Website of the Department of Health

Speech by the Rt Hon Alan Johnson MP, Secretary of State for Health, 20th February 2008: Well at Work

INTRODUCTION

Thank you very much, Nicki [Cooper – Head of Education at the British Heart Foundation], for that kind introduction.

It’s a pleasure to be here today to help launch the evaluation of the Well at Work pilots.

I’d like to thank the British Heart Foundation for all they have done to make Well at Work possible. I’d also like to acknowledge the wider work they do, not only to support those living with heart conditions, but also to promote health and wellbeing more generally. They are, in many ways, at the forefront of the debate on preventative healthcare.

This debate naturally focuses on what happens in the workplace. Increasingly, employers, government and health professionals recognise the importance of actively promoting health and wellbeing.

You have already heard from Carol Black, who will be publishing her review of the health of the working age population shortly. Carol has immersed herself in this work with great expertise and energy and we are looking forward to her Report.

HISTORY

This is not, of course, the first generation to recognise the importance of protecting workers’ health, or to make the connection between a person’s physical health and what they do for a living.

The ancient Egyptians wore veils to stop them inhaling lethal dust when mining for cinnabar (red mercury oxide), which was used in cosmetics. And it was as early as 1700 that Bernardino Ramazzini wrote the first treatise on occupational diseases, in which he insisted that doctors should ask their patients what they did for a living before attempting a diagnosis. 

Yet despite the ferocious campaigning of reformers such as Lord Shaftesbury, Robert Owen, and eminent medics including William Farr, and Thomas Legge, progress has been relatively slow. As recently as the early 1970s, before the Health and Safety at Work Act, eight million workers had no legal safety protection at work. Since the Act, the number of fatal injuries has fallen by 73 per cent, and the number of non-fatal injuries by 70 per cent. 

The chance of serious injury in today’s workplace has declined significantly. But new challenges have arisen. The shape and nature of the workplace has changed radically over the last thirty years. With the rise of the service sector, more and more of us have adopted sedentary professions.  Technology has made a contribution too through BlackBerrys, I-phones and super speed internet connections. In many professions, it no longer matters if staff are at their desks, on a train or sitting at their kitchen table – the pressures of work are ever present.

Occupational health is not just about preventing the worst case scenario – making sure people wear protective clothing or sticking a yellow sign up when someone spills a cup of coffee. Issues such as stress, depression and back pain can cost employers millions of pounds every year, which is why employers are increasingly seeing significant benefits from promoting good health among their staff.  

Ten years ago, we started the debate on work-life balance. Increased maternity leave, the introduction of paternity leave, time off for adoptive parents and the right to request flexible working have led to a quiet revolution in our workplaces, as more employers recognise that supporting a healthy work-life balance is essential to recruiting and retaining talented staff.  The next stage I believe is to incorporate work-life balance with work-health balance.   

THE ECONOMIC CASE

There is an economic case for this.

The CBI estimates that 175 million working days are lost due to ill health every year. This costs the nation around £13 billion a year. The Health and Safety Executive estimates that 36 million of these are days lost because of occupational ill health.

Back pain alone costs employers £600 million a year, with sufferers of persistent back problems on average taking 17 days off sick per year. Only half of those signed off for six months or more return to work. Only a quarter of those signed off for a year or more will return to work.

Mental ill health – mainly caused by work-related stress -  adds another £8.4 billion to the bill, including a total of £2.4 billion which employers spend on replacing staff who leave their jobs because of poor mental health.

For employers who take small, cost effective steps to manage issues such as stress more effectively, there are clear business benefits. Somerset County Council invested £339,000 in identifying the causes of stress and tackling them more effectively. As a result, the average annual sickness absence rate has fallen by two days. The Council estimates that this is saving £1.9 million every year.

GlaxoSmithKline’s programmes to promote individual and team resilience has brought productivity increases of 13 per cent. Let’s not forget our hosts. BT’s mental health wellbeing strategy reduced mental health related absence by 30%.

THE SOCIAL CASE

The irony is that absence from work doesn’t improve these conditions. Poor working conditions lead to poor health, not work itself. Paradoxically, unemployment is progressively damaging, leading to more sickness, mental illness, disability, increased use of medication, higher hospital admission rates and shorter life expectancy. Suicide rates are 35 times higher among the long-term unemployed than among those in employment.

And there is strong evidence that the impact of returning to work – even after long periods of unemployment – has the capacity to improve health, to the same extent that being out of work can damage health.

Yet the vast majority of people who are forced to leave work because of poor health rarely make it back into the work place, despite the fact that most want to.

Nine out of ten of those who come on to incapacity benefit want and expect to return to work. Many start claiming incapacity benefit because of back and neck pain, depression or heart and circulatory problems – medical conditions, yes; but not ones that make long term unemployment inevitable.

We know the depressing statistics about incapacity benefit. Those who are on it for one year are likely to stay on it for eight. Once they’ve been on it for two years, they are more likely to die or retire than ever work again.

The UN Universal Declaration of Human Rights states that everyone has the right to work, to free choice of employment, to just and favourable conditions of work and to protection against unemployment. 

It is wrong to deny anyone the opportunity of a fulfilling career because of a disability, or a long term condition that could be properly managed. 

This government can be justly proud of the increase in the number of disabled people now in work – from just over a third ten years ago, to nearly fifty per cent today. Disabled people are increasingly breaking down the prejudice and ignorance that confined them to unemployment or menial work. As a boy, David Blunkett was told that the best future he could hope for was to become a braille typist or a piano tuner. His experience reflected a culture that still persists in some quarters today – disabled people expected to be the passive recipients of benefits for the rest of their lives.

