Working for a healthier tomorrow

CBI Absence and Well-being conference, 2008

Carol Black DBENational Director for Health and Work

CBI survey results – a compelling case for change

• This year’s survey adds new weight to the emerging consensus on a new approach to health and work in Britain:

• Costs of sickness absence to business creates compelling case to invest in the health and well-being of employees

• But employers want help to do so. Only 3% of those surveyed felt they didn’t need government support to tackle sickness.

• Urgent need for Government action – for fitnotes; for improved partnership working with GPs and healthcare professionals; and for improvements in tackling public sector sickness absence too.

• Powerful evidence of effectiveness of early intervention – the fundamental premise for a new Fit for Work service.

The cost to business

• In 2006, CBI reported sickness absence amounted to:

• 7 days per employee• a total of 175 million working days lost• a cost to the economy of £13.4 billion

• 2007 shows a small improvement:

• 6.7 days per employee• a total of 172 million working days lost • a cost to the economy of £13.2 billion

• But adding indirect costs takes this figure to an estimated £20 billion. A huge burden on UK business

The cost to the economy

• Overall costs of sickness absence and health-related worklessness among those of working age is in excess of £100 billion per year - equivalent to GDP of Portugal and more than the annual NHS budget

• Total costs to the taxpayer, in terms of benefits and forgone tax revenue, are over £60 billion per year

• 2.65 million people are on incapacity benefits with direct costs of £12.5 billion a year

And there are other costs – economic and social

• Costs of those ill at work “presenteeism” likely to be greater than absence costs – estimated cost due to mental ill-health alone is £15 billion (Sainsbury Centre for Mental Health)

• While the human costs are potentially even greater than the economic costs

• 30% of children who have a parent with a disability or health condition live in poverty (HBAI)

• Children living in workless households are more likely to suffer from worse health, and worklessness themselves as adults (National Statistics, National Audit Office)

Remit of my Review

• Comprehensive review of the health of working age people

• Considers the myriad factors that influence health and well-being, including being in work or workless, and having long-term health conditions

• Seeks to lay foundations for necessary and wide-ranging reform – but partnership between business and Government is pivotal to achieving this.

A new vision for health and work

• The contributions of over 260 responses to the Call for Evidence, and especially the support of organisations like the CBI, have provided a clear and compelling case for reform

• At the heart of this vision are three key objectives:

1. prevention of illness and promotion of health and well-being;

2. early intervention for those who develop a health condition; and

3. an improvement in the health of those out of work.

1. Preventing illness and promoting health: the role of the workplace

• 75% of working age people in Britain are in employment – and so spend high proportion of waking hours in the workplace

• The workplace offers great scope for targeting messages and initiatives about healthy living – with potential impact on both employees and their families

• Need to go beyond essential compliance with health and safety legislation and promote health and well-being more generally

The business case for employers to invest in employees’ health

PwC research:• Studied evidence from 55

UK case studies and wider literature

• Wide variety of employers – all sizes and sectors

• Many employers invest in employee health from a sense of corporate social responsibility

• But results show a business case for investing in employees’ health

From compliance to leadership

• Responses to the Call for Evidence highlighted many health and well-being initiatives which employers are already undertaking in the workplace

• But many employers are not aware of the business case for investing in employees’ health

• And there is a lack of understanding of the type of health and well-being initiatives employers can implement

• Small and medium-sized enterprises (SMEs) especially struggle to find accessible, affordable sources of support and advice

From compliance to leadership - recommendations

• Government should initiate a business-led health and well-being consultancy service, offering tailored advice and support and access to occupational health at a market rate – geared especially towards smaller organisations.

• Government should work with employers and representative bodies to develop a robust model for measuring and reporting on the benefits of employer investment in health and well-being.

• Employers should use this model to report on health and well-being in the boardroom and in company accounts.

A new tool to evaluate the benefits of investing in employee health

• In partnership with BITC’s Business Action on Health campaign, PwC are building on their original work to develop a free-to-use evaluation tool for measuring the economic benefits of investing in employee health

• Launching a pilot in July. Keen for CBI and its members to help us by agreeing to take part in this pilot.

• Signal your commitment to promoting health and well-being and help us develop and enhance the tool.

