Addressing Worklessness and Health the potential role of Government. Dr Bill Gunnyeon Chief Medical Adviser Department for Work and Pensions

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1 Addressing Worklessness and Health the potential role of Government Dr Bill Gunnyeon Chief Medical Adviser Department for Work and Pensions

2 Key Issues Taking an holistic approach Reducing the potential for worklessness Avoiding the onset of worklessness Reversing worklessness

3 Reducing the potential for worklessness Preventing work related illness and injury Reducing lifestyle related ill health Minimising impact of ill health Reducing health inequalities

4 Self-reported work-related ill health and injury Incidence rate per 100k workers / / / / / / / / / / /10 Reportable workplace injury Work-related ill health Source: Labour Force Survey average sample variability +/-8% for injuries, +/- 6% for ill health

5 Reducing the potential for worklessness Preventing work related illness and injury Reducing lifestyle related ill health Minimising impact of ill health Reducing health inequalities

6 Chronic ill health Obesity levels are too high, with significant impact on individuals, the health service and society as a whole By 2050, if trends continue, 60% of men and 50% of women could be clinically obese (UK Foresight report) Healthy Weight, Healthy Lives HEALTH IMPACT 58% type 2 diabetes 21% of heart disease 10% of non-smoking related cancers 9,000 premature deaths a year in England Can reduce life expectancy and quality of life COST National Health Service - 4.2bn Wider economy bn Foresight estimates by 2050 costs to economy of 50bn Overweight & obesity forecast trend

7 Reducing the potential for worklessness Preventing work related illness and injury Reducing lifestyle related ill health Minimising impact of ill health Reducing health inequalities

8 Life expectancy and disability free life expectancy From Fair Society, Healthy Lives

9 Avoiding the onset of worklessness Ensuring incentives in system are correctly balanced Speedy and effective work focussed healthcare and other support Improved communication between GP, individual and employer Support for employers and healthcare professionals Changing culture and behaviour

10 The current journey Incentives to rehabilitate and retain individuals in work lies with employers weeks 39 weeks ESA benefit and support Work Sickness absence Claim to Employment Support Allowance (ESA) Work Capability Assessment JSA benefit and support Work Inactivity Employers pay sick pay and some offer rehabilitation and occupational health support. 10

11 The current journey GPs also play a crucial role 28 weeks 39 weeks ESA benefit and support Work Sickness absence Claim to Employment Support Allowance (ESA) Work Capability Assessment JSA benefit and support Work Inactivity GPs provide sickness certification and are typically the first healthcare professionals that people encounter when off sick from work. 11

12 The current journey The State s main interventions are focused on the after job-loss period 28 weeks 39 weeks ESA benefit and support Work Sickness absence Claim to Employment Support Allowance (ESA) Work Capability Assessment JSA benefit and support Work Inactivity The State defines levels and duration of SSP and controls the benefit system. 12

13 Origins of people flowing onto IB/ESA Breakdowns of people whose origins are known* Directly from work, 53% Directly from benefits, 47% * These proportions use tax record information from HMRC. This data does not capture those who are selfemployed, nor does it include some people earning under the lower earnings limit. An immediate origin is allocated if we have evidence of work or benefits in the 91 days before the claim takes places. Source: DWP admin data and HMRC data, 1st Mar 2009 to 28th Feb 2010, aged 16-SPA Labour Force Survey, average number in employment between Mar 2009 and Feb 2010, year olds

14 Avoiding the onset of worklessness Ensuring incentives in system are correctly balanced Speedy and effective work focussed healthcare and other support Improved communication between GP, individual and employer Support for employers and healthcare professionals Changing culture and behaviour

15 Fit for Work Service Pilots Provides employees who are in the early stages of sickness absence with case-managed multidisciplinary support covering healthcare, employment, skills, housing and debt to enable a return-to-work In the first year, 6,500 people sought help from eleven Fit for Work Service pilots across Great Britain. The Scottish FFWS pilot Working Health Services Scotland is the largest pilot and supported around 2,400 of the total 74 per cent of all those using the service who were off sick from work when they entered, had returned to work when they left the service (to March 2011) Seven of the original pilots were selected to continue to offer support until March 2013, including the Scottish one, utilising the service models designed by local partners and providers These range from the central hub and Health Boards model that operates across Scotland, through to far smaller face-to-face services based in primary care or other local settings

16 Avoiding the onset of worklessness Ensuring incentives in system are correctly balanced Speedy and effective work focussed healthcare and other support Improved communication between GP, individual and employer Support for employers and healthcare professionals Changing culture and behaviour

17 Employees: sickness absence incidence Days lost Days lost Male 4.1 Up to Female ,400-15, ,600-20, ,800-31, , Mgrs/Snr officials Professionals 4.1 LT health condition 7.7 Asso. Professional/technical 6.6 No LT health condition 3.4 Admin/Sec 4.5 Private 3.8 Skilled/trades 4.0 Public 7.2 Personal service 5.7 S Sales & customer service 5.0 M Process, plant/machine ops 3.7 L Elementary 7.7 Source: Health and well-being at work: a survey of employees, DWP Research Report 751. Note: Calculations are based on respondents who had worked for their employer for at least 12 months.

