Transcript Health, Work, Well Being - a national perspective (,

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 21st century? Westendorp
RGJ Am J Clin Nut, Vol. 83, No. 2, 404S-409 (2006)
40
50
AGE
60
70
80
90
Costs of working-age ill-health
Financial
Social
• Overall costs of
working-age ill-health
in UK exceed £100
billion per year
“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.”
• Around 172 million
working days were
lost to sickness
absence in 2007, at a
cost to the economy
of over £13 billion
(CBI)
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
Working
for afor
Healthier
a Healthier
Tomorrow,
Tomorrow,
Dame
Carol
Carol
Black,
Black,
1717
March
March
2008
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 1m people in 2005-06, twice as many
as suffered from ‘stress’.
• Responsible for 9.5m 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
MacMillan 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.