession of OH is positioned at the crossroads of the employer-employee-healthcare interface. • OH professionals have a distinct and logical role in advocating prevention-oriented programmes that protect and assure the health of employed and productive citizens. • OH professionals could make a compelling case to government of their value to a productive society.

Insights from employers/line managers Key Disincentives to Change: Other Barriers to Change: 1. Not knowing/understanding the benefits of health and well-being initiatives 5. Present economic climate 6. Sickness Policy contributing to rather than encouraging change 2. Lack of awareness of the benefits of early intervention 7. 3. Lack of incentive to look after low-skilled staff’s welfare Line managers ill-equipped to handle sickness absence and health/well-being issues 8. Unenlightened attitudes towards mental health / chronic pain 4. Perception that you do need to be 100% fit to return to work 9. Perception of ‘welfare and health issues’ as ‘nannying and fussing’ After Andrew Irving Associates

Black Review Recommendations and 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 people stay in work, and maximise health and wellbeing.

Occupational Health Advice Helpline 0800 077 8844 • Provides SMEs and GPs with tailored occupational health advice, by advisers with special training in Mental Health – run in partnership with NHS Plus for GPs in England – Scotland Healthy Working Lives Advice line – Health at Work Advice Line Wales 42% of calls are about sickness absence 24% of calls are about the fit note 20% of calls are about mental health (anxiety, depression, stress, and other mental health conditions)

Feedback from the Occupational Health Advice Helpline “It’s good, it’s business-focussed, it’s responsive and the advice is accessible when we need it. ” - caller to the England adviceline Feedback from the user survey indicates that: • 92% find the service fairly or very useful • 94% appreciate that the support is free • 95% appreciate that they get to talk to an individual

Small Business Awards: The Challenge Fund allocated to 73 small and medium sized businesses to improve health and welfare at work. 14 organisations will be receiving grants in the next few weeks for the second year of a two year project. Evaluation of this project is underway and results are expected in 2012. Case study: Chess Telecoms (100 employees) Free fruit, on-site 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 Results: Rise in sales and profits over the last 3 years with an increase in profitability of 51% 08 -09 to 09/10 attributed largely to healthy workplace initiatives (Anne Binnie, Chess Telecoms HR & Compliance Director)

Workplace Well-being Tool The Workplace Well-being Tool (WWT) is a free online resource allowing employers to: • calculate the overall cost to their businesses of ill-health; • compare their results against benchmarks in other organisations; • get practical ideas to help reduce health and well-being costs in their organisation; and • work out the costs as well as the benefits of investing in a well-being programme. The tool was launched in March 2010 and is hosted on the Business Link website. There are currently around 1500 registered users. 629 registrations from SMEs Across every sector including manufacturing, financial services and the voluntary sector Those logging on include Company Directors, Finance Managers, HR Personnel and Health and Safety Representatives.

“ Workplace Well-being Tool: Stratford-on-Avon District Council I’ve been able to use the tool to highlight the cost of absence in the organisation and, therefore, make the case for a range of interventions that will become self-financing as they contribute to reducing the level absence. ” • Last year the Council reported 11 days absence per employee. • This year the target has been 9 days. • The Council is now on target to reduce that figure to 7. 5 days. • The cost of absence last year was £ 500, 000. This year it’s forecasted to be £ 265, 353.

Importance of Fit for Work Service Pilots • Identifying underlying problems with rapid referral • One stop supported approach • Practical support in non-medical areas • OH input as required These measures are to help people remain in work or return to work more quickly

Leicester City & Leicestershire Fit for Work Service Vision • Move management of sickness absence from the medical model into vocational rehabilitation. • Move vocational rehabilitation closer to mainstream primary care. Dr Rob Hampton, Clinical Lead Commissioning Partnership

Advantages of Leicester FFWS Model Convenient for patients • Contact within 24 hrs • First appointment within a week • Mobile phone communications • Choice of venue for consultation: 40 surgeries, 12 MAC sites, PCT, Council and Provider premises Helpful to GPs • Ease of referral – no forms • Musculoskeletal interventions funded • Service signs Fit Notes • Service provides audit data to GP practices

Interventions: proportion of clients Musculoskeletal 15% Psychological Employer dialogue Amended/Phased Return To Work 30% 50% 40% Alternative employment Information and guidance Referred to MACs (financial/family/legal) 5% 20% 40% JC Plus 5% Leicester Ff. WS Client: ‘Never gave up on me, helped with all problems. ’

