Health and work strategy: review report

9 Availability of Fair and Healthy Work

Recommendation 2.1

Maximise access to and uptake of on-line advice and support on Fair and Healthy Work.

Implementation

• Ensure maximum ease of access to comprehensive web-based support for employers and employees around Fair and Healthy Work.
• Integrate Health and Work support into the proposed new business portal.

Evidence/Rationale

The pressures on employers and the workforce in terms of Fair and Healthy Work, as evidenced by stalling health improvement, absence and Presenteeism, have never been greater, and the impact of economic, labour market and demographic change can be expected to exacerbate these challenges. It is therefore essential that investment in support for employers to improve the health of their employees is also increased, whereas in practice, the level of investment in health and work support has declined in recent years.

Evaluation^[60], market research^[61] and on-going customer feedback^[62] from employers has demonstrated the impact of and overwhelming satisfaction with the services provided by Healthy Working Lives, including www.healthyworkinglives.scot which attracts around 25,000 visitors per month. Market research has consistently identified on-line information channels as being the channel or choice for SMEs.

Employers and individuals consistently ask for a single access point to quality assured information and self-help focused advice via the web that is as joined up as possible in order to maximised ease of access. The new business portal referred to in the Fair Work Action Plan would provide such a vehicle.

Digital exclusion is an issue that needs to be considered, however, as not all individuals (personally or in the workplace) or businesses, have the necessary digital access. Maintaining a sustainable physical workforce, able to support employers and employees over the phone or in person therefore remains important, and is addressed in Recommendation 2.2.

Target Audience

Employers in all sectors, employees and the self-employed.

Stakeholders

SG Fair Work, SG Health at Work, NHS Boards, Employer Organisations Trades Unions.

Cost

Based on the most recent UK figures^[2], the cost of health related absence and worklessness in Scotland is approximately £4,000 for every working person. Current expenditure on the entire Healthy Working Lives offering through NHS Health Scotland and territorial NHS Boards is currently under £1 for every working person.

Complexity

Relatively straightforward as new work can be built upon the existing infrastructure and the new Business Portal as it develops.

Impact

Research undertaken by PWC^[7], which echoes other studies, demonstrated a significant return on investment in workplace health initiatives. Specific impact evaluation of Healthy Working Lives concluded that the "research evidence shows that it is making a positive impact on employers."

Recommendation 2.2

Ensure adequate skills and capacity are in place to support employers in improving their workplace health practice - both locally and nationally.

Implementation

• Increase investment in local and national employer focused advice on Fair and Healthy Work.

Evidence/Rationale

The pressures on employers and the workforce in terms of Fair and Healthy Work, as evidenced by stalling health improvement, absence and Presenteeism have never been greater, and the impact of economic, labour market and demographic change are expected to exacerbate these challenges. It is therefore essential that investment in support for employers to improve the health of their employees is also increased, whereas in practice, the level of investment has fallen in recent years.

The Healthy Working lives programme, which is a partnership-based programme between NHS Health Scotland and the 14 territorial NHS Boards, delivers advice and support to employers and employees across Scotland. Its' staff deliver support on a face-to face, telephone and web-chat basis, as well as through formal training courses, and are also responsible for the content of healthyworkinglives.scot. Staff also undertake the development of new resources, typically in partnership with other stakeholders. Funding for the programme has reduced significantly in recent years, impacting on the sustainability of the service and its ability to innovate and develop new resources.

An external evaluation^[60] undertaken by the University of Glasgow of the Healthy Working Lives Services delivered by NHS Health Scotland and the 14 Scottish territorial Health Boards concluded that the "research evidence shows that it is making a positive impact on employers," with 90% of employers reporting an impact on policy and behaviour, and 90% reporting an impact on performance measures such as reduced sickness absence, better productivity and lower turnover. The biggest impact was seen with SMEs and third sector organisations, reflecting the fact that they have the most to gain, and the greater the engagement with Healthy Working Lives, the greater the impact.

Market research^[61] and on-going customer feedback^[62] with employers has demonstrated the impact of and overwhelming satisfaction with the services provided by Healthy Working Lives, with very high Net Promoter Scores^[62] for all of its services ranging from 67% to over 85%.

Target Audience

Employers in all sectors and the self-employed. Employees can also access Healthy Working Lives Support but are not the primary audience.

Stakeholders

SG Health and Work, NHS Boards, Employer Organisations, Trades Unions.

Cost

Based on the most recent UK figures^[2], the cost of health related absence and worklessness in Scotland is approximately £4,000 for every working person. Current expenditure on the entire Healthy Working Lives offering through NHS Health Scotland and territorial NHS Boards is currently under £1 for every working person.

Complexity

Relatively straightforward as this would simply involve scaling-up existing service support. It would be necessary to ensure any new investment was focused on Health and Work additional to the level of investment currently being made.

