Transcript v - Be Healthy At Work

Healthy Wealthy and Working
2nd 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
Examples
– 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.
•
Investigations more extensive
•
Diagnosis can be difficult
•
Treatment – good medicine, good flexible
employers, plus rehabilitation
Prevent chronicity
•
Prevent deterioration
•
– post-trauma disability
MacMillan 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.
MacMillan 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
- only12% 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 6.1m (21%) are in the public
sector.
• Of the 22.8m in the private sector, 9.2m (40%) are in large
companies (with more than 250 employees).
• Of the other 13.6m (60%), working in SMEs:
- 11.0m (81%) work in Small companies (less than 50 employees)
- 3.9m working alone;
- 3.8m in companies with 1 to 9 employees; and
- 3.3m in companies with 10 to 49 employees
- 2.6m (19%) work in Medium-sized companies (50 to 249 staff).
• Note: There are 3.1m sole proprietorships, of which 10% have
employees; 0.45m partnerships, of which 38% have employees;
and 1.3m 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.
Line managers ill-equipped to
handle sickness absence and
health/well-being issues
3.
Lack of incentive to look after
low-skilled staff’s welfare
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
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 24hrs
• 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
30%
50%
Amended/Phased Return To Work
Alternative employment
Information and guidance
Referred to MACs (financial/family/legal)
40%
5%
20%
40%
JC Plus
5%
Leicester FfWS
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
• Clients staying ‘on the books’ for
longer than anticipated
• Case managers have a very
comprehensive understanding
of our clients’ barriers
• 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
problems are solved.
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 3.4m 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 and 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/