South West OH Nurses Spring Study Day Exeter, 24 May 2012

1. South West OH Nurses Spring Study Day Exeter, 24 May 2012 The relationship between work, health, and an ageing workforce Dame Carol Black Expert Adviser on Health and Work Department of Health, England

2. Flourishing productive societies • Governments around the world have different ways of raising revenue to support their activities and society • In the UK a significant proportion comes from businesses and income tax • Much of that income tax comes from working people • For people to be in work and sustainable employment they need health, both physical and mental • Businesses need healthy workforces • Professionals engaged in healthcare need to understand and act on this • Each year the UK spends £ 107 billion on the National Health Service – is there adequate return to the UK economy?

3. Work, long-term conditions, ageing and society Society needs the maximum number of productive years from as many people as possible. Those not working depend on others. We need the ratio of earners and wealth-generators to dependants (children, pensioners, unemployed) to be as high as possible. Childhood Working life Retirement Being sufficiently healthy is a condition for work, and maximising healthy life as a proportion of total life is therefore a desirable goal for individuals and society. On current predictions, the future population will be composed of longer survivors, some with several long-term health conditions. The first challenge: minimise ill-health and mitigate its effects on function, enabling participation in work and extended working life.

4. The UK workforce • Every day the average lifespan of British citizens increases by between five and six hours. • The proportion of people in the UK over 65 is expected to increase from 16% in 2004 to 23% in 2031. • By 2020 almost a third of the workforce will be over the age of 50. • In 2010, total employment in Britain went up by 218,000, of which 104,000 went to those over 65 • thus nearly half of all new jobs went to a sector representing just 3% of the labour force. • The increase has generally been largest for those with higher levels of education. The work is often part- rather than full-time.

5. UK health and wellbeing today • We are living longer, with dramatic improvements in overall health over the last 150 years: • infectious diseases now account for only 2% of deaths • 4 in every 5 deaths occur after the age of 65 • we have clean air, water, and environmental protection • BUT: success brings new challenges : • circulatory diseases account for 34% of deaths … • … cancers 27% and respiratory diseases 14% • rising prevalence of mental ill-health • persistence of long-term conditions • Lifestyles influence outcomes and inequalities : • 21% of the adult population still smoke • 61% of adults are overweight or obese • fewer than 40% of adults meet physical activity guidelines • 1 in 4 men and 1 in 5 women drink over the recommended guidelines

6. Obesity and consequent disease in the UK It is likely that by 2025 40% of adults will be obese, and the number of people living and working with long-term conditions will rise steadily. This will affect morale, competitiveness, profitability, and the UK economy.

8. The needs of a worker, male or female • to be healthy enough to work • safe healthy workplaces - physically safe • - emotionally healthy • good work: • - job security • - work varied and interesting • - workers have some autonomy, control and task discretion • - fair rewards (not just financial) for effort • - supportive social relationships • - worker engagement. • The various countries of the world are at different stages in providing the above. • The nature of work is changing in many countries.

9. UK Employment and Health Mental ill-health is the most common reason for claiming health-related benefits. Employed population 27.5 million 26% with a health condition or disability 2.4% off sick Inactive (about a third as many as are employed) 48% with a health condition or disability Source: Labour Force Survey of UK men and women aged 16-64 Unemployed (about a tenth as many as are employed) 29% with a health condition or disability Beneath these figures lie diminished lives, little aspiration, and disrupted families.

10. 7.2 million in work 3 million or 42% with a health condition or disability 3.5 million inactive 2.4 million or 70% with a health condition or disability 0.4 million unemployed 0.2 million or 52% with a health condition or disability 50- 64 yr olds Employment and Health Statistics – 42% in work with a health condition You do not have to be 100% fit to work. Source: Labour Force Survey 4 qtr average to Dec 2011, men & women aged 50-64 in GB

11. Long-term conditions – increasingly common • If LTCs are managed effectively, disability can be minimised and disease progress stopped or delayed - thus extending working life and reducing the load on health and care services. • They do not deny the possibility of fulfilling work or an extended working life. • They require: • motivated, fully-informed patients, in control, co-creating health • good clinical care, Vocational Rehabilitation, well- informed work-conscious healthcare professionals • flexibility and adaptation in the workplace. • Previously fatal diseases are becoming chronic.

12. Chronic conditions include pain management Common chronic conditions are often associated with pain. This should not deny the possibility of fulfilling work. Pain is often wrongly seen as part of the ageing process. If managed effectively and proactively, pain can be minimised, allowing people to stay in work. • Pain related chronic conditions require: • Good clinical care at GP and secondary care level • Vocational Rehabilitation • Well-informed work-conscious healthcare professionals. We are very short of these. • Flexibility and adaptation in a health-promoting workplace.

