1. WorkTech 15 Conference Future of Work and the Workplace London, 17 November 2015 Dame Carol Black Expert Adviser on Health and Work Department of Health and Public Health England Principal, Newnham College Cambridge Healthy Visions

2. Work and Life span Society needs the maximum number of productive years from as many people as possible. Those not working depend on others. We need the ratio of earners and wealth-generators to dependants (children, pensioners, unemployed) to be as high as possible. Childhood Working life Retirement Being sufficiently healthy is a condition for work, and maximising healthy life as a proportion of total life is therefore a desirable goal for individuals and society. This needs to be a shared enterprise.

3. Healthy Visions: What is needed “In the UK, we need to compete on the quality of what we do – and that makes staff performance and productivity vital. And workplace health is essential to both of those key factors. ” Neil Carberry CBI director of employment & skills “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, … ” “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.” Simon Stevens Apr 2014

4. Health and wellbeing Good health, wellbeing and resilience are crucial in any workforce to secure engagement and enhanced productivity. Different sectors have different workforces and different products – but all employees respond in fairly similar ways to the presence or absence of ‘good work’ or a ‘good workplace’.

5. What prevents us from working - or from working well and feeling good ? Common mental health problems Musculo-skeletal problems The quality of work and the workplace - organisation of work - leadership and Board engagement - managerial behaviour Other important reasons - long-term conditions – some obesity-related - psychosocial/ home-related problems - lack of education and/or skills.

6. Mental Health and the Workplace Institutions and businesses need to recognise that : Mental health is a business issue The economic cost of failure is high The human cost can be far higher Managers need help to understand it, and be appropriately trained Most interventions are low key Poor leadership or management may contribute to ill-health.

7. Leaders and their influence After adjustment for age, sex, skill level, back pain severity and other potential confounders, the most consistent predictors of back pain were: empowering leadership at work (lowest OR 0.59; 99% Confidence Interval: 0.38-0.91) fair leadership at work (lowest OR 0.54; 99% CI: 0.34-0.87) decision control at work (lowest OR 0.68; 99% CI : 0.49 -0.95), Christensen JO, Knardahl S. 2012 Leadership is crucial to Health and Wellbeing.

8. 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.

9. The Power of the Workplace for Health and Productivity Improvement The potential for large-scale health impact: 31 million employees in the UK families of employees extend impact further 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 employer/employee relationships can sustain healthy behaviour infrastructure for measurement of health outcomes is often in place. A business case can be made.

10. 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.

11. Employees’ physical health Challenges from Britain’s Healthiest Company survey 2015 –20.7% 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.

12. Workplace health : BHC 2015 Over 15% of employees reported being bullied. 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. Best companies had 24% lower cost of lost productivity (sickness absence and presenteeism) than the worst-performing companies. Courtesy C van Stolk, Rand Europe

13. Good Work for All Stable and safe work - that is not precarious Individual control – part of decision making Work demands – quality and quantity Fair employment – earnings, security Flexible arrangements – where possible Opportunities – training, promotion, “growth” Promotes Health and WellBeing – mental/physical Prevents social isolation, discrimination & violence Shares information - participation in change Reintegrates sick or disabled wherever possible. (mixture of Marmot and The Work Foundation)

14. Control at Work : My train driver Baker Street station, London Early shift Bakerloo line Good things for the driver : This is my train – I’m in charge ! Shift work suits my life I know the Bakerloo line – I’m competent ! I don’t need extra variety, this work gives me enough. Good mates, good OH, reasonable pay.

15. Empowering Staff Long-term improvements in H&WB need individuals to act on their personal health issues Employers can support this. Example: The Walton Centre NHS Hospital : ‘ Work well ’ Implemented HWWB plan that staff helped to design Focused on key health issues where staff said help needed Considerable emphasis on physical activities Almost halved sickness absence rates from >7% to <4% in 18 months.

16. Prevent Health Inequalities at Work Marketing Site : Factory Site : Proportion of people with heart ages in different ranges above actual age – very different at the two sites, reflecting socio/economic gradient. 0 Heart Age above actual 0 + An online tool finds your estimated Heart Age from input of personal information on risk factors. Inequalities of health !

