Workplace Well-being & Inequality ADPH Conference May 2010

1. 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

2. Good Work • A tale of two post women!! • By way of context

3. 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

4. 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).

5. 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”

6. 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

7. 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

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

9. 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)

10. 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

11. Unemployment rate by previous occupation

12. Long term conditions:SMR for 3 respiratory diseases TBCa lungCOPD Long term conditions are more likely to be work-limiting in poorer socio-economic groups before retirement age 300 – 200 – 100 – 1 2 3n 3m 4 5 1 2 3m 3n 4 5 1 2 3m 3n 4 5 Ratio Unskilled manual: professional 8.9 4.6 14.2 Source Office for National Statistics SMR = Standard Mortality Rate

13. Marmot - Two inter related aims! • Reduce the adversity of adverse working conditions • Targeting interventions proportionately towards lower socio-economic groups

14. 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

15. 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

16. 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

17. 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

18. 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!

19. HWB and organisational performanceThe Case for Change Correlation between HWB performance and outcomes

20. 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

21. 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

22. 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

23. 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

24. Why Health and Well-being in the NHS?We tried to articulate a case for change – seeking higher priority for staff health 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: NHS cornerstone of Government response to Dame Carol Black • Patients and public – quality of care • Staff – rewarding jobs in a healthy and safe environment • NHS should be an exemplar of workplace health • Improving staff health can improve the health of the general population 1 Source: NHS Chief Executive’s annual report 2008/09