Health Works A review of the Scottish Governments Healthy Working Lives Strategy A report on implementation May 2013

1. Background and Policy Context

Work is a key social determinant of health (1). It is now well understood that health and social inequalities result in substantial levels of working-age ill health and disability. In Scotland, we recognise the importance of work (paid or unpaid) to people's health. The Chief Medical Officer's annual report (2) describes the loss of self-esteem and sense of control that come from decades of unemployment in areas of Scotland.

We know there is a correlation between health inequalities, poverty and affluence. Health inequalities emerge from a range of determinants that are wider than health and include social, economic, educational and environmental factors. The NHS is being asked to adopt a multifaceted approach to addressing health inequalities that includes promoting opportunities for improvement across a person's life course (3).

The costs of ill health in the working-age population - to the individual, to business and to society - can be extremely high. The estimated cost to the British economy in 2008 in lost productivity, lost tax and increased health and welfare costs was £100 billion (Figure 1) (4). Reducing these costs is clearly a desirable objective.

Figure 1. Health and work continuum

Demographic predictions and the rising age of retirement mean that people will have to stay healthier throughout their lives, self-manage their health conditions more effectively and work for longer. Work has positive benefits for health, income, social status and relationships. Employment is a recognised core plank of independent living and plays a key part in establishing personal identity for many people.

The benefits of work are greater than the harmful effects of long-term unemployment and prolonged sickness absence. There is strong evidence that the longer the duration of a period of sickness absence, the lower the chances of, and the greater the obstacles to, returning to work.

Health Works

The Health Works report (5), published in 2009, presents the conclusions of the review of the Healthy Working Lives strategy and actions. It sets out why we want to change attitudes to health and work among employers, workers and healthcare professionals and how the change can be achieved. Following on from Healthy Working Lives: a plan for action (6), it aims to:

• contribute to economic growth and other national outcomes by promoting health, safety and well-being in and through the workplace;
• improve healthcare professionals' recognition that work is a key social determinant of health and that a return to work should be a central outcome of patient care;
• improve support for those who are unemployed as a consequence of a health condition to move back towards work.

Responsibility for delivering Health Works aspirations is shared between government, territorial NHS boards, special health boards and, through collaborative partnerships, trade unions, charitable organisations, business and employability partners and others. It has influenced and been a feature of other policy relevant to the working population, such as:

• the allied health professions (AHPs) delivery plan (7), which makes a commitment that all AHPs should ask people about their work status and initiate support to enable individuals to remain in, or return to, work;
• the Mental Health Strategy for Scotland 2012-2015 (8), which includes a commitment to promote evidence-based practice in relation to employability and to refocus practice on more effective approaches;
• Modernising Nursing in the Community (9), whose "Health, work and well-being" programme has a clear focus on promoting health and work as part of routine nursing care in the community.

Cross-government collaboration

The Scottish Government collaborates with the United Kingdom and Welsh Governments on the Health, Work and Wellbeing strategy (10).

Dame Carol Black was appointed as the first UK National Director for Health and Work in 2006, a post she held until the end of 2011. The recommendations of her review of working-age health (4) have led to a number of initiatives being taken forward across the UK. Activity in Scotland includes:

• the introduction of a "fit note" to replace the traditional sick note issued by doctors;
• a pilot Fit for Work service (Working Health Services Scotland (WHSS)) to allow access to quick diagnosis and referral to relevant health and other services for people working for small and medium-sized businesses without in-house occupational health services;
• an advice line offering occupational health advice to employers, particularly in small and micro-sized businesses;
• a Health, Work and Wellbeing Coordinator, hosted by the Scottish Government, to raise awareness of the benefits of good work to health (and vice versa) and identify and promote best practice and innovation in health, employment and skills.

This report

This report provides an update on progress with the delivery of the Scottish Government's Health Works. It is based on wide consultation and partnership working with relevant stakeholders throughout Scotland and presents information to the end of March 2013. Brief case studies are presented throughout the text to illustrate the kinds of positive initiatives that services are taking forward across the country.