Working For Health NI Blog

The 2006 HSENI Spring Conference included a puzzle jigsaw within the delegate pack whose tagline read - ‘Putting health into health and safety. It’s more than just a tick in the box.’

However as debated elsewhere in these pages, it could be suggested that all aspects of workplace health could be seen by some employers / managers as just that i.e. “the training has been done, so I can forget about that for a few years.”

Musculoskeletal conditions may well fall into that category. Some people may think that “all my staff have been trained in manual handling or safe lifting, so there’s no need to worry about back pain in the future.” They may not think that the process in question could be changed (often quite simply and at minimum cost) to eliminate the risk of musculoskeletal disorders occuring. 

If the problem occurs, then the necessary advice should be supplied. Although the current medical research indicates that sufferer should remain active,  is this always being followed (by the patient) or is this advice even being made clear to the sufferer. How can everyone be made aware of the right steps to take if damage occurs? Would a promotional campaign assist this process?

In other words:
Is any additional workplace health training or information required locally for GPs and occupational health professionals to reiterate the current medical thinking (similar to desk-top advice produced for GPs in Wales) ?
Are public media campaigns required to promote the ’stay active’ message?
Should more be done on the ground by employers to combat the risk before it occurs?

All comments and suggestions are welcome.   

Although the statistics speak for themselves, they’re not talking loudly enough.

172 million working days lost, at a cost of close to £20 billion or 3.1% of payroll for a typical employer (according to the 2008 CBI / AXA Insurance Absence and Labour Turnover Survey). 

Despite all this, Professor Dame Carol Black’s review of the health of Britain’s working age population states that as many as 40% of organisations have no sickness absence management policy at all.

As one manager responding to the 2006 FSB Health Matters survey states ”If I go sick, my company does not run - simple as that. I can’t afford to take time off sick, as I would have no assistance from the government should I do so.” A self employed person comments that ”If I was employed I would have been signed off for eight weeks. As it was, I only took the day off for the operation.” This is summed up by another respondent - “With a small business, we have no slack in the system.”

Yet other FSB surveys (Whatever happened to common sense, 2007) indicate that the battle for hearts and minds has not yet been completely won - to over 20% of respondents, good health still does not mean good business.

How can SMEs be supported to cope with such a difficult problem.
Are websites or similar booklets enough to provide basic support, or is some sort of telephone helpline or similar one-to-one assistance required?
Should assistance be more hands on - with a case manager available at the end of the phone to deal with problems around the issue of staff rehabilitation for example?  
Should support for small firms be linked with the ocupational health departments of larger organisations (via the supply chain) within their specific locality or alternatively linked to some type of NHS support service (like NHS plus in the UK).

Some of these issues are currently being discussed by the Occupational Health Support and Rehabilitation Programme Team as part of their current work,  as a direct consequence of a Model of Best Practice being developed during the first phase of the strategy.

A selection of small firms will also be included within a survey which is due to be carried out by Working for Health over the coming months to gather opinion on what assistance is required and to determine current workplace health problem areas. However, HSE GB and NHS Occupational Health services (among other providers) were not seen as providing support to SMEs when questioned for the aforementioned 2006 FSB Health Matters survey about the management of long-term sickness absence.

However, all comments and suggestions as to how we can provide support and rehabilitation services for small firms are welcome. 

The statistics contained within Professor Dame Carol Black’s review of the Health of Britain working age population make for startling reading (available within the Health, Work and Wellbeing website - accessible from links) . The annual cost of over £100 billion due to the economic costs of sickness and worklessness associated with working age ill-health is probably the most disturbing fact of all. Reducing this cost will be a delicate task, but an essential one, if the economy is to survive, with numerous key steps required .

The main thing is to alter this cycle by getting people (off on long-term sickness absence) either back into their current work, or to ensure that (if this is not possible) they are able to be rehabilitated back into another job 

In addition, how can we assist GPs to support such proposals if introduced in the future? It has been suggested that GPs currently perceive their role to be as a patient advocate, rather than providing advice as to when their patients should go back to work. Is it possible to change the medical culture through increased awareness of occupational health matters or additional workplace health training? Is it necessary for the sicknote to be scrapped and a welllness note introduced instead (as discussed in Dame Carol Black’s report).

A recent GB survey reiterates that GPs are not aware of recent research by Gordon Waddell and Kim Burton indicating the benefit of work on health, for common health problems such as mental health, musculoskeletal and cardio-respiratory problems  (Work and Health Leaflet). Is addional training or media campaigns enough to raise awareness of the benefits of work on health among the medical profession?

Additional funding and staffing may also well be required to provide this support. There are currently very few local GPs who have any Occupational Health involvement or experience. Most small firms have no access to any specialist medical support, unlike the larger companies (which may have their own Occupational Health departments or be able to buy in support from outside professionals / consultants).

