Regional health: Encouraging a healthy outlook

When the health of the people of the north-east of England makes the news it is usually for the wrong reasons – binge drinking in its city centres and stories about the health legacy of its asbestos past are common. However, this is changing, and good news stories are starting to replace these stereotypical images, including in the field of workplace health.

The North East Better Health at Work award is a collaboration of trade unions, employers and workplace health specialists from 12 NHS primary care trusts (PCTs) established under the umbrella of the region’s public health strategy, Better Health, Fairer Health

G4S Utility Services: ‘stress down day’

G4S is a national supplier of metering and related field services and has its headquarters in Newcastle. It signed up to the Better Health at Work award scheme last year, and issued a health needs questionnaire to all head office staff, who produced a 47% response rate. The main health issues identified were stress, back pain, work-life balance, healthy eating and exercise. Employees taking part also asked for information on a range of safety issues, including first aid, trips, slips, falls and workplace violence.

Ten health campaigns were planned for 2009 to address the workplace health issues raised in the staff survey, including a ‘stress down day’, during which employees took part in a variety of health checks, such as blood pressure and BMI testing. The organisation believes its participation in the workplace health award scheme is beginning to foster a positive health culture within the site, pointing out that overall sickness absence fell in 2007-09, apart from an increase last summer attributable to swine flu.

Source: ‘Good work is good for you’, Northern TUC/NHS Public Health North East, 2009.

TUC and PCTs working together

Tom Ross of the northern regional TUC is working to ensure union buy-in to the regional public health strategy by encouraging trade union representatives to get involved in the Better Health at Work award.

In 2009, Ross and a group of PCT workplace specialists, or ‘leads’, worked with 93 employers and 110,000 employees, helping them towards a bronze, silver or gold level award by running health at work campaigns and initiatives. Most employers are working towards a bronze level award by focusing on the building blocks for a healthy workplace:

Introducing or improving systems for consulting staff on health needs and interests

Improving sickness absence recording and monitoring – for example, by capturing reasons for sickness and analysing trends

Focusing on key policy areas, such as healthy eating, mental health and the workplace environment.

Ross explains how a single award scheme for the region evolved out of a number of more local initiatives, particularly one in Northumberland and a similar scheme at the opposite end of the region in Durham. “These local schemes had involved union representatives in organisations where they existed, but had generally not sought union buy-in,” he explains.

The regional award was developed by a group of PCT workplace leads, with health and safety input, and operates as a partnership between workplaces, their local PCT public health departments and the northern regional TUC. The North East award is the only such scheme in the country, according to Stephen Singleton, regional director of public health and medical director of the region’s strategic health authority.

The North East award scheme is different from other workplace awards in that it is not based on primarily large organisations, many of which have comprehensive occupational health (OH) support, putting themselves forward. Instead, employers sign up for the initiative following a joint approach by the PCT workplace leads and Ross.

“The workplace leads often ask for my help in gaining an introduction into a unionised workplace, and once the union reps have bought into the idea of workplace health, then I will approach the management team, explain the virtues and business case for investing in workplace health, and then will work with the PCT to develop a plan for the organisation,” Ross explains, adding that “none have refused” so far.

Indeed, as Denise Orange, public health project manager at Public Health North East, and responsible for overseeing the health at work award, adds: “The issue is not persuading employers to come on board, but rather managing the demand.”

The first year of the health initiative has established a proven demand for the award scheme, and feedback shows that organisations value it highly.

Orange explains: “We are building the case for sustainability – for example, by encouraging employers to put together case studies on their experiences.”


Health advocates are key

The role of health advocates in participating organisations is key, championing workplace health and working with employers on campaigns and policies. Advocates tend to be trade union representatives in the organisations that Ross works with, but he has been involved with organisations where the advocates are line managers.

“It is more important that the advocates are interested and committed to workplace health, and are good communicators,” he adds.

For example, at Nestlé recently, 43 people out of a workforce of 300 expressed an interest in becoming an advocate, “which is a fantastic response”, according to Ross. The role of a health advocate is similar to that of a union learning representative, but focuses on health. “We’re not asking for athletes or medics, but good communicators, which tends to fit well with the existing role of many union reps,” he adds.

The primary role of a health advocate is to signpost further help and information and to help run health promotion campaigns. For example, many were involved in No Smoking Day initiatives on 10 March 2010. “The job is not to tell people to stop smoking, but to provide them with the opportunity to access smoking cessation services,” Tom Ross explains. This can sometimes require innovative approaches: “One International Paint employee’s efforts to give up smoking were hampered by his family’s smoking habits, so the advocate got the family involved in the site’s smoking cessation programme,” he adds.

Five health advocates were identified when crane manufacturer Liebherr Sunderland Works decided to try for a health award. Almost all of its 215-strong workforce is male, often with a background in the North East’s heavy industries. There is access to OH provision, but the employer decided that participating in the award scheme would be a good way to gain buy-in from the workforce.

After basic training, the advocates set up a resource centre in the works canteen, offering PCT-provided leaflets on a range of issues. The advocates were also involved in a series of health events covering healthy eating and smoking cessation, and in a well-subscribed cycle purchase scheme.

Health advocates at Redcar and Cleveland Borough Council include representatives from unions Unison, GMB and Unite. The PCT and steel maker Corus also trained 12 employees to deliver mental health first-aid training in the workplace to more than 50 managers and supervisors in 2009. Mental health first-aid training is now being offered to all employees.

