1. South East Regional Public Health Group Information Series 3 Employment and Health: Enhancing Quality of Life and Sustainable Growth Why it’s Important Enhancing quality of life and productivity are essential components for developing sustainable growth as highlighted by the South East Regional Economic Strategy. In order to ensure these aims are achieved, the role health plays in employment needs to be addressed. There are two key strands to this approach:  Creating well-being and health in the workplace  Increasing employment levels of socially excluded populations Promoting well-being in the work place is important because a persons workplace has major impacts on the health and well-being of that person AND because ill-health or stress in the workplace can lead to a reduction in efficiency and productivity, leading in some cases to sickness, absence and job loss. This relatively neglected area of improving health in employment has a huge impact upon the economy and is important for the following reasons:  Because you can improve productivity, performance, morale, commitment, efficiency and sustainability by creating a healthy workplace.  Promoting well-being at work can improve an organisation’s external image and reputation of being a socially responsible and quality employer, with the message to the outside world that the company ‘looks after the employee and looks after the product/ service’  In the UK, an estimated £77 billion pounds is lost to the economy through people with stress related and mental health problems being unable to work. (Mental Health and Social Exclusion’).  On the basis of the old (pre-October 2006) PCT areas, sickness absence directly costs each Trust around £4 million a year; agency staff account for 4.2 per cent of Trust staffing costs, or £2.3 million per old PCT  Sickness absence rates in the health and social care sectors are the highest of all sectors at 4.8 per cent (the UK average is 3.4 per cent), and the estimated cost to the UK economy is £4 billion per year  There is a 50 per cent excess of mental ill-health in the NHS workforce when compared to equivalent working populations  NHS staff turnover stands at 14.5 per cent a year, with the average recruitment cost for new staff at over £4,600 per employee. Vision Maximise health to maximise productivity, enhance quality of life and sustainable growth, by increasing wider social inclusion in employment and creating well-being in the workplace. Audience Those interested in economic development, employers associations, human resources and occupational health in the private and public sector including local authorities and health trusts, and those promoting social inclusion, independence and supporting people on incapacity benefit back into work. PROTOTYPE – JANUARY 2008 This information series has been compiled by the Regional Public Health Group based in the Government Office of the South East. They aim to summarise key public health issues based upon evidence, in order to facilitate good practice and improve health at local and regional levels. They are NOT policy documents.

2.  Sickness absence costs UK employers around £12.2 billion each year- of which the SE has the highest sickness absence rates in the whole country, reducing efficiency, productivity and competitiveness.  Stress-related conditions and musculoskeletal disorders are now the most common reported cause of absence from the work place.  Alcohol misuse in this country accounts for £6.4 billion pounds in lost productivity through absenteeism, unemployment and death.  Employers have a statutory responsibility to make ‘reasonable adjustments’ to employees who have a health condition and/or disability under the (Disability Discrimination Act. DDA)  Being in employment acts as a protective factor for mental and physical health, empowers individuals and reduces poverty, inequalities and social exclusion.  As with the rest of the country, the South East is predicted to have an increasingly ageing population, with a reduction in the ratio of workers to people of “retirement age”. Workplaces need to start adapting themselves for an older workforce, where promoting well-being will be key to maximising benefits from this experienced and skilled work population. Current Situation South East Incapacity Benefit Hotspots Map showing rates of Incapacity Benefit and Severe Disablement Allowance claims by Middle Super Output area in the South East, 2005.© Crown copyright. All rights reserved SEPHO. License number 100039906, 2006.Source: Neighbourhood Online Statistics (Office of National Statistics).

