CIPD response to Dame Carol Black’s review of the health of Britain’s working age population
Ben Willmott, CIPD Adviser on Employee Relations
Introduction
With 130,000 members, the Chartered Institute of Personnel and Development (CIPD) is the largest organisation in Europe concerned with the management and development of people .
The CIPD has been at the forefront of encouraging employers to address issues of health and well-being. Over many years the CIPD has produced reports, surveys, tools, factsheets and other products designed specifically to support employers and HR professional on these issues. The Appendix to this Response lists some of the most recent examples and demonstrates both the CIPD’s expertise and depth of understanding of these issues.
As part of its chartered status and responsibility for professional standards, the CIPD also delivers a broad range of accredited training courses and programmes on many topics including absence, health, psychology of organisational wellbeing, health & safety law etc. The CIPD also runs an annual Absence Management Conference. Take up and interest in these issues is very high amongst CIPD members.
How can we keep working age people healthy and how can the workplace be used to promote health?
Good people management and effective work organisation
The starting point for promoting and supporting employee health and well-being has to be good people management and effective work organisation.
The CIPD research report
Employee Well-being and the Psychological Contract (2004) found that there is clear link between good people management practice and lower levels of stress.
The research found that a cluster of practices are associated with the concept of the high quality workplace. These are:
- family friendly policies
- effective supervisory leadership
- the delivery of employment promises (leading to perceptions of fairness of treatment and high trust)
- progressive human resource practices.
The progressive HR practices associated with high quality workplaces are:
- training and development
- employee voice
- internal career progression
- fair pay
- opportunities for varied work.
The presence of practices associated with high quality workplaces is the most significant factor associated with lower levels of stress. Higher stress is associated with lower work satisfaction, lower levels of loyalty to line management and a higher intention to leave the organisation. High quality workplaces are strongly associated with a range of positive outcomes including:
- higher commitment
- motivation
- work satisfaction
- satisfaction with work-life balance
The CIPD research report
Working Life: Employee Attitudes and Engagement (December, 2006) found that engaged employees take less sick leave, perform better, are more likely to recommend the organisation they work for and are less likely to quit.
The main drivers of employee engagement according to this research are:
- having opportunities to feed views upwards
- feeling well informed about what is happening in the organisation
- thinking that your manager is committed to the organisation you work for
- the provision of flexible working opportunities.
CIPD research shows clearly that attempts to improve and promote employee health and wellbeing and manage absence effectively will be fatally undermined if people are not managed properly and work is not organised effectively. This is why the CIPD has been a supporter of the Health and Safety Executive stress management standards which identify six causes of work-related stress: demand; control; support; roles; relationship; and change. The standards, which provide step- by-step guidance for employers on how to conduct a risk assessment for work-related stress, are the only light touch policy intervention that explicitly encourage employers to consider the impact on employee health of how people are managed and how work is organised.
Effective absence management practice
Good absence management practice based on the use of management information is also absolutely central to meeting the challenges of keeping people of working age healthy and of promoting health through the workplace.
The CIPD’s research report
New Directions in Absence Management (2007) underlines the importance of good quality management information to identify individuals with particular absence and health problems so as to ensure that early and appropriate steps are taken to help return them to health and to work.
The annual CIPD absence management survey identifies the most effective practices for managing short-term absence as:
- Use of return to work interviews
- Use of trigger mechanisms to review attendance
- Use of disciplinary procedures for unacceptable levels of absence
- Restriction of sick pay
- Line managers taking primary responsibility for absence management
- Line managers trained in absence management
- Occupational health involvement
- Sickness absence information provided to line managers
The research underlines the importance of the line manager in ensuring absence management policies are followed through on a day-to-day basis if absence is to be managed effectively. The CIPD is working with the HSE on research to develop a competency framework identifying the behaviours that help line managers mitigate and manage stress at work. The CIPD has in collaboration with Acas and the HSE developed an online absence management tool for line managers which is free to access from all three organisations’ websites.
The top three rated interventions for managing long-term absence in terms of effectiveness are access to occupational health support, the use the rehabilitation programmes based on individual case management and flexible working.
