This document summarizes Dame Carol Black's presentation on health and wellbeing in the workplace. The presentation covered several key topics: 1) Developments in promoting workplace health and wellbeing, including the impact of demographics, importance of job quality, mental health, staff engagement, and the role of managers. 2) The relationship between work, health, and society, and how maximizing productivity benefits individuals and society. 3) Initiatives to promote longer working lives such as addressing barriers like common mental health issues, musculoskeletal problems, and job/workplace quality. 4) Characteristics of "good employment" and "good workplaces" that promote health and wellbeing.

1. Investors in People
Health and Wellbeing Seminar
London, 25 March 2015
Dame Carol Black
Expert Adviser on Health and Work
Department of Health and Public Health England
Principal, Newnham College Cambridge
Health and Wellbeing
in the working
environment

2. Content – What is new or developing ?
• Awareness of impact of demographics
• Importance of ‘good work’ and good workplaces
• Mental Health and resilience
• Staff Engagement and its relationship to wellbeing
• Role of the manager : NICE Guidance
• Sedentary workers
• Integration of services
• Sector-specific activity, e.g. NHS, railways

3. Work, health and society
Society needs the maximum number of productive years from as
many people as possible. Those not working depend on others.
The ratio of earners and wealth-generators to dependants (children,
pensioners, unemployed) needs to be as high as possible.
Childhood Working life Retirement
Being sufficiently healthy is a condition for work, and
maximising disability-free life as a proportion of total
life is therefore a desirable goal for individuals, health
professionals and society.

4. Fuller working lives
A Framework for Action, DWP June 2014
Life expectancy is increasing – by 2030 those over 65 will increase by
50% and those over 85 will double. One third of children born today will
live to be 100.
•both a huge opportunity and a huge challenge for Government, impacting
on every aspect of society. But compared with 50 years ago, people
exit the labour market earlier.
• Of those between 50 and state pension age, 28% are out of work
- of these 25% have retired, and 60% see another job as unlikely.
•Over 50% of adults have already stopped working by the year before they
reach state pension age ...
…. many are sick, disabled or carers, or have given up looking for work

5. The world of work is changing
• The industrial landscape is changing, and a knowledge-
based economy has emerged
• Globalisation of labour markets, leading to a
work-anywhere culture
• Transferable skills needed, with flexibility, upskilling,
lifelong education and training
• Female employment projected to increase, reaching
47.5 % of the total in 2020 UK
• Many people wanting or having to work after 65
• Fewer permanent ‘core’ staff, with out-sourcing
and zero-hours contract work
• Concept of ‘good work’ and good workplaces
The pattern of
damage at work
is changing.
Mental ill-health
is increasing.

6. Good Employment :
Essential characteristics
Good work Good workplaces
• Stable and safe
• Individual control
• Fair work demands
• Flexible arrangements
• Opportunities training,promotion
• Promotes Health and Wellbeing
• Prevents isolation, discrimination
• Shares information
• Reintegrates sick /disabled if
possible
• Visible senior leadership
• Appropriately trained
managers
• Integration of OHS with
health promotion and
illness prevention
• Monitoring &
measurement
• Empowering employees
to care for their own
health
• Enabling staff

7. What prevents us from working
– or from working well ?
• Common mental health problems
• Musculo-skeletal problems
• The quality of work and the workplace
- organisation of work
- managerial behaviour and leadership
- absence of ‘good work’
• Other important reasons
- long-term conditions – mental and physical
- psychosocial/ home-related problems
- lack of education and/or skills.

8. Common Mental Health Problems :
What and Why
• Stress, anxiety, mild depression
- high prevalence across populations
- little or no objective disease or impairment
- most episodes settle rapidly, though symptoms
often persist or recur
- essentially whole people, should be manageable.
• These symptoms are often an expression of, or
reaction to, poor work, poor workplaces, and/or
poor leaders or managers.
• Health interventions such as drugs, EAPs, CBT etc
may help BUT not address the real root problem(s).

9. Mental Health Care Systems
Mental Health Services in most countries often:
• do not help with employment issues, do not partner
with employers – are not ‘joined up’
• leave health care and employment services separate
• do not include employment among care quality indicators
• neglect common mental health conditions (CMDs) and provide few
services for them
• leave healthcare professionals believing that work is neither a
realistic aim nor beneficial for people with mental ill-health
• provide sparse evidence on Mental Health and connection with work.