3. The Inter-Relationship of Health and Employment:  Perceived poor job satisfaction for example, Low control and low reward for high effort in ones job significantly increases the risk of heart disease, even after accounting for other risk factors.  The number of days taken off sick due to mental ill health has increased 20% since the 1970s. Stress related absences account for half of all sickness and cost about £4 billion/year.  Only 21% of people with long-term mental illness are employed – the lowest of any disabled group. Being in employment helps protect peoples mental well-being, this is a missed opportunity for increasing overall social well-being and costs the economy £23 billion/year.  Stress also contributes to physical health problems, including musculo-skeletal problems, alcohol and drug misuse, smoking and heart-disease.  An ageing and increasingly overweight workforce will need more input from employers to reduce sickness, maintain and improve good health. The figure below illustrates that being depressed or having anxiety is especially associated with being economically inactive amongst men. Whilst employed men are less likely to have a neurotic disorder. A similar pattern is seen in women, though to a lesser degree. However, here is no statistical difference in the rate of having anxiety or depression with educational status or social class. The proportion of males and females with anxiety or depressive disorders vs no disorder and employment status, England 2000, ONS. Sickness Absence Rates Winter 2005 (percent region of residence) Percentages relate to the proportion of employees who were absent from work for at least one day in the reference week United Kingdom2.7 North East1.9 Wales2.4 West Midlands3.0 North West2.2 East Midlands2.8 York and Humberside2.8 East3.2 London3.2 South West2.6 Scotland2.3 South East3.3

4. Predicted demographic changes showing a greater increase in numbers of older people compared to younger age groups between 2006-2027, SE England Factors in the workplace that impact negatively upon health and well-being: Management Style and Work Culture Factors influenced by organisational Environment: Associated with increased mental and physical health problems. Stress related absence costs economy £4bn  High demand/low control  Long hours  Bullying and harassment  Poor effort /reward ratio  Lack of organisational justice  Job insecurity  Social support at work  Smoking- Heart disease, strokes, cancers, respiratory disease- costing regional economy £1.8bn.  Obesity- increasing trends causing heart disease, cancers, diabetes, musculo-skeletal disorders; currently cost economy £8 bn, worsened by obesogenic work environments encouraging unhealthy eating and lack of activity.  Activity- lack of physical activity on the journey to work and during work contribute to obesity levels, heart disease and stress cost economy £8 bn.  Alcohol and drugs- used socially and in response to stress, increases accidental and intentional injuries, physical and mental health problems, costing the economy £6.4 bn.  Injuries – work related injuries, including musculo-skeletal disorders are influenced by the work environment, work place policies and adherence to Health and Safety regulations  Flexible work hours and child poverty- Child unfriendly work policies have an impact on child health, especially by acting as a barrier to employment for lone parents.

5. The diagram below illustrates the interaction between the two strands of employment and health – creating well-being in the workplace and increasing employment for socially excluded groups. What Works, Ways Forward and Resources Promoting General Health in the Workplace Creating a Healthy Workplace: A Guide for Occupational Safety and Health Professionals and Employers’ Faculty of Public Health and Faculty of Occupational Health, 2006. www.fph.org.uk and www.facoccmed.ac.ukwww.fph.org.ukwww.facoccmed.ac.uk Sign Up: Improving Health is everyone’s business A joint Department of Health and HSE newsletter aimed at the business sectorwww.signupweb.netwww.signupweb.net

