To Hain and Black:
What you don’t know is killing us

Dame blast

The government’s ‘work is good for you’ push to make the sick work is overlooking one inconvenient truth. Hazards editor Rory O'Neill warns a combination of long hours, job insecurity, punitive sick leave policies, a failure to recognise the extent of the work-related health crisis and a lack of safety enforcement means for many work is bad and getting worse.

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The working wounded

Dame Carol Black, the government’s national director for health and work launched a review of the health of the working age people on 11 October 2007.(1) The intention of the “call for evidence” is to identify the action “government, business and the medical profession should take to improve the health of working age people and help more people who develop health problems to remain in or quickly return to work.”

At the launch, work and pensions secretary Peter Hain said: “Last year 175m working days were lost to sickness absence, costing organisations about £650 per employee. But the human cost is worse. Without the right support people can be relegated to a life on benefits as they fall out of the workplace and loose the confidence and skills to re-enter work.” He added: “This, as well as increasing mental illness and the need for more and more people to work in to their older age, means that we urgently need to address how we improve people’s health and support them to stay in or return to work. That is why we have asked Dame Carol to scrutinise this area and provide us with some answers.”

Dame Carol said: “People that work are healthy, wealthier, and live longer than the unemployed. The benefits to the individual are clear; but employers also have much to gain.” She asked: “But why don’t more employers invest in this area? Do GPs provide the right advice to patients? What support should the government provide? And what are the true costs of ill-health – to society, business, and individuals? I will be seeking answers to tough questions like these over the coming months.”

When work turns bad

There is an unanswerable case that work can have considerable benefits, most directly related to the size of the associated wage packet. But does recognising unemployment is bad mean, conversely, “work is good for you”?

Not necessarily. Carcinogen exposure isn’t good for you, but over a fifth of the workforce could be regularly exposed and thousands develop work-related cancers every year. Heart-bursting work overload isn’t good for you. And job insecurity isn’t good for you. TUC says up to one in five of the workforce may be considered vulnerable workers (Hazards 99). They include agency workers, particularly the unskilled, casual workers, industrial home workers and migrant workers – an October 2007 Home Office paper reported people born overseas account for one in eight (12.5 per cent) of the UK's working age population. Precarious work has been linked to host of workplace injury and chronic health risks.

Good work may be good for you, but good work is in short supply. Instead, sick workers face increasing pressure to make an early return to work or to stay in work when sick, with this approach often formalised in sickness absence policies (Hazards 85). It is an unhealthy strategy. A 2003 British Medical Journal report of findings of the Whitehall II study of UK civil servants, the UK's biggest ongoing occupational health study, concluded “short term absences may represent healthy coping behaviours,” with these workers less likely to end up on the long-term sick list.(2)

Some employers have been willing to take drastic action to curtail sickness absence, without making any attempt to curtail sickness levels. One health board in Scotland is considering issuing sick staff final written warnings. Commenting in November 2007 on the strategy document considered by NHS Glasgow and Clyde and prepared by its human resources director Anne McPherson, UNISON regional organiser Matt McLaughlin said: “We would expect a reasonable employer to be proactive about sickness at work and look at issues such as staffing levels, working practices, improved training and support for staff rather than simply adopting a blanket approach which will put hard worked staff under even more pressure.”

The union said under the proposal sickness strategy nurses in Glasgow could for example be fired if they suffer work-related health problems or injuries of if they follow a key health board policy to prevent deadly infection outbreaks. Matt McLaughlin said the approach was “disgraceful”, adding: “It is clear from these proposals staff who are injured at work or are terminally ill will be given final written warnings and could be sacked.”

Increasingly punitive sickness absence policies have been hounding the walking wounded into work. Presenteeism brings under-performing workers into the workplace, hindering their recovery, possibly spreads infections – colds feature as one of the top causes of sick leave in listings - and damages productivity.

The problem in many workplaces is being exacerbated by efforts to curtail expenditure on ill-health pensions. London Underground union RMT this year had to threaten strike action to protect an agreement that guarantees pension rights of Tube employees forced to leave their job through ill-health.

The deal, which involves companies covered by the Transport for London (TfL) Pension Fund, came after RMT members voted by to strike against moves that would have dramatically affected qualification for ill-health pensions. Pensions are currently granted to workers whose ill-health makes them unfit to do their job, including those affected by work-related health problems. RMT said the proposed changes, which have now been withdrawn, would have meant that anyone capable of earning any income at all – whether or not there was a job for them to do - would probably not qualify for an ill-health pension.

In October 2007, firefighters' union FBU warned it could take action as a result of pension scheme changes that have seen injured and sick firefighters pushed out of a job then denied an ill-health pension. It said changes to the Firefighters Pension Scheme (FPS) have already seen three firefighters in London lose out, one after developing work-related hearing loss.

Raising the union concerns in a letter to ministers, FBU general secretary Matt Wrack wrote: “The effect of these changes will be to place firefighters in limbo. They will not be able to continue in their profession due to ill health. They will not be entitled to a pension. They will also not be guaranteed any employment since there are few, if any, such (non-operational) jobs in existence within the Fire and Rescue Service.” He added that firefighters has paid high contributions “to allow for the possibility of early retirement due to ill-health” but now faced poverty as a result of the changes.

