Future challenges in workplace health

Organisations must be proactive in educating an ageing workforce about health, for the sake of the employees and the economy, says Nic Paton.

Few occupational health practitioners would dispute the contention that huge advances have been made in workplace and occupational health in recent years. Workplaces have, by and large, become safer and there has been greater realisation among many employers that looking after and supporting workers who are unwell or off sick can bring real business benefits as well as being a good thing to do. Similarly, there has been a growing understanding of the benefits to people’s health of being in work, as well as a greater recognition of the need to look at health and wellbeing “in the round” rather than simply as an issue of absence or attendance management.

What we are going to see increasingly is the impact of lifestyle conditions, especially things such as obesity.“ Helen Vaughan-Jones, policy research senior manager, BUPA

But that in no way means occupational health can afford to rest on its laurels. Far from it in fact, if a new report from workplace health provider BUPA is anything to go by. Its Healthy Work: Evidence into Action report, published at the end of June, has highlighted how workplaces are going to face significant, ongoing health-related challenges in the years ahead.

Government, the NHS, private providers and OH professionals, the report has argued, are all going to have their work cut out in dealing with an ageing, sicker working population, while firms with the healthiest (and therefore least absent) and most engaged workforces will be the ones best placed to thrive in an increasingly competitive, global environment.

Moreover, the workplace itself is likely to become a more important location for discussions, activity and interventions about health, wellbeing and healthy living.

“What we are going to see increasingly is the impact of lifestyle conditions, especially things such as obesity,” explains Helen Vaughan-Jones, senior manager, policy research at BUPA, and co-author of the report.

“More people will be living and working on a daily basis with a certain level of ill health or living with obesity or chronic conditions. So how employers support people with long-term health conditions at work will become more important.

“Occupational health professionals will have a very important role to play in this. They will in particular be in demand because of their ability to offer expert advice on how businesses can best support their staff and get them back to work if they are off sick.”

More people will be living and working on a daily basis with a certain level of ill health or living with obesity or chronic conditions. So how employers support people with long-term health conditions at work will become more important.“ Helen Vaughan-Jones, policy research senior manager, BUPA

Healthy Work: Evidence into Action report

The report, compiled in conjunction with workplace think-tanks The Work Foundation and RAND Europe and not-for-profit organisation C3 Collaborating for Health, is the conclusion of an 18-month health-at-work project led by BUPA to identify ways to improve the effectiveness of workplace health provision and support in the UK.

It follows on from a report published in April 2009, Healthy Work: Challenges and Opportunities to 2030, which looked at some of the issues around managing an ageing workforce that was more likely to be living and working in ill health.

As well as examining more than 600 pieces of evidence on the effectiveness of various workplace health interventions, the latest report makes a series of recommendations for Government, employers and workplace health providers. It, for example, urges the new coalition Government to revisit the issue of incentives for employers that invest in workplace health – something consistently rebuffed by Labour but which the Conservatives have previously said they would be prepared to reconsider.

It has suggested that ministers at the very least examine the feasibility of options such as subsidising employers to invest in workplace health, offering matched funding as an incentive or tweaking the tax system to make workplace health interventions more attractive.

Similarly, it has called for the creation of a new classification scheme for workplace health interventions, so that employers better understand what terminology such as “health promotion” or “smoking cessation support” actually mean.

“If there were a classification scheme of workplace health interventions, there would be more consistency in the use of terminology and this would mean that employers could compare the results of different studies with greater confidence that they were comparing like with like,” the report has argued.

The report has made the case for the establishment of a broader range of core indicators for workplace health to encourage employers to go beyond simply measuring absence or absenteeism rates. This could include indicators such as an employee’s health-risk profile, including lifestyle issues such as smoking, alcohol, obesity and stress, as well as the prevalence of medical conditions in the company. Or it could encompass metrics on employee engagement, employee satisfaction or retention.

The report argues: “Currently, researchers looking at the benefits of workplace health use different measures for evaluating processes, outputs and outcomes. For example, one study measuring the impact of an employee assistance programme (EAP) might measure the number of employees who call the EAP helpline; while another might measure the number of employees who go on to receive treatment after calling it. This makes it difficult to compare the effectiveness of different interventions.”

Key findings of report

In the future, UK workers will be older and sicker, thereby putting increasing pressure on employers at a time when they should be investing to sustain future growth. With 40% of adults set to be obese by 2025, the number of people living and working with chronic conditions is likely to rise steadily, so levels of absence will rise, productivity will fall and this has the potential to damage morale, competitiveness and profitability. In an increasingly competitive global economy it will be the healthiest businesses that prosper. Companies that invest to support the health of their employees have the potential to be fitter for purpose and better placed to cope with changing economic conditions over the long term. By promoting the link between organisational performance, national prosperity and the health of the workforce, and by improving links between the workplace and traditional healthcare settings, the Government could encourage employers to invest in a broader range of interventions to support key public health goals. Improving workplace health has the potential to make a significant contribution to the economy and to public finances in these difficult times, as well as to reducing levels of illness and disease in the UK generally. While some employers are ahead of the game, others still consider workplace health to be a benefit or perk for senior managers and little more. Most invest only in interventions likely to deliver a short-term return to their bottom line or as an aid to recruitment and retention, with small and medium-sized enterprises one area of real, ongoing challenge. Employers need to recognise they can take a few simple steps that will deliver “quick wins” by investing in interventions now and doing so in a way that is informed by an understanding of the health profile of their workforce, they can make a significant contribution to reducing levels of illness and disease. The UK, longer term, needs to invest more in research to build up the evidence base around workplace health and to encourage academics and employers to share knowledge about what is beneficial. If employers are to increase their investment, and the Government is to encourage them to do so, they need to know that appropriate provision is in place. Workplace health providers need to be developing interventions suited to the specific health needs of tomorrow’s workers. Although the worsening health of UK workers will present huge challenges, it is also a potential opportunity.