6. Mental Health in the Workplace Tackling stress: The Management Standards approach The Health and Safety Executive leaflet that contains notes on good practice which are not compulsory but which you may find helpful in considering what you need to do. www.hse.gov.ukwww.hse.gov.uk Shift - Line Managers web resource: A line manager’s guide to reasonable adjustments for people with mental health problems. http://shift.org.uk/~employers/line-managers-resource.html Leading by Example A guide to making the NHS an exemplar employer of people with mental health problems. Sainsbury centre for mental health website: www.scmh.org.ukwww.scmh.org.uk The Mindful Employer is a collaboration of employers who’ve signed up to promoting mental well being and work place fitness for Mental Health Service Users. Sainsbury Centre: www.scmh.org.uk and www.mindfulemployer.netwww.scmh.org.ukwww.mindfulemployer.net Employers Forum on disability: A practical guide to adjustments for people with mental health problems A series of briefing papers published by the Employers Forum on Disability providing practical guidance on specific subjects relating to the employment of disabled people, including ‘Realising Potential- the Business Case’ for employers to employ people with disabilities. www.employers-forum.co.uk Supporting people back into work Pathways to Work – to start in SE in 2008 In 2002, the Government announced plans to provide “a new framework of help for those who through illness or disability have applied for incapacity benefit” to help get them back into work. The proposals are set out in “Pathways to work: helping people into Employment” www.dwp.gov.uk Since then, several areas have piloted the scheme, examples can be found on www.scmh.org.ukwww.dwp.gov.ukwww.scmh.org.uk Improving Access to Psychological Therapies (IAPT) Significant additional funding (£173m) has been identified to improve access to evidence based psychological therapies over the next three years. The new money will establish psychological therapies services in around half of all PCT areas from 2008-11 and ensure plans are in place to extend this across the country. The increased availability of psychological therapies will make a significant contribution to enabling people with mental health problems stay in or return to employment (estimated 25,000 fewer people with mental health problems on sick pay and benefits nationally) and be delivered in conjunction with the national roll-out of the DWP Pathways to Work Condition Management Programme. More information on the programme can be found at www.mhchoice.csip.org.ukwww.mhchoice.csip.org.uk and www.southeast.csip.org.uk/iapt.www.southeast.csip.org.uk/iapt Workplace Health Connect For more information on Workplace Health Connect, the organisation providing the regional ‘pathfinder’ service and details of the areas covered.www.hse.gov.uk/workplacehealth/ The new Workplace Health Connect newsletter is available at:www.hse.gov.uk/workplacehealth/ http://www.scmh.org.uk/80256FBD004F6342/vWeb/wpKHAL6N4F9G

7. Opportunities to improve health through employment  The Economic Development Agency and Regional Assembly should focus on the close inter- relationship between employment and health within the Regional Economic Strategy in order to maximise productivity, quality of life and sustainability.  Local Strategic Partnerships (LSPs) Local Chambers of Commerce and Local Area Agreements (LAAs) are opportunities to raise awareness of the importance of close inter-relationship between employment and health and develop local alliances to share good practice.  LEGI- Local Enterprise Growth Initiative, for economic development and regeneration.  Health Trainers- providing support and advice to self-manage long-term health conditions to enable individuals to get back into work; alternatively health trainers could be used to promote healthy workplaces.  Access to Psychological Therapies- pilots are being established in Portsmouth and Hastings, two areas with high rates of incapacity benefit take up. More information on the programme and further roll out, can be found at www.mhchoice.csip.org.uk and www.southeast.csip.org.uk/iapt.www.mhchoice.csip.org.ukwww.southeast.csip.org.uk/iapt Networks and Alliances National Employment and Health Innovations Network This national network is funded by the Department of Work and Pensions and is supported by the Department of Health, the Welsh assembly Government and the Scottish executive. It brings together innovative practitioners, researchers and policy makers in an informal setting to develop ideas, good practice and an evidence base for the future. Register for future events at: www.scmh.org.ukwww.scmh.org.uk Corporate Alliance Against Domestic Violence An alliance of employers who aim to raise awareness of and taking action to reduce the human and economic impact of domestic violence in the workplace, for example by ensuring there are work place policies for supporting victims of domestic violence. www.corporateallianceuk.comwww.corporateallianceuk.com Business in the Community Business in the community is a network that aims to engage and support business in continually improving its positive impact on society. www.bitc.org.ukwww.bitc.org.uk South East Regional Employment Partnership As a response to the Cabinet Office action plan on social exclusion (Reaching Out), all the regions in England have been asked to form regional partnerships made up of key organisations, and to develop a statement of priorities and an action plan which will result in improved employment outcomes for people who experience mental illness. For more information about the partnership, please contact: Stephany Carolan, Programme Lead (Employment) SE Development Centre / Care Services Improvement Partnership stephany.carolan@csip.org.ukstephany.carolan@csip.org.uk