Lessons learnt • More complex than anticipated • Need to establish very good relations with GP practices • Clients like: - ‘one stop’ supported approach - practical support in non-medical areas • Supporting clients to move into a new job/retrain an be a better outcome than returning to the same work • Some employers’ reluctance to discuss phased return to work until after an OH assessment can delay return to work • About 20% are reluctant to return to work even when all • Clients staying ‘on the books’ for problems are solved. longer than anticipated • Case managers have a very comprehensive understanding of our clients’ barriers

From ‘sick note’ to ‘fit note’ Sick note: • For the past eighty years or more, a GP assessed a person’s health and ability to work. Fit note: GPs share responsibility with employers: • GP knows health condition and impact • Employer knows job Adjustments being made: • The old form required the doctor to state whether or not the patient could work, and how long they should refrain from work if sick. • Phased return to work • Partial ability to work was not considered. • Practical adjustments in the workplace. • Part-time working • Working from home • Flexible start times • Different tasks

Feedback and Insights from GPs on the Fit Note The Good: The Challenges: • “The forms stimulate a far more meaningful conversation with my patients on taking time off work for sickness as well as considerations on returning to work after a period of sick leave. ” • Still too few GPs maximising their potential • “Many examples of patients going back earlier to work mainly because a plan is established at a much earlier stage. ” • “One of my patients needed adaptations to get back to work earlier. They were put in place and enabled her to get back to work initially by working at home remotely using computers provided by the employer. ” • Need for much more training • Feeling that the benefits system works against encouraging people (back) into work • This is probably a fiveyear programme.

Fit Note Case Study “ A woman in her 50's suffered minor head injury at home when her ceiling collapsed and hit her on the head. She felt unable to work and seen by me after two days and then weekly. After one week much improved, but after two weeks recovery stalled. The new form caused me to enquire more closely about the nature of her work. She worked at night, happily, and alone, happily, but following the minor injury had become fearful of entering the container containing provisions where the light was activated by a passive infra red detector. I was able to suggest a return with altered conditions i. e. the light could be activated manually with a switch.

Fit Note FAQs Some of my colleagues are saying you can only back date the fit note for a maximum of one month, is that true? Am I legally liable if something goes wrong with the patient at their workplace? Is it true that I can only write down what the patient says to me in the comments section? Do I have to indicate whether I want to see the patient again? http: //www. healthyworkinguk. co. uk/documents/h ealthyworkingukfitnotefaq. pdf

E-learning for health professionals 1. Flexible training materials for healthcare professionals about work and health. . With scenario-based learning, they illustrate how practising clinicians can incorporate work and health issues into their daily management of patients. 2. The e-learning packages will be freely accessible by anyone, including nurses, medical students, GPs and secondary care doctors. It will also include a new short 10 minute interactive programme on how to complete the fit note.

The Council for Work & Health The Council will facilitate the sharing of skills and expertise by gaining consensus and agreement across the professions and practitioner communities for core content for education and training in health, work and wellbeing issues. The embryonic Council first met in October 2008 and since then has expanded to incorporate representatives of all healthcare professionals involved in the delivery of health and wellbeing services 1. Guidance for employers on communication with general practitioners 2. Training and qualifications for occupational health nurses 3. Training and qualifications for allied health professionals 4. Fiscal disincentives to health promotion in the workplace

The Public Sector as Exemplar: Health and Wellbeing of NHS Staff • Black Report (2008) asked for the public sector to be an exemplar – over 6 million people work in it, in UK. • Government chose to review the health of NHS staff • Healthy NHS staff means optimum care for patients. • The Review NHS Health and Wellbeing (Nov. 2009) by Dr Steve Boorman concluded that it should be possible for the NHS to reduce sickness absence by one third : – Saving up to £ 550 m per year – Gaining 3. 4 m working days per year – Equivalent to 14, 900 extra staff All recommendations were accepted by the Government.

