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New work and health strategy
Workplaces make people sick. They kill tens of thousands each year. A new government workplace health strategy could make a difference. But Hazards editor Rory O’Neill discovered the government plan gives far greater emphasis to changing your lifestyle than changing your workplace.
The government’s new strategy, ‘Health, work and well-being – Caring for our future’ (1), is clear that work can be bad for your health. A foreword to the October 2005 report, produced jointed by the Department of Work and Pensions (DWP), Department of Health (DH) and the Health and Safety Executive (HSE), notes that “40 million working days are lost every year to occupational ill-health and injury, and a third of those people coming on to Incapacity Benefit have come from work.”
A new National Director of Occupational Health – the workplace health “czar” – is due to be appointed early in 2006 and will oversee the strategy, raise awareness of the work and its relationship to health and well-being, develop measures to monitor progress and success and lead a national debate on occupational health and well-being, including how innovative proposals might be developed and funded. The government says its new strategy “will enable us to work with our partners across and outside government to break the link between ill-health and inactivity, to advance the prevention of ill-health and injury, to encourage good management of occupational ill-health, and to transform opportunities for people to recover from illness while at work, maintaining their independence and sense of worth.”
There’s already a dizzying blur of new organisations and programmes
set up, all with government support, to deal with the challenge, and more
on the way – the Centre for Workplace Health, Pathways to Work,
Well@Work, Workplace Health Connect, NHS Plus, Safe and Healthy Working,
Pathfinders. One priority of the strategy will be to “address gaps”
in provision of return-to-work programmes and to extend vocational rehabilitation.
The 30 page blueprint for health at work has three key aims – getting
people into work, keeping them in work and using the workforce as a captive
audience for workplace health promotion activities.
The health, work and well-being strategy includes some far-reaching proposals to address Britain’s occupational injury and disease epidemic (Hazards 92). But while the joint DWP, DH and HSE workplace health initiative is upfront about the high financial and human cost of work-related ill-health, the strategy itself is heavily skewed towards health promotion. Also on the to-do list, is promoting health promotion and health improvement advice.
The clear intention is to prioritise measures in the workplace to address workers’ personal fitness, diet and assorted bad habits. Under the plan, the British workforce could be doing jumping jacks around the office, skipping up the stairwells, foregoing the fry-up and chomping on nicotine gum. It’s only their jobs that would stay the same.
There are dangers in prioritising health issues at work over those caused by work. Employers may have a greater appetite for cheap, easy and voluntary lifestyle measures, and workplace risk prevention - changing an employer’s bad behaviour - could be further sidelined as result. And while grand claims are made for workplace health promotion, the reality may be less impressive.
The new strategy document cites just one independent study (4) to support this practice and says this review “showed that heart conditions and other risks factors were lessened by participation in an occupational activity programme.” In fact, the paper does not identify a reduction in heart conditions in any of the studies it cites. The authors showed a stunning lack of knowledge of prevention of occupational health risks, however, only identifying one paper – a review on prevention of musculoskeletal disorders - that met their criteria for inclusion in their paper.
The authors also admit to a shocking flaw in the workplace health promotion evidence. The review says it must be assumed that the impact on “average” employee of sports or nutrition programmes, for example, “are considerably lower than the published figures suggest, as the study participants normally represent a small, health-conscious minority.” It adds: “In North America the success of activity programmes has been challenged since appraisals indicate that, at best, 20 to 30 per cent of the entitled employees participate. This is especially problematic against the backdrop of self-selection as it must be assumed that it has not been possible to reach exactly those employees, who would profit most from the behavioural changes.”
It could also unleash an invasion of health promotion advisers with little or no knowledge of or interest in workplace risk factors and a blitz of self-proclaimed but wholly unregulated rehabilitation programmes.
The government’s health, work and well-being strategy evangelises about the personal health side of the equation, and is encouraging initiatives like Well@Work to promote exercise, smoking cessation and healthy diets. It is also pushing measures to get the sick and injured back to work, through sickness absence management and vocational rehabilitation.
Where is falls flat is in prevention of the poor working environments and the work pressures that drive many of us drink, or that leave us no time or energy for exercise and neither the time nor the cash to make healthy choices about diet. Low pay is a health issue; long work hours are a health issue; hazards at work are a health issue. Telling employees to clean up their act while the workplace and the work remains unchanged is a patently suspect and potentially unhealthy recipe.
And lifestyle measures themselves should only be introduced “in a supportive, and non-judgmental way,” says TUC’s Frances O’Grady. “Don’t make the mistake of one large employer who almost had a strike on their hands when they unilaterally removed the full English breakfast from the canteen menu because they thought it would be good for workers. That kind of paternalistic approach is not going to help.
“Instead look at supporting social clubs and getting them to provide a range of activities beyond a snooker room and an annual booze cruise to Calais. Look at providing a canteen with a range of options. Give time off for smoking cessation classes, and have a positive drugs and alcohol policy. These are all great. But do them with the workforce, not for them.”
