Policy responses and statements
- Name of organisation:
- Department for Work and Pensions (DWP)
- Name of policy document:
- Carol Black's Call for Evidence on the Health of Britain's Working Age Population
- Deadline for response:
- 30 November 2007
Background: Dame Carol Black, National Director for Health and Work, is undertaking a review of the health of Britain's working age population. Earlier this year the Secretaries of State for Health and for Work and Pensions commissioned the National Director for Health and Work, Dame Carol Black, to undertake a review of the health of Britain’s working age population.
Practical steps to improve people's health and help them remain in or return to work are the aim of the Government's 'Call for Evidence', as part of the first ever review of the health of the working age population. Last year, 175million working days were lost to sickness absence, costing organisations about £650 per employee. Without the right support, people can slip into a life on benefits and lose contact with the labour market and that there is therefore an urgent need to address how people's health can be improved and how they can be supported to stay in or return to work.
Dame Carol sought evidence to inform her review – and in particular was keen for responses to the following questions:
How can we keep working age people healthy and how can the workplace be used to promote health?
How can people best be helped to remain in or quickly return to work when they develop health conditions including chronic disease or disabilities?
How does the age of the person affect the support that is needed?-
How can we encourage action to improve employee health?
What underlies the apparent growth in mental health problems in the working age population and how can this be addressed?
What constitutes effective occupational health provision and how can it be made available to all?
What would be the impact on poverty and social inclusion of a healthier working age population?
What are the costs of working age ill-health to business and what are the benefits to companies of investing in the health of their staff
COMMENTS ON
DEPARTMENT FOR WORK AND PENSIONS
CAROL BLACK'S CALL FOR EVIDENCE ON THE HEALTH OF BRITAIN'S WORKING AGE POPULATION
The Royal College of Physicians of Edinburgh is pleased to respond to the DWP on Carol Black's Call for Evidence on the Health of Britain's Working Age Population.
This College believes that the capacity to work is of fundamental importance for everyone who wishes to work, and who has yet to take their place in the workforce. To many people, it is the reason to be healthy - both to be able to work and to provide for their family. The capacity to work, therefore, is one of the most important health outcomes which perhaps may have been underestimated in the past. Work, itself, is a vital determinant of health and wellbeing.
To the questions:
1. How can we keep working age people healthy and how can the workplace be used to promote health?
First, it is important to maximise the benefits and minimise the risks to health at work. Underpinned by the Health and Safety at Work Etc Act and subsequent legislation, this is a matter which has a clear legislative framework and places a duty not only on the employer, but also the employee. Second, there is an ethical dimension to maximising benefit and minimising harm. Third, there is a reputational dimension for the business concern, in that a failure to take health at work seriously would undermine the credibility of many other measures to promote the interests of the workforce.
It is most important to develop and sustain good sources of information on the risks of work-related ill-health, on examples of good practice to manage these risks, and to investigate and report on work place environments that encourage wellbeing. This promotes not only the image and reputation of the employer, but is evidence for Government and employees, and other employers more generally, thus informing public policy, good practice and employee behaviour.
Continuous investment in routine sources of recording such as THOR and academic and research capability to address and answer important strategic and practical questions on health in the workforce.
Education-based information sources and research are essential concomitants to work. Lacking from most undergraduates' health professional courses is a grounding in occupational medicine. Recent attention to health in the health service workplace may drive changes in this respect, bearing in mind the prominence of HAI as an issue for patients, but also the role of health care workers in control of these risks to themselves and their health care 'consumers'.
2. How can people best be helped to remain in or quickly return to work when they develop health conditions, including chronic disease or disabilities?
First, and a matter that would mark a major change in the practice of primary medical care, the General Practitioner must see themselves as a co-producer of health. The widespread practice of GPs in an unquestioning approach to the relationship between health, impairment and capacity to work requires a major change of culture and primary care education. This education and training should occur at undergraduate, postgraduate and continuing levels, and should encapsulate rehabilitation, as well as health conditions. These subjects should also encompass specialty training in relevant areas of hospital and community practice.
Good practice guidelines, which are evidence-based in the occupational medicine field, are essential to encourage and develop. This would "level up" the standard of practice in non-specialist, as well as specialist, areas, and incentives in primary care should align with results such as early return to work.
The role of employers and employees in understanding and making full use of occupational health services would contribute greatly to systems that would aid people to return to work with chronic disease or disability.
Finally, channels of rapid assessment and intervention for conditions that would be self-limiting if addressed early are a matter for strategic, clinical and ethical debate. Priority setting for the working population over the non-working members of society for such services as physiotherapy is a matter that merits a public airing.
3. How does the age of the person affect the support that is needed?
The age of the person should be immaterial to the nature of the complaint. It is true that older people are more likely to carry conditions and latent conditions, also several co-occurring conditions that may complicate the picture. However, age itself is not a bar to any measure of support as long as there is evidence of effective remedy and levels of rehabilitation that restore function and capability. Also, while the prevalence of most chronic illness increases with age, often younger people may need more support in some matters, for instance, stress. This is also true of younger or older managers who may require a greater amount of support in managing a return to work due to their relative inexperience or, perhaps, fixed notions of work capability.
