Workplace Health Cornwall Healthy Workplace Awards 2015

1. Workplace Health Cornwall Healthy Workplace Awards 2015 Wadebridge, 29 February 2016 Health and Work : update Dame Carol Black Expert Adviser on Health and Work Department of Health and Public Health England Principal, Newnham College Cambridge

2. Cornwall - Healthy Workplace Awards • Their value is to provide knowledge, encouragement, challenge and recognition. • Today we are here to celebrate and recognise effort and achievement.

3. Topics to be covered • Better Health, Wellbeing and Productivity in all workplaces • Britain’s Healthiest Companies • Mental Health Taskforce, February 2016 • NICE Guidance on Workplaces, June 2015 • Office design - digitalisation • Physical inactivity • Obesity • Sector development: NHS; Railways • Government initiatives

4. Health, Wellbeing and Productivity • for the public sector • for big companies in the private sector • for Small and Medium-sized Enterprises (SMEs) • and for all workers in all sectors.

5. Our State of Health : Britain’s Healthiest Company • Running for 3 years: in 2015 ; 111 organisations (inc. 2 hospitals), 32,500 employees • Objective: - Make society healthier by generating a credible evidence base linking employee health & wellbeing and company productivity, - thus increasing the number of companies taking responsibility for employees’ health. • Approach : - Understand the prevalence of modifiable risks in the workplace - Add to the evidence base on the effect of clinical and non-clinical risks to productivity - Determine the effectiveness of workplace interventions in promoting employee health. Supported by Vitality Health and Mercer: analysis Rand & Cambridge Univ.

6. Employees’ physical health Challenges: Britain’s Healthiest Company survey 2015 • 21% of employees report being obese • 28% not exercising enough • at least 25% reporting high blood pressure • nearly 30% having some health risks (present or past) related to smoking • 33% having health risks related to alcohol • around 50% have suboptimal nutrition.

7. Workplace health : BHC 2015 • A majority of employees say they face unrealistic time pressures. • Less than 70% feel their manager cares about their health and wellbeing. • A minority of employees feel their line manager has received training to support their health and wellbeing. • Over 15% of employees reported being bullied. • Best companies had 24% lower cost of lost productivity (sickness absence and presenteeism) than the worst-performing companies. Courtesy C van Stolk, Rand Europe

8. What prevents us from working - or from working well and feeling good ? Common mental health problems - nearly half of all absence - 70 m lost working days/year - 1 in 6 depressed, anxious or stressed - average annual cost £1,035 per employee - reduce GDP by £52 bn per year. Musculo-skeletal problems The quality of work/workplace - organisation of work - leadership and /board engagement - managerial behaviour Other important reasons - long-term conditions - home-related problems - lack of education and/or skills.

9. NHS Mental Health Taskforce 2016 • Mental Health and Work : • Only 43% of those with MH problems are in work, against 81% all adults. • For those supported by secondary MH services, there is a • 65% employment gap compared with the general population. • Of people with ‘mental and behavioural disorders’ supported by the Work Programme, only 9.5% have been supported into employment. • Employment is vital to health - should be recognised as a health outcome. • The NHS must play greater role in supporting people to find or keep jobs. • Access to psychological support must be expanded to reach at least 25% of all who need it. • There must be doubled access to Individual Placement and Support (IPS).

10. Young People with Mental Ill-health : Education and School-to-Work Transition • Childhood and adolescence. • Every second mental illness starts before age 14. • Sufferers from mental ill-health are more likely to leave school early, poorly educated and with greater difficulty in the labour market. • Education systems have a key role in identifying early and supporting children with MH issues and enabling transition into work. • Policy conclusions : • Develop MH competencies in teachers and authorities • Give sufferers timely access to co-ordinated support • Invest in prevention of early school leaving • Provide effective support for school-to-work transition .

11. Public Reporting of Wellbeing and Engagement • Since 2007 BiTC’sWorkwell Campaign has been researching trends in public reporting by FTSE 100 companies. • Key findings 2015 (the third annual cycle) : • Strongest reporting areas remain Health and Safety and Diversity and Inclusion, reflecting legal needs. • Companies reporting an Employee Assistance Programme increased, recognising importance of supporting mental health. FTSE 100 public reporting employee engagement and wellbeing • Otherwise little change in scores – progress erratic and slow. • “ There are signs of improvement, but clearly still work to be done to create a stronger flow towards enhanced public reporting.”

12. NICE Guideline June 2015 Workplace policy and management practices to improve health and wellbeing of employees. Recommendations focussed on organisational culture and line managers. Aims : • promote leadership supportive of H&WB • help line managers achieve this • explore positive/negative effects of organisational culture • provide a business case and economic modelling for strengthening role of line managers.

