Health – How long to sing this song?

Hard economic times mean employers remain under increasing pressure to cut costs and restructure businesses. Julie Riggs considers recent government policy and asks whether the safety and health community could bring more to the table by helping improve the health of workers and deliver the related business benefits and efficiencies, which — for many years, now — it has been argued are achievable.

Two years ago, a survey by the Confederation of British Industry (CBI) found that 190 million working days are lost annually through sickness absence — at a cost of £17bn to the economy — with 30.4 million days classified as “non-genuine” sickness.¹

While we might be forgiven for expecting sickness absence to increase in the current climate, alongside longer working hours and increased work demands, we have actually seen the opposite. In the last ten years, some of the lowest figures for sickness absence have been recorded, with the Chartered Institute of Personnel and Development reporting a drop from 7.7 days reported in 2011 to 6.8 last year.²

Concern is growing, however, that the downward trend could, in part, be explained by a rise in employees attending work when unwell, with anxiety about their job security often cited as a common reason.³

Moreover, ill-health concerns around presenteeism are more than just an immediate concern for employers; they also need to contend with the prospect that the burden of chronic illness among the working-age population could deepen over the next 30 years.4 The UK, it could be argued, is not only facing economic problems but a long-term health crisis.

Mixed messages

In 2011, a Government-commissioned review on health at work made several proposals to improve the health and well-being of the working-age population, including incentive schemes, and supporting businesses with access to occupational health.⁵

Although the report was generally well-received, criticism has been growing and is aimed, in particular, at the lack of training for GPs on how to use the fit note, along with concerns that the Government’s proposed health and work assessment and advisory service, due to launch next year, could supplant the role of existing employer-based occupational-health services.

The role and influence of the HSE in the Government’s health and work agenda is also far from satisfactory. By portraying the HSE as an obstacle to business growth, the Government has repeatedly failed to recognise the relationship between the HSE, employers, trades unions and safety and health practitioners and their representatives.

Via its associations with key organisations, such as IOSH and BOHS, the HSE is well-positioned to help drive change in public-health matters and support individuals back to work, but the negative perception of the regulator prevents it from adopting an active role in such matters.

Rather than reducing the HSE’s involvement in health, the Government should be considering how to give it a bigger role. Research suggesting a potential 88 per cent of GPs are spending a quarter of their time dealing with minor medical issues that do not need to be seen by either a nurse or GP illustrates the gap that the HSE could fill in assisting organisations to manage health on a more strategic level.6 Such an approach could also provide evidence for cost-modelling of health-investment initiatives and encourage cross-fertilisation of ideas and research.

The role of practitioners

We now appreciate that health is ultimately more complex than implementing early-intervention methods and tax initiatives. Poor health is entwined with such factors as insufficient pay, repetitive work tasks, incompetent management, long hours, lack of training, and so forth. Good work culture can help reduce absence and ill health, so it would seem logical to enlist the health and safety community to use its skills in recognising and quantifying risks to determine how best to manage them.

Many employers now recognise the importance of delivering beyond their typical stress-management programmes and embracing proactive management of broader mental health. To this end, many employers are providing external occupational-health support by offering counselling through employee assistance programmes (EAPs).  The importance of this type of support can be illustrated by a comparison of response times — while EAP services can often be accessed on the same day as the initial referral, it can take an average of 78 days from referral to the first treatment session, if care is accessed through a GP.7

Practitioners, too, continue to throw their weight behind myriad health promotions, many of which focus on diet, exercises and lifestyle choices, such as drinking and smoking, and offer support via mental-health resources.

However, too great a focus on health and well-being initiatives of this nature can give the impression that employers have too ‘soft’ an approach to the issue. This is not to say that such programmes do not offer value in addressing public-health issues but there is a greater need to re-think the drivers of promoting health as a cost-effective business imperative. Consideration of a full health panacea — from recruitment, retention and rehabilitation, through to healthy and thriving — is required.