• Sign up today at www.workingforhealth.gov.uk free of charge!

2. Sickness Absence and Early Intervention

• The CBI survey shows:

– Sickness absence varies widely across different firms

– Substantial savings from the worst organisations achieving average rates of absence

– Public sector behind the private sector

– Large organisations behind smaller organisations

– Positive impacts from health and well-being initiatives

– 18% of employers still have no sickness absence management policy

2. Sickness Absence and Government Action

• Smaller organisations average intervention time in sickness absence is 5 days. For the private sector it is 8 days. For the public sector it is 10 days.

• Why Wait? The supportive employer should look to intervene sooner

• But clear that employers want Government to do more to help

• The majority want Government to prioritise the move from the sicknote to a fit note

• Also, improved partnership working with GPs and other occupational health professionals is seen as critical

Dealing with illness: from sick note to fit note

• Current sick note reflects assumption that being ill means absence from work

• Needs to be overhauled, so that focus is on what a patient can do rather than on what they cannot

• Paper-based sick note should be replaced by electronic fit note

• Would aid communication between GPs and employers, as well as enabling improved monitoring and analysis of trends

• Strongly welcome the support of CBI and many others for the move to a fit note

Improved partnership between employers and healthcare professionals

Vital that employers, healthcare professionals and the publicbetter understand the positive links between work and health

• Work is generally good for both physical and mental health and well-being – not the converse – and the beneficial effects of work outweigh the risks

• Individuals can return to work even if not 100% fit – and work can aid recovery

• A sick note may not be a good thing

• Employers must have sickness absence policies designed to enable an early return to work which aids sustained recovery

Dealing with illness: changing the perceptions of healthcare professionals

Healthcare professionals, andespecially GPs, must:

• Better understand the positive links between health and work

• Be equipped to engage with patients and employers to explore options for returning to work

• See a return to work as a key indicator of clinical success in the treatment of working age people

• Refresh and expand occupational health as a speciality

Healthcare Professionals’ Consensus Statement

Ground-breaking Consensus Statement, signed on 5 March 2008 by the leaders of the healthcare profession, is a pledge to promote the link between good work and good health.

Early intervention for those who develop a health condition

What’s not working:

• Fallacy persists that individuals should only be at work if 100% fit

• No clear pathway of rehabilitation for work-related ill-health

• This belief has led to sub-optimal treatment of patients and out-dated procedures for certification of sickness absence

Dealing with illness: early intervention

• Changing perceptions and establishing the new fit note is not enough - GPs must be able to refer patients quickly to the treatment or care which will support early return to work

• CBI shows that the majority of absence (95%) is short-term, under 20 days in duration

• But 5% of absence spells are longer-term and account for 40% of all time lost

• Huge savings can be made with co-ordinated, health and work focused interventions

Early intervention: a Fit for Work service

• Recommend that a new Fit for Work service be piloted - should be based on case-managed, multidisciplinary support for people in the early stages of sickness absence

• The Fit for Work service must be available to all so that access to occupational health support is no longer the preserve of the few

• Fit for Work should be complementary to in-house provision of occupational health and other rehabilitation services

• GPs would use the new fit note to refer patients to the Fit for Work service

• Patients with ‘red flag’ conditions (recurrent conditions, or serious underlying conditions) would be referred onwards at the earliest opportunity

But timing is crucial…

How the new model could work

3. Improving the health of those who are out of work

• Current arrangements for handling sickness at work all too often lead to individuals losing their jobs and moving onto incapacity benefits

• This happened to around 350,000 people last year

• Cost to public purse of each claimant is around £5,250

• With over 600,000 unfilled vacancies in the UK, returning the workless to employment is vital to business and the economy

• We need to equip people with not just the health support, but also the skills and confidence to access employment opportunities and return to work

Integrating employment, health and skills

This Review joins other recent reports to Government – the challenge in taking this forward is how to fully integrate the employment, health and skills agendas

Reducing dependency, increasing opportunity: options for the future of welfare to work.

by David Freud

Review of the health of the working age

population: Working for a healthier

tomorrow

by Dame Carol Black

Prosperity for all in the global economy – world class skills

by Lord Leitch

Final thought

“Health is created in places where we live, love, work and

play”

World Health Organisation