8. Case Study: Creating Bridges - a Service User Employment Project for the Kent and Medway NHS Social Care and Partnership Trust, Mental health Trust. Since May 2003, Creating Bridges has supported people with long enduring mental health issues with work experience placements within the Trust. Placements include kitchens, portering, administration, reception, finance, auditing, health care assistant on in-patient settings, support workers in community settings and within the Crisis Resolution at Home Team. These placements provide recent work experience and references for an individual’s CV, as well as increasing confidence, skills and motivation. The Trust is also part of the Mindful Employers Initiative: The Trust has ratified a Mental Health in the Workplace Statement that’s included in Recruitment documents, setting out the Trust’s commitment and duties to people with mental health issues whilst in employment;  Advertisements declaring that ‘The Trust welcomes people who have experienced mental health issues to apply for the post;  Recruitment packs which contain a statement of the Trust’s commitment to being a ‘mindful employer’, and details of the Creating Bridges Project are provided if any support is needed during recruitment or whilst in the post. Creating Bridges has facilitated the development of a network of 66 local businesses who have signed up to the Mindful Employer initiative, and provides businesses with information on:  Employers’ responsibilities regarding the Disability Discrimination Act;  Information on mindful recruitment and retention;  What support to give if someone has a mental health crisis;  Information on benefits to the business, by stimulating creativity and diversity, recruiting people with a wide range of life skills and experiences, and increasing retention rates. Creating Bridges plans to develop a GP vocational advisors service, whose role would be to mediate between employers and patients, aiding overall recovery and supporting return to work. For further details, please contact: Lynn Jackson, Service User Employment Project Manager, Kent and Medway NHS Social Care and Partnership Trust: Lynn.Marchant@ekentmht.nhs.uk

9. ‘Healthy Workplace Code’ Workplaces to adopt a senior staff member to ensure implementation of the Healthy Workplace Code 1.Adopt a smoke free policy: -Offering smoking cessation support to staff -Offering smoking cessation support for clients/ patients 2.Ensure Healthy Nutrition options are the primary choice provided: -For staff canteens and vending machines -For clients/ patients and meetings 3.Promote Physical Activity travelling to and at the workplace: -Adopt Travel Plans that promote active transport -Encourage and incorporate physical activity into the daily routine 4.Develop a Substance Misuse Policy: - Provide brief interventions or refer for support - Ensure no alcohol or drugs are allowed in the workplace 5. Promote Mental Well-Being: -Implement the HSE managing stress standards including: Appropriate work demand; promote control of work; supportive management; build positive relationships; ensure clear roles; manage change. -Improve access to psychological therapies for those with stress, anxiety or depression 6. Adopt a Management and Work culture style that increases effectiveness at work and reduces stress: -Leadership regarding direction and purpose -Provide variety and opportunities to develop -Address bullying & harassment, support poor work & praise good work -Promote equality and diversity -Promote flexible work hour arrangements for all workers -To support flexible working arrangements especially for those with child and other caring arrangements 7. Reduce Injuries and promote Safety: -Implement lifting and handling policies & active rehabilitation for muscular strains -Implement Zero Tolerance to violence against staff -Ensure a Bullying, Harassment & Domestic Abuse Policy 8. Widen the remit of Occupational Health & Human Resources: -To actively promote well-being of its workforce -To assess and intervene early in sickness absence -To provide support on returning to work following sickness -To provide good pre-retirement advice and support