Recruitment

Brand the health and well-being of your organisation to attract talent. Are you an employer of choice? Do you participate in national health promotions? Do you promote non-pay aspects of the company, such as health-related benefits and facilities on site? Do you create a pleasant working environment?

On appointing a new employee, conduct health screening to understand the individual’s medical capability to do the job, assess any reasonable adjustments, and provide a base reading for any further screening. Lifestyle questionnaires (diet, smoking, exercise, sleeping) and screening (blood pressure, cholesterol checks, previous medical history, existing conditions) can also be used to increase awareness of health. Such data, when anonymised, can assist with designing targeted health promotions.
Provide information for employees during induction on the company’s commitment to health and define the expectations of individuals to participate in this commitment.
 
Retention

Introduce procedures to encourage prompt reporting of any symptoms, or changes in conditions early — before they become an absence. Consider the use of body-mapping questionnaires and risk-assess activities that can impact on health.

Provide training for employees on how to support employees with long-term health conditions; how to make reasonable adjustments; or how to support individuals with depression. Consider health-providers on site — alternative therapists often offer treatments for employees at reduced rates, at no cost to the employer.
Introduce a range of mental and physical well-being programmes suited to your workforce. Also, consider the culture of your organisation — for example, where the boundaries of work and life balance lie.
 
Rehabilitation

Effective rehabilitation should be delivered through a case coordinator, whose role it should be to ensure appropriate adjustments and support are provided for those returning to work. This role can be complex, as it involves evaluation both of the medical needs of an individual and the practicalities of phased returns to work. But there is no reason an OSH practitioner, HR professional, or line manager cannot carry out this role, providing they are given information and support from appropriate professional advisors — e.g. occupational-health providers, GPs, etc;

Maintain contact with employees during their absence and have clear guidelines on timescales and expectations for when they might be able to return to work. Always conduct back-to-work interviews and conduct reviews regularly during rehabilitation to measure progress and monitor adjustments. Be flexible, as the individual may need access to medical services, or feel excessively tired during this initial period.

Short-term activities

With the aim of realising some quick wins (see panel), there are many initiatives that practitioners can introduce to help raise awareness of health issues within their business. But, regardless of your chosen campaign, you should do the following:

• consult employees to ensure engagement with any health promotions, with the ultimate aim of building a community that drives health and well-being initiatives;
• tailor your programme to your organisation, ensuring you encourage participation in a variety of ways — for example, not all employees wish to have their blood pressure taken;
• ensure leaders commit to the programme — not simply by providing the necessary resources but by being visible and actively demonstrating their involvement; and
• evaluate the programme’s return on investment — e.g. how many people changed their eating habits, or gave up smoking after the campaign?

Long-term roadmap

The NHS has identified five elements to address in creating a ‘pathway of change’ in its workplaces, including evidence-based improvement plans; strong, visible leadership; improving managers’ capabilities; access to OH services; and encouraging staff to take ownership of their health. The same principles can be applied in many other work environments, so consider the following:

Board vision

• Craft a clear vision statement, with roles and responsibilities defined, to incorporate health into the Board’s activities;  
• appoint a Board sponsor to ensure consistent visibility;
• articulate a broader perspective of health and well-being and how it will advance your organisation’s core strategy; and
• introduce health metrics within your organisation’s performance data.

Health and well-being strategy and policy

• Develop a health and well-being strategy and corresponding action plan to set direction, maintain momentum and hold individuals to account for delivery; and
• Consider linking the strategy to existing mission, values and objectives.

Health metrics and reporting

To manage occupational health effectively, a system for measuring proactive health metrics and reactive data, including absence, will assist in targeting specific action for continual improvement.  

Health indicators may include: mental well-being; smoking and drinking habits; weight management/BMI; exercise routines; length of hours worked/holiday patterns; body mapping; absence data and trends; and occupational-health surveillance.