4. How can we encourage action to improve employee health?
The main evidence-based interventions are education, advice and ease of access to the means to sustain good health. This encompasses the interest of the employer, an understanding and rigorous application of enlightened health policies, the right incentives to take sick leave when appropriate, and encourage return to work when appropriate. Employee health may also be promoted, depending on the work and industry, through job design and evidence interest in general lifestyle - such as a choice of healthy canteen food, ready access to public transport, rather than private transport, to inform work and during work, smoking cessation support, stress management and the availability of counselling, on-site physiotherapy etc. A recent American review and report covers this area (New England Journal of Medicines, 11 October 2007, 357; 15: 1,465-69).
5. What underlies the apparent growth in mental health problems in the working age population and how can this be addressed?
There are 2 possible explanations for this apparent trend. The first relates to the changing nature of work where less of the hazards are physical, chemical or biological, but there are more psychological demands, and job insecurity; second, there may be cultural reasons - with perhaps a shift in diagnostic labelling from musculo-skeletal to mental ill-health as it is 'more acceptable' now for workers to admit or claim to have a mental disorder. At the same time, disorders such as 'back pain' now have a stronger (and more widely accepted) evidence-base supporting early rehabilitation and return to work.
Therefore, the lowering of stigma and greater acceptance of mental health problems, and the greater willingness to disclose problems that may have contributory factors that are related both to work and non-work, will have driven this trend.
6. What constitutes effective occupational health provision and how can it be made available to all?
(a) Effective occupational health provision must be integrated with overall employee and employer practice. It should start with an understanding of the issues by management at all levels who should take steps to reduce risk and make work an enjoyable experience in a positive environment. Health professionals, and not only occupational health professionals, should be adequately aware of and competent in occupational health matters specific to a work situation, as relevant to their practice or specialty.
(b) Effective occupational health provision' depends on the employment sector in question. Some industries require a high proportion of specialist trained professionals, whilst others require more general and less rich skill mix of occupational health staff, together with ratios of health staff. Therefore, definitions depend on the setting and the employment in question.
(c) Some NHS organisations already provide occupational health services and/or occupational medicine referral services to non-NHS employees, in addition to their responsibilities for NHS employees. These initiatives have demonstrated great potential, and an enrichment of the standards and motivation of occupational health services.
(d) While it is important to recognise that achieving and re-validating professional standards in specialist health professionals, such as occupational health physicians and nurses, is only part of that required to achieve quality in service provision, regulatory arrangements should ensure much greater coverage of trained health specialists offering occupational health advice and services.
7. What would be the impact on poverty and social inclusion of a healthier working age population?
A healthier working age population would result in a better reputation for employment at the margins, especially in low paid sectors. It would offer a first rung on the ladder of inclusion for people at the edges of the workforce - both from populations who have never known work, and those who are in and out of unstable employment on a regular basis for whatever reason. A healthier working age population would therefore go a great distance to alleviate poverty and promote social inclusion. This requires efforts both in incentives to come off benefits, with adequate training and education, and entry to the world of work for those who are not habituated to the experience.
8. What are the costs of working age ill-health to business and what are the benefits to companies of investing in the health of their staff?
This is a detailed matter for which there is evidence that it is widely available of the burden of disease that prevents work, encourages non-work. The effective cost runs to tens of billions of pounds per annum for the UK. Health-related "presenteeism" (people at work but under-performing) is a further phenomenon which drives up the costs of poor health, and alcohol problems are at the forefront of such a phenomenon. The National Health Service, as one of the largest employers, sees this phenomenon for itself, the cost to pensions. Pension funds and incapacity benefit are costs to the State and finance industries, quite apart from wealth loss to businesses and to communities and families.
Conversely, the benefits to companies are of lower staff turnover, higher loyalty, lower absenteeism, healthier lifestyles and staff who are fitter for longer. Employers who take an interest in the welfare of their staff know that "good health is good business", to quote a HSE campaign strapline on the subject.
Research from the THOR programme at the University of Manchester has shown that insofar as work-related ill-health is concerned, work-related mental disorders (including "stress") are the predominant "cause" of sickness absence. Resource to reduce the sickness absence burden should be directed at mental disorder and, because they are of comparable economic importance, musculo-skeletal disorders are of equal importance.
In conclusion, we welcome this open-minded consultation. Whilst these responses are not specific in evidence, the College trusts that the precision of evidence will be forthcoming from those with specialist interests in this area of medicine. The College wishes the Enquiry every success in promoting measures to improve the health of Britain's working age population.
Copies of this response are available from:
Lesley Lockhart,
Royal College of Physicians of Edinburgh,
9 Queen Street,
Edinburgh,
EH2 1JQ.
Tel: 0131 225 7324 ext 608
Fax: 0131 220 3939
[29 November 2007] |
