Where do you stand on health?

The role of the employer was once restricted to providing employment. This was then modified to providing em-ployment that did not put the ‘health, safety and welfare’ of workers at excessive risk. Today, it is difficult to find any employer who does not regard the health and wellbeing of employees as a business issue. The steady advance of ‘new paternalism’ may be upon us.

To find new paternalism in action, simply visit some of the big names among the professional services and business advisory firms, such as Accenture, BT, Goldman Sachs, Clifford Chance or PricewaterhouseCoopers, where ‘wellness’ programmes run through fitness and nutrition advice, work-life policies, desk massage, subsidised gym membership, counselling for employees and their families, stress management, physiotherapy and emotional health initiatives.

Some of these firms have also signed up to a campaign offering support to staff suffering from domestic violence. None go as far as singling out the breathless or salad-averse for a referral to a dietician. But they do distribute pedometers and encourage employees to put in 10,000 steps a day. Naturally, these firms all dispatch smokers to brave the elements outside their office buildings.

It was the great Quaker industrialists of the 18th and 19th centuries who, with their model villages, schools and hospitals, best exemplified the view that a stable, cared-for and healthy workforce was likely, in the long run, to be a more productive one. People needed help to help themselves, they believed.

When George Cadbury instituted a morning assembly for his employees, the stated purpose was two-fold: to invigorate workers with community spirit, and “to check any tendency to impropriety”. Is the new paternalism a direct descendent of the old?

Naturally, the association is denied. Yet with the stress on productivity and ‘self-responsibility’, it is difficult to avoid the comparison. This time, the new paternalists have scientific evidence to substantiate what the Quakers merely suspected. Research commissioned by wellbeing consultancy Vielife, from the Harvard Medical School and the Virginia-based Institute of Health and Productivity Management, says that ‘healthy’ workers are 20% more productive.

People with a waist measurement of more than 37 inches are at a higher risk of ischemic heart disease, notes Dr John East, medical director of the Society of Occupational Medicine.

“Obviously, it would be intrusive to go around taking measurements, but good employers regard health and fitness as very much their business,” he says.

A new priority

Whether caring or creepy, it is an agenda that is expanding fast. The 1970s workplace that inspired the Health and Safety at Work Act took health, safety and welfare to refer principally to physical hazards, such as asbestos, explosions and falls from ladders. Obviously, such perils remain. Yet fatal injuries at work have been falling consistently (in 2004-05 there were 220 deaths at work, down from 236 a year earlier).

Health is the new priority and, 30 years on from the introduction of health and safety legislation, the field is dominated by psychosocial conditions, such as stress. The Health and Safety Executive’s standards for how employers should control stress, for example, have little to do with traditional health and safety. Instead, they are about job design, change management, dealing with work relationships, and autonomy over how work is done. These are the areas most likely to help build psychological health – or so the thinking goes.

The prevailing mood among employers is opposed to a strict demarcation between what is and what isn’t a work issue. Employers increasingly regard anything that may impinge on work performance and absence, whether caused or exacerbated by work or not, as matters to be ‘managed’ by them. Hence the advice about emotional wellbeing.

“As little as five years ago, most employers regarded health and wellbeing as the workers’ responsibility,” says Jenny Lanyon, senior operations manager for PPC Worldwide, an employee assistance programme provider. “There has been a significant shift in the way emotional issues that affect work are handled.”

The list of what ‘social services’ employers offer to staff has always fluctuated, depending on demand and on what the state already provides. For example, eight years ago, the Post Office offered a well-woman clinic to female employees. It was scrapped after NHS facilities in this field improved and waiting lists decreased. Similarly, if waiting times are long for some referrals, such as the current eight weeks’ wait for physiotherapy, there is likely to be a rise in demand for employer referrals because it is cost-effective for an employer to intervene to get people back to work quickly.

Nevertheless, employers are being pushed into new areas. The Corporate Alliance Against Domestic Violence aims to highlight the human and economic toll of domestic violence. Of the latter, the alliance claims a 2.7bn cost in lost productivity, absenteeism and extra burdens shouldered by co-workers. At the BBC, a third-party counselling service is offered to the immediate family of workers as well as to the workers themselves.

The slide towards locating all social ills in the workplace, favoured by a few, is leading to some striking discrepancies. Hugh Robertson, head of health and safety at the TUC, backs employer efforts to provide a healthy and supportive workplace. But he cautions against “red herrings”. Offering desk massage and free pedometers while doing nothing to tackle stress by shortening the working day is one common example.
“We don’t want people healthy just so they can be exploited more,” he says.

Similarly, while a few paternalistic employers are pioneering sophisticated new services for staff, many are still struggling with more basic concepts, such as flexible working and family-friendly policies.

According to the most recent government-backed Workplace Employment Relations Survey, the flexibility to vary work patterns to cope with personal and family problems is a freedom not enjoyed by most workers. Arguably, therefore, one of the most simple, practical, and supportive things employers might do to help staff who are suffering emotional difficulties – offering paid discretionary leave – is just not available to most.