Care pathways

Care pathways are coordinated multi-disciplinary care services. A proactive care-pathway service and a supportive working environment play an important part in preventing work-related ill health and in proactively managing common health problems, in order to help employees remain in work. In respect of care pathways, practitioners should:

• evaluate the current provisions and services according to the risks identified in the business, investing in specific and proactive health-care arrangements;
• identify risk factors and trends, and provide a strategic approach to developing flexible solutions for employees to manage their work-life balance;
• ensure the care pathways cover recruitment, retention and rehabilitation;
• identify and collate necessary data and outcome measures required to monitor and evaluate the delivery and impact of projects and intervention measures;
• consider practical interventions, such as workplace adjustments to tasks, or working hours, as these can make all the difference when identified at an early stage;
• review the occupational health and EAP service-provision to ensure the services are tailored to the needs of the business and those using them; and
• use data from a variety of sources as intelligence to plan interventions.

Competencies

• Conduct a gap analysis to identify competencies of key stakeholders responsible for implementing the strategy and care pathway;
• Develop values and expectations for leaders to engage with the strategy; and
• rovide clear guidance and responsibilities for managers to implement occupational health-care management and rehabilitation.

Staff engagement

• Integrate health and well-being into departments/managers’ strategies to ensure a collective approach to self-management;
• Assess employees’ needs via a range of methods (surveys, counselling reports, etc) and involve employees and their representatives in planning and delivery of health and well-being programmes;
• Develop a cross-function working party to discuss key issues in the organisation; and
• Enlist champions/health advocates for behavioural health.

Conclusion

The roles of practitioners and governing bodies are pivotal to influencing positively the health of workers and the public, through the prevention of ill health, early interventions, dynamic care pathways and instilling vibrant visions and strategies that make a difference. So, as you put down your working lunch and dust off the crumbs from your keyboard, consider your role in contributing to the development of a healthier Britain.

References
1    CBI (2012): ‘Healthy returns? Absence and workplace health survey 2011’ — www.cbi.org.uk/media/955604/2011.05-healthy_returns_-_absence_and_
workplace_health_survey_2011.pdf
2    CIPD (2012): ‘Sickness absence falls by nearly a day, annual survey reveals’ — www.cipd.co.uk/pm/peoplemanagement/b/weblog/archive/2013/01/29/sickness-absence-falls-by-nearly-a-day-annual-survey-reveals-2012-10.aspx
3    Personnel Today (2008): ‘Occupational health feels effects of economic downturn’ — www.personneltoday.com/articles/17/10/2008/48033/occupational-health-feels-effects-of-economic-downturn.htm
4    Vaughan-Jones H and Barham L, (2009): ‘Healthy work: Challenges and opportunities to 2030’, London: Bupa
5    Black, C and Frost, D (2011): ‘Health at work — an independent review of sickness absence’, DWP — https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/181060/health-at-work.pdf
6    Aviva Health (2011): ‘Doctors orders in a changing environment. The tenth health of the nation index’ — www.aviva.co.uk/healthcarezone/document-library/files/ge/gen4190.pdf
7    Trusler, K, Doherty, C, Mullin, T, Grant, S and McBride, J (2006): ‘Waiting times for primary-care psychological therapy and counselling services’ in Counselling and Psychotherapy Research, volume 6, issue 1, pp 23-32
8    NHS Workplace Charter http://wellbeingcharter.org.uk
9    DWP Well-being calculator — www.dwp.gov.uk/health-work-and-well-being/our-work/workplace-well-being-tool/

Julie Riggs MSc CMIOSH has worked in the health and safety profession for the past 20 years.

What makes us susceptible to burnout?

In this episode  of the Safety & Health Podcast, ‘Burnout, stress and being human’, Heather Beach is joined by Stacy Thomson to discuss burnout, perfectionism and how to deal with burnout as an individual, as management and as an organisation.

We provide an insight on how to tackle burnout and why mental health is such a taboo subject, particularly in the workplace.

Listen now!