Workplace Well-being & Inequality

ADPH Conference May 2010

Dr Steve Boorman Director CR and Chief Medical Adviser

Royal Mail Group

NHS Workforce HWB- Lead Reviewer

Good Work

A tale of two post women!!

By way of context

Marmot Priority Objective CCreate Fair Employment & Good Work For All

Improve access to good jobs and reduce long-term unemployment across the

social gradient

Make it easier for people disadvantaged in the labour market to obtain and keep

work

Improve quality of jobs across the social gradient

Health inequalities and work!

Health inequalities result from social inequalities in the conditions in which people

are born, grow, live, work and age

Action taken to reduce health inequalities will have economic benefits in reducing

losses from illness associated with health inequalities. These currently account

for productivity losses (estimated £33bn/year), reduced tax revenue and higher

welfare payments (up to £32bn/yr) and increased treatment costs (£5.5bn/yr).

Work as a harmful myth!

Work widely perceived as noxious Health Risk = smoking 10 packs of cigarettes per day (Ross 1995) Suicide in young men > 6 months out of work is increased 40 x

(Wessely, 2004) Suicide rate in general increased 6x in longer-term worklessness

(Bartley et al, 2005) Health risk and life expectancy greater than many “killer diseases”

(Waddell & Aylward, 2005) Greater risk than most dangerous jobs (Construction/North Sea)

“Long term worklessness is one of the greatest known risks to public

health”

Working For a Healthier Tomorrow

Dame Carol Black’s appointment and review

Ill health among working age population has equivalent cost of

running a second NHS

Work not seen as an important clinical outcome

Consequences of worklessness on long term health – of individual,

and of family

Black built on earlier work and Marmot accepts case that

unemployment (particularly long term) impacts on physical and

mental health

Taken further – Good Work protects health

What is our overall goal?

Healthy engaged workforces in well-managed organisations

• A quality product• A high-performing resilient workforce

• Enhanced productivity

Contributing to : • A well- functioning society

• UK plc

• Two-thirds of sickness absence and long-term incapacity is due to mild and treatable conditions:

• 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)

• Poor retention in the workplace of those with disabilities or chronic disease

• Obesity and demographic shift are significant risk factors to exacerbate

Why people are off work in the UK and many other countries

Mental health: the facts

• 1 in 6 working age adults have symptoms associated with mental ill-health (e.g. sleep problems, fatigue, etc) which do not meet the criteria for diagnosis

• A further 1 in 6 working age adults experience diagnosable mental health problems (e.g. depression, anxiety, etc)

• An estimated 1-2% of the population have severe mental health problems (e.g. schizophrenia, bipolar disorder, etc)

• 44% of people on long-term health related benefits have a mental or behavioural disorder as primary conditions

The Royal College of Psychiatrists: Mental Health and Work (2008)

• 11.4 m days lost in 2008/09 due to stress/depression• Mental illness causes 46% of all sickness absence (average

length of absence 28 days per case)

Mental health and work

• Being in work generally leads to good mental health, self-esteem and well-being

• Being out of work is associated with poor mental health, increased likelihood of anxiety and depression, and increased use of medication

• When people return to work their mental health and well-being generally improve

• Although work can pose a risk to mental health, the positive effects far outweigh the risks

• People with mental health problems attach a high priority to work, and work can be part of the recovery process

• Poor mental health associates with low earnings, social exclusion, poorer physical health, child poverty, disrupted education

Unemployment rate by previous occupation

Long term conditions:

SMR for 3 respiratory diseases

300 –

200 –

100 –

1 2 3n 3m 4 5 1 2 3m 3n 4 5 1 2 3m 3n 4 5

TB Ca lung COPD

8.9 4.6 14.2RatioUnskilled manual: professional Source Office for National Statistics

Long term conditions are more likely to be work-limiting in poorer socio-economic groups before retirement age

SMR = Standard Mortality Rate

Marmot - Two inter related aims!