Early occupational health support is crucial if appropriate treatment strategies are to be put in place and opportunities for phased returns to work in less demanding or reduced hours roles considered.
The use of focused rehabilitation programmes based on individual case management can ensure that people returning to the workplace after long periods of time off sick are given the necessary support to help them regain confidence and get back up to speed at the correct pace, leading to successful and lasting recoveries.
Flexible working can help individuals balance the often competing pressures they are under from home and work. Flexibility over working time or patterns also provides individuals with a measure of control over their working lives which research shows help to mitigate the causes of stress. The CIPD would like to see the Right to Request Flexible Working legislation extended to cover all employees.
The CIPD survey shows that many organisations could do much more to improve how they manage absence and particularly long-term absence.
Nearly a third of respondents to the CIPD absence management survey provide employees with no access to occupational health services and only 40% of employers use rehabilitation programmes even though they are rated as the second most effective approach to managing long-term absence by survey respondents.
Management buy-in at all levels
Since the CIPD started the absence management survey in 2000, it has been characterised by yoyo-ing in the overall average level of absence. This highlights one of the challenges of managing absence for many employers, which is that absence management tends to become an organisational priority only when absence levels climb to a particular level – leading to management action and often to changes to policy and procedures. However, once absence levels fall again, it ceases to be a management priority and often creeps back up. To counter this, employee absence must be a key performance indicator which is discussed regularly at board level. In addition line managers must be made accountable for their absence management performance through their annual appraisals and performance targets. The 2006 CIPD absence management survey showed that only a third of organisations include absence management performance as an element of line managers’ appraisals/performance targets.
Employee wellbeing support
Employers are rightly identified as key stakeholders in the Government’s Health, Work and Wellbeing strategy to improve the health of the working age population. CIPD research shows that employers are increasingly willing to provide support to help employees adopt healthier lifestyles.
One of the most striking findings from the CIPD’s 2007 absence management survey was the significant increase in the proportion of employers with an employee well-being strategy. This showed that the proportion of employers with employee well-being strategies increased to more than four in ten from one in four the previous year.
The survey findings show that organisations are providing a wide range of well-being benefits to support employees’ mental and physical health. Counselling services, employee assistance programmes, ‘stop smoking’ support, health screening, healthy eating options and subsidised gym membership are among the most popular benefits provided.
The market in employee well-being is set to expand further, with more than 40% of respondent organisations planning to increase their well-being spend in 2008, compared with just 2% intending to reduce investment in this area. This shows that organisations are increasingly understanding the benefits of supporting employee wellbeing.
Respondent organisations are investing an average of 5.4% of their total pay bill in these benefits but, despite the size of this financial commitment, just 13% of employers are looking to evaluate the impact of this spend. Ongoing investment in employee well-being may be difficult to justify unless it’s possible to demonstrate the return on this investment. More evidence of the bottom line benefits of investing in employee wellbeing is needed and the CIPD is exploring research opportunities in this area going forward.
How can people best be helped to remain in or quickly return to work when they develop health conditions including chronic disease or disabilities?
Role of GPs
GPs and employers need to work together more closely to help individuals with health problems make phased returns to work in less demanding or reduced hours role as part of their recovery and rehabilitation. The CIPD’s
Labour Market Outlook survey shows that 80% of employers believe GPs and employers should work together more closely and that GPs are typically rated negatively by employers for the level of support they provide in helping people return to work. Almost 40% of employers rate GP support in this area as either very poor or fairly poor compared to only 19% who rate GP support as good or very good.
The survey also show that currently employers receive medical reports from GPs on just 50% of employees off work with long term mental health problems, even though seven in ten employers report they contact GPs to ask them to provide such a report.
The research shows that there are some GPs who are rated highly in the support they provide employers in helping people return to work so it is obviously not the case that GPs cannot fulfil this role. The challenge is to encourage more GPs to make common sense recommendations, whenever circumstances allow, to help individuals make timely and phased returns to work.