13. Research: chronic pain and employment Knowledge about workers who stay at work despite chronic pain is limited The following were found to be important factors and prerequisites for staying at work: personal characteristics, well-developed self-management skills, and motivation to work behaviours promoting staying at work: adjustments where possible, changing pain-coping strategies, organizing modifications and conditions at work, finding access to healthcare services, and asking for support. De Vries et al (2011), BMC Musculoskeletal Disorders

14. Cancer and work 109,000 working-age people are diagnosed with cancer in the UK each year 775,000 people of working age in the UK have had a cancer diagnosis Long term cancer survivors are 1.4 times more likely to be unemployed yet… … research shows that cancer patients want to work One in four long term cancer survivors say their cancer is preventing 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. Cancer is becoming a long term conditionmost frequently found from mid-life onwards. MacMillan Cancer Support

15. National Cancer Survivorship InitiativeEmerging findings – September 2010 Joint project : Macmillan Cancer Support, Department of Health and NHSI testing ways of providing Vocational Rehabilitation for people with cancer. Seven pilot sites across England to test a model of VR which includes providing information, face to face support, and access to learning programmes and a case manager. • Emerging themes: • Patients want attention to work issues early, and revisits during treatment and follow-up. • Health professionals inadvertently give mixed messages about work. • Line managers are key but may not have the knowledge and skill to manage a patient’s return to work. • Patients need more information about rights and responsibilities with regard to employment. • Specialist vocational rehabilitation services can proactively anticipate patient problems.

16. National Cancer Survivorship Initiative : Health Professionals • Health professionals need to: • - raise work issues early • - recognise the risk factors ‘work flags’ • - respond effectively to patients and refer them onwards • - revisit work issues during treatment. • Tailor information and advice to support self-management. • Support specialist Vocational Rehabilitation for people with complex problems. • Use protocols and procedures for effective liaison across organisations and local statutory/voluntary services to support cancer patients in work. National Cancer Survivorship Initiative

17. National Cancer Survivorship Initiative: Employers Employers should appreciate that patients want: To keep channels of communication open To be kept ‘in the loop’ while on sick leave To understand long-term effects of treatment, fatigue etc Cancer not to be stigmatised, but positive informed attitudes amongst colleagues Negotiated return to work plan, before return Structured schedule to talk about return to work progress Reasonable adjustments in the workplace Flexibility about hours, tasks and responsibilities in the initial months after return to work Understanding of their rights under Equality Act 2010 Employer willing to meet health professionals who have been involved in employee’s vocational rehabilitation National Cancer Survivorship Initiative

18. Dehumanisation of work Polly Toynbee : ‘ Hard Work’ In the book she explored the disadvantages for those in low-paid work by undertaking, aged 55 at the time, a series of poorly-paid, poorly-regarded jobs. Often she worked as a casual agency employee at or near the minimum wage. Not only was her experience an indictment of policies that have broadened the gap between rich and poor in the UK .... .... it also highlighted the working realities for thousands of women. Some 80% of the ten lowest-paid occupations are undertaken by women.

19. Women: poverty, mental ill-health and work in the EU • Women form the majority of the EU’s economically inactive, more likely than men to be poor. Some 35% of single parents, mainly women, live in poverty. • Adults in the poorest fifth of the income distribution are more at risk of developing a mental illness than those on average income – and they are less likely to be employed. • Therefore, poorer women have worse levels of mental health and coping capacity to deal with life circumstances. • One in six adultsin the UK suffer from a common mental health disordersuch as depression, anxiety, phobias and panic attacks. • About 12.8 million working days (40% of total in UK) are lost due to stress, anxiety and depression each year. • From Scottish Government and Health Action Partnership International, 2012

20. Domestic Violence • Globally, at least one in three women is beaten, coerced into sex or otherwise abused by an intimate partner, in the course of her lifetime. • Some of the reasons DV still persists: • Women’s economic dependence on men • Expectations of roles within relationships • Limited access to employment in formal and informal sectors • Limited access to education and training for women • Lesser legal status of women in some countries by written law and/or practice (though with some ongoing improvement). • Domestic violence has damaging consequences to health and to the economy. • In India, each incident of domestic violence translates on average into women losing seven working days[United Nations report]. • This is a difficult topic for employers, but there are some exemplary companies.