13. NICE Guideline 2015: Organisational commitment • Make H&WB a core priority for top management • Value the strategic importance/benefits of healthy workplaces • Encourage consistent, positive approach to H&WB for all. • All with remit for workplace health should address issues of : • physical work environment • mental wellbeing at work • fairness, justice, participation, and trust • senior leadership • line managers’ role, leadership style, and training • job design.

14. NICE Guideline 2015 : Further Key Factors • Senior leadership • provide consistent leadership from the top, ensuring positive approach to H&WB, and policy implementation • in everyday running, as well as reviews of management performance and organisation’s objectives. • Line managers • recognise and support their key role • use as 2-way communication, to encourage staff motivation • seek their views on morale, staffing, and HR issues This endorses previous views.

15. Changing nature of office work More personal accountability – staff now assessed on measured outcomes (see diagram). Senior managers less keen to adopt change in workplaces - their personal history. Growing evidence – downsides of technology hamper its delivery of improved productivity. Quora survey 2015 Interruptions caused by technology (emails, texts, skype) now occupy 28% of the working day. Employees feel 40% more pressurised. Meetings with phones, laptops etc lose creativity, criticality and results. Such interruptions occur far less where co-workers sit together. Over half respondents felt workplace layout hindered productivity.

16. Physical inactivity at work • British Heart Foundation research 2015: • “sedentary work is killing people by discouraging exercise” • they correspond by email even when sitting at next desk • 52% regularly eat lunch at their desk • 31% sit so long they even put off going to the toilet • 78% of office workers feel they sit too long at work • 62% fear that this could impact health negatively • 66% say less active at work than at home • Should we not build in need for more mobility around the building, rather than ever greater densification ?

17. Obesity : the costs for businesses • McKinsey Global Institute (Nov.2014) : obesity generates a UK economic loss of £47 bn per year. Total economic impact on UK employers is around £5 bn annually, much due to decreased productivity. • IHPM : “Employers used to see obesity as just a personal problem, but that is changing. Prevention is always better than cure, and employers should continue to focus on that.” • NICE states: “On average obese people take four extra sick days per year.” • Health and Safety Executive (2013): Employers might be expected to take responsibility for encouraging or assisting staff to reduce or avoid obesity, and may need to take special account of obese workers in job design and risk assessments.

18. London Underground: data on Body Mass index and sickness absence • Study by Kings College and Kings College Hospital • Lead researcher Dr Samuel Harvey • Published in 2010 Occupational Medicine August 2010 Volume 60 Issue 5: pp362-368. S.B. Harvey et al. Obesity and sickness absence: results from the CHAP study. • Data on more than 9000 operational staff (all operational staff employed between 1st April 2005 and 31st March 2007) was analysed, matching Body Mass Index information against sickness absence • Information about individuals’ medical diagnoses was also available. Courtesy Dr Olivia Carlton

19. BMI and sickness absence • Positive linear trend (p<0.001) • No evidence of gender interaction (p=0.23) • Overweight employees have more short- and long-term sickness absence Workers typically had per annum : - 6 days sick leave if of healthy weight, - 9 days if obese, and 11 days if very obese. Increased long-term sickness absence in obese employees appears to be due to obesity-related medical disorders.

20. UK Case Study : National Grid • Over 10,000 workers, maintaining gas and electricity networks. • Targeted health screening programmes: • Are engineers fit enough for their work ? – wearing breathing apparatus, digging holes, climbing towers. • More broadly, health checks – weight, blood pressure and glucose, cardiac risk – enable risks to be identified and targeted. • Data shows rising proportion of workers screened have BMI over 30, up from 22% in 2013, through 27% in 2014, to 35% in 2015. • Diet and lifestyle advice was instituted, and proportion with high blood glucose has dropped from 20% in 2013 to 12% in 2015. • 2016 surveillance will test physical fitness and encourage exercise. • A business case for the health-promotion campaign has been made. • Courtesy Andy Buxton

21. Railways : costs of impaired health • £320m pa - the estimated cost of direct and indirect sickness • £480m pa- the estimated costs of presenteeism • For every £13 lost to sickness absence, £1 is spent on supporting their health • 3.9% - the approximate Lost Time Rate (LTR) across the rail sector

22. Top 5 health-related risks RSSB • Common Mental Health problems • - high sickness absence, impaired performance • Musculo-skeletal problems - effect as above • Diabetes and other endocrine problems - increasing safety risk • Heart and circulation problems - sickness absence, safety risk • Sleep disorders, apnoea - emerging issue, safety risk - limited awareness Items 3 to 5 may be obesity-related

23. Progress in different sectors NHS Fire Service Each sector defining its own needs. Construction The City (Mental Health Alliance) Police Service

24. The NHS Workforce • Simon Stevens said in his inaugural address on 2 April 2014 : “If like me you believe in a tax-funded NHS you’ll want the Health Service to play its part in growing our nation’s economy, precisely so that we can sustain public health services for generations to come.” “To do this, NHS employees will need to be healthy, both mentally and physically, have good well-being, and be fully engaged in their work towards improved outcomes for patients.”