10. • Government, directly and through arms-length bodies :
- Health and Safety Executive (HSE)
- Acas (Advisory Conciliation and Arbitration Service)
- Special health authorities e.g. NICE
• Employers
- public, private, large, medium, small
• Health Professionals
- and their organisations e.g. RCPsych
• NGOs
- e.g. MIND, Tomorrow’s People, Comic Relief,
MHFA
Mental Health and Work : UK Progress

11. Government Initiatives supporting
Mental Health in the Workplace
• Mandates – to NHS, local government, etc.
• “No health without mental health” cross-Dept strategy
• “Time to change” National Anti-Stigma Campaign
• Public Health Responsibility Deal (Department of Health)
Health at Work Network, Mental Health pledge
• Achieving Better Access by 2020
• Chief Medical Officer’s Annual Report 2014
• Closing the Gap: Priorities for essential change in MH

12. “New data shows public attitudes towards mental illness have
improved significantly – with the biggest one-year
improvement in the last decade taking place in 2013.”
“However, there is still more work to be done to end life-
limiting stigma and discrimination.”
says Time to Change, the mental health anti-stigma programme run by
Mind and Rethink Mental Illness, funded by DH, Comic Relief, Big Lottery.
Survey first conducted by TNS in 1993, additional analysis since 2003 by the Institute of
Psychiatry, King’s College London.
Since Time to Change began in 2011, an estimated 2m people, 4.8% of
the population, have improved attitudes towards people with mental illness.
Public Attitudes to Mental Health
Time to Change, October 2014

13. Survey questions: What do the general public think about the one-in-
four people who have a mental illness?
•6% rise in willingness “to continue a relationship with a friend with a
mental health problem” (82 to 88%, change 2009 to 2013)
•7% rise in willingness “to work with someone with a mental health
problem” (69 to 76%)
•5% rises in willingness “to live near..” (72 to 77%) and “to live with .. ”
(57 to 62%) someone with a mental health problem
More people now acknowledge that they know someone with an MH
problem (rise 58 to 64%) but attitudes in employment are lagging ..
- still nearly half (49%) would feel uncomfortable talking to an employer
about their own mental health.
Public Attitudes to Mental Health
Time to Change, October 2014

14. The Political Landscape
• Nick Clegg announced on 3 October 2014 :
People with depression should from April 2015 begin
‘talking therapies’ within 18 weeks.
and on 19 January 2015 he announced:
A ‘zero suicide’ ambition for the NHS.
• Ed Milliband on 19 January 2015 launched his Party’s
plans on mental health “The Mentally Healthy Society” :
“Mental Health starts in our workplaces, schools and
communities. We need a MH strategy outside as well
as inside the NHS.”

15. Wellbeing, Mental Health
and Engagement
• Wellbeing includes our psychological state
• High levels of staff engagement are not sustainable without wellbeing.
• Engagement without wellbeing can lead to a burned-out workforce.
•Robertson and Cooper have shown that the top driver for employee
engagement is the extent to which employees believe that their senior
management has a sincere interest in their wellbeing.
•Approximately 25% of the variation in reported levels of employee
productivity is predicted by a combination of:
- psychological wellbeing
- perceived commitment of the organisation to the employee
- access to appropriate resources, and
- good communication.
Donald et al, 2005

16. IPA . Meeting the challenge
Joe Dromey 2014
NHS Managers :
Engagement, wellbeing and health
Employee
engagement
Communication, senior
managers and staff (%)
Engagement and communication at
acute trusts (NHS Staff Survey 2013)
4.0
3.6
3.3
Staff engagement and overall
patient experience
Improving NHS Care by Engaging
Staff & Devolving Decision-Making
Panel Review, chair C.Ham 2014

17. Engagement at Serco
Contracts with higher levels of
engagement lose fewer staff members
to attrition, so carry less of this cost.
(Evidenced across 47 matched contracts
suitable for analysis, in three Divisions).
Contracts with lower engagement
levels have more Lost Time Incidents,
reducing productivity and raising
operating costs.
Rate-of-change of engagement is also
important, increase lowering LTI rates.
Staff turnover pa
Lost Time Incidents
(per year, per 100,000 staff)

18. Engagement and Disengagement
Lack of motivation and sub-optimal health cause UK workers to work
below peak productivity, holding back potential growth. Study of 5000 workers
•About half of people do not go above and beyond at work because they
think it won’t be acknowledged or rewarded.
•Over a third of teams are experiencing extra stress and
pressure due to staff ill health and absences
•One in four staff admit they don’t want to win new business
as it will only mean more work for them.
•Failure to unlock employees’ ‘discretionary effort’ costs businesses
dearly, cutting a potential £6 billion – equivalent to 0.4 per cent of
GDP – from the UK economy in 2012.
BUPA/Centre for Economics
and Business Research,
December 2013

19. Train your Managers
• Good line management is key to good workplace health.
• Managers should focus on:
– effective communication with the
employee and other members of staff
– awareness of the issues and the
ability to empathise
– developing open culture with employees feeling
able to discuss their problems.
• Learning about mental health enables managers to judge when
they need to refer employees to outside help.
• There are many sources of advice and good training courses.