Even if the benefits of work on health are made clear and GPs feel informed enough to discuss the workplace setting with patients (and also discuss return to work patterns, alternative jobs etc with employers) , how can we get the working age population on board. How can someone who has never worked in their life be influenced to go to work? This links in with the wider picture and ongoing international research on the social determinants of health, which illustrates how work, culture, lifestyle, housing, social deprivation and other influencers (e.g. diet, exercise, smoking etc) all affect health.

Finally, how can sickness and worklessness be reduced from the current annual cost of £100 billion? Reduction of, or the threatened removal of someone’s incapacity benefits would be one route to entice those off on long-term back leave into the workforce (except for those who have been classified as medically incapable of work). The introduction of improved employment schemes or similar job retention grants / employment initiatives may be another mechanism. A public health campaign on the benefits of health on work could also shake up the system. A persuasive radio ad campaign on the cost to the economy from long-term sickness absence could also utilise this subtle approach. 

All suggestions and thoughts are appreciated
         

The newspaper reports make it seem like the public sector is rife with stress, especially when you read the annual statistics for local Government Departments or District Councils within Northern Ireland. The annual statistics produced by HSEGB also reiterate this point. It has been suggested that we should be talking about distress at work, rather than stress, as some pressure / stress is required for motivational purposes, to enable us to do our jobs.

However, when you check statistics from small businesses and other sectors, the problem doesn’t seem to be anywhere near as bad. Is this caused by a different culture within the public sector (possibly more slack in the system so seen to be more acceptable to take time off?) , whereas in smaller companies it’s all hands to the pump in order to maintain the company’s existance (employees thinking about their colleagues all pulling together and how it will affect the company, if they go off sick, so they decide to struggle on) . Is the threat of getting fired more persuasive in the private sector, as how often do people get dismissed from the public sector for a poor sickness absence record? 

Regarding Stress support, HSEGB has introduced the Stress Management Standards and rolled these out over the last few years. Similar efforts have been made in NI by HSENI to either work hands-on with some public sector organisations , or to facilitate the organisation and running of their workshops. The standards have proven to be a very useful tool but may possibly be seen as too complicated and too demanding for smaller firms to use. The Work Positive tool (which incorporates the standards) may prove to be more beneficial for smaller companies? A series of questions must be investigated:       

How can we change the stress culture that currently exists?
Is is only a public sector problem?
Is it even caused by work, or is it largely due to extenal pressures (from home life)  invading our workplace?
Is stress used as the catch all term for more serious mental health conditions (looks better on the sicknote)? 
Are the HSE stress management standards being used by local public sector organisations?
Is the Work Positive tool easy to utilise for smaller (non-departmental) companies?     

All comments or thoughts are welcome.   

Having discussed the experiences of various support services currently available (as highlighted within the pages section of this blog), it seems that some businesses only pay lip service to workplace health (if they even acknowledge it in the first place) or believe that it’s included within safety.

Numerous information (unfortunately mainly GB based) is available which pieces together the business case for taking workplace health on board. I have been collating these together into a summary report providing some of the current statistics and this will be placed on the Working for Health site shortly to illustrate some of the statistical findings.  

The question is how can companies be enticed to take this issue on board.
If support was available to all companies, would they use it?
Should enforcement or legislation be used to place workplace health onto the business agenda, or is there already enough red tape out there for business to deal with?  
Would accurate data, detailing costs and savings, get the point across to local businesses, if used as part of targeted campaigns?

All suggestions and comments are welcome    
   

As discussed within the pages section, data on the local costs of workplace health is difficult to obtain. It may be possible to produce some case studies highlighting the perceived benefits for smaller companies who have adopted schemes such as Foyle Health at Work, Workplace Health Initiative, Work Well etc but it is doubtful whether hard financial data will be available. Currently data is easiest to obtain for certain areas of the public sector - NICS Government Departments and District Councils, while data for large private sector organisations has been more difficult. There have been discussions that some of the larger public sector companies may include data within future annual reports. I know that this is being proposed as part of Business in the Community’ s Business Action on Health Campaign.

However, the majority of companies within NI are classified as SMEs (Small and medium enterprises) and it will be difficult to obtain full data from this sector, although some information comes in already in the form of FSB’s biennial ‘Lifting the barriers to growth’ survey. 

In order to accuratley guage the scale of the problem, should it be made compulsory for companies with 50 or 100 employee and above to report on sickness absence and the associated costs, with some kind of anonymised central registar of such information kept as a means to produce local data? If such a reporting scheme was ever introduced in the future and utilised to develop a suitable baseline against which progress can be measured, it must be repeatable on a ongoing basis (for comparison purposes). 

All suggestions are welcome on how to gather local data

    

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John Wilson
Working for Health Strategy
HSENI
83 Ladas Drive
Belfast
BT6 9FR

Tel: 0800 0320 121 or E-mail: workingforhealth@detini.gov.uk 

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