The CIPD supports a number of proposals that will help achieve this including:
- A revamped Med 3 Sicknote including more information on phased return to work – 77% of respondents to the CIPD’s Labour Markey Outlook survey (November 2007) thought this would be effective or fairly effective
- Improved training for GPs on “fitness for work” issues – 77% of respondents rated this proposal as effective or fairly effective
- Changes to GPs contracts to incentivise closer working with patients’ employers and provision of advice on phased return to work – supported by 70% of respondents as effective or fairly effective
- Employment advisers in GP surgeries – supported by 60% of HR practitioners as likely to be effective or fairly effective
- Early intervention and referral to OH.
CIPD research on absence management consistently rates access to occupational health support as the most effective intervention for managing long-term sickness absence. However despite this a significant proportion of employers provide no access to occupational health support. The business case for providing occupational health services needs to be made strongly and widely promoted to encourage more organisations - particularly smaller employers – to proved access to occupational health services.
The services provided by Workplace Health Direct and NHS Plus need to be developed so that smaller employers can get access to cost-effective occupational health advice and support.
Rehabilitation programmes
The use of rehabilitation programmes based on individual case management is rated as the second most effective approach for managing long-term absence by respondents to the CIPD absence management survey. However only 40% of organisations covered by the CIPD absence management survey use coordinated rehabilitation programmes.
Such programmes can ensure that people returning to work after long periods are given appropriate and individual support by someone within the organisation who takes overall responsibility for overseeing their rehabilitation in the workplace. Ideally this role would be filled by an occupational health professional but there is no reason why an HR practitioner or line manager shouldn’t be the case manager provided they are given information and support from the appropriate professional such as GP, external occupational health provider or occupational psychologist.
How does the age of the person affect the support that is needed?
Younger people and child workers are separately covered by health and safety and working hours but employers should be wary of making assumptions about the kind of support that is required purely on the basis of age. The Age Regulations (2006) were introduced to outlaw discrimination on the grounds of age in connection with employment and training and there are proposals for access to goods and services to be covered by law in the future. Additionally disability legislation requires organisations to make reasonable adjustments to enable people with disabilities covered by the law to access jobs and training and goods and services.
Existing age law allows for both justified direct and indirect discrimination and for positive action so that different needs can be catered for where this can be shown to be necessary. This approach would provide scope for different health provisions and support interventions to be designed for different age groups nevertheless it would be good practice and more strategic to encourage both organisational and personal responsibility for health care and work/life balance through the provision of inclusive portfolios of health-related activities and initiatives and work/life balance offerings. Inclusive approaches, while being open to all are also flexible and responsive to individual needs.
CIPD research shows that age does influence patterns of health and illness in populations. The CIPD research report
New Directions in Managing Absence (2007) shows that the average length of absence spells per employee increase with age:
Mean days per absence spell
Under 25 3.67
25-34 4.27
35-34 5.31
45-54 6.57
55 years and over 9.08
This underlines the importance of early intervention and referral to occupational health services to ensure that treatment strategies are put in place at an early stage before a health problem can escalate to the point where it results in a long period off work. However this principal is true for employees of all ages. Good absence management practice should ensure that health concerns are identified early and appropriate interventions taken regardless of the age of the individual.
Similarly the caring responsibilities people have and the pressures they create in connection with the work/life balance are diverse and vary over their life times. Caring responsibilities range from child care dominating parents and grandparents to eldercare and the care of dependents with disabilities for example.
The ways in which health, disability and caring affect peoples lives are individually focused and while there may be common patterns which will influence the demands for different kinds of support and provisions, an inclusive approach to accessing them is imperative to avoid unfairness.
How can we encourage action to improve employee health?
The CIPD Change Agenda
What’s Happening with Well-being at Work (2007) finds that employers are already under pressure to improve how they manage absence and support employee well being as a result of:
- The costs and risks associated with long-term sickness and absence damaging their productivity, growth, retention and employer brand
- Employees starting to expect that their employer will help them achieve individual wellbeing
- The law and government policy driving employers to recognise their impact on employee health to help in the government’s aims to get more of the working population back and active in the workplace.