What do they know?

When it comes to harm caused by work, there is substantial evidence the government doesn’t know what it is talking about – but it continues to evangelise about the benefits anyway. A September 2007 survey for the DWP of 1,500 GPs “found that two-thirds (64 per cent) are unaware of the evidence that work is beneficial for physical and mental health. However, nearly 90 per cent said that if they knew of this evidence it would affect the advice they give to their patients.”

Announcing the findings, safety minister Lord McKenzie said available evidence proves “conclusively” that work is good for you. “The recognition that there is evidence that work is good for people’s health is, I believe, that powerful. Because it means staying in work or returning to work could actually be part of the solution to ill-health - no longer be seen as part of the problem.”

The evidence they lean on, a September 2006 ‘Is work good for your health and well-being’ paper prepared for DWP, played down the harmful effects of work but even then concluded that for 10-20 per cent of workers, work made their health worse – and this was a net loss, more than offsetting any positive effects (Hazards 98).

When the government does acknowledge work’s potential to cause some harm, it falls back on the Health and Safety Executive’s Labour Force Survey figure of 2 million people saying they were suffering an illness they believed was caused or made worse by their work in the previous year.

The only problem here is that this estimate is transparently nonsense, under-estimating or ignoring entirely the majority of cases and causes of work-related ill-health (Hazards 92). How far off the mark was illustrated by a July 2007 National Audit Office report which revealed the government missed hundreds of thousands of miners with chronic lung disease and vibration white finger, only discovering the cases were out there when they all trooped forward to request compensation from a new scheme (Hazards 99).

The government’s original forecast was that there would be a total of 218,000 vibration white finger (VWF) and chronic obstructive airways (COAD) disease claims under the scheme, launched in 1998, but the final claims total for the decade long scheme was over three times higher, at 760,000. The Health and Safety Executive’s (HSE) estimates of occupational ill-health in Great Britain, also published in July 2007, say in 2005/06 there were only 156,000 people in Great Britain with “breathing or lung problems” related to their current or past work.(4)

However, the coal miners’ health scheme alone has identified in the last decade almost three times as many workers from just one occupation, coal mining, suffering from COAD, just one of the many occupational lung conditions. Although some of the COAD claimants have now died, latest government figures indicate 242,000 are still alive, and like affected workers in many other occupations, appear to be largely missing from HSE estimates.

Vibration white finger does not even register in the HSE report, despite affecting over 140,000 coal miners alone. These VWF cases have been confirmed in coal health scheme medical evaluations, with the government in June 2007 indicating over 85 per cent of the affected workers are still alive. Together the COAD and VWF claimants amount to hundreds of thousands of occupational disease cases missed in just one occupation.

Add in other jobs and under-estimates of other conditions, including work-related heart disease, cancer and musculoskeletal disorders, and it becomes clear that while the government promotes work as good for you, it is profoundly ignorant of how damaging it can in fact be.

Even LFS figures do not offer much by way of reassurance. Latest statistics released by HSE on 1 November 2007 show a dramatic rise in work-related ill-health.(5) The work-related ill-health toll for Great Britain is up 10 per cent according to the new LFS figures, with 2.2 million people suffering from work related illnesses. The occupational fatality rate and the number of workers killed is up 11 per cent, to 241 worker fatalities in 2006/07.

HSE concedes it is set to miss targets on a reduction in work-related ill-health and on day’s lost as a result of work-related illnesses and injuries. Deaths from the asbestos cancer mesothelioma hit a record 2,037 cases in 2005, the most recent year for which statistics are available.

Strategic problem

A major flaw in the government strategy fronted by Dame Carol is that it relies almost entirely on goodwill. And while voluntary action has been pushed to the forefront, enforcement of the legal duty on employers to provide a safe and healthy workplace has been relegated to a lightly used, lightly applied tool in the government’s armoury. Over the last two years, 2005/06 and 2006/07, HSE notices issued and prosecutions taken have been at the lowest levels for a decade, although the latest figures for both are slightly up on the preceding year, which was a record low.

Statistics for 2006/07 – Dame Carol’s first year in post - showed an increase in both fatal injuries and the incidence of work-related ill-health. And even business admits that over a year into the workplace health czar’s reign a large slice of the nation’s businesses are showing little or no interest in their workers’ health and well-being.

A Business in the Community (BITC) survey report published in October 2007 concluded a third of workers (31 per cent) feel their health is neglected at work, while six in 10 (62 per cent) “don't believe bosses consider staff as assets worth investing in.” Almost half (46 per cent) claim apathy towards employee wellbeing has taken its toll on workplace productivity. Nearly half (44 per cent) said they were discouraged from taking sick days when unwell, with the same proportion reporting they were under pressure to do unpaid overtime. Over half (55 per cent) said they were suffering stress and over a third depression (38 per cent).