21. Co-ordinated community response in the UK • Government, law enforcement, courts, the voluntary sector and private sector have all worked together in partnership. Legislative framework and National Delivery Plans helped to set out the aims. • Some of the outcomes include: - 64% fall in the number of domestic violence incidents between 1995 and 2007/8. - successful prosecution rate increased from 47% to 64% in 2007/08, and then 72.5% in 2009, and in some areas up to 90%. - significant decrease in fatalities reported by the Metropolitan Police, from 49 deaths a year in 2003 related to domestic violence to 5 in 2010. • Greater coordination of services has meant better value for money, and more effective response.

22. The workplace – its potential • There is increasing emphasis on the role of the workplace in influencing and providing the conditions necessary for healthy and fulfilling working lives … • … with persuasive evidence that the health and well-being of employees are significant determinants of the success of business enterprises and services.

23. The ripple effect to business.. Advantages of the workplace: a microcosm of society, as to age, gender, income, ethnicity powerful communication vehicle, peer support possibilities for preventions and promotion, including mental health a culture of health at work can reinforce positive health behaviours good employer/employee relationships can sustain healthy behaviour interventions can benefit employees, employers and the public purse families of employees extend impact further. Workplace health and well-being initiatives support a healthier population

24. OH Nurses and their relationship to : • UK plc ? • an ageing workforce? • productivity ? • engagement ? • wellbeing and health ?

25. History of Occupational Health:- prevention “It strikes me that as a specialty we have lost that focus and become too reactive to issues such as sickness absence… with a predominantly downstream focus… to the detriment of the workforces we serve and poorly aligned to the HWWB agenda.” Dr Steve Boorman, Occupational Medicine physician • Early 18th C, the specialty began with prevention, risks associated with certain professions, Dr Ramazzini • 19th C pro-active, early prevention e.g. Dr Snow, cholera • Mid 20th century, both downstream and upstream support • Today, too little prevention. More emphasis on prevention and well-being in training of OH nurses ?

26. Training of OH nurses • Is it fit for purpose ? • Does it consider ? - an ageing population - increasing chronic disease - obesity and its consequences – prevention not reaction • Are these topics adequately covered ?

27. Flexible working – and extending working lives • Many of those approaching retirement age do want to continue with some form of part-time or flexible working. • Around 60 per cent of over 50s would like to continue working after state pension age, but on a part-time basis. • Two-fifths would like to stay in their current jobs, but with greater flexibility in hours or days worked.[1] [1]Equality and Human Rights Commission (2010), Working Better – The Over 50s, the new work generation.

28. ASDA and Older Workers This supermarket chain currently employs over 20,000 older workers (19% workforce) Business benefits include • Mirrors the business's customer base more closely, thus providing better customer service • Professional and life experience shared with colleagues • Continuity of staff and experience • Extra flexibility • Improved customer satisfaction survey results and staff satisfaction. ASDA supports older workers • One week unpaid leave for grandparent or carer duties • ‘Benidorm Leave’ – up to three months unpaid leave • ‘Seasonal squad’ – choose to work only during 10 busiest weeks of the year (Christmas, Easter) Absenteeism has reduced to levels that are a third lower than the national average for this industry. WANTED ASDA is looking for workers in the 50-plus age group.

29. Older workers and Sickness Absence A representative survey of 2,000 employees carried out by DWP indicated that over a 12 month period: • Fewer older workers took any time off due to sickness absence (41% of those aged 55+ had any sickness absence compared with an average 48% for all employees) • However, of those that took time off, average working days lost were higher (18.2 days compared with 10.3 days for all employees). • Overall, the average number of working days lost per older worker (including those with no absence) was 7.6 days compared with an average of 4.9 days for all employees. • Note calculations are based on respondents who had worked for their employer for at least 12 months.

30. Supporting the employment of older workers Provides good practice case studies, FAQs, guidance on fixed retirement age and research into extended working lives www.dwp.gov.uk/age-positive Provides guidance for employers on employing older workers, including recruitment, flexible working, training and development, and retirement www.businesslink.gov.uk Co-financed by the European Regional Development Fund, the Silver Academy encourages the over 50s in engaging with new enterprises and SMEs, and runs practical workshops www.peopleproject.eu

31. Extending working lives: steps to be taken • Strengthen concerted action, across clinical medicine, OH and employment practice, to minimise the impact of ill-health and ageing on capability for work. • Develop and promote fuller understanding of : - the role of healthcare in maintaining/restoring function, - employers’ role in enabling people not wholly well, or ageing, to work, - the natural history of common disorders in relation to function, - interplay of psychosocial, economic and medical factors in relation to work. • Strengthen the evidence base on the clinical and cost effectiveness of interventions in relation to disability and extended working life • Ensure the workforce has the skills required to maintain and extend working life • Develop practical arrangements and interdisciplinary practices required to realise these aims.