Improving the Health and Wellbeing of FE Staff

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Leading by Example? Why the mental health and
well-being of staff in Further Education is a
leadership issue 1 February 2011

• Improving the Health and Wellbeing of FE Staff

Dame Carol Black National Director for Health
and Work
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Why invest in the health and well-being of FE
staff?

• The rewarding but difficult work of education
  can not be carried out well by people who are
  stressed and tired, but can be done well by staff
  with energy, commitment and a positive outlook.
  - Well-being facilitator
• All staff are role models for students and can
  demonstrate how to lead a healthy and balanced
  lifestyle
• Staff well-being may affect institutional
  performance (a study by Birkbeck College in
  partnership with Work Life Support (2007)
  suggests that there are links between average
  teacher well-being in schools and pupil
  performance 8 of variation in SAT scores show
  significant correlation with staff well-being)
• Improved health and well-being can reduce absence
  and improve retention of staff

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The Boorman review The Impact on Service
Delivery and Outcomes
over 80 of staff felt that their health and
well-being impacts upon patient care, and
virtually none disagreed yet only 40 think
that their institution cares about their health
and well-being.
Trust A Trust B Trust C Trust D
Absence Rate 4.21 4.04 4.58 4.70
Turnover Rate 10.5 9.79 11.65 17.02
Agency Spend 1.70 2.96 1.71 4.57
Patient Satisfaction 78.9 76.4 77.4 67.5
MRSA rate 0.65 0.88 1.56 0.95
Health Check Quality of Services Excellent Excellent Weak Fair
Health Check Use of Resources Excellent Excellent Weak Weak
data correlation also showed some significant
relationships
NHSHealthandWellbeing The Boorman review
Source RAND Europe
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What is our overall goal?

• Healthy, engaged workforces

Well-managed organisations

• A high-performing, resilient workforce
• Enhanced productivity

• Contributing to
• A well-functioning society
• Better economic performance

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A new vision for health and work
A Review of the health of the working-age UK
population, commissioned in 2007 by the
Secretaries of State for Health and for Work and
Pensions.
At the heart of this Review is a recognition of,
and a concern to remedy, the human, social and
economic costs of impaired health and well-being
in relation to working life in Britain. The aim
is to identify the factors that stand in the
way of good health and to elicit interventions,
including changes in attitudes, behaviours and
practices as well as services that can help
overcome them. Working for a healthier tomorrow,
2008
Working for a Healthier Tomorrow
Prevent illness, promote health, intervene early,
improve the health of the workless.
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Costs of working-age ill-health

• Financial
• Overall costs of working-age ill-health in UK
  exceed 100 billion per year
• Around 172 million working days were lost to
  sickness absence in 2007, at a cost to the
  economy of over 13 billion (CBI)
• Black Report, 2008

Social If people are not healthy enough to work
or are inadequately supported through ill
health to make a return to work possible it is
not just the individual or the business which is
affected. The bottom line is often the impact on
his or her family and children. Lane
Lecture, University of Manchester, November 2007
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Factors that stand in the way

• Culture beliefs and attitudes needing change
• Misconceptions about health and work e.g. need
  to be 100 fit
• Inappropriate medicalisation of complex
  psycho-social problems
• Poor retention in work of those with disabilities
  or chronic disease
• Managerial attitudes, organisational behaviour,
  unable to make business case.
• Inadequate systems
• Inflexible system of sickness certification the
  sick note
• No pathways of rapid intervention to keep you in
  work or return you to it
• Health, work and well-being not part of training
  curricula or clinical practice
• Poorly-supported healthcare professionals. No OH
  advice for GPs.
• Lack of Primary Care involvement
• Rehabilitation to work not a performance measure
  for responsible local health bodies
• Configuration of Occupational Health services
  no national standards.
• Next generation
• Little attention to building mental and emotional
  resilience in our future workforce

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Why are people off work?