Funding was secured last year from the Learning and Skills Council to offer all health advocates Royal Society of Public Health-accredited training in Understanding Health Improvement, which 67 employees from the region attended. Local colleges have agreed to offer heavily discounted courses in 2010 so that this training can continue, according to Ross.

Baseline surveys

The PCT workplace leads play a more active part in securing buy-in from employers where there is no trade union recognition, particularly giving advice and support in the NHS aspects. To take part, senior managers from the organisation concerned must sign a Better Health at Work charter, which encourages senior level commitment to the scheme, and makes clear the requirement for workplace health advocates to be identified within the organisation and given support.

Once employers sign up for the award scheme, the first step is usually to complete a baseline data questionnaire, covering policies and practices in place at the point of signing up for the award, and relevant data – for example, on sickness absence and accidents.

This is followed by a workforce health needs assessment, asking employees to prioritise workplace health issues and for ideas on making the workplace healthier. The questionnaire used by many participating organisations is “basic”, according to Ross, but crucially is branded with the TUC, NHS and employer logos, giving real credence to the partnership approach. “The NHS is a good brand and helps to secure high response rates – up to 90% but averaging 50-60% – which is still a good return rate for this type of survey,” he adds.

The employer commits to three workplace health initiatives over the course of the following 12 months, covering the main concerns highlighted in the employee survey – often stress and musculoskeletal disorders, according to Ross. Employers work closely with the workplace health advocates on a health strategy, and in presenting a portfolio to the local workplace lead, who acts as an award co-ordinator, for assessment. The assessment includes an examination of sickness absence and accident data and a range of other criteria appropriate to the level of award being sought.

All organisations are encouraged to spend 12 months at each level of award – “there’s no automatic short cut to gold”, Ross points out – although there is flexibility for those that need it. Holders of the gold award are expected to share best practice and act as exemplars.

Newcastle Contact Centre, Jobcentre Plus: body-mapping

The Newcastle Contact Centre, Jobcentre Plus, employs 250 staff, based in premises on a business park in North Tyneside. As part of its participation in the regional Better Health at Work award, a trade union branch executive meeting decided to develop a survey using body-mapping techniques. A joint survey was developed between the employer and the PCS union, giving employees the opportunity to highlight health symptoms they experience on a map of the body.

Completed surveys were returned to the contact centre’s trade union representatives to evaluate and identify common problems. Employees who returned surveys on a named basis were contacted individually and offered further health information, – for example, on the employee assistance programme or workstation assessments.

The unions and employer produced a quick guide to healthy and safe working based on the feedback from the body mapping exercise, which was issued to all staff in autumn 2009. Part two of the guide will cover stress, and the partners on the project intend to repeat the employee survey every six months.

Source: ‘Good work is good for you’, Northern TUC/NHS Public Health North East, 2009.

‘Crucial’ OH role

The role of the OH department is “crucial”, Ross believes, adding that in the TUC’s experience there is still a perception among employees in some organisations that a referral to OH is “the end of the road”, and that the job of the OH department is “to ease them out”.

However, in the award scheme, organisations working towards each level are expected to show that the OH emphasis is always on rehabilitation and overcoming barriers to a return to work.

“At Cummins, we recently had a member who was back on site two weeks after a hip replacement, thanks to a very proactive OH input,” says Ross.

OH departments are expected to be proactive in health promotion when participating in the award scheme. British Aerospace’s work towards an award in 2009 included hosting a men’s health week – leading to the early diagnoses of three cases of prostrate cancer, according to Ross.

But what about small firms with no access to OH? Ross argues that NHS PCTs can offer such employers a great deal of advice and support, particularly in the health promotion/disease prevention areas – for example, smoking cessation and cardio health. He says the award scheme offers employers without OH, or who use it in a reactive way, the confidence to tackle workplace health issues and to perhaps even consider bolstering their OH offering.

Orange adds that PCT leads will also signpost employers that have no immediate access to OH to the region’s Health for Work advice line – a Black review initiative targeted at small- and medium-sized enterprises.

Sustaining the effort

Health advocates fully embrace the award scheme and work hard to promote healthy lifestyle choices to their colleagues, according to Orange. She finds that in many cases organisations have gone far beyond the minimum requirements to achieve the award.

NHS primary care trusts fund the workplace leads, many of which are permanent posts, and the award scheme is one way of helping them fulfil their role, Orange points out. Funding is available to keep Ross active in the workplace health field for a further 12 months, but he accepts that sustaining the trade union’s input into the North East Better Health at Work initiative will be challenging. However, he believes the business case for investing in workplace health is beginning to hit home, citing housing organisation South Tyneside Homes as an example.

An employee healthcare plan was introduced last year, and more than 350 staff have been provided with a mini health MoT by the South Tyneside PCT’s health trainer service, including referrals to further advice and support, particularly exercise schemes and weight management programmes. The employer claims dramatic savings of £266,000 in reduced sickness absence costs are attributable to the health award scheme.

“The North East does not have a particularly healthy record – some areas are the worst in the country for people not looking after themselves – but I’m confident that we have the strategies in place to bring about health improvement, even if it does take 25 years and involve a generation change,” Ross concludes.











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