10. Priority Areas Identified in the SE Regional Health Strategy ObjectiveKey actionsDelivery Agents 1. Improve health in the workplace Promote the adoption of the Healthy Workplace Code or other recognised quality mark such as the Work Wise standard by NHS organisations, public, private, and community and voluntary sector employers South East Economic Development Agency (SEEDA), Health and Safety Executive, NHS Chief Executives, Local Authority Chief Executives, Chambers of Commerce, Environmental Health, Private and community and voluntary sector employers, Sport England, Occupational Health and Human Resources 2. Improve mental well- being in the workplace Increase the number of sites across the South East piloting ways of increasing access to psychological therapies Care Services Improvement Partnership (CSIP), SEEDA, Employers, Primary Care Trusts (PCTs), GPs and Primary Care, Mental Health Trusts Promote management styles and human resources practices that promote mental well being Mindful Employers, SEEDA, CSIP, Occupational Health and Human Resource leads, Chances for Change Big Lottery Fund Well Being Programme 3. Increase levels of physical activity both during work and on the journey to work Increase levels of active transport (cycling or walking) to work and during work Regional and County level transport leads, Employers Sport England, Regional Public Health Group Increase participation in physical activity and sport within the work environment Employers, Sport England, Local Authority Sport and Leisure Facilities, Regional Public Health Group 4. Improve education and skill levels of those not in employment and for those in employment and encourage community based interventions to help achieve work readiness Target high risk groups (teenage parents, those with mental health problems, disabilities, children in care, school excludees, young offenders, older workers) not in education, employment or training Connexions, Learning and Skills Council, Youth Offending Teams, Local Authorities Children’s Leads, Learning Disability Teams, SEEDA, CSIP Work to promote and support education, training and volunteering opportunities for those with long-term mental health problems as a potential stepping stone to employment Mental Health Trusts, CSIP, Learning and Skills Council Educational Establishments, Voluntary Community Sector, SEEDA Work to promote skills development in the workforce and increase the proportion of older people in employment in order to increase retention, flexibility and resilience Learning and Skills Council, Employers Organisations represented on the SE Older Workforce Action Group SEEDA, CSIP 5. Increase employment levels among socially excluded populations Increase the number of people returning to employment from incapacity benefit Job Centre Plus Local Authorities, Employers, CSIP, NHS Mental Health Trusts, SEEDA Promote flexible working patterns (eg use of information technology, flexible hours and working from home) to facilitate ease of work for parents, carers, previously excluded groups Employers, Learning and Skills Council Workwise, SEEDA, CSIP

11. Local Area Agreements National Indicators Most Relevant to improving Employment and Health Above Indicators are in The National Outcome and Indicator Set http://www.communities.gov.uk/publications/localgovernment/nationalindicator Children and Young People Indicators related to school achievement in general and specifically those that positively influence poor achievement for example: NI 50 Emotional health of children PSA 12 NI 86 Secondary schools judged as having good or outstanding standards of behaviour DCSF DSO NI 88 Number of Extended Schools DCSF DSO NI 90 Take up of 14-19 learning diplomas DCSF DSO NI 91 Participation of 17 year-olds in education or training DCSF DSO NI 105 The Special Educational Needs (SEN)/non-SEN gap – achieving 5 A*-C GCSE inc. English and Maths DCSF DSO NI 106 Young people from low income backgrounds progressing to higher education PSA 11 NI 108 Key Stage 4 attainment for Black and minority ethnic groups DCSF DSO NI 109 Number of Sure Start Children Centres DCSF DSO NI 112 Under 18 conception rate PSA 14 NI 114 Rate of permanent exclusions from school DCSF DSO NI 116 Proportion of children in poverty PSA 9 NI 117 16 to 18 year olds who are not in education, training or employment (NEET) PSA 14 NI 118 Take up of formal childcare by low-income working families DWP DSO Safer and Stronger Communities NI 6 Participation in regular volunteering CO DSO NI 7 Environment for a thriving third sector CO DSO NI 13 Migrants English language skills and knowledge HO DSO NI 45 Young offenders engagement in suitable education, employment or training MoJ DSO Adult health and wellbeing NI 130 Social Care clients receiving Self Directed Support (Direct Payments and Individual Budgets) DH DSO NI 136 People supported to live independently through social services (all ages) PSA 18 Tackling exclusion and promoting equality NI 141 Number of vulnerable people achieving independent living CLG DSO NI 144 Offenders under probation supervision in employment at the end of their order or licence PSA 16 NI 146 Adults with learning disabilities in employment PSA 16 NI 148 Care leavers in employment, education or training PSA 16 NI 150 Adults in contact with secondary mental health services in employment PSA 16 Local economy NI 151 Overall employment rate PSA 8 NI 152 Working age people on out of work benefits PSA 8 NI 153 Working age people claiming out of work benefits in the worst performing neighbourhoods DWP DSO NI 161 Learners achieving a Level 1 qualification in literacy PSA 2 NI 163 Working age population qualified to at least Level 2 or higher PSA 2 NI 173 People falling out of work and on to incapacity benefits DWP DSO NI 174 Skills gaps in the current workforce reported by employers DIUS DSO NI 176 Working age people with access to employment by public transport (and other specified modes) DfT DSO