• Two-thirds of sickness absence and long-term
  incapacity is due to mild and treatable
  conditions, often with inappropriate
  medicalisation, needing vocational
  rehabilitation
• Depression, anxiety, stress-related mental health
  problems (est. cost 28.3 bn in 2008)
• Musculoskeletal conditions mild and often soft
  tissue (est.cost 7 bn in 2007)

The art of medicine remains the art of
identifying the patients problem (which is
something more than diagnosing the disease) .
Sir Douglas Black echoing Sir Robert
Platt
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Different problems need different approaches

• Symptoms 2/3 of cases
• Often mild
• Symptoms not diseases
• back pain
• musculo-skeletal symptoms
• stress
• anxiety, mild depression
• Few investigations required
• Diagnosed with relative ease
• Intervention needs to be early, often
  non-medical, good vocational rehabilitation,
  regular contact between employee and employer.
• Prevent chronicity

• Chronic conditions 1/3 of cases
• Examples
• chronic rheumatic diseases
• endogenous depression
• bipolar disorders, schizophrenia
• diabetes, cancer
• post-trauma disability
• Investigations more extensive
• Diagnosis can be difficult
• Treatment good medicine, good flexible
  employers, plus rehabilitation
• Prevent deterioration

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Health of teachers

• Reported rates of occupational stress, depression
  or anxiety are twice as high in the teaching
  profession than that for all other occupations.
• A National Association of Head Teachers (NAHT)
  survey found that 40 of teachers reported having
  visited their doctor with a stress-related
  problem in the previous year.
• 20 of teachers considered they drank too much
  and 15 believed they were alcoholics.
• The National Union of Teachers reports that
  around half of teacher ill health retirements
  take place for stress / psychiatric illnesses.

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Costs of mental ill-health at work

• Total cost to UK employers is estimated at 26
  bn per year
• (2006 Centre for Mental Health), including
• 2.4 bn in replacing staff who leave because of
  mental ill-health
• 8.4 bn in sickness absence (40 of the average
  7 days off sick per year is for mental health
  problems) but
• 15.1 bn in reduced productivity at work.
  Presenteeism loses 1.5 times the working time
  lost due to absence - costs more as more common
  in higher-paid work
• NICE If mental illness costs employers 28.3
  billion per annum in 2009
• prevention and early identification of problems
  should save employers at least 30, i.e. 8
  billion each year
• for a 1,000 employee company annual costs could
  be reduced by 250,000.

• November 2009 NICE guidance presents the business
  case.
• www.nice.org.uk/PH22

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The old system, and the need for early
intervention

• Work-related health problems often not
  life-threatening, but life-diminishing (MSDs and
  mental health conditions)
• No clear pathways of vocational rehabilitation or
  standards treatment all too often slow and
  inefficient, often with a poor outcome for the
  patient
• GPs have no easy access to expert help or OH
  advice, or vocational rehabilitation
• Repeated Medical Certificates can lead to
  worklessness

GPs issued sick note

• Problems are often mild and treatable

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The workplace findings of the Black Review (2008)

• Poor understanding of relevance of Health, Work
  and Wellbeing
• Employers unaware of the business case for
  investing in health and well-being
• Accessible and affordable sources of support and
  advice rarely available for small and
  medium-sized companies (SMEs)
• Line managers behaviour crucial, but there is
  often little training
• Employers inflexible about necessary adjustments
  for those with disabilities or chronic disease
• Often no policy on handling mental ill-health
• Often no sickness-absence policies to promote
  return to work
• Patchy Occupational Health services, of variable
  quality
• No national standards available to employers when
  they purchase occupational health or well-being
  services

And yet, the workplace provides great potential
for prevention promotion
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Health promotion and ill health prevention in
the workplace

• Advantages of the workplace
• a microcosm of society, as to age, gender,
  income, ethnicity
• powerful communication and education structures
• a culture of health at work can reinforce
  positive health behaviours
• good employer/employee relationships can sustain
  healthy behaviour
• infrastructure for measurement of health outcomes
  is often in place
• interventions can benefit employees, employers
  and the public purse
• families of employees extend impact further.

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Promotion of health in the workplace

• The promotion of physical health and fitness,
  and the prevention of physical disease, are
  highly-desirable goals, often pursued by
  companies.
• But the promotion of positive mental health
  and fitness is done by too few companies.
• Physical health influences mental well-being.

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Positive Workplaces

• Key features common to those organisations which
  have achieved success in promoting health and
  well-being
• Senior visible leadership
• Accountable managers throughout the organisation
• Attention to both mental and physical health
  improvements
• Systems of monitoring and measurement to ensure
  continuous improvement
• Empowering employees to care for their own health
• Fairness
• Flexible work

Health and well-being need to be embedded in
every aspect of an organisations structure and
work
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HSE Management Standards

• The standards define a desirable set of
  conditions to work towards
• Demands which includes issues like workload, work
  patterns
• Control which is how much say the person has in
  the way they do their work
• Support which includes encouragement and
  resources provided by the organisation line
  management
• Relationship includes promoting positive working
  to avoid conflict
• Role which ensures people are aware of their role
  in the organisation and there is no conflict in
  roles
• Change covers how organisational change (large or
  small) is managed and communicated by the
  organisation
• http//www.hse.gov.uk/stress/standards/