Measures to address the workplace risk factors that drive poor lifestyle choices – more humane hours and breaks, action on shiftwork and systems of work, improved job satisfaction and control, substitution of chemicals, action on risk assessments, more job security and addressing low wages - can have tangible benefits for all the workforce.
But the component of the strategy intended to improve health and well-being is almost entirely concerned with lifestyle, with the workplace a convenient pulpit from which to preach the lifestyle lesson. The work-related component is concerned with after-the-fact interventions – getting the sick back to work and productivity. A greater emphasis on primary prevention of hazards could yield by far the most significant impact on health, and though that on sickness absence. Work is one of the major contributors to all the UK’s major killers – cancer, heart disease and obstructive lung disease (Hazards 92). The same goes for the major causes of long-term sick leave, including mental illness and back pain. And employers have a legal duty to address the causes of work-related ill-health.
However enforcement of the laws intended to address work-related injury
and ill-health has dropped dramatically, latest figures show (6).
Crucially, the strategy ignores entirely the way bad employers drive employees
bad habits, including drug and alcohol use (Hazards 84). According
to TUC deputy general secretary Frances O’ Grady: “We need
to look at the deeper relationship between work and health. That means
addressing work-life balance and giving people the time an opportunity
to make choices about their health.” She said this should include
“empowering workers to make their own choices and involving safety
representatives.” O’Grady added: “We do not want to
see any move from prevention towards sickness absence management.”
Some commentators are already warning the approach is seriously flawed. A December 2005 report from The Work Foundation (8) says the health, work and well-being strategy “lacks cohesion and will have little impact on the real issues affecting health and productivity,” because it underplays the harm causes by work and is poorly coordinated.
‘Healthy work: Productive workplaces', produced with the London Health Commission, says problems such as sickness absence, dependence on welfare benefits and low pay have their root in bad jobs that give employees little voice and control. It says other issues that impact health and productivity include imbalances between effort and reward, bad management and poor job design. The report argues that employers must tackle the whole system and not just symptoms in isolation. It says initiatives to improve health and work are tackled by several different government agencies and social partners who too often don’t work together.
According to report co-author David Coats: “If work is one of the major routes to both a healthier population and a more productive one then government must sort out the muddle of agencies by creating a clear strategic framework, transparent policy objectives and a route map that all can follow.”
And the health, work and well-being strategy is a wish-list, not a regulation-backed and enforced prescription for better workplace health. There is no compulsion anywhere in the plan. It is a take-it-or-leave approach that relies entirely on employer goodwill. That may work to varying degrees with the better employers, but the worst employers offering the most unhealthy conditions inside the workplace together with the wages and conditions conducive to poor health outside it, can and will ignore the whole initiative.
Alongside the plethora of workplace health organisations – described as “a bonanza for outside contractors” by one well-placed HSE insider who contacted Hazards - there is a role for unions, and particularly safety reps, says the strategy. On healthy workplaces, the strategy highlights “working with trade unions at local, regional and national levels to build on the successful work that they have already undertaken in partnership with employers to better protect employees from health risks in the workplace. In particular, we will seek to develop the constructive and supportive role of safety representatives.”
The strategy also envisages “engaging all stakeholders, but especially employers, unions and insurers, to develop a coordinated and mutually supportive approach to the health and well-being of people at work and to demonstrate the positive impact this will have on people’s lives, and therefore on the competitiveness of Great Britain.” And on occupational health support the it says it will be “exploring innovative models of occupational health delivery which will help to address resourcing issues, review the role which health and safety representatives might play and explore the nature and delivery of training that such groups would require.”
So far, however, there has been no sign of any cash bonanza for unions conducting this work. And while the strategy identifies a need to involve unions and union reps, the government has consistently refused to extend workers’ rights, including the creation of “roving safety reps” which could at a stroke create a national network of trained and union-resourced health and safety advisers (Hazards 89).
Companies, meanwhile, are encouraged “to report their occupational health and safety performance as a key part of their business performance reporting, using the HSE’s Corporate Health and Safety Performance Indicator (CHaSPI) system (9) and the equivalent Health and Safety Performance Indicator for small businesses. The strategy goals also include “identifying incentives for businesses to encourage the provision of occupational health support”, with more emphasis on rehab.
The new work health strategy says the government wants “to achieve access to competent occupational health advice and support for all employees.”
A centrepiece of the government’s plan is Workplace Health Connect (10), privately run but wholly funded by the government to the tune of £20m over two years, kicking off in February 2006. It will provide an advice line for England and Wales and five regional hubs or “Pathfinders”. This new service for small and medium sized firms will offer “free and impartial advice on occupational health, safety and return to work issues.” However, the service can only be accessed by employers, with the service refusing to talk directly to employees.