12. Legislation The 1995 Disability Discrimination Act (DDA) (amended 2005), and Disability Public Sector Duty The DDA requires employers not to directly discriminate against disabled people, to make reasonable adjustments for disabled people, not to practice disability related discrimination, and to protect disabled people from harassment in the field of employment. http://www.drcgb.org/thelaw/thedda.asp Health and safety legislation: All employers have duties under the following: The Management of Health and Safety at Work Regulations (1999) to assess the risk of stress- related ill health arising from work activities. The Health and Safety at Work Act (1974) The Health and Safety Executive (HSE) expects employers to carry out a suitable and sufficient risk assessment for stress in their workplace, and to tackle any problems that are identified. The HSE Stress Management Standards were issued in 2004 to help this process. www.hse.gov.ukwww.hse.gov.uk The Welfare Reform Bill (due to be passed Autumn 2006) – see details of Green Paper- National Drivers There are a number of key drivers for making improvements that effect the health and well being of the work force. This is reflected in the Government’s strategy ‘Health, Work and Well-being’. This strategy encourages and supports employers in initiatives to improve the health and well-being of people of working age. ‘A new deal for welfare: Empowering people to work’ illustrates how, with the right support, most people who want to work can do so. There remains a wealth of skills available to employers of people currently in receipt of benefits. There are real opportunities here to make a real difference to people’s lives and boost the economy. Key National Drivers Choosing Health: Making healthy choices easier Public Health White Paper, 2004 http://www.dh.gov.ukhttp://www.dh.gov.uk Outlines three actions: Reducing barriers to work to improve health and reduce inequalities through employment Improve work conditions to reduce the causes of ill health related to work Promote the work environment as a source of better health Our Health, Our Care, Our Say- A new direction for community services, 2006 http://www.dh.gov.ukhttp://www.dh.gov.uk includes commitments to: help people with health problems and disabilities to remain in or return to work Improve access to Computerised Cognitive Behaviour Therapy

13. For further information please contact: Jo.Nurse@dh.gsi.gov.uk For additional copies of the Information Series please visit the SE Public Health Observatory Website http://www.sepho.org.uk/viewResource.aspx?id=10297http://www.sepho.org.uk/viewResource.aspx?id=10297 Key National Drivers A New Deal for Welfare - Empowering people to work 2006 (Green paper): http://www.dwp.gov.uk/aboutus/welfarereformhttp://www.dwp.gov.uk/aboutus/welfarereform aims to increase the employment rate of our working age population to 80% by: Reducing by 1 million the number of people on incapacity benefits Help 300,000 lone parents into work Increasing by 1 million the number of older workers Social Exclusion and Mental Health report, Social Exclusion Unit, ODPM, July 2004. In terms of the employment agenda, the programme is undertaking several pieces of work: Employer engagement to share thinking and good practice on recruitment and retention of people with mental health problems; Working with Employers Forum on Disability to test employer facing tools for intermediaries; Working with a range of stakeholders to develop the mentally healthy workplace agenda; Working with the HSE on the development of workplace health connect. http://www.socialexclusion.gov.uk/downloaddoc.asp?id=134 http://www.socialexclusion.gov.uk/downloaddoc.asp?id=134 Health, Work and Well-being “Health, work and well-being - Caring for our future: A strategy for the health and well-being of working age people” DH, DWP and HSE, 2005, www.health-and-work.gov.ukwww.health-and-work.gov.uk aims to: Support people to remain in or return to work following an illness; Reduce the incidence of work related ill health; Maximise the potential work offers to promote good health. This diagram overleaf summarises the variety of components that contribute to well being in the workplace. Maximise productivity by enhancing organisational design, culture and management style to promote health and well-being in the workplace.