Impact

Research undertaken by PWC^[23], which echoes other studies, demonstrated a significant return on investment in workplace health initiatives. Specific impact evaluation of Healthy Working Lives concluded that the "research evidence shows that it is making a positive impact on employers^[60]."

Additional funding would enable the up-scaling of activity and enable the development of new resources to support employers with the priorities highlighted within this report, such as gender based workplace issues and supporting an ageing workforce.

Recommendation 2.3

Encourage innovation and learning in relation to workplace health and wellbeing practice – especially in SMEs.

Implementation

• Encourage new and innovative practice through a business challenge fund targeted at supporting workplace health for SMEs.
• Disseminate this and wider learning through an annual event and/or existing channels such as business organisations, Healthy Working Lives and Fair Work.

Evidence/Rationale

Almost all evaluated examples of workplace health programmes have taken place in larger employers, yet what works for larger employers, who will generally have HR and other support in place, is not necessarily applicable to smaller employers. Such an approach would develop SME specific practice for sharing and adoption elsewhere.

The use of challenge funds is a tried and tested approach for encouraging innovation and developing new practice and would not need to be large in scale. It would require evaluation support and a mechanism for dissemination though the infrastructure for the latter is already in place through business organisations and existing programmes. Promotion thorough, and engagement of the Federation of Small Businesses and Chambers of Commerce in the wider process, would ensure the programme reached a wide audience and would help strengthen employer engagement in Fair and Healthy Work.

The Learning Occupational Health by Experience Risk (LOcHER)^[61] initiative has been highlighted as an approach that could be applied more widely in this context, indeed LOcHER projects could be included in the wider dissemination activities.

Target Audience

SMEs, particularly those employing under 100 staff.

Stakeholders

SG Health and Work, SG Fair Work, FSB, Chambers of Commerce. University support for evaluation.

Cost

Individual awards would not need to be large, indeed if significant investment were required it would not be replicable in other employers. Resources needed to support evaluation would likely be of a higher order.

Complexity

There are many examples of similar programmes to model upon and the work could be taken forward by one of a number of existing organisations.

Impact

Likely to be small at first, though dissemination of successful interventions over time would increase this. It would also be valuable in engaging SMEs. Creating a joint programme between the Work and Health and Fair Work policy teams and establishing shared criteria would promote an integrated approach.

Recommendation 2.4

Improve the co-ordination of interactions with employers between employer-facing government activities.

Implementation

• Locate as much business support as possible on the new business portal.
• Increased awareness of and training on the different offerings available through relevant agencies and encouragement of cross-promotion.
• Coordination of marketing campaigns to employers.

Evidence/Rationale

There are many good examples of coordinated action both nationally and locally, but there is scope for greater collaboration in terms of the interface between national and local government functions and employers.

There are a range of programmes and services that contribute to Fair and Healthy Work, including Employability Programmes, Healthy Working Lives, Working Health Services, the Living Wage, Carer Positive, Re:Markable, environmental health services, HSE and the Scottish Fire Service (Fire Safety), together with others including Business Gateway and the Enterprise Agencies which have a wider business focus.

The new Business Portal, which is currently under development, provides a real opportunity to bring together online support for employers on the range of issues that affect them and therefore should be as broad as possible in its scope. It would also provide a resource and would enable easy cross referral, with staff of different bodies being supported and encouraged to consider wider business needs should they see them. This could extend to them promoting the marketing campaigns of one another's agencies and indeed ensuring the marketing is co-ordinated to avoid employers being overwhelmed with messages.

Target Audience

All employers and the self-employed.

Stakeholders

SG Health and Work, SG Fair Work, employer facing government programmes.

Cost

Minimal, indeed it may be possible to generate savings from more coordinated activity that could be reinvested.

Complexity

Straightforward in principle but in practice difficult to achieve as evidenced by continued fragmentation.

Impact

Improved co-ordination of activities and messaging would lead to a clear call to action for employers and a greater likelihood of engagement.

Recommendation 2.5

Improve the skills and confidence of employers/managers to contribute to improved mental health and wellbeing.

Implementation

• Increase investment in Mentally Healthy Workplace Training (MHWT) to enable more employers to be able to access it.
• Commission an evaluation of the training to specifically consider the impact of the training on the mental wellbeing of the staff managed by recipients of the training.

Evidence/Rationale

Promoting positive mental health at work and supporting a positive environment for those with poor mental health feature within the Scottish Government's Mental Health Strategy (Action 36), and work is being taken forward on action this by a range of partners led by NHS Health Scotland. The increase in mental health related absence and rise in presenteeism underline the importance of this work.

