If you think investing in employee health is a benefit you can only afford in the good times, then you may have to have a rethink. In November, the government announced plans that aim to give employers a leading role in improving the health of working-age people.
While the national media focused mostly on the launch of a ‘fit note’ to replace the sicknote, this was only one of a range of proposals announced in the government’s Improving Health and Work: Changing Lives document that will underpin the way HR approaches the issue. The document is the product of three separate departments – a rare example of joined-up government – and was launched in response to recommendations by Dame Carol Black, the national director for health and work.
Health and HR
Black’s review of the health of working-age people, published in March 2008, identified an annual cost of ill health of more than £100bn, and cited the £13bn annual cost of sickness absence identified in a survey by the CBI and insurer AXA PPP.
Most of Black’s recommendations have been taken up by the government, which suggests it is serious about these reforms despite the recession, with £45m being allocated over the next three years. The plans should be seen in light of the government’s welfare reforms, which aim to reduce the number of people on incapacity benefit by one million from the current level of about 2.5 million.
So what impact will these reforms have on HR? And will they be enough to persuade HR professionals to make the business case for investing in employee health? Looking at the wider aims, one obvious question is how will the government cut the numbers of people on incapacity benefit when many jobs are disappearing from the UK economy?
GPs under fire
So far, the proposal that has attracted the most attention is the replacement of the sick note with a ‘fit note’, which has been tested by 500 GPs across the UK.
Employers have seen GPs as an obstacle to reducing absence because of their willingness to sign individuals off indefinitely. And early responses from HR suggest the fit note will be welcomed by the profession.
Mat Baker, HR consultant with online medical information service Perceptive Informatics, says: “This will aid a swift return to work for the employee and, in the current financial climate, ensure productivity and delivery of services while allowing and enabling the company to remain competitive.”
The design of the new fit note has not been finalised, but the aim is to enable GPs to suggest tasks that an employee is able to do, rather than note down only what they cannot do. The government plans to develop an electronic version of the fit note depending on the results of a pilot in Wales.
The fit note alone, however, will not ensure a rapid return to work. For their part, managers and especially HR will need to be proactive in communicating with GPs and employees. The principle of a fit note may help with this as it will remove the sense that communicating with an absent employee potentially amounts to harassment, and it will help identify the causes of absence and what intervention is needed to achieve a return to work.
Fit for work
While occupational health (OH) training is being rolled out for GPs, the plans will depend on them having the time and the will to take on this responsibility, says Mark Simpson, an OH doctor and medical director of OH service provider AXA ICAS.
“It is vital that their key role in these initiatives is recognised by GPs themselves,” he says. “If it is perceived as another heavy handed imposition of further work for them, there is likely to be resentment and non co-operation. Government recognition and British Medical Association support will be critical to winning them over.”
GPs are also central to the government’s plans to introduce new fast intervention services – the ‘fit for work’ teams – as well as an extension in early 2009 of the Pathways Advisory Service for three years. This scheme puts employment advisers in GP surgeries to help people on incapacity benefits return to work.
The fit-for-work pilots will run until at least 2011 and, if successful, could be the most radical reform in the package. The aim is to prevent employees on sick leave from being victims of long NHS waiting lists by giving them access to multi-disciplinary teams co-ordinated by case managers, who liaise between the different practitioners and the employer and support the employee back to work.
Stress-related ill health is seen as a priority, and later this year the government will launch the first mental health strategy for working-age people. However, it is not yet clear whether it is the NHS or private sector OH service providers that will offer the service in the long term, nor is it apparent how it will be paid for once the £13m pilot fund has run out.
Another problem is that there is a shortage of OH doctors and nurses, and it is not clear who will make up the army of other practitioners, such as case managers, that will be needed to provide the new services. While doctors and nurses are regulated, it will be a key challenge to develop a regulatory framework and accredited qualifications for these other practitioners.
Other initiatives in the government’s package include regional health, work and wellbeing co-ordinators to support local work and health initiatives, an expansion of the NHS Plus OH service for small and medium-sized companies (SMEs), and an OH helpline for SMEs.
A new National Centre for Working-Age Health and Wellbeing will produce evidence on the impact of OH interventions, which should help employers identify what is right for their own organisations and how much to spend.
When they are launched later this year, HR professionals will also be expected to use a range of tools – developed by Business Action on Health, an offshoot of the corporate responsibility employers’ group Business in the Community – to promote employee health.
However, all these initiatives will not be enough to transform the workplace into a setting for improving the health of working-age people. And HR professionals will have to demonstrate bottom-line benefits to convince senior managers to invest.
But will HR accept this responsibility? Yes, says Richard Crouch, head of HR and organisational development at Somerset County Council. “Health is directly related to sickness absence, which is ordinarily seen to be a performance function of HR,” he says. “And the huge organisational cost of sickness absence, particularly for front-line service roles, is well known to HR professionals.”
However, Baker argues that health and wellbeing is not the responsibility of HR, but of the business as a whole.
“It is only with the support of the senior management group that a business will be able to truly make such initiatives successful,” he says. “Companies need to be able to measure success, where possible, and the key performance indicators chosen will be important contributors to the success.”
The government hopes that HR managers will use tools such as the Business Healthcheck Tool – developed by consultancy PricewaterhouseCoopers and launched in 2008 – to demonstrate a return on investment. This will encourage employers to invest in health promotion and wellbeing schemes with clearer objectives and measures of success.
In the long term, the government’s work and health strategy depends on somebody footing the bill, and it may be asking too much for employers to do this alone.
The Improving Health and Work document suggests the government is leaving the door open to consider tax incentives for employers to invest, stating: “The costs of ill health and sickness absence in particular fall to individuals, employers and the state. We want to review whether the current system is appropriately balanced”.
More radical steps, such as a law forcing employers to provide access to OH, or a requirement for board reports to cover employee health, are more remote possibilities. In the meantime, Business in the Community is currently working with the government to ensure that 75% of FTSE 100 companies voluntarily report on their employees’ health and wellbeing at board level by 2011.
The pinnacle for work and health would be if employers saw the wellbeing of staff as a strategic advantage, and elevated it to a boardroom issue. And HR could stress the less tangible benefits such as more motivated and productive employees, less working time lost to ill health, better staff retention, greater competitiveness, and higher profits.
Now, when jobs are being cut, staff are being asked to go the extra mile and stress levels are high, could it be the right time for HR to make the case for investing in effective absence management and employee health and wellbeing? Crouch thinks so.
“It’s very clear that a healthy workforce is a happier workforce, and that this is directly proportional to productivity,” he says.