Health and work strategy: review report

3 Background

Two hundred years ago on the banks of the River Clyde at New Lanark, the industrialist and Social Reformer Robert Owen was making waves. During his years of ownership between 1800 and 1825, Owen introduced workplace practices as well as wider health and social measures that can be considered the precursor of todays' health and work agenda. Crucially, he demonstrated that by focusing on the health and social wellbeing of its employees, business could be a very profitable endeavour.

Two hundred years on, Scotland remains at the forefront of the health and work agenda and is recognised on an international level as having a strong commitment both to policy and practice.

Since Devolution, the Scottish Government has this commitment, including through the publication of its Healthy Working Lives Strategy^[3](2004), which provided a definition for Healthy Working Lives and which also led to the establishment of the Scottish Centre for Healthy Working Lives in 2005, a collaboration between NHS health Scotland and the 14 territorial NHS Boards which supports over 3,000 employers annually and which has working with in excess of 20,000 since its inception.

The Scottish Government's review of the Healthy Working Lives Strategy, Health Works^[4], was published in (2009) and set out the ambition to develop early intervention support for individuals with a health barrier to entering or fulfilling their potential in work, with the Health and Work Continuum helpfully identifying the rationale in terms of the cost to society for investing in such support

Figure 1 The Health and Work Continuum (Health Works (2009)

Services introduced to support individual job retention have included: The roll-out of Working Health Services Scotland^[5](2010) which supported over 13,000 patients in its first four years of operation with over 90% experiencing a positive health impact and either remaining or returning to work^[6]; the introduction of the Fit For Work Service^[7](2014), which whilst regrettably cancelled by the Department of Work and Pensions after just three years nevertheless proved impactful for the individuals accessing it and provided enormous learning, and most recently the introduction of the Health and Work Support Pilot^[8] (2018) in Dundee and Fife.

The Health and Work agenda is notable for the degree of reach it has across Government Policy areas, both in Scotland and UK level.

It is explicit within the Scottish Government's Economic Strategy^[9](2015) and the Fair Work Framework^[10] (2016) and there are clear linkages to the Disability Employment Action Plan^[11](2018) and the Fair Work Action Plan^[12] (2019). Achieving a Scotland where we have a sustainable, inclusive economy, is one of the six Public Health Priorities for Scotland ^[13](2018) established by the Public health Reform Programme which provides an important mandate for investing in health and work.

At UK level it has been at the heart of the joint work across the Department of Work and Pensions and Department of Health and Social Care, including the seminal Working for a Healthier Tomorrow^[2] (2008), Improving Lives, the Future of Work, Health and Disability Strategy^[14](2017) and the Stevenson/Farmer Review of Mental Health and Employment^[15] (2017).

In practical terms, Health and Work encompasses efforts through the work of organisations including the NHS, Local Authorities, the HSE and Employers to improve health, safety and wellbeing at work and reduce exposure to occupational risk; it includes programmes aimed at supporting those with a health condition to remain in work or return to work more quickly, such as through programmes such as Working Health Services Scotland, and the Health and Work Support Pilot; and it extends to efforts to support people more distant to the labour market to access work. As such, it embraces work across the Health and Fair Work policy areas within the Scottish Government. It is for this reason that the Review has been entitled Fair and Healthy Work For All and it is essential to its success that policy and practice are as joined-up as possible. The Scottish Plan for Action on Safety and Health (SPlASH)^[16] (2017), an initiative of the Partnership for Health and Safety in Scotland (PHASS)^[17] which brings together a range of partners including the Health and Safety Executive and Scottish Government's Health and Fair Work policy teams, provides a powerful example of what can be achieved when we work together.

The imperative for and evidence base for Health and Work is well developed. The costs of health related absence and worklessness for the UK was quantified in 2008^[2] at £100 billion per annum (around £9 billion for Scotland pro-rata), equivalent to the cost of the NHS, a figure that remains valid given the stalling of improvements over the last ten years. These figures do not include costs associated with 'presenteeism' which have been estimated by Professor Cary Cooper^[18] to be double those associated with absenteeism.

Health and work is cited as a public health priority by the World Health Organisation^[19] and features heavily in two of the six evidence based policy areas identified by Michael Marmot^[20] (2012) as requiring action if health inequalities are to be prevented or reduced. It has been subject to detailed evidence reviews including: Is work good for your health and wellbeing?^[21] (2006);Carol Black and David Frost's Review of Sickness Absence in the UK^[22] (2012); Building the Case for Wellness^[23] (2013); and Thriving at Work^[14] (2017). There remains, however, a challenge in translating this into successful population health programmes with reach into all areas of the economy, especially with Small and Medium Sized Enterprises (SMEs).

In summary, there is a positive and supportive policy environment for the Health and Work agenda and a substantial range of interventions are in place across different policy domains. This Review is not about reinventing the wheel, but in instead focused on the gaps that exist in the response, and on the new challenges that are emerging. It is focused on the contribution that can be made directly in respect of the interaction between health and work, including considering the contribution of the health system in Scotland. It is about identifying what improvements can be made to keep Scotland at the forefront of the health and work agenda and is about creating the conditions to enable Fair and Healthy Work for All.