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Black Review Health, Work and Well-being
Initiatives
Fit Note In use from 6 April 2010
11 Fit for Work service trials Live 2009 -2011
Public sector exemplar Boorman review of NHS staff health in England Recommendations included in NHS Operating Framework 2010/11
National Standards for provision of OH services Published Jan 2010
Council for Health and Work Established 2009
Regional co-ordinators of health, work and well-being Live 2009-2011
Education and training initiatives for GPs and secondary care professionals Live 2009-2011
Working our way to better mental health a framework for action Published Dec 2009
Occupational Health Adviceline for SMEs Live 2009-2011
Challenge Fund for Small and Medium Enterprises Live 2009-2011
Free interactive Workplace Wellbeing Tool Launched 2010

All intended to help maximise health, wellbeing
and productivity.
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From sick note to fit note

• Fit note
• GPs share responsibility with employers
• GP knows health condition and impact
• Employer knows job

• Sick note
• For the past eighty years or more, a GP assessed
  a persons health and ability to work.
• The old form required the doctor to state whether
  or not the patient could work, and how long they
  should refrain from work if sick.
• Partial ability to work was not considered.

• Adjustments being made
• Phased return to work
• Part-time working
• Working from home
• Flexible start times
• Different tasks
• Practical adjustments in the workplace.

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Importance of Fit for Work Service Pilots

• Identifying underlying problems with rapid
  referral
• One stop supported approach
• Practical support in non-medical areas
• OH input as required

These measures are to help people remain in work
or return to work more quickly
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Leicester City Leicestershire Fit for Work
Service
Vision

• Move management of sickness absence from the
  medical model into vocational rehabilitation.
• Move vocational rehabilitation closer to
  mainstream primary care.

Dr Rob Hampton, Clinical Lead
Commissioning Partnership
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Advantages of LeicesterFFWS Model

• Convenient for patients
• Contact within 24hrs
• First appointment within a week
• Mobile phone communications
• Choice of venue for consultation 40 surgeries,
  12 MAC sites, PCT, Council and Provider premises
• Helpful to GPs
• Ease of referral no forms
• Musculoskeletal interventions funded
• Service signs Fit Notes
• Service provides audit data to GP practices

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Interventions proportion of clients
Musculoskeletal 15
Psychological 30
Employer dialogue 50
Amended/Phased Return To Work 40
Alternative employment 5
Information and guidance 20
Referred to MACs (financial/family/legal) 40
JC Plus 5
Leicester FfWS
Client Never gave up on me, helped with all
problems.
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Occupational Health Advice Helpline

• Provides SMEs and GPs with tailored occupational
  health advice, by advisers with special training
  in Mental Health
• Majority of call are about sickness absence and
  attendance management
• Increasing number about the fit note
• 90 of callers find it useful or very useful

WALES Health at Work Advice Line Wales ENGLAND
run in partnership with NHS Plus SCOTLAND
Healthy Working Lives Advice line
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Workplace Well-being Tool

• Free on-line resource to help employers calculate
  financial costs of employee ill-health to their
  organisation
• Can be accessed at www.workingforhealth.gov.uk

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Mental Health how can savings be delivered?

• Awareness training for line managers, to increase
  understanding of MH issues and their ability to
  respond confidently and rapidly, e.g. at the
  Centre for Mental Health (one of many such
  courses).
• Prevention of directly-work-related MH problems
  (around 15 of total) e.g. by providing
  mentally-healthy working conditions and practices
  (see guidance by UK Health and Safety Executive)

• Better access to help for employees,
  particularly to evidence-based psychological help
  and support while carrying on working
• Effective rehabilitation for those who need to
  take time off, including regular contact with the
  employee during periods of absence

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Case study-EoN

• E.ON is the worlds largest investor owned gas
  and electricity company
• Approx 18000 employees in the UK, over 50 sites
  across UK
• Reviewed their structure, implemented strategic
  Business Partner roles
• Employed a specialist Case Manager and
  Communications Specialist
• Aligned Health to the Business commercial
  customer focus
• Made health relevant to the individual

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EoN-Staff Roadshows innovative health promotion

• The number of new cases days lost through
  mental health related absence has reduced by 25
  since launch
• Continuous reduction in sickness absence over 2
  years, approx 11.8m cost savings

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Case study Airbus

• Commercial partnership between a large company
  and an NHS Trust.
• Male-dominated environment with 7,500 employees.
• Marketed programme around well-being and not
  mental health, to avoid latters stigma.
• Mental Health First Aid courses to Managers, Shop
  Stewards and Apprentices.
• Encouraged the men to open up and be more honest
  among themselves.