25. NHS Five Year Forward View October 2014 • A healthier NHS workplace for its 1.3 m staff • The NHS could reduce its sickness rate by a third – equivalent to adding 15,000 staff or a cost saving of £0.5 bn. • Proposals by Simon Stevens, develop an ‘offer’ for NHS staff, e.g. : • - cut unhealthy food, and provide healthy options at night • - implement NICE guidance on workplaces, especially for mental health • - promote initiatives that seem to work e.g. the Workplace Wellbeing Charter and Global Corporate Challenge, • - measure staff health and wellbeing • - strengthen OH with the Faculty of Occupational Medicine.

26. Initial activity – working with 15 Trusts What is being done : • Most Trusts consulted Staff • Many initiatives – but evaluation scanty, so hard to prioritise • CEO involvement rarely mentioned (some exceptions) • Little discussion of Board-level involvement • Little direct focus on line-manager training • Most offer healthy food choices, fitness classes etc • Participation patchy • Most Trusts target Mental Health and MSDs • Incentives: little evidence of use • Evaluation, mostly of secondary effects (e.g. long-term absence, staff turnover etc).

27. West Midlands Ambulance Trust • Health offer : • - covers both mental and physical health • - emphasis on resilience, positive MH, physical activity • - weight management programme. • Cost : £368k in 2014-15 • Participation : • - all levels of staff, impression but not measured • - Board and Chairman engaged • Promotion – Yes, Incentivisation – No. • Evaluation : • - sickness absence, and cost to Trust • - endeavouring to quantify each initiative. • Outcome : • - % sickness absence 2014-5, WMAS 5.1, all amb 6.5.

28. Ambulance Trusts : sickness absence Coloured bars represent other Ambulance Trusts

29. NHS Staff health at work • Ten NHS organisations, with 55,000 staff, will lead implementation, committing to six key actions, providing: • Board-level director lead, and senior clinician champion • training on staff health for all line managers. • health checks for staff aged 40 or over • staff access to physiotherapy and MH talking therapies • healthy options in food sources on site • physical activity - yoga, competitive sport, Cycle to Work • full implementation of NICE guidelines on workplace health and Workplace Wellbeing Charter. • Project started December 2015.

30. How productive is your workplace ? Bank of England 2014: Several possible factors restraining UK productivity growth, not least working conditions and work styles. OECD 2014 : UK GDP per head is 17% lower than a decade earlier. Factors cited : nature of work is changing, but working environments are not keeping up. Definition of what a workplace is needs significant revision. Think FM conference 2015 : Productivity gains hampered as we just ‘take old business models and digitize them.’

31. Remember too – the world of work is changing • The industrial landscape is changing • A knowledge-based economy has emerged • Digitalisation of the labour market. • Globalisation of labour markets has reshaped the workforce. • Female employment is projected to continue increasing, reaching 47.5 % of the total in 2020. • By 2035 the number of over-65s is expected to almost double. • Life-long learning, changes in career direction, skill mismatch Mental ill-health is increasing.

32. Government Fit for Work Service 2015 A voluntary service developed from the Black-Frost Review 2011 … to empower employees and employers to take control and help people back to work through advice, consultation and assessment. • When fully operational a GP, or after 4 weeks an employer, can refer an individual to dedicated support where Health Professional (HP) case managers will create a return to work plan. • A biopsychosocial assessment, covering medical and non- medical issues, will take place within two working days of referral. • Primarily a telephone service. Face-to-face limited to those for whom telephone is not suitable (assessment then within 5 days). • an advice line and web portal is also provided.

33. New Development 2016 : Cross- Government Work and Health Unit Departments of Health and of Work and Pensions have set up a new collaborative Unit, with many partners : • Department of Business and Skills (input re industry and training) • HM Treasury (input re investment and cost/benefit) • Department of Communities and Local Government (local factors) • NHS England and Public Health England (healthcare expertise) • Cabinet Office ( input on policy, data-sharing) • Other Government departments (Scotland, Wales, Health and Safety) • External Input (Employers/Industry; Academics; Voluntary bodies)

34. What I have learnt • The work I’ve done since 2006 tells me that the things that matter are: • Understanding that good work is good for your health • Early intervention - crucial • Informed, pro-active healthcare professionals • Employers who create ‘good work’ and good workplaces • Interventions that are ‘best practice’ based • Employees empowered to take care of their own health • Vocational Rehabilitation – anything that keeps you in work, or gets you back to it. • Cross-government and cross-agency collaboration • Research – as yet we are evidence-light.