20. Re-integration into Work :
after Mental Ill-health
Time to Change, survey of the public,
October 2014
•7% rise in willingness “to work with
someone with a mental health
problem” (69 to 76%)
Promote health and wellbeing.
OECD Report 2011 :
•Globally, employment opportunities for people with
mental ill-health are low, many of those who are
employed struggle in their jobs, and disability caused by
mental ill-health is frequent and rising.

21. Re-integration into Work : Cancer
• 109,000 working-age UK people diagnosed
with cancer each year
• 775,000 working-age UK people have had
a cancer diagnosis
• Research shows that cancer patients
want to work … but
… long term cancer survivors are 1.4 times
more likely to be unemployed.
• One in four survivors say their cancer
prevents them working in their
preferred occupation
• The average fall in household income for a
family of working age with cancer is 50%...
. . . and 17% lose their home.
MacMillan Cancer Support
- change in culture
is needed.
Cancer is becoming a
long term condition

22. Source: Maddams J, Utley M, Møller H. Projections of cancer prevalence in the
United Kingdom, 2010-2040. Br J Cancer 2012; 107: 1195-1202.
The number of UK people living with
cancer is set to double by 2030
Predicted numbers:
2010 2 million
2020 3 million
2030 4 million
(with over 2.5 m diagnosed
over five years earlier)

23. NICE: Public Health Draft Guideline
Workplace policy and management practices to improve
the health and wellbeing of employees
• makes recommendations, focussed on organisational culture and
the role of line managers
• for employers, managers and employees, and those working in
Occupational Health, health and safety, Trade Unions etc.
Aims to:
• promote supportive leadership and help line managers achieve it
• explore the positive and negative effects organisational culture can
have on workpeople’s health and wellbeing
• provide a business case and economic modelling for managers.

24. Integration : Total Worker Health
• Traditionally, workplace Health and Safety has been separated from
Health Promotion.
• NIOSH (National Institute for Occupational Safety and Health, USA)
is now emphasising Total Worker Health :
“ Growing evidence supports the effectiveness of combining these
efforts through workplace interventions that integrate health
protection and health promotion. ”
“ Integrating health protection and promotion will create synergy,
enhance overall health and wellbeing of the workforce, and
decrease the likelihood of workplace injury and illnesses.”
“ Having a psychologically-healthy workplace and having a profitable
and sustainable business are linked.”

25. Gains in health
wellbeing,
fitness for duty
Absence of
illness or injury
incidents
Illness/injury
incidents
Gains in
company
performance
Cost
minimisation
Loss
Control
Organisational Health and
Safety
Strategic, integrated
Harm Minimisation
Compliance, systems,
culture
Integration : Total Worker Health
Slide courtesy of Anne-Marie Feyer and Niki Ellis
ExpandedExpanded
value chainvalue chain
goes beyondgoes beyond
absence ofabsence of
injuryinjury

26. Health and Wellbeing Programmes
Depend on circumstances – place, time, organisation
• Consult staff – then design.
• Mental Health : Prevention 1st
, 2nd
and 3rd
!
- counselling, mediation, yoga, stress management ,
resilience training
• Physical Health : (also benefits mental resilience)
- health assessments, running clubs, discount on
gym membership, fit bug, smoking cessation, dietary
changes in canteens, Well Point, physiotherapy,
pilates, reflexology, etc.
• Lifestyle : - make the most of money, well done letters,
flexible retirement policies, lifewise flexible working,
reading clubs, choirs, garden allotments .

27. Sedentary workers
Welcome
to a new
dawn
In Scandinavia 90% of office workers have sit-stand desks, in Britain 1%.
On average British people sit for 8.9 hours each day, 70% of that at work.
Research provides compelling evidence that sitting for more than 4 hours :
- shuts down enzymes that burn harmful blood fats
- reduces calorie burn and disrupts blood-sugar levels
- increases insulin levels and blood pressure.
Prolonged sedentary working increases risk of heart disease, diabetes, etc.