MHWT is a blended-learning based course comprising an e-learning module followed by 6 hours of face to face contact that is delivered to employers across Scotland by NHS Health Scotland the local NHS Boards. It is designed specifically for line managers and supervisors, and is also available on a Training for Trainers basis for larger organisations.

The training is well received by employers and has been evaluated positively in terms of improving the skills and confidence of managers. The training meets the six mental health core standards identified by the Stevenson/Farmer Review^[15], the Review also highlighting the return on investment in a 4 hour manager mental health training programme to be £9.98 for every pound invested^[63]. A more recent meta-analysis of manager training in mental health concluded there was positive impact on managers' knowledge, attitudes and behaviour in dealing with mental health issues, but was more cautious around the impact of this on the level of psychological distress on staff due to the lack of data^[64].

A modest investment to promote MHWT and to train and resource more staff to deliver it would enable faster roll-out and increase the number of employers and line managers to benefit. An evaluation of the impact on the psychological wellbeing of employees would be a useful addition to the evidence base and would validate wider roll-out.

Target Audience

All sectors, but could begin intensively with public sector bodies and their contractors using the lever of procurement.

Stakeholders

Health and Work, NHS Boards, 3^rd Sector Organisations.

Cost

The intervention cost is not significant and the investment could be scaled according to the desired scale of the roll-out. Any formal quantitative evaluation of impact would need to be specified and could either be outsourced at cost or prioritised for delivery by an appropriate public sector partner.

Complexity

The MHWT programme already exists and could readily be rolled out, though there are other programmes available in the marketplace. Pooling efforts around one consistent and evidence based would be advantageous.

Impact

Increased availability of the training will enable more employers to be reached. Evidence indicates that there is a positive impact on manager knowledge, attitude and behaviour, and whilst more data is required to confirm the impact on their staff, the training meets the current best practice guidance that does exist.

Recommendation 2.6

Quantify and track the development of Fair and Healthy Work in Scotland.

Implementation

• Identify mechanisms for gathering performance data on Fair and Healthy Work.
• Combine efforts with the Fair Work Action Plan proposal to measure progress towards a Fair Work Nation.

Evidence/Rationale

Comprehensive data on access to Fair and Healthy work is lacking, making progress difficult to assess. This issue has also been recognised within the Fair Work Action Plan^[12], which proposes the development and adoption of a set of indicators to measure progress in delivering a Fair Work Nation.

Given the close relationship between Health and Work and Fair Work, and the benefits of pooling resources and co-ordinating data collection and analysis, it would be logical for this work to be expanded to explicitly include health and wellbeing measures.

Target Audience

SG Fair Work and SG Health and Work.

Stakeholders

SG Health and Work, SG Fair Work, NHS (including Public Health Scotland), Local Authorities, academia.

Cost

The cost will largely depend on the specification of the data and collection method and is work to take this forward will be required in terms of Fair Work. Including health and wellbeing measures from stage one will minimise any additional cost.

Complexity

Whilst some data sets will already exist, such as that which is currently included in National Performance^[55] dataset, in all likelihood there will be the requirement to identify new measures and mechanisms for collecting data

Impact

Improved data and intelligence to inform policy and practice.

Recommendation 2.7

Ensure a robust occupational health and safety regulatory, inspection and enforcement environment supported by workplace occupational safety and health advice.

Implementation

• Maximimise co-ordination of activity across enforcement, regulatory and advisory branches of government.
• Continue to work through the Partnership on Health and Safety in Scotland (PHASS) to identify and prioritise higher risk industries and take

Evidence/Rationale

Formal arrangements exist between the Health and Safety Executive and local authority environmental health services to avoid duplication and maximise effort. A Service Level Agreement between the HSE and Healthy Working Lives was put in place some years ago and (bearing in mind the latter is focused on support and advice and lacks any regulatory or enforcement function) would usefully be updated given developments that have affected both partners in the intervening period, and could also be extended into a three way agreement with environmental health services.

PHASS also provides an important vehicle for supporting collaboration, extending beyond the governmental providers of enforcement, regulatory and advisory services to include industry groups, businesses, trades unions and safety bodies, and plays an important role in identifying priorities and encouraging joint working, such as through the Scottish Plan for Action on Safety and Health (SPlASH).

Concern has been expressed through the Review about the scale of the collective resource invested in this area

Target Audience

All employers, but with the prioritisation of higher risk sectors.

Stakeholders

Health and Work, Fair Work, HSE, Environmental Health, NHS, Industry and Trades Unions

Cost

Improved co-ordination of effort is expected to lead to a more efficient use of resources, although the overall scale of activity that can be maintained is inevitably constrained by the resources available.

Complexity

Joint working in this area is already strong, with PHASS providing an excellent example on which to build.

Impact

More coordinated action can be expected to result in greater, and more targeted impact.