In the fourth and final part of our series on the evolution of occupational health, Nic Paton looks at the growth of employee wellbeing programmes and health benefits. Employers are now increasingly focused on prevention and intervention, rather than the costs of sickness absence and treatment.
There would be merit in extending incentives for employers in England who provide NICE-recommended, effective, workplace health programmes for employees.”
It is perhaps a stretch to argue that this apparently straightforward comment by NHS England chief executive Simon Stevens sums up the changing dynamic, and priorities, of workplace health and workplace health-based benefits. But it is not far off.
This is because, arguably, this single sentence, part of Stevens’ Five year forward view blueprint for the future of the NHS published in October 2014, goes to the heart of one of the key ongoing tensions in the delivery of healthcare for our working-age population: the role of the state versus that of employers.
Superficially, it is possible to argue that the state – ie the Government and the NHS – has, since 2010, and the launch of the fit note been vastly more interventionist and proactive around workplace health than any previous UK Government.
More on wellbeing and health benefits
Between then and now we have had, of course, the Dame Carol Black and David Frost independent review of sickness absence in the UK (2011), the Government’s response recommending the creation of workplace health advisory and assessment service (2013), Chancellor George Osborne putting in place a £500 tax break for employers investing in health interventions (2013), the launch of Fit for Work last December and now, this summer, the completion of its national roll-out. Stevens, too, in September launched a £5 million initiative to improve the health of all NHS staff and establish an occupational health service specifically for GPs.
But it is also possible to see all this in completely the opposite light, as evidence of a gradual retreat by the state, in line with the Government’s focus on contracting the welfare state, in terms of how it – through both benefits and the NHS – supports the health needs of working-age people. And, in turn, the increased onus being put on employers to step up and play their part.
The fit note, while obviously generated by a GP, is designed to encourage a debate with, and action by, employers to help get an individual back to work. A key tenet of the Fit for Work service is to encourage employers to take a lead and refer consenting employees into the service, and then fund interventions or services. And, let’s not forget, the service itself is being funded by the scrapping of the Statutory Sick Pay Percentage Threshold, again, the withdrawal of a previous state subsidy for illness.
As John Ritchie, chief executive of group risk insurer Ellipse, has argued, it is possible to view this emphasis on encouraging employer-led intervention rather than relying on the NHS as “conditioning us for a differently shaped future”, one where employer-funded healthcare benefits, even potentially employer/employee co-funded “sick pay” in the shape of increased access to products such as income protection, could become much more commonplace.
This is a tension also identified by Debi O’Donovan, founder of the Reward & Employee Benefits Association (REBA). In November 2015, REBA published its REBA/JLT Employee Benefits Shifts Research 2016. This, O’Donovan argues, pointed to a much more integrated benefits and healthcare landscape in the future, one where the NHS may still be there but where there is also an expectation that employers will be doing more, and where there is a greater emphasis on “wellbeing” (physical and, increasingly, mental) as well as health, sickness and absence.
However, whether or not employers will have the appetite – let alone the cash – to step up in this way remains very much a moot point, she cautions. “Employers, by and large, would like to do more but cost pressures – things like next April’s national living wage and pensions auto-enrolment, among others – are forcing them to push it more on to employees. With something like income protection (IP), for example, we are expecting to see a 60% increase in IP going through flexible benefits rather than employer-funded GIP [group income protection] programmes within the next five years.
“This is even more pronounced within private medical insurance [PMI], where we are expecting to see a 188% increase in the number of employers putting this through their flex programme. Employers simply feel they cannot pick up these costs anymore and so are putting them into flex programmes where it’s down to employees to pick up the cost if they want to take up that benefit,” O’Donovan adds..
Employee wellbeing as a strategic business priority
Having said that, there has been a clear, and broadly positive, evolution in how health and wellbeing is now viewed within many organisations, especially larger employers, as Louise Aston, wellbeing at work campaign director at Business in the Community, points out.