Reduce the adversity of adverse working conditions

Targeting interventions proportionately towards lower socio-

economic groups

Prioritise active labour market programmes

Integrate unemployed in to work v passive income support

Create jobs, offer employers subsidy to offer employment opportunities and

grants for start ups

Support for retraining and reintegration – improving occupational mobility for

unemployed

Improving job matching programmes to increase success rate of at risk groups

such as long term unemployed

Evidence to date is mainly short term but is positive for disadvantaged groups

(especially mental ill health now reflected in New Horizons

What is Good Work?Marmot highlighted ten key components

Precariousness – stable, risk of loss, safe Individual control – part of decision making Work demands – quality and quantity Fair employment – earnings and security from

employer Opportunities – training, promotion, health, “growth” Prevents social isolation, discrimination & violence Share information, participate in decision making collective bargaining, justice if conflicts Work/life balance Reintegrates sick or disabled wherever possible Promotes HWB – psychological needs self efficacy,

self esteem, belonging and meaningfulness

Both physical and psychosocial environments critical

Creating better work!

Risk assessment – physical and chemical risk factors

Shift work & work time factors (eg breaks, working hours, time control, flexibility)

Improving psychosocial workplace risk factors

These are largely intuitive and already subject to law

Vital few

Creating good work

Psychosocial and physical work environment critical

Lack of reward and lack of control – stress risk factor and worse for lower socio

economic groups

Work environment change combined with positive health promotion beneficial in

creating health promoting work

Preventative and rehabilitation approaches need improvement to create health

promoting work

Leadership and Staff EngagementIs HWB Important?

Although 80% of NHS staff felt their HWB impacted on quality of patient care, only

40% believed their employer cared!

We also found over 65% of staff reported coming to work in last month feeling ill

enough to consider taking time off!

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

Strongly disagree Disagree Neither disagree nor agree Agree Strongly agree

Interest in health and wellbeingMy colleagues take a positive interest in my health and wellbeing

My line manager takes a positive interest in my health and wellbeing

Senior managers in my organisation take a positive interest in the health and wellbeing of the employees in my workplaceMy NHS employer takes a positive interest in the health and wellbeing of all its employees

HWB and organisational performanceThe Case for Change

Correlation between HWB performance and outcomes

LSE Research headlines (Value of Rude Health - Independent evaluation)•>£227 mil saving over 3 years, £46mil investment

•Small depot - impact equivalent to 14 extra parcels or £2700 a day on P&L

•Direct link to Q of S and sales

•Maps our initiatives to our attendance improvement flight path – ie HWB interventions did reduce SA

•Since savings continued and attendance now 40% improved on base line

Time periods 2011 - 2015

Develop Active labour market programmes

Improve quality of work across social gradient, adhere to legislation and equality

guidance and ensure compliance with stress management and well-being

promotion at work

Improve security and flexibility of employment via increased flexibility around

retirement age, and encouraging employers to adapt jobs to accommodate

especially lone parents, carers and those with physical and mental health

problems

Time periods 2016-2020

Widen use of Active labour market programmes to intervene early & decrease

long term unemployment

Improve implementation of quality of work across social gradient, increase job

security in employment contracts and employers adhering to equality legislation

and extending stress management and active HWB programmes

Extend security and flexibility of employment via continued flexibility around

retirement age, and continuing efforts for employers to adapt jobs to

accommodate especially lone parents, carers and those with physical and mental

health problems

Time periods beyond 2020

Use of Active labour market programmes to achieve timely interventions and

reduce long term unemployment

Improve quality of work across social gradient, building in job security to

employment contracts and monitoring employers adhere to legislation and

equality guidance and monitor compliance with stress management and well-

being promotion at work

Continue to achieve flexibility of employment via a tax & benefits system that

promotes flexible working and ensuring jobs are suitable for lone parents, carers

and those with physical and mental health problems

Why Health and Well-being in the NHS?We tried to articulate a case for change – seeking higher priority for staff health

•NHS should be an exemplar of workplace health

•Improving staff health can improve the health of the general population

•Patients and public – quality of care

•Staff – rewarding jobs in a healthy and safe environment

Healthy workforce essential for the NHS to meet 21st Century challenges and deliver Lord Darzi’s

vision of High Quality Care for All

•Rising demand driven by demographics and increasing expectations

•Imperative to deliver better quality care

•£20bn savings1 can only be delivered by a healthy and productive workforce

•Innovative approaches required to address additional pressures on staff

•Keeping communities well needs prevention as a key workforce skill

NHS Constitution gives legal rights to:

1 Source: NHS Chief Executive’s annual report 2008/09

NHS cornerstone of Government response to Dame Carol

Black