Public Sector : ‘Boorman’ HWWB Programme in the NHS 1. Develop and monitor local plans to deliver the national ambition of £ 550 m productivity savings: - to reduce sickness absence for Northern regional authorities to 3. 4% and for Southern ones to 3. 0% by March 2013 2. Enable the improvement of Occupational Health Service provision - to develop and implement common standards for OH provision to ensure maximum value for money 3. Deliver the NHS Physical Activity Challenge - to get 25 % of staff in each region engaged in Physical Activity within work time, by 2012 4. Promote Health and Well-being - to identify and share Health and Well-being best practice 5. Measure the success - to ensure the delivery of improved Health and Well-being across the NHS in England

New OH Standards and Accreditation 1. Enable services to identify the standards of practice to which they should aspire; 2. Credit good work being done by high quality occupational health services, providing independent validation that they satisfy standards of quality 3. Raise standards where they need to be raised 4. Help purchasers differentiate occupational health services that attain the desired standards from those that do not. Standards were published in January 2010 and the accreditation scheme was launched in 2011. www. seqohs. org

Results so far Since December 2010… Over 100 occupational health services have registered for information and many have signed up to be accredited. Many NHS Trusts have expressed interest and are waiting for the new financial year to register for accreditation 33 clinicians have volunteered to be auditors and will now go through the relevant training. The team has also had contact with OH professionals in Ireland Canada, Australasia and India about potential reapplication of SEQOHS.

The role of HWWB Regional Co-ordinators There are eleven Health, Work and Well-being Co-ordinators were appointed, one for each of the English regions, Scotland Wales, who act as champions of the Health, Work and Well-being agenda across Great Britain. – Facilitate an integrated approach to health and business at a local level – joining things up, making local connections – Encourage partnerships between businesses and health networks in the local area – signposting to funding opportunities and facilitating better links – Promote best practice and encourage innovation within businesses on health, employment and skills. Focusing on small and medium businesses and developing a portfolio of best practice and workplace well being models – Co-ordinate health, work and well being strategies and activities for public and private sector and working closely with the Co-ordinator network and the Health, Work and Well being Directorate in DWP and the Department of Health

Some of the essential steps to maintain progress • Health Issues: - spread the message that Work is generally good for Health - create services that deal with the common symptoms, which are often bio-psycho-social - do not medicalise unless necessary - recognise the burden of chronic diseases: prevent where possible, control, stop progression, enable people to work - educate and train professionals. • Public Sector and Private Businesses: - make the business case for investing in Health, Work and Well-being, show what works, spread good practice – make HWWB a productivity issue - enable SMEs to be engaged – get the Trade Unions on board.

Future direction: challenges and opportunities • Maintaining progress, and measuring it • Public Health Responsibility Deal • Public Health White Paper • Welfare Reform • pressing economic issues • inter-relation with other goals • Health, well-being, engagement, productivity • Occupational Health: encourage prevention, promotion, concern for population not just individuals • increased life expectancy and work - changing nature of work • long-term conditions (LTCs) and common Mental Health problems • early-life building for a resilient future workforce • socio-economic status, poor fitness and physically-demanding jobs

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.

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

Public Health Responsibility Deal The Responsibility Deal is delivered through 5 networks: • Food An initiative of the Secretary of State for Health, the business community, the voluntary sector and NGOs, working together to: • recognise their vital role in improving people’s health • Alcohol • encourage and enable people to adopt a healthier diet • Physical activity • foster a culture of responsible drinking • Behaviour change • encourage and assist people to be more physically active • Health at work • actively support our workforce to lead healthier lives.

Responsibility Deal: Health at Work network The aim of the Health at Work Network is to find ways to help employers use the workplace to improve the health of their employees. Current work includes: Providing generic guides on managing chronic conditions in the workplace Local Business Partnerships: Unilever, Mars UK, Novo Nordisk, mentoring SMEs What works for SMEs Develop ways to make occupational health more proactive and preventative Developing pledges for action to help people at work lead healthier lifestyles. The network is now working to agree the initial pledges that will form part of the Public Health Responsibility Deal on its launch early in 2011.

The vision “ We want to create a society where the positive links between work and health are recognised by all, where everyone aspires to a healthy and fulfilling working life, and where health conditions and disabilities are not a bar to enjoying the benefits of work. ” Improving health and work: changing lives UK Government Response to the Black review, 2008

Further information Health Work and Well-being - Health, Work and Well-being is a cross-government initiative that promotes the positive links between health and work. Check out this website for information, tools and practical support: http: //www. dwp. gov. uk/healthwork-and-well-being/