Dame Carol Black National Director for Health and Work

1. Leading by Example? Why the mental health and well-being of staff in Further Education is a leadership issue 1 February 2011 Improving the Health and Wellbeing of FE Staff Dame Carol Black National Director for Health and Work

2. Why invest in the health and well-being of FE staff? “The rewarding but difficult work of education can not be carried out well by people who are stressed and tired, but can be done well by staff with energy, commitment and a positive outlook.”- Well-being facilitator All staff are role models for students and can demonstrate how to lead a healthy and balanced lifestyle Staff well-being may affect institutional performance (a study by Birkbeck College in partnership with Work Life Support (2007) suggests that there are links between average teacher well-being in schools and pupil performance – 8% of variation in SAT scores show significant correlation with staff well-being) Improved health and well-being can reduce absence and improve retention of staff

3. The Boorman review The Impact on Service Delivery and Outcomes … over 80% of staff felt that their health and well-being impacts upon patient care, and virtually none disagreed… … yet only 40% think that their institution cares about their health and well-being. … data correlation also showed some significant relationships… NHSHealthandWellbeing The Boorman review Source: RAND Europe

4. 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

5. 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. “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 Working for a Healthier Tomorrow Prevent illness, promote health, intervene early, improve the health of the workless.

6. Costs of working-age ill-health Financial • Overall costs of working-age ill-health in UK exceed £100 billion per year • Around 172 million working days were lost to sickness absence in 2007, at a cost to the economy of over £13 billion (CBI) Black Report, 2008 Social “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.” Lane Lecture, University of Manchester, November 2007

7. 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

8. Why are people off work? • Two-thirds of sickness absence and long-term 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

9. Symptoms: 2/3 of cases Often mild Symptoms not ‘diseases’: back pain musculo-skeletal symptoms stress anxiety, mild depression 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 Chronic conditions: 1/3 of cases Examples chronic rheumatic diseases endogenous depression bipolar disorders, schizophrenia diabetes, cancer post-trauma disability Investigations more extensive Diagnosis can be difficult Treatment – good medicine, good flexible employers, plus rehabilitation Prevent deterioration Different problems need different approaches

10. Health of teachers Reported rates of occupational stress, depression or anxiety are twice as high in the teaching profession than that for all other occupations. A National Association of Head Teachers (NAHT) survey found that 40% of teachers reported having visited their doctor with a stress-related problem in the previous year. 20% of teachers considered they drank too much and 15% believed they were alcoholics. The National Union of Teachers reports that around half of teacher ill health retirements take place for stress / psychiatric illnesses.

11. Costs of mental ill-health at work • Total cost to UK employers is estimated at £ 26 bn per year • (2006: Centre for Mental Health), 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 - costs more as more common in higher-paid work • NICE: If mental illness costs employers £ 28.3 billion per annum in 2009: • prevention and early identification of problems should save employers at least 30%, i.e. £ 8 billion each year • for a 1,000 employee company annual costs could be reduced by £250,000. • November 2009 NICE guidance presents the business case. • www.nice.org.uk/PH22

12. The old system, and the need for early intervention • Work-related health problems often not life-threatening, but life-diminishing (MSDs and mental health conditions) • No clear pathways of vocational rehabilitation or standards: treatment all too often slow and inefficient, often with a poor outcome for the patient • GPs have no easy access to expert help or OH advice, or vocational rehabilitation • Repeated Medical Certificates can lead to worklessness GPs issued ‘sick note’ • Problems are often mild and treatable

13. The workplace: findings of the Black Review (2008) • Poor understanding of relevance of Health, Work and Wellbeing • Employers unaware of the business case for investing in health and well-being • Accessible and affordable sources of support and advice rarely available for small and medium-sized companies (SMEs) • Line managers’ behaviour crucial, but there is often little training • Employers inflexible about necessary adjustments for those with disabilities or chronic disease • Often no policy on handling mental ill-health • Often no sickness-absence policies to promote return to work • Patchy Occupational Health services, of variable quality • No national standards available to employers when they purchase occupational health or well-being services And yet, the workplace provides great potential for prevention & promotion

14. Health promotion and ill health prevention 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.

15. Promotion of health in the workplace The promotion of physical health and fitness, and the prevention of physical disease, are highly-desirable goals, often pursued by companies. But the promotion of positive mental health and fitness is done by too few companies. Physical health influences mental well-being.

16. 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 • Attention to both mental and physical health improvements • Systems of monitoring and measurement to ensure continuous improvement • Empowering employees to care for their own health • Fairness • Flexible work Health and well-being need to be embedded in every aspect of an organisation’s structure and work

17. HSE Management Standards The standards define a desirable set of conditions to work towards: • Demands which includes issues like workload, work patterns • Control which is how much say the person has in the way they do their work • Support which includes encouragement and resources provided by the organisation & line management • Relationship includes promoting positive working to avoid conflict • Role which ensures people are aware of their role in the organisation and there is no conflict in roles • Change covers how organisational change (large or small) is managed and communicated by the organisation http://www.hse.gov.uk/stress/standards/

18. Black Review: Health, Work and Well-being Initiatives All intended to help maximise health, wellbeing and productivity.