Defining OH roles

The role of OH practitioners within this increasingly challenging, future workplace health landscape could be critical, concedes Vaughan-Jones. She says: “OH will, I suspect, have a vital role to play in gathering evidence around workplace health interventions, what works best in what circumstances and how best to implement interventions, how interventions can perhaps be best adapted to specific workplaces or the best sort of support to offer.

“Then they will have a role in ensuring that information and best practice is shared most widely and is available to employers. There needs to be an improvement in the coordination of research and an improvement in the evidence base of workplace health,” she says.

Best practice in OH

OH practitioners are also likely to be at the heart of ensuring that any workplace health interventions put in place by an employer have clear objectives. Practitioners will in all probability become more closely involved in the development of robust business cases and will be an important part of the process of measuring and evaluating interventions.

“It will be about employers, managers and OH taking the time really to understand the needs of their workers, planning their approach effectively and offering support of all shapes and sizes and being able to offer a range of integrated workplace health interventions,” Vaughan-Jones argues.

Alongside all this debate the report cites a number of case studies of best practice to highlight the benefits of its approach, including energy company Centrica and HR consultancy Hewitt Associates.

Health and wellbeing needs to be on the HR agenda much more regularly. But you do need to be able to demonstrate the benefit of what you are doing, and presenting ROI or the business case can be one of the challenges.“ Colin Bullen, head of health and risk benefits, Hewitt Associates

At Centrica, which employs 30,000 staff in the UK, the report has highlighted the success of its ongoing programme of back-care workshops, which have since 2004 reduced back-pain-related absence by 43% and had a return on investment (ROI) of £31 for every £1 spent.

Group head of health Tricia O’Neill explains: “You get to have a whole day talking about your back with a physiotherapist, something that you would never be able to get on the NHS. You learn about the mechanics of your back, what is normal and not normal and how to manage your back, and any back pain, in the longer term.”

But the programme is just one among many, she emphasises, with the company having a history of pioneering OH work. Its activities include a musculo-skeletal disease return-to-work programme, knee-care clinics, a system whereby employees who have been absent for eight days can, instead of going to their GP to be signed off, be referred to occupational health for a workplace health assessment and, last year, the creation of a group-wide health and safety strategy.

“The key is to put together a sound business case. You need to be quite rigorous and mathematical about it to ensure that people buy into it,” O’Neill adds. “It is about changing behaviours and getting people to take more personal ownership of this as an issue.”

At HR outsourcing company Hewitt Associates a health audit in 2008 concluded that employee ill health was costing it some £2,850 per employee per year, or around £5.7 million across its 2,000 employees. This has now been reduced to under £2,500 per head in part by the introduction of a day-one absence monitoring service, with health initiatives now coming under a single “Be Healthy With Hewitt” banner.

“We can track things much better and know exactly what our costs are, what seasonality factors there may be and so on. You typically see a 30%-50% reduction in absence as a result of implementation of a day-one system, though it obviously depends on where you are starting from,” explains Colin Bullen, Hewitt’s head of health and risk benefits.

“We were a pretty well-managed business beforehand anyway, but we still reduced absence by a quarter. We thought, for example, we were averaging around four to five days per employee but in fact it turned out it was more like six, so we have been able to get a picture of what our absence actually is,” he adds.

Making it work

The company has recently begun to offer private medical insurance to all its employees, rather than through a flexible benefits package. The next phase will be to ring-fence a budget for a mental health and wellbeing programme, including a series of educational and awareness-raising events, training, presentations to employees and interactive workshops.

“Health and wellbeing needs to be on the HR agenda much more regularly. But you do need to be able to demonstrate the benefit of what you are doing, and presenting ROI or the business case can be one of the challenges. So it is important to be building up as much factual evidence of what has changed as a result of interventions and to look, as we do, at the total cost of health level.”

“For OH the key is to be spotting the link between health and wellbeing and the rehabilitation-type of interventions. It is about increasingly trying to draw that together,” he adds.

Key recommendations

For government Improve coordination of government policy on workplace health, especially to emphasise further the link between organisational performance, national prosperity and the health of the nation’s workforce. Promote greater awareness of the workplace as a location for improving public health by encouraging primary care trusts to partner with local employers. Encourage more employers to report publicly on their investment in workplace health by recognising those that do so. Carry out research on the options for financial incentives for employers to invest in workplace health. Improve the coordination of research to improve the evidence base for workplace health. For employers Invest where it makes sense, especially in health interventions that are known to be effective. Work more to understand the health profile of the workforce and involve employees in decisions about investment in workplace health. Ensure workplace health interventions have clear objectives and are supported by senior management. Track key metrics about the health of the workforce, such as levels of sickness absence, health and general wellbeing. Consider how it is possible to improve the quality of work as well as more traditional workplace health interventions. Find innovative ways to involve as many employees as possible in workplace health interventions. For providers of workplace health interventions Provide better tools to help employers understand the health profile of their workforce. Develop a broader array of interventions that support employees’ efforts to lead healthier lives. Similarly, develop a broader array of interventions that support people with long-term conditions in the workplace. Gather more evidence on how to manage the impact of work on health and share this knowledge with employers. Similarly, gather more evidence on how to implement workplace health interventions in a way that will maximise their effectiveness and share this knowledge with employers. Offer a more integrated set of workplace health interventions.