Workplace Health Connections

A report out this week finds the government is under  fire again for failing to address the tax barriers to employers investing in health promotion and return to work interventions. Now that Dame Carol Black's recommendations demand early intervention to get people off sick and back to work and keep them there there, the government has run out of excuses not to change a system that is unfair and riddled with contradictions.

For example, if employees are exempt from tax when their employers provide an Employee Assistance Programme (EAP) (which allows staff to discuss health issues not related to their work), then why should an employee be taxed when their employer pays for them to join a private gym? Currently there is tax relief when a big employer provides a gym or sports facilities but employees in smaller firms are penalised if their employer pays for private gym membership. This is a barrier to smaller employers investing in the health of their staff. How can this tax regime be justified when the Black review points out that the vast majority of employees without access to occupational health are working for small and medium sized companies.

Then there is the issue of tax on employers who spend to get sick staff back to work. Even if the government baulks at introducing tax incentives for employer spending that promotes health among people who are not incapacitated, surely it should provide tax exemptions for all spending on vocational rehabilitation, regardless of whether the illness or injuries are solely work-related or not. Currently if an employer pays for an employee's treatment to get them back to work for reasons which are not solely work-related the employee has to pay tax on it. Yet there are often long waiting lists on the NHS meaning treatment is provided too late to stop the employee swelling the ranks of those on incapacity benefits. Taxing the employee completely contradicts the aims of Dame Carol Black's recommendations. 

Realistically, employers may prove reluctant to help fund  a national OH service  without any financial support.The government should consider reinvesting some of the money it plans to save by cutting the numbers on incapacity benefits to support employers who are expected to foot the bill for getting sick employees back to work. This may have to be done through private medical insurance (PMI). However, up until now the government has had a very Old Labour suspicion of PMI despite its aim introduce more private sector investment into the NHS. The solution is to introduce tax exemptions on PMI and the use of private medical services only when they are used for the purposes of vocational rehabilitation. Surely that would be a more joined up way to achieve the government's objectives for the health of working age people. 

The government is due to respond to the Black review in the autumn and if it fails to address the non-sensical tax system it will be failing employers, employees and itself.  

So a dyslexic medical student is to launch a legal claim against the General Medical Council to try and get the GMC to stop using multiple choice tests. The 21-year old student, Naomi Gadian claims that the test is discriminatory and inappriopriate as it is unlikely she would be presented with four options when making a diagnosis or selecting a therapy in a real job situation. The student has good A-levels so obviously hasn't been held back so far in her medical education by her dyslexia.

This issue worries me. Maybe I'm making too light of a serious issue but isn't it the case that medical terminology is particularly hard to spell and being good at recognising one condition or treatment from another is a required skill for the job?

Conceptually the whole idea of 'disability' as covered by the Disability Discrimination Act  is problemmatic as far as I'm concerned. The law should be there to protect people from discrimination which is not relevant to the job or profession. Therefore, discrimination on the grounds of ability that is relevant to the job is surely reasonable? For some professions, dyslexia is going to make someone less able to do the job than another person without the 'disability'.  It doesn't seem unreasonable in medicine to require students to be able to distinguish between technical terms reasonably quickly and accurately. But this is an issue where feelings tend to run high so I expect others may disagree. 

If, like me, you like to start the weekend with a take-away and general blow-out slumped infront of the TV, then maybe you should know about some new research showing a link watching TV  crime shows and obesity. The research study has found that people who are thinking about their own deaths want to eat and shop more. Or at least if you've got low self-esteem. Research involving 746 people in Europe and the US found that death-related news can also make people more patriotic about what brands they buy. This shows that death is good for business, or retail at least. 

Obviously there is a big opportunity for cookie manufacturers to book advertising space during TV programmes involving lots of death, but the implication for people with responsibilities for workplace health are more obscure. Perhaps, as well as advising staff to give up smoking and join a gym, we should be warning them about the danger of watching too much of CSI: Crime Scene Investigation or The Bill .
 

The research, "The Sweet Escape: Effects of Mortality Salience on Consumption Quantities for High- and Low-Self-Esteem Consumers", appears in the Journal of Consumer Research, . For more information email natherton@noirsurblanc.com.  

This month's annual meeting of the Society of Occupational Medicine brought out a rash of announcements from government people to try and push forward the health and work strategy. First off, Bill Gunnyeon, director, health, work and wellbeing and chief medical adviser, Department for Work and Pensions.. er where was I? Oh yes, he gave us a sneak preview of a GP survey due out later this month which is a repeat of the one carried out last year, and it shows, at long last, that GPs are finally getting the message that work is good for people's health.  

Meanwhile Lord McKenzie announced that on 17 July the Vocational Rehabilitation Taskforce  will be publishing an evidence review of the cost effectiveness of interventions on musculoskeletal disorders, mental health, cardiovascular respiratory conditions. He added that Dame Carol Black is going to be 'supporting' the government's first ever do-ordinated strategy for mental health at work. This starts on 10 July with a meeting of eminent experts from business and academic medicine.

Finally,  if you don't know already the government has produced a tool for employers to help them assess the cost benefit of interventions in occupational health, based on consultancy PWC's report earlier this year. If you want to volunteer your company as a pilot just click here and you can download the tool for free.  

Today is the Society of Occupational Medicine's annual conference and president Dr Gordon Parker has stated that occupational health services  should be free at the point of delivery in the NHS. The call comes in the week the NHS celebrates its 60^th birthday and the day after Lord Darzi announced his proposals for the future of the NHS. I would like to support the SOM's aims but  they do raise a few complicated questions.