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

20. 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

21. 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

22. Advantages of LeicesterFFWS 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

23. Interventions: proportion of clients Leicester FfWS Client: ‘Never gave up on me, helped with all problems.’

24. Occupational Health Advice Helpline • Provides SMEs and GPs with tailored occupational health advice, by advisers with special training in Mental Health • Majority of call are about sickness absence and attendance management • Increasing number about the fit note • 90% of callers find it useful or very useful • WALES: Health at Work Advice Line Wales • ENGLAND: run in partnership with NHS Plus • SCOTLAND: Healthy Working Lives Advice line

25. 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

26. Mental Health: how can savings be delivered? • Awareness training for line managers, to increase understanding of MH issues and their ability to respond confidently and rapidly, e.g. at the Centre for Mental Health (one of many such courses). • Preventionof directly-work-related MH problems (around 15% of total) – e.g. by providing mentally-healthy working conditions and practices (see guidance by UK Health and Safety Executive) • Better access to help for employees, particularly to evidence-based psychological help and support while carrying on working • Effective rehabilitation for those who need to take time off, including regular contact with the employee during periods of absence

27. Case study-EoN • E.ON is the world’s largest investor owned gas and electricity company • Approx 18000 employees in the UK, over 50 sites across UK • Reviewed their structure, implemented strategic Business Partner roles • Employed a specialist Case Manager and Communications Specialist • Aligned Health to the Business – commercial & customer focus • Made health relevant to the individual

28. EoN-Staff Roadshows & innovative health promotion • The number of new cases & days lost through mental health related absence has reduced by 25% since launch • Continuous reduction in sickness absence over 2 years, approx £11.8m cost savings

29. Commercial partnership between a large company and an NHS Trust. Male-dominated environment with 7,500 employees. Marketed programme around “well-being” and not “mental health”, to avoid latter’s stigma. Mental Health First Aid courses to Managers, Shop Stewards and Apprentices. Encouraged the men to open up and be more honest among themselves. Results Saved £1.7 million of direct costs over 3 years Sickness absence fell by 3 to 4% social benefits: one employee’s partner approached a manager in a local supermarket to say the programme had improved her life too. Case study: Airbus

30. Grimsby Institute:Introduction Grimsby Institute of Further and Higher Education has won many awards for employee health and well-being. “ Our approach is determined by the desire to provide customers (students and others) with the best possible service. To achieve this, we need to employ excellent staff who perform each day to their best. If they are not at work, they cannot do this. ”

31. Health and wellbeing strategy aligned with: Institute mission, values and business plans staffing procedures key business processes employee benefits onsite catering charity fundraising sport and activity internal communications health and safety Health and wellbeing team who work with other experts. Speedy & supportive interventions to keep people at work or accelerate returns to work. Helping other organisations understand the value of health and wellbeing. Regular management training. Extensive employee communication. Measuring the impact. Grimsby Institute:Key to success

32. Sickness absence: Level of accidents at work dropped from 424 in 2004/05 to 253 in 2008/09 Quality of observed teaching has improved Size of the organisation has grown (£17m in 2001 to £47m in 2010) Financial health improved Grimsby Institute:Results

33. Improving the health and well-being of University staff ‘Improving performance through wellbeing and engagement’ : a two year national project funded by HEFCE in partnership with Scotland and Wales to support institutions to enhance their performance through their people. 60% The project, led by the Universities of Leeds and Glasgow in partnership with the a number of Higher Education institutions, has so far engaged 60% of HE institutions.

34. ‘ Improving performance … • The project aims to: • Develop a higher education specific business case for employee wellbeing and engagement — showing what aspects make the biggest impact on performance • Support institutions to enhance their practice by developing a bank of practical case studies and resources • Support learning and sharing across the sector by developing an employee wellbeing network, supported by regional meetings.

35. Recourse • Recourse provides free and confidential services to those working in post-16 education. • This includes serving, former and retired staff and their dependents plus employees and former employees of UCU, AUT and Natfhe. Recourse (formerly CUSN – the College and University Support Network) is the charity established by Teacher Support Network, in partnership with UCU, to improve the well-being and effectiveness of all working in the adult, further and higher education sectors.

36. Recourse services • 0808 802 03 04 • 24/7 Support Line providing practical, emotional and financial support • Run every day of the year by fully-trained counsellors and coaches • www.recourse.org.uk • E-mail support from fully-trained counsellors and coaches • Web-based InfoCentre • Online self assessment tools • E-newsletter • All of Recourse’s services are completely free and confidential, thanks to the continuing donations of the UCU and over 15,000 of its members

37. How Recourse can help – Daniel’s story Daniel, 30, got his first post as a lecturer last year. He contacted Recourse as he was struggling with his workload. Feeling anxious and pressured, his work had begun to adversely affect his sleep patterns and short-term memory. Firstly, Recourse’s coach encouraged Daniel to seek medical advice. He then helped him to realise that he needed to learn to manage his workload more effectively and, most importantly, say no when things were getting on top of him. Daniel’s state of mind had improved significantly by the end of the coaching programme and he had more confidence and better communication with his Head of Department.

38. 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