So what are the limits of an employer’s responsibility towards the wellbeing of staff? The most accurate answer is that there are none: employers go where they perceive a need, but there are some tacit ground rules that tend to be respected.

You cannot force the issue

Like the paternalists of yore, employers such as Goldman Sachs stress ‘self-responsibility’ in their wellness programmes. The employer’s role is in lifestyle advice and encouragement; it is up to employees whether they listen to it.

Discriminating against the unhealthy, or docking the wages of smokers, as one or two US employers do to compensate for higher health insurance premiums, is legally dubious in the UK, and a recipe for troubled employment relations.

At Dounreay nuclear power station in Scotland, the replacement of chips and burgers with salads was successfully reversed by the workforce. Neil Budworth, president-elect of the Institution of Occupational Safety and Health, says that where the advice is specific to the job, it is most likely to be useful. “A truck driver working unsocial hours has limited choice about where to eat,” he says. “It is useful to know if they are better off at a caf or a fast food chain.”

Handle with care

The more sensitive areas of occupational health, such as depression and stress-related conditions, are invariably not provided by employers themselves. Employee assistance programme providers and wellbeing consultancies offer confidential services, and would only reveal the identity of a client in exceptional circumstances.

Typically, employers only receive information about how many people are using the services. Also, the services are limited to the ‘talking cures’ end of the emotional health spectrum. Serious mental illness, such as manic depression and personality disorder, needs to be referred to the NHS. Lanyon says employers are conscious of the ‘big brother ethic’. “It does need to be handled very sensitively,” she adds.

Responsibility extends beyond work

Employers do not regard their responsibility as ending the minute employees walk out the door. With psychosocial conditions, such as stress, the origins are impossible to discover anyway: the interplay between the stressors of home and the stressors of work are too complex.
Getting people back to work is the overriding priority. So employers hope that by reinforcing messages about health that exist in wider society – about nutrition, for example – they add to the pressures promoting lifestyle reform.

Is it about a legitimate concern for productivity or a sneaky desire to micro-manage the personal lives of workers? It is easy to see why such questions have always dogged paternalism. Yet they are unlikely to stop more employers becoming convinced that their future business interests lie in the health promotion business.

Should employers be responsible for a healthy workforce?

“Yes. But it needs to be done in co-operation with the workforce – not done for them, but done with them. Sometimes initiatives distract from any real attempt to tackle the causes of stress, but broadly we are in favour.”
Hugh Robertson, senior health and safety policy officer at the TUC

“Yes, a person who is fit, happy and motivated is likely to give more to the company. But the company culture needs to be ready for this otherwise it can be misinterpreted as intrusion. It would be quite wrong to impose it on anyone.”
Janet Asherson, head of health and safety at the CBI

“Yes. The law is concerned with the basic duty to provide a safe working environment, and, within that, stress management has become a major issue. Yet beyond the legal obligations, many employers are taking the approach of dealing holistically with the whole organisation and looking out for the psychological welfare of their staff.”
Chris Rowe, head of the psychosocial policy unit at the Health and Safety Executive

“Yes. There is a continuum between basic safety and health. If you have referral processes in place for employees who are ill, it tends to pay back very quickly. It makes good economic sense. The workplace is an effective way for getting health messages across. It is then up to the individual whether to take that advice.”
Neil Budworth, president-elect of the Institution of Occupational Safety and Health

“Yes. When people are working they should be supported to stay in work and to be healthy. Workforce health remains a priority for this government. We will shortly be appointing an occupational health director to spearhead efforts to improve the health of workers.
Spokeswoman, Department for Work and Pensions

“Yes. Where employers are managing these things successfully, people tend to take less time off sick. Employers can only do so much and, of course, much stress is caused outside work. But as long as you are not shoving it down people’s throats, providing support and flexibility has to be a good thing.”
Ben Willmott, employment relations adviser at the Chartered Institute for Personnel and Development

“Yes. If it leads to less absence and a more contented workforce, I would think employers would do it for normal business reasons. I guess it could be a bit corny and intrusive, but I don’t really see anything wrong with it.”
Geraint Day, policy adviser at the Institute of Directors

Flexible working and leave arrangements for non-managerial employees

Flexible working arrangement

                                                                               Percentage of workplaces
                                                                                  1998                     2004

Switching from full-time to part-time hours        46                          64

Flexitime                                                                    19                         26

Job-sharing                                                               31                         41

Homeworking                                                           16                         28

Term-time only                                                          14                        28

Annualised hours                                                     8                          13

Zero hours contracts                                                3                          5

Leave arrangements

                                                                              Percentage of workplaces
                                                                                  1998                     2004

Parental leave                                                          38                          73

Paid paternity/discretionary leave for fathers     48                          92

Special leave in emergencies                              24                          31

Base: All continuing workplaces with 10 or more employees in 1998 and 2004. Figures are weighed and based on responses from at least 847 managers.

Source: Inside the Workplace – the 2004 Workplace Employment Relations Survey

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