The business case for promoting and supporting employee health and wellbeing is becoming increasingly clear. Employers can gain clear benefits in reducing employee turnover and increasing the productivity and engagement of their employees. The CIPD will be conducting further research to provide additional evidence on the benefits of organisations proactively managing employee health rather than managing employee sickness and absence. The CIPD publishes a wide range of information resources to help employers adopt good practice on promoting and supporting employee health at work.
The CIPD is keen to work with the Government to encourage more employers to embrace the wellbeing at work agenda. However, just as importantly individuals have to take responsibility for their own health and lifestyles and other key stakeholders including education providers, local authorities, the NHS, food manufacturers and advertisers have to play their part in promoting healthy living.
A nationwide initiative to find the healthiest workplaces could help raise the profile of, and interest in this issue.
SMEs should be made more aware through a high-profile publicity campaign that occupational health support which furthers their businesses, is tax deductible.
What underlies the apparent growth in mental health problems in the working age population and how can this be addressed?
One of the reasons for the increase in mental health problems in the working age population may be that there has been an increase in work intensity.
Research by the economist Francis Green shows work intensity (how hard employees think they are working) increased significantly in the UK from 1992 to 2001.
He found this was due to a number of factors including:
- growing competitive pressures being passed on to employees;
- technological advances;
- a decline of union power;
- and HR developments such as wider use of performance-related pay.
All of these factors are still in play today. Many employees - particularly those in the public sector - are working in more performance managed and more target oriented work environments than they were 20 years. There has also been an increasing individualisation of work as a result of the decline of collective representation and the increasing mobility of employees.
Technological advances are adding to the pace of work, with the internet, email, blackberries, mobile phones meaning the weight of information that people are having to process has increased. In addition the use of technology means that the boundaries between work and home are becoming increasingly blurred with the result that people find it harder to switch off and relax outside the workplace.
Another factor may well be the unprecedented level of organisational change that is occurring as UK businesses respond to the growing competitive pressure from the global economy. Evidence shows that change is a significant cause of work-related stress particularly where it is poorly managed without any consultation.
However, of course the working environment is only part of the story and changes in wider society are likely to have had a significant impact on the increase in the prevalence of mental ill health. The breakdown of traditional communities and family groups and the increase in single occupancy households has contributed to an increase in social isolation. The increasing use of technology must also have a role to play as the use of the internet, emails, blogs and computer games reduce the opportunities for social interaction. People have fewer opportunities to have the sorts of conversations with family and friends that help put life and its problems into proportion.
None of these factors are likely to go away so it is important that the people who do suffer from mental health problems for whatever reason have access to the necessary support and treatment both in the workplace and in society as a whole.
In the workplace this means that employers should be conducting risk assessments for stress to help identify the early warnings signs which might indicate that employees are beginning to suffer from stress and mental health conditions.
The provision of flexible working opportunities helps people balance the competing pressures they are under from home and work. The CIPD has published a wide range of research and guidance to help organisations to develop and embed flexible working practices.
Employee assistance programs can provide advice and support as well as counselling to help individuals start to resolve problems they may be facing in and outside work.
Line managers also need to be aware of the early warning signs which might indicate that someone is starting to suffer from a mental health condition so that they can refer them to occupational health at an early stage. The CIPD’s guide Managing Organisational Stress identifies the behaviours that might indicate that someone is suffering from stress at work.
Just as importantly treatments such as Cognitive Behavioural Therapy must be readily available through the NHS.
What constitutes effective occupational health provision and how can it be made available to all?
The provision of access to good quality occupational health services is key if employers are serious about supporting employee wellbeing and health and managing absence. The use of occupational health services is the most effective approach to managing long-term absence according to the CIPD’s absence management survey.
Occupational health services should:
- help identify health problems and fitness for work issues at an early stage through effective monitoring of absence data
- formulate rehabilitation programmes/return to work strategies
- work closely with line managers and HR professionals
- promote employee wellbeing and healthy living.