This “no workers” decision has been criticised by TUC. “The reality is that most workers are very reticent t go through their employer to access any form of service,” TUC deputy general secretary Frances O’Grady told a joint TUC/HSE December 2005 conference on the new strategy (11). “Any employee-centred approach must be on the basis that because the service is for the benefit of the employees themselves, it must be aimed at being accessible by the employee and for the employee.”
An HSE insider told Hazards they see Workplace Health Connect as “backdoor privatisation”. He added: “If it was to apply nationwide its budget would rival that of HSE. It performs functions many will recognise as jobs traditionally done by HSE, but without the enforcement.” The service is expected to conduct 5,700 visits over the next two years. When HSE inspectors see “matters of evident concern” on a visit, for example high risk activities, they are required to act regardless of the original purpose of the visit. Workplace Health Connect has no such duty nor any power to intervene.
Sickness at work
DWP sees workplace sickness absence management programmes as a key part of strategy. It says they lead to a dramatic decrease in the number of sick days and much swifter return to work. The work, health and well-being strategy dovetails with other government initiatives. In January 2006, secretary of state for work and pensions, John Hutton announced “something for something” incapacity benefit reform. Currently about 2.7 million people claim incapacity benefit, resulting in an annual bill of £12.5bn.
The plans are spelled out in a 24 January 2006 Green Paper (12). Incapacity benefit will be replaced with a single payment called the Employment and Support Allowance. The government plans to get one million incapacity benefit claimants back into work within 10 years. The minister has also indicated that GPs could be paid cash incentives to encourage the long-term sick back to work.
The health, work and well-being strategy also envisages a greater role for GPs by “ensuring effective links between GPs, occupational health professionals and employers are developed”, and improving the education of GPs in relation to health and work, “to assist them in providing better fitness for work advice to patients”. The strategy also says the government will be piloting links between GPs and employment support to assist patients in staying in or returning to work, following health problems.
Unions are concerned that workplace sickness absence initiatives, a big component of the new strategy, assist and don’t harass sick employees back to work. Scientists’ union Prospect asked to visit the private firm running the Ministry of Defence pilot on sickness absence reporting. It wanted to ensure the nurses employed by Active Health Partners “support staff rather than put pressure on them to return to work before they are ready.”
Reducing sickness absence is not the same as reducing ill-health. There is compelling evidence in fact that going those taking sick leave are more productive in the long-term than the working wounded. Britain’s biggest ongoing workplace health study, the Whitehall II study of civil servants, reported in the British Medical Journal that “short term absences may represent healthy coping behaviours,” with workers were less likely to end up on the long-term sick list (13).
And the whole health, work and well-being strategy pre-supposes employers are going to want to employ those 1m workers that are being targeted for a transfer from welfare into work. A 2005 report from the Chartered Institute of Personnel Directors found that the core jobless, which grouped those with a history or long-term sick leave alongside those with a criminal record or a history of drug or alcohol problems, were shunned by many employers.
Centre for Workplace Health A “national centre of excellence to promote health in the workplace” was launched in September 2005. The Centre is a collaboration between the University of Sheffield, The Sheffield Teaching Hospitals Foundation Trust and the HSE’s Health and Safety Laboratory. more
Pathways to Work Pilot projects to assist people on incapacity benefit back into work. The government intends to roll out the programme nationwide. more
Workplace Health Connect A confidential service designed to give free, practical advice on workplace health, safety and return to work issues, to smaller businesses (with 5 to 250 workers) in England and Wales. Includes an advice line, which will only respond to queries from employers. Will undertake workplace visits on request. To start in February 2006. more
NHS Plus NHS Plus is a network of NHS occupational health departments across England, supplying services to non-NHS employers. It offers support to industry, commerce, and the public sector, with a focus on small and medium sized enterprises (SMEs) more
Scotland’s Health at Work A national award programme “which rewards employers who demonstrate commitment to improving the health and ultimately the performance of their workforce.” more
Safe and Healthy Working Safe and Healthy Working is part of the Scottish Centre for Healthy Working Lives and provides an occupational health and safety service for small and medium sized enterprises in Scotland. more
Constructing better health An industry led and funded initiative. The Leicestershire based project is a pilot for a planned national initiative. more
BBC Big Challenge Healthy workplaces. Part of the BBC’s health promotion campaign. more
2 Health and Safety Statistics 2004/05, HSE, 2005.
3 Survey of use of occupational health support, Institute of Occupational Medicine, 2002.
4 Julia Kreis und Wolfgang Bödeker. Health-related and economic benefits of workplace health promotion and prevention: Summary of the scientific evidence. Essen: BLL Bundesverband, 2004 [pdf]
5 Well@Work, British Heart Foundation.
6 Offences and Penalties Report 2004/05, HSE, 2005.
7 BT Work Fit programme. CWU website guide.
9 CHaPSI company reporting system, HSE.
10 Workplace Health Connect. HSE webpage
11 Papers from HSE/TUC health, work and well-being seminar, 5 December 2005.
12 A new deal for welfare: Empowering people to work, Green Paper, January 2006.
13 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. more
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