28. Sedentary workers
• Australian studies show the ameliorating influence of
workplace interventions to promote standing breaks and
sit-stand adjustable work stations.
• These interventions led to improved health-risk markers,
improved productivity quality and efficiency, and greater
sense of collaboration among employees.
Healy G., Eakin EG et al, Preventive Medicine 2013
• These examples provide cost savings to both the health
service and the employer, along with knock-on positive
effects on the productive lives of others, e.g. carers.

29. Investors in People
The most important asset your organisation has is its people. The
biggest asset they have is their health and wellbeing. It therefore
makes good sense to look after it.
The IiP Health and Wellbeing Award recognises businesses that go the
extra mile. How do your Health and Wellbeing practices stack up? Our 20
question test will help you compare against the very best.
Key features:
- Explores the key enablers of healthy workplaces
- Establishes how well your plans and policies are implemented
- Develop your personal action plan
How does it work?
- Take 10 minutes to complete 20 questions
- Results give a clear picture of how your organisation is performing
- Download your personal Health and Wellbeing report
We know how to get
the best from people.

30. Investors in People
Health and Wellbeing Framework :
Plan Do Review
Free Tools:
Health and Wellbeing
Benchmarking

31. Increasing Sector-specific Activity
Examples :
1. NHS
2. Construction
3. Railways
4. Police
5. Fire Service
6. Higher Education

32. RCP Audit of NHS Trusts on NICE Guidance
Summary of results, Rounds 1 and 2
Setting higher standards
6 NICE Guidances
Improvement in most
areas in the 3 years
between Round 1 and
Round 2.
2010
2013
Board
engagement
Obesity
Physical activity
Smoking
cessation
Long-term
sickness absence
Promoting
mental wellbeing
Overall

33. Where there is clear NICE
guidance we should be using it
Does the trust actively promote
healthy food choices , for example
using signs, pricing and
positioning of products to
encourage healthy choices in:
Round 1 Round 2
Vending machines
34% 45%
Shops for staff and clients 34% 53%
Hospitality 51% 65%
Staff restaurant 77% 84%
2010 2013
62% evening
27% overnight
Does the trust offer overweight and
obese staff interventions that
address activity, eating behaviour
and weight reduction ?
29% 38%

34. The National Health (NHS) Workforce
•Simon Stevens said in his inaugural address on
2 April 2014 :
“If like me you believe in a tax-funded NHS you’ll
want the Health Service to play its part in growing
our nation’s economy, precisely so that we can
sustain public health services for generations to come.”
To do this, NHS employees will need to be healthy, both
mentally and physically, have good well-being, and be fully
engaged in their work towards improved outcomes for patients.

35. NHS Five Year Forward View
October 2014
A healthier NHS workplace
“ We will establish with NHS Employers new incentives to ensure
that the NHS sets a national example in the support it
offers its own 1.3m staff to stay healthy, and serve as
‘health ambassadors’ in communities.”
•Only a third of Trusts offer support in keeping healthy weight –
and 75% don’t offer healthy food to staff working at night.
•The NHS could reduce its sickness rate by a third – equivalent
to adding 15,000 staff or a cost saving of £0.5 bn.
•The ‘offer’ by NHS England is now being worked up.

36. New vision for the Health and
Wellbeing of Railway Employees
28 April 2014 the UK Rail Standards and Safety
Board published their vision :
•A new website area on Health and Wellbeing
•Currently cost of sickness absence and
presenteeism is reckoned at £790m yearly
•The ‘roadmap’ to better health aims to save at
least £32m per year. Suggested ‘tools’ support
different aspects of health promotion.
•“ GB railway is an industry where everyone
takes responsibility for health and wellbeing
and benefits from it.”

37. Office of Rail Regulation :
Occupational Health Programme 2014-19
What we expect from the industry:
• Excellence in health risk management, implementing strategies
e.g. exposure monitoring, health surveillance
• Greater engagement with employees, e.g. signing PHRD pledges
• Better efficiency and reduced costs due to work-related ill-health
• Enabling improvements in competency, information, co-ordination.
Also:
• Senior-level commitment to the above, driving
improvements in health and wellbeing
• Better use of specialist resources, ergonomists, physiotherapists etc
‘Health’ is to be understood to cover three things:
• Effect of work – adverse dust, noise, vibration, stress, MS risk
• Fitness for work – safety-critical tasks, drug/alcohol, capability
• General well-being – lifestyle, absence management, rehabilitation.

38. Railway Health and Wellbeing Roadmap
RSSB Rail Safety
and Standards Board

39. A Watershed in Life and Work
Change is the law of life.
And those who look only to the past or present
are certain to miss the future.
John F. Kennedy