“I’ve been working in the workplace health and wellbeing sphere for around seven years and I’ve really seen a lot of change from when I first joined. Health, wellbeing and engagement used not to be a strategic boardroom issue; it was just a nice thing to have on the side and was normally ‘owned’ by OH or HR.
“Now we’re seeing organisations taking a much more holistic approach and there is much more collective ownership of this as an issue; it is not necessarily something owned by HR anymore. It has become a much more strategic boardroom issue, often linked to meeting business objectives,” she adds.
“The more sophisticated companies are also no longer separating their benefits strategies from their employee wellbeing programmes. There has been a move away from a one-size-fits-all approach, especially around benefits; there is much more scope for someone to be able to choose the benefits they want to suit them,” Aston continues.
“The ageing workforce has also, of course, become a major issue; people working for longer and continuing working while having chronic health conditions, plus more people caring for elderly dependents. Then there are the challenges of the big ‘lifestyle’ conditions, such as obesity and diabetes. When you link this with increased agile and flexible working, these are big changes,” she adds.
Indeed, on the generational issue alone it is clear employers and benefits providers are already having to think more creatively about how they respond to the “greying” of the workplace. Research in September 2015 by Aon Employee Benefits highlighted how traditional notions of generational segmentation when it comes to benefits – for example that it is only older workers who will be interested in health or pensions – is becoming outdated and simplistic.
A shift to flexible employee health benefits
As Martha How, reward partner at Aon, argued: “It’s a common view that we now have five generations in the workforce, each with differing needs and preferences. These can be caricatures – for example, that twenty-somethings aren’t interested in pensions, while fifty-somethings are worriers about pension and health.”
Nuffield Health goes back to school to pilot the role of “head of wellbeing”
With heads of wellbeing becoming more commonplace within the corporate world, as we have seen, not-for-profit healthcare organisation Nuffield Health in September launched a pilot to look at how this role might work in the education sector.
The pilot will see Nuffield Health working with Wood Green School in Witney, Oxfordshire, following a national competition to find a secondary school to host the pilot.
The initiative, said to be the first of its kind, will be funded by Nuffield Health and will see the two-year secondment of a head of wellbeing.
Their role will be to help develop and implement health and wellbeing strategy at the school, including tackling issues such as obesity, lack of exercise and healthier diets among both children and staff.
A Nuffield Health “Lifestyle health assessment” will be offered to all staff and health and lifestyle coaching sessions will run for students.
Nuffield Health highlighted in research carried out to coincide with the pilot that teachers report some of the highest levels of stress of any profession, with 73% of teaching staff feeling that their job had a negative impact on their health and wellbeing. Support structures in schools were also often felt to be inadequate.
The two-year pilot will be evaluated by the Lancaster University-based think-tank The Work Foundation, including measuring how the various health and wellbeing interventions implemented improve individual physical and psychological health, as well as school outcomes.
Not all workers and workforces display the same characteristics, and employers therefore need to address generational segmentation when delivering employee reward and benefits, she emphasised.
While, clearly, the legal obligations and duty of care employers have around health and safety have not gone away, there is a much greater recognition of the links between health (and wellbeing) and engagement, performance and productivity, argues Stephen Haynes, director of Navigator Health.
“At the end of the day, businesses are in business to make money but they can only do that if they have healthy, productive workers, which may be a cliché but it is also true,” he says.
Rise of the wellbeing director
Part of this evolution is around who is leading this more integrated, holistic approach. By and large, of course, health has traditionally sat within the remit of HR, even if it is then often split off into OH or health and safety. What we are seeing now is the rise of the “wellbeing director” or “head of wellbeing”.
“The wellbeing lead, the wellbeing director, is a crucial function. This time last year I certainly saw growth in recruitment of such people. Having that dedicated resource is crucial; if you don’t have anyone doing it, or if the responsibility is split around multiple people, then it is not going to get done,” says Haynes.