There is the question of who is going to provide these OH services. The SOM seems to be fixated on OH doctors and nurses doing it but in reality there are never going to be enough available and a lot of the services are not of a primarily clinical nature in any case, for example "benefits advisers and others associated with workplace wellbeing" to quote the SOM.  There are also case managers, disability assessors and a range of other services which are unlikely to be provided by doctors or nurses. 

 Will NHS Trusts be willing to use NHS funding to provide services which are not 'clinical'? It all boils down to the cost benefit case. In an apparently under-funded service where rationing is the norm, could we, to give one example, demonstrate that return to work through psychological therapies would save a fortune on anti-depression prescription drugs? If we save millions on incapacity benefit can that then be reinvested in improving NHS services? Over to you, Lord Darzi.  

For the time being it is safe to assume that employers will be footing the bill for OH for some time to come.

This morning I went to a business breakfast organised by Business Action on Health, a group of larger employers who have committed themselves to good practice in health at work. The campaign aims to get 75% of FTSE companies to report employee wellbeing in their company reports by 2011. At the moment only 25 of them do so. The information has to be quantative too, not apple pie rhetoric (although I dare say that apple pie is off the menu on account of the refined flour, sugar and fat content). This would be a big step to getting health and wellbeing seen as a core strategic issue - a great aim, but not easy to achieve.

The campaign is organised by Business in the Community, an employer-led organisation which aims to make employers fairer and more responsible. BITC aims to get employers to invest in health at work by emphasising the impact on the employer brand and employee engagement.  Research BITC launched today by YouGov involving 1,347 adults in the UK has found that three out of five workers would consider quitting employers who fail to address workplace health and safety and four out of five say this would influence whether they took a job.

The problem with getting commitment from senior managers though is trying to get them listening in the first place, when they have a lot of other priorities. Absence costs are a blunt weapon but may be the best way to get boardroom attention, suggested Peter MacDonald, HR director of  Parcelforce, at the meeting.

At Parcelforce, which as part of Royal Mail is not able to compete on cost, the company's performance depends on making deliveries on time. The case for good absence management is clear. And you can produce key performance indicators for it which might look good in a company report. 

Once you've whetted their appetite with some cost savings in cutting absence, the trick then will be to get managers to look at the business case for health and wellbeing interventions in the round.

Is most of our bad behaviour simply a result of our diet? Apparently, in a US study they managed to reduce the reoffending rates of prisoners from 80% to 20% by giving them healthier food. Scientist Udo Erasmus, a name I am going to have to use if I ever decide to write a gothic vampire novel or something, concluded from his study that the answer is to prevent low blood glucose (hypoglycaemia). Does the Home Office know about this?

I came across the information this week when I was chairing an IRS conference on managing stress. Here is a round-up of the hot ideas that came up for anyone interested in managing their own stress or responsible for stress management in an organisation:

• Energy management. Yes, energy is the new resilience when it comes to wellbeing at work. Dr Adrian Chojnacki, VP of employee health management at pharmaceuticals giant GSK UK, advises that you work in sprints rather than flat out, and he says it's all right to take time out.
•  Both Chojnacki and Dr Wolfgang Seidl, executive director of Validium Group told delegates that we should develop 'health habits and rituals'. Go jogging every day when you get home from work and you will automatically crave a run round the park, as opposed to, say, a  take-away pizza and four cans of strong lager. And remember what I said about diet and bad behaviour.  
• Remember that stress is not the problem - it is the lack of recovery time that makes you sick. Unless you're stressed non-stop  for days on end it might even be doing you some good.  
•  Dr Ivan Robertson, managing director of Robertson Cooper, has the helpful idea of thinking in terms of 'challenge pressures' and 'hindrance pressures'. Hindrance pressures include things like role ambiguity, work overload and job insecurity and the challenge pressures include things like having achievable and specific goals and well managed change.

There - I bet you feel better already.  

Now that our national papers have got bored with RSI scare stories it would be tempting to assume the problem had gone away. In fact, it could be that mobile technology and the trend for people to work outside working hours on trains or in other locations will put the issue back on the news agenda. IT giant Microsoft  has put out a survey today  showing there is an epidemic of 'blackberry thumb'  and that Work-related RSI cases are at an all-time high with sprialling business costs. OK, admittedly this is from a company that wants you to buy its ergonomically designed hardware.

For years, HR and occupational health specialists have had an uneasy feeling about home-working and health and safety. The increasing use of mobile technology such as laptop computers, blackberrys and mobile phones with or without internet access means that risk management and health surveillance may have to extend beyond the home office into the car, the train and even the local Starbucks.

Microsoft want to publicise this to sell their ergonomically designed hardware but this issue goes beyond this into work design and practices, including working hours. Maybe now is the moment to dust off the policy on home-working and make sure your organisation is covered against absence costs or a potential costly tribunal claim. If you're old enough to remember the early days of RSI then you'll know that the condition does seem to be catching too (if one person in a department gets it, others will follow) and it is notoriously difficult to get an accurate diagnosis of the cause.

This blog’s main aim is to get people with responsibility for workplace health talking to each other and collaborating, as our millions of enthusiastic readers know. In keeping with that, here are two opportunities to win an award for delivering good workplace health services in 2008 and they are both free to enter.

The latest opportunity is a new category in the Personnel Today Awards, the Award for Health at Work. If you’ve been to this event before you’ll know it is quite a bash, so well worth getting on the shortlist. You’ve only got a month left to enter so get to work on your entries now. I know for a fact that there are lots of you doing innovative things who can demonstrate the benefits for staff and the organisation alike.

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