17. What is a good Workplace ? Key features common to those organisations which have improved health, well-being, resilience and engagement : Visible senior leadership Board-level or equivalent engagement Accountable trained managers Enabling engagement Attention to both mental and physical health improvements Evaluation to ensure continuous improvement

18. Managers’ Mental Health training Aims: Preserve life when in danger Provide help to prevent deterioration Promote recovery of good mental health Provide comfort to the distressed Skills: Recognition of mental health symptoms Provision of initial help Guidance towards appropriate professional help Outcome: –97% increased awareness and understanding –91% increased confidence –94% provided additional skills –90% helpful or very helpful in their managerial role –36% applied in 6 months after attendance Courtesy Dr Catherine Kilfedder

19. Engagement Matters RBS (formerly Royal Bank of Scotland) : Nailing the evidence – the link between Engagement, leadership and Business Performance. Studied over 370 anonymised business units (headcount >10) for any correlation between staff engagement, business results, leadership capability and customer service,) Courtesy Greig Aitken

20. Engage for Success – a movement : Four Enablers of Engagement Visible, empowering leadership providing a strong strategic narrative about the organisation. Engaging managers who - focus their people, give them scope - treat them as individuals - coach and stretch them. An employee voice throughout, for reinforcing and challenging views – employees are seen as central to the solutions. Organisational integrity – the values on the wall are reflected in day to day behaviour. Consider joining the movement. David Macleod, Nita Clarke

21. 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.

22. Augmenting organisational health Need to pay specific attention to……so that we can… Enhance the delivery of sustainable business performance Personal physical and psychological health Organisational integrity Leadership commitment to wellbeing BT : Addressing Health & Well-being holistically in a business context BT, formerly British Telecom Courtesy Paul Litchfield

24. Work : its value Work is generally good for your health Enabling people to be in productive work is a health issue Work provides income, material well-being and participation in today’s society Work meets important psychosocial needs in societies where employment is the norm Employment and socio-economic status are the main drivers of social gradients in health Work needs to be ‘good work’ Galen (129-200) “Employment is nature’s physician and is essential to human happiness.”

25. Key players in a shared agenda Good work Good workplaces Well workers Government Non-governmental bodies and NGOs Public Health professionals and organisations OH professionals Insurers Employers Employees Trade Unions Hospital practitioners General practitioners

26. Board Leadership : National Health Service England Board level involvement will make the difference Where NHS Boards live the values they want to achieve, staff will take those values seriously. A named board member responsible for H&WB and reviewing progress every 6 months will drive this agenda forward. Example: York Teaching Hospitals NHS FT Used board engagement to drive progress across the Trust Board visibly involved in events to promote better health and well- being, and communicated this to staff. Delivered sickness absence savings of £2.7m yearly, and 72% reduction in long-term absence.

27. Engagement and Disengagement Lack of motivation and sub-optimal health cause UK workers to work below peak productivity, holding back potential growth. ( Study of 5000 workers) Many people do not go ‘above and beyond’ at work, thinking it won’t be acknowledged or rewarded. Over a third of teams are experiencing extra stress and pressure due to staff ill health and absences. One in four staff admit they don’t want to win new business as it will only mean more work for them. Failure to unlock employees’ ‘discretionary effort’ cut a potential £6 billion – equivalent to 0.4 per cent of GDP – from the UK economy in 2012. What is the equivalent in Universities ? BUPA/Centre for Economics and Business Research, December 2013

28. Mental Ill-health Time to Change, survey of the UK public, October 2014 7% rise in willingness “to work with someone with a mental health problem” (69 to 76%) promoting health and wellbeing. OECD Report 2011 : Globally, employment opportunities for people with mental ill-health are low, many of those who are employed struggle in their jobs, and disability caused by mental ill-health is frequent and rising.

29. The gradient in health and motivation in workplaces Overall organisational productivity depends critically on workers’ aggregate performance - their contribution is essential to success. There is need to understand the linkage, in typical pyramid-shaped organisations, between, on average, poorer health (mental and physical) and lower motivation and engagement at work. Recognition of this needs to be properly factored in to management thinking about health, wellbeing and engagement Top management Usually declining income and health Workforce, many more at the foot, is not uniform in health, wellbeing or motivation

30. Targeting Sectors Each sector defining its own needs. NHS Fire Service Police Service Construction The City (Mental Health Alliance)