“This year, too, we are beginning to see a shift in health and safety roles, with more advertisements for health, safety and wellbeing roles. But for large organisations I’d say it’s very risky to have someone running all three; it can be quite tricky to manage that. “It is hard to predict what is going to be in place in two to three years’ time, but in-house wellbeing roles are becoming more commonplace.
A number of larger companies are recruiting in-house capability in this area. I would not be surprised if within 10 years we see half of big organisations having dedicated in-house wellbeing functions; it just needs to be joined-up,” he adds.
“We are seeing the more sophisticated thinkers starting to link wellness with benefits much more closely; they are taking a much more holistic view,” agrees Rebekah Haymes, senior consultant, health and benefits at Towers Watson.
“It is now often being looked after by a wellbeing manager, and that can make a real difference, or it is often addressed by a benefits person as part of their role. Often it will depend on what is driving it for the organisation and where it sits within the corporate structure,” she adds, echoing Haynes.
Making the business case for employee wellbeing
The collection, use of and interrogation of data and analytics is another factor likely to become increasingly important within this evolving landscape, especially when it comes to: making the business case for investment in a cash-tight climate; and trying to target and align your benefits with your increasingly complex multi-generational employee demographic, as has already been highlighted.
As Dr Bridget Juniper, of consultancy Work and Well-Being, makes the point, the dearth of good, solid academic evidence to show within OH that if you do x, y happens has long been recognised. Rectifying this is, of course, part of the motivation between initiatives such as the development of a Faculty of Occupational Health Nursing, currently underway, and the MoHAWK clinical benchmarking tool, among others.
Alongside data, technology will also play an increasingly important role, predicts Dr Juniper. “With smartphones, often you don’t need that face-to-face consultation. I think that is going to be very, very interesting, as well as the investment organisations such as Apple are putting into wearable devices like Fitbits.”
Apps such as Babylon, which has recently partnered with private healthcare provider Bupa, and services such as Axa PPP healthcare’s Doctor@Hand, among others, have the potential to transform how employees access healthcare both during and outside the working day, she points out.
“Employers are simply looking to be more creative around benefits, or to try and keep benefit costs unchanged but stretching what they are offering,” argues O’Donovan.
Mental health and resilience
“We are also seeing mental health support becoming a big issue, with things such as access to counselling, CBT [cognitive behavioural therapy] or EAPs [employee assistance programmes]. Our survey found 89% of employers now offer EAPs or counselling. Of course, often this comes bundled within an income protection policy anyway, but what it does show is employers do not want to be caught out when it comes to stress and mental ill health, and are becoming much more proactive; it is not just a box-ticking exercise, it is about understanding and recognising the importance of employee resilience within the workplace,” she adds.
Alongside this, there is a growing recognition of the importance of encouraging employees to have greater “resilience” (in other words, education and support) around issues such as finance and debt, and how money worries can be a significant trigger for notionally work-related stress.
EAPs can, of course, offer advice in this area but employer-funded financial education is also a growing market, both in the context of helping older workers plan for retirement and manage their new pensions’ “freedom” and to support younger workers around things such as debt, mortgages and student loans.
“Debt management and financial education are both areas wellbeing managers are starting to engage with much more,” argues Iain Laws, managing director for healthcare and group risk at Jelf Employee Benefits.
“Generally there is a greater focus now on prevention and intervention rather than just the cost of absence and treatment; we are seeing that coming through very strongly in the medical insurance market,” he agrees.
But this, in turn, will create its own challenges, not least how to communicate and engage with an ever more demanding, mobile and flexible workforce.
“People join an employer, they’re told they have PMI and get sent a membership pack, but how many really read it or fully understand all of the features and what the incentives are for them?
“So employers do need to engage employees through regular communication and education rather than just leaving it up to the programme or benefit itself.
“There is an opportunity here for employers to maximise the engagement potential of their benefits through effective communication,” he adds.