Evidence that work-related ill-health is a considerable, neglected public health issue is a major concern the government is failing to address. Starved of funds, HSE’s medical section EMAS has virtually disappeared and the workplace safety watchdog can no longer meet even minimal inspection goals.(7) Years of calls from unions, including HSE inspectors’ union Prospect, and safety campaigns and professional bodies for more HSE resources have been ignored. HSE has witnessed a long-term and rapid drop in its staffing, resources and enforcement effort.

By contrast, when the business lobby group CBI called on 18 September 2007 for government action so sick workers could attend the doctors in their own time (below), the government response came the next day and from the top. Prime minister Gordon Brown announced there would be more out of hours GP coverage.

Swallowing the employer line that sickness absence is a costly burden is not just damaging to the interests of sick workers, it is almost certainly a myth. A study published in April 2007 the journal Economic Inquiry dismissed the CBI costs argument in its entirety.(8) Swansea University economist Professor John Treble, who led the research, said: “We believe that any estimate of the cost of absenteeism to industry must take into account how much it would have cost to have prevented the absences in the first place. Our estimates include the cost of prevention as well as the cost of lost production. It turns out that these two figures more or less cancel each other out, implying a net cost close to zero.”

Helping people back to work through support and rehabilitation is a laudable goal, but not if this is at the expense of recuperation or where an early return to work really isn’t in the patient’s best interest. The Economic Inquiry study and the 2003 Whitehall II study present a compelling case for supporting workers taking sick leave, on grounds of both health and short- and long-term economic performance.

GPs, at the forefront of the government’s campaign to get people off the sick and swiftly back to work, are singularly ill-fitted to make these judgments. Family doctors are virtually uneducated in occupational health, rarely ask what job a person does and will scarcely ever understand the risks posed by the job. Even if they had the knowledge and the inclination, they certainly do not have the time.

And workers are not getting their occupational health cover at work. DWP itself in 2006 reported that only 15 per cent of firms provided even basic occupational health support, with only 3 per cent providing comprehensive support (Hazards 99).

Nor does the presence of occupational health cover necessarily mean any emphasis is placed on prevention. In autumn 2007, HSE issued Liverpool City Council with an improvement notice requiring it to improve occupational health services for its 19,000 staff. It said the council only acted after workers had become ill, but was not taking the necessary action to prevent work-related ill-health. HSE inspectors found the council was not carrying out regular checks or screening to protect the health of staff. The HSE move follows similar action against Dundee council in 2006 (Hazards 98).

And despite recent government initiatives like Workplace Health Connect (WHC) and two £10m capital hand-outs to beef up NHS Plus occupational health facilities available to small firms, only a small minority of workers have access to comprehensive occupational health services (Hazards 99). A new evaluation shows WHC particularly has been a costly flop, with barely 1 in 10 calls received about workplace health (see below).

Meanwhile, the mainstream NHS services do not have the resources to fill the gap. In September 2007, physio’s union CSP reported that just 24 per cent of the current crop of physio graduates had a job. CSP chief executive Phil Gray said: “Thousands of junior physiotherapy jobs have been frozen or deleted to help the health service reach financial equilibrium; yet the NHS is forecasting an operating surplus of almost £1 billion. If the NHS is financially secure, the government should ensure that all local health employers take their share of responsibility for resolving this crisis by using the money to invest in jobs for unemployed junior physios. They are desperate to put their skills to use and this move would enable them to play their part in relieving the pain and suffering of a broad range of patients, including those who’ve been injured at work and need help returning to the job market.”

Without better access to occupational health services, rehabilitation support and better designed, good jobs and a greater measure of job security, work can be anything but good for you, especially if you are already injured or ill.

Prevention of work-related ill-health, through the creation of better, safer, healthier jobs would of course be the most cost effective strategy. But as HSE slowly withers away, so does any prospect of real prevention any time soon.

References

1 Carol Black’s call for evidence, deadline for responses 30 November 2007.

Health, work and well-being website
Related DWP news release and DH news release

2 Kivimäki M and others. Sickness absence as a global measure of health: evidence from mortality in the Whitehall II prospective cohort study. BMJ, vol.327, pages 364-70, 2003.

3 Quality of Working Life report, executive summary, CMI, October 2007 • CMI news release.

4 Self-reported work-related illness and workplace injuries in 2005/06 [pdf]

5 Self-reported work related illness and workplace injuries in 2006/07: top-level tables

6 BITC news release • BITC healthy workplaces campaign

7 HSC/E stats news release • HSE news release, statistics 2005/06 webpage and statistics webpages

8 Melvyn Coles, Joseph Lanfranchi, Ali Skalli and John Treble. Pay, technology, and the cost of worker absence, Economic Inquiry, Volume 45, Issue 2, Page 268-285, Apr 2007 [abstract]

9 Workplace Health Connect: July Progress report, HSE, published online 30 October 2007 [pdf] • Workplace Health Connect

Hazards resources

OHS SOS. Safety reps’ guide to occupational health services, Hazards magazine, Number 99, pages 18-19, July-September 2007.

Futile exercise? New health, work and well-being strategy puts lifestyle measures first, Hazards magazine, Number 93, pages 18-19, January-March 2006.