In addition occupational health services should:
- ensure compliance with health and safety regulations
- minimise and eliminate hazards
- deal with cases of drug and alcohol abuse, and advise on HIV/AIDS issues
- offer pre-employment health assessment
- monitor the health of employees after an accident, illness and during and after pregnancy
- manage clinic facilities, basic health checks and first aid
- advise on medical severance and ill-health retirement
- advise on ergonomic issues and workplace design
- promote good health education programmes
- promote healthy eating
- monitor symptoms of work-related stress
- provide advice and counselling
- work with special needs groups.
Early intervention and referral to occupational health services is also vital if maximum benefit is to be achieved through their use. The Royal Mail now refers individuals with mental health or musculoskeletal problems on day one of absence to the company’s occupational health service provider in recognition that such conditions are likely to be either recurrent or long-term unless treatment strategies are put in place at an early stage.
Many employers define long-term absence as starting at four weeks and only consider referring to occupational health at this point, whereas earlier referral can often be much more cost-effective as it will aid a much quicker recovery by putting in interventions before a condition has deteriorated.
The business case for providing occupational health services needs to be made strongly and widely promoted to encourage more organisations - particularly smaller employers – to provide access to occupational health services.
The services provided by Workplace Health Direct and NHS Plus need to be developed so that smaller employers can get access to cost-effective occupational health advice and support.
What would be the impact on poverty and social inclusion of a healthier working age population?
The ‘spillover’ effects of the routine behaviour of organisations as they go about their day-to-day business of producing goods and services is a major determinant of general economic and social well being. Such ‘spillovers’ (or externalities) occur when the actions of organisations create benefits or give rise to costs that extend outside those organisations into the wider economy and society. Unfortunately, there is no guarantee that the actions of organisations will serve to maximise the benefits and minimise the costs – the social spillovers from poor workplace health being a case in point.
A rough estimate would suggest that workplace accidents and work related ill-health could cost the economy up to £30 billion of lost output every year. In human terms the cost is even more graphic. Figures from the Office for National Statistics, for example, show that death rates vary considerably by occupational group as measured by characteristics such as security of employment and the degree of control a person has over his or her job – men in routine low control jobs being almost 3 times more likely to die between the ages of 25 and 65 years than those in high discretion managerial posts.
Less drastic but more widespread and insidious are the effects on poverty and social exclusion. The £12 billion annual bill for Incapacity Benefit offers some indication of the scale of the problem. Obviously, health problems have multiple causes, including those that stem from outside the workplace as well as from within, so not all this cost can be attributed to workplace practice. However, a substantial number of people flow onto Incapacity Benefit each year because of problems that develop at work or that could be alleviated if work were adapted to help people cope with a health problem .
Although there is considerable focus on the disincentives to find work inherent in the Incapacity Benefit system, life on benefit is miserable and causes social exclusion as well as poverty. Moreover, in addition to the thousands of people made jobless by avoidable work related ill health thousands more may suffer in silence in the workplace and suffer in isolation outside work if health problems diminish the quality of their lives. This is particularly true of those who suffer work related stress or mental health problems – they not only often struggle against the odds to hold down their jobs but also lose the will and energy to do anything else once they clock off.
A healthier working age population would therefore result in a reduction in a wide variety of economic and social costs.
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?
The CIPD 2007 absence management survey finds that the cost of absence is £659 per employee per year. Not surprisingly nine out of ten employers identify absence as a significant or very significant cost to the workplace.
The average level of absence is eight days per employee per year. Small reductions in absence can generate significant savings for employers.
For example, an organisation with 500 employees with average earnings of £250 a week and an absence level of 10 days per employee per year, can make a saving of £50,000 a year if it reduces absence to 8 days a year.
It is not just the direct wage cost savings that employers who support employee wellbeing and manage absence effectively benefit from. CIPD research shows that well managed organisations that foster employee engagement benefit from lower levels of absence, lower levels of stress and higher levels of commitment and motivation.
Appendix
An Appendix to this Response list some of the most recent examples of CIPD's reports, surveys, tools, factsheets and other products designed specifically to support employers and HR professionals on issues related to health in the workplace.