These are the problems; let me turn now to the possible solutions.

ACTION: GOVERNMENT AND EMPLOYERS
  
There are in my view three essential action points:

• First, employers need to take steps to promote health and wellbeing in the workplace;
• Secondly, government and employers must work together to improve how we identify potential health risks  and address them - in particular around stress and mental health;
• And thirdly, government must do more to help those who have become inactive but are able to work to find their way back into the workplace. 

Taking the first of these, we need employee health and wellbeing to be a higher priority for employers and to be championed at the highest level. Sickness absence and work-related stress are among the biggest inhibitors of productivity.  And as our recently published obesity strategy pointed out, by actively promoting health and wellbeing in the workplace, employers could play a significant role in tackling obesity this and other health issues.

Those of us who work fulltime spend a fifth of our lives in the workplace. What we eat there, how we sit, how we travel to the office, how we deal with pressure, whether there are opportunities to exercise – these things affect both our productivity and our long-term health.  

The average worker spends just under an hour travelling to and from work every day. The British Heart Foundation recommends we do half an hour of moderate exercise, five times a week. It is estimated that seven out of ten adults fail to meet this recommendation.

But if every employee were to walk, cycle or jog at least part of their journey to work each day, we would increase the number of adults doing enough regular exercise from a desultory three out of ten to seven out of ten.

Obviously; it is not for employers to police how much exercise their staff do - ultimately, these things are the responsibility of each individual.  But by actively promoting health and wellbeing, employers can incentivise changes in behaviour as well as reducing stress and other causes of employee absence.

Yet few employers report on the health and wellbeing of their workforce at board level.  I know from dealing with a constituency case how lax employers can be about dealing speedily with alleged offences by their staff, and the distress this can cause. My constituent was suspended for two years while his employer meandered through a disciplinary process that in the end found there was no case to answer. In the meantime, his health deteriorated because of stress and depression, caused by being under suspicion and a good employee with 30 years service lost faith with his employer – and this was in the public sector, which employs one in five workers  in this country,  has a poorer record than the private sector on sickness absence and must now lead by example.

Like many large employers, the NHS is adversely affected by sickness absence and low productivity because of poor health.

We will pilot health and wellbeing schemes in a number of NHS Trusts who are facing the biggest health issues. These have been developed with the support of the unions and Royal Colleges.  Employees will get confidential feedback on their health, alongside personalised advice on healthy lifestyles. And employers will get anonymised data on the health status of their workforce that can be used to target actions to improve health and wellbeing.

On the second action point, we need to do more to identify and address new risks to health in the workplace – and in particular to support those who develop health conditions while at work.

We have made good progress on safety. However,  government and employers must co-operate more; in particular, we must help smaller companies, which employ the majority of the workforce – to enable them to identify and address new health challenges such as stress and back pain.

Again, I expect the public sector – particularly the NHS - to lead the way. Each GP practice is a small business. Doctors, just like everyone else, suffer from work-related stress and poor mental health. Often, because of fear of stigma, they are less likely to seek help when they are ill – many doctors are not even registered with a GP- a new slant on “physician heal thyself”

Today, we are publishing the recommendations of Professor Louis Appleby, my National Director for Mental Health, on how we can support doctors more effectively. And I can announce that from Autumn this year, we will be piloting a service in London, for doctors who are struggling with mental illness. In particular, the pilot will focus on how to get better at intervening early, so that a minor problem doesn’t escalate into a full-blown crisis. 

On the third and final essential action point, we must provide better services for staff who fall ill to get back into work. In too many cases, what starts off as a short term health issue slowly develops into a much deeper problem that prevents someone from ever working again.

Incapacity benefit should not be a one-way street that starts in the GP’s surgery and ends as a lifetime on benefits. While we don’t expect GPs to police the border between having to work and being entitled to claim benefit, I want to continue our work with the BMA and others to explore how GPs can help to change our sick note culture into a well note culture – just as incapacity benefit is being converted to an Employment Support Allowance, which will set out an individual’s capabilities rather than their incapacity. The evidence shows that far from being damaging, work is generally good for people’s health. In fact staying in work or returning to work is often in a patient’s best interests.

As I say the medical community are already working with the Government on this issue, as part of Dame Carol Black’s work. James Purnell and I will be considering the resultant recommendations very carefully.

CONCLUSION

Thanks to health and safety legislation, today’s workplaces are safer than they have ever been.

But today’s new challenges call for cultural change rather than legislative action.

Stress and back pain are not necessarily ills that can be seen. You can’t stick a hazard notice on them or fence them off like pieces of dangerous machinery.

Today’s workplace dangers can be less visible and their impact may be less immediate, but they are just as devastating.

Those who are forced to leave the workplace because of such illnesses are too often given up for lost by both employers and the authorities and left to face a lifetime of unemployment and exclusion.

While it may have been fashionable in the sixties to eschew the benefits of being in paid work, even Philip Larkin who talked about the toad work squatting on his life, seemed to recognise that it was  better to be working than on the outside, looking in: “Turning over their failures by some bed of lobelias, nowhere to go but indoors, nor friends but empty chairs - ”

The vast majority of those who leave work because of poor health want to return. And no employer wants to lose creative, knowledgeable staff.

Unsurprisingly, there’s no sub-clause in the UN Declaration that mentions gyms in the workplace or the food that’s served in the company canteen. But sixty years on, our understanding of what is meant by a safe and healthy workplace must adapt, for the benefit of employers, for the benefit of their staff and for the overall benefit of our society. 

Thank you.