• Results
• Saved 1.7 million of direct costs over 3 years
• Sickness absence fell by 3 to 4
• social benefits one employees partner
  approached a manager in a local supermarket to
  say the programme had improved her life too.

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Grimsby InstituteIntroduction

• Grimsby Institute of Further and Higher Education
  has won many awards for employee health and
  well-being.

Our approach is determined by the desire to
provide customers (students and others) with the
best possible service. To achieve this, we need
to employ excellent staff who perform each day to
their best. If they are not at work, they cannot
do this.

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Grimsby InstituteKey to success

• Health and wellbeing strategy aligned with
• Institute mission, values and business plans
• staffing procedures
• key business processes
• employee benefits
• onsite catering
• charity fundraising
• sport and activity
• internal communications
• health and safety

• Health and wellbeing team who work with other
  experts.
• Speedy supportive interventions to keep people
  at work or accelerate returns to work.
• Helping other organisations understand the value
  of health and wellbeing.
• Regular management training.
• Extensive employee communication.
• Measuring the impact.

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Grimsby InstituteResults

• Sickness absence

• Level of accidents at work dropped from 424 in
  2004/05 to 253 in 2008/09
• Quality of observed teaching has improved
• Size of the organisation has grown (17m in 2001
  to 47m in 2010)
• Financial health improved

Year age of days off sick Days / person / year
2004/05 1.62 3.60
2005/06 1.63 3.60
2006/07 1.31 3.23
2007/08 1.18 2.61
2008/09 1.24 2.74
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Improving the health and well-being of University
staff
Improving performance through wellbeing and
engagement a two year national project funded
by HEFCE in partnership with Scotland and Wales
to support institutions to enhance their
performance through their people.

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The project, led by the Universities of Leeds and
Glasgow in partnership with the a number of
Higher Education institutions, has so far engaged
60 of HE institutions.
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Improving performance

• The project aims to
• Develop a higher education specific business case
  for employee wellbeing and engagement showing
  what aspects make the biggest impact on
  performance
• Support institutions to enhance their practice by
  developing a bank of practical case studies and
  resources
• Support learning and sharing across the sector by
  developing an employee wellbeing network,
  supported by regional meetings.

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Recourse

• Recourse provides free and confidential services
  to those working in post-16 education.
• This includes serving, former and retired staff
  and their dependents plus employees and former
  employees of UCU, AUT and Natfhe.

Recourse (formerly CUSN the College and
University Support Network) is the charity
established by Teacher Support Network, in
partnership with UCU, to improve the well-being
and effectiveness of all working in the adult,
further and higher education sectors.
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Recourse services

• 0808 802 03 04
• 24/7 Support Line providing practical, emotional
  and financial support
• Run every day of the year by fully-trained
  counsellors and coaches
• www.recourse.org.uk
• E-mail support from fully-trained counsellors and
  coaches
• Web-based InfoCentre
• Online self assessment tools
• E-newsletter
• All of Recourses services are completely free
  and confidential, thanks to the continuing
  donations of the UCU and over 15,000 of its
  members

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How Recourse can help Daniels story

• Daniel, 30, got his first post as a lecturer last
  year. He contacted Recourse as he was struggling
  with his workload.
• Feeling anxious and pressured, his work had begun
  to adversely affect his sleep patterns and
  short-term memory.
• Firstly, Recourses coach encouraged Daniel to
  seek medical advice. He then helped him to
  realise that he needed to learn to manage his
  workload more effectively and, most importantly,
  say no when things were getting on top of him.

Daniels state of mind had improved significantly
by the end of the coaching programme and he had
more confidence and better communication with his
Head of Department.
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Mental health and work

• Being in work generally leads to good mental
  health, self-esteem and well-being
• Being out of work is associated with poor mental
  health, increased likelihood of anxiety and
  depression, and increased use of medication
• When people return to work their mental health
  and well-being generally improve
• Although work can pose a risk to mental health,
  the positive effects far outweigh the risks
• People with mental health problems attach a high
  priority to work, and work can be part of the
  recovery process
• Poor mental health associates with low earnings,
  social exclusion, poorer physical health, child
  poverty, disrupted education

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