18 GPs attitudes towards patients health and work 99% of GPs agree that work is generally beneficial for people s health Work is beneficial for health 99% Worklessness is detrimental to health 96% Helping people stay in/return to work is important part of role 88% Staying in/returning to work indicator of success 77% GPs have a responsibility to society to facilitate return to work 66% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Somewhat/completely agree Somewhat/completely disagree Source: GP Attitudes to Health and Work Survey

19 GPs attitudes towards patients health and work A patient has to have fully recovered before I recommend a return to work 19% I feel obliged to give sickness certificates for reasons not strictly medical 77% I feel confident dealing with patient issues around return to work 59% My knowledge of guidelines on sickness certification is up-todate 80% My knowledge of the benefits system is up-to-date 23% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Somewhat/completely agree Somewhat/completely disagree Source: GP Attitudes to Health and Work Survey

20 GPs attitudes towards patients health and work 70% 60% 50% 40% 30% GP responses to the statement: The Fit Note has. 60% 54% 48% 42% 36% 26% 20% 10% 7% 5% 6% 10% 13% 12% 0% Improved quality of discussions with patients about return to work Improved advice I give to patients about their fitness for work Increased frequency with which I recommend return to work as aid to recovery Helped my patients make a phased return to work Increased length of my consultations Made no changes to my practice Completely Agree Somewhat Agree Somewhat Disagree Completely Disagree Source: GP Attitudes to Health and Work Survey

21 Avoiding the onset of worklessness Ensuring incentives in system are correctly balanced Speedy and effective work focussed healthcare and other support Improved communication between GP, individual and employer Support for employers and healthcare professionals Changing culture and behaviour

22 Sickness Absence and Rehabilitation Survey EEF 20% indicated Fit Note had already reduced sickness absence 28% agreed Fit Note had improved quality of return to work discussions between line manager and employee Proportion of companies contracted by GPs to ask about availability of adjustments doubled after Fit Note introduction Reduction in proportion of employers identifying GPs as a barrier to rehabilitation from 39% in 2006 to 26% in 2010

23 Occupational health advice services Occupational health advice services for small businesses provide support to employers and line managers to help them keep employees healthy and at work, or support an employee back to work The Scottish Centre for Healthy Working Lives delivers the service to small and medium sized businesses in Scotland, as part of their wider health promotion / health and safety / occupational health support service for employers and employees in all businesses Interim findings from the first 11 months of operation December 2009 to October 2010 showed that across Great Britain: the services successfully reached their target group of small and mediumsized employers most employers want advice on individual employee health issues 15% of calls were about mental health issues (including anxiety, depression, other common mental health conditions, and stress)

24 Healthy Working UK

25 Avoiding the onset of worklessness Ensuring incentives in system are correctly balanced Speedy and effective work focussed healthcare and other support Improved communication between GP, individual and employer Support for employers and healthcare professionals Changing culture and behaviour

26 Employers attitudes to health and well-being amongst their employees Employers have a responsibility to encourage employees to be physically and mentally healthy There is a link between work and employees' health and wellbeing The financial benefits of spending money on employee health and well-being outweigh the costs In general your employees do not want you to intervene in terms of their physical and mental health Currently, sickness absence is a real barrier to productivity in your organisation % 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% % Strongly agree % Tend to agree % Neither agree nor disagree %Tend to disagree % Strongly disagree % Don't Know Source: Health and well-being at work: A survey of employers

27 Measures used in the last 12 months by employers to help keep employees with health problems in work or facilitate their return to work Percentage of employers citing each Allowing reduced or different hours Meetings with employees to discus extra help Reducing employee workload Different duties Extra breaks Phased return to work Different chairs/desks 11 Access to OH services 9 Other specialised equipment Building modifications Job coach/ personal assistant No measures provided 67 Source: Health and well-being at work: A survey of employers

28 Attitudes of working age adults to health and work Percentage who agree 100% 90% 80% 70% 60% 50% 40% 30% 20% 84% 83% 91% 62% 58% 10% 0% Paid work is generally good for physical health Paid work is generally good for mental health Go to work with a cold Go to work if had long term back pain and back was sore Go to work if had long term depression and were feeling down

29 Reversing worklessness Speedy progress of claims for benefit and accurate assessment of fitness for work Removal of disincentives to work Provision of support to transition back into sustained work Changing culture and behaviour

30 Sources: Adult Psychiatric Morbidity Survey, (General population statistic); DWP administrative data (Sickness benefit claimants) Rates of common mental health conditions General population, % Sickness benefit claimants, %

31 Distribution of sickness benefit claimants by health condition, % 40% 35% 30% Mental and Behavioural Disorders Diseases of Nervous System 25% 20% 15% 10% 5% 0% Circulatory/ Respiratory Diseases Musculoskeletal System/ Connective Tissue Injury, Poisoning etc. Source: DWP administrative data

32 Harrington Review I do not believe the system is broken or beyond repair. Work is, by and large, good for people. The benefits of work generally outweigh the risks of work and undoubtedly outweigh the appallingly harmful effects of worklessness. If the WCA works well, it should enable many people to re-enter the world of work in which they regain their self-esteem and improve their general health, whilst the money saved by the State in benefits could be more appropriately focused on those who need it most. Professor Malcolm Harrington November 2010

33 Reversing worklessness Speedy progress of claims for benefit and accurate assessment of fitness for work Removal of disincentives to work Provision of support to transition back into sustained work Changing culture and behaviour

34 Reversing worklessness Speedy progress of claims for benefit and accurate assessment of fitness for work Removal of disincentives to work Provision of support to transition back into sustained work Changing culture and behaviour

35 The Work Programme The biggest single payment by results employment programme the country has ever seen For those at risk of long term unemployment at a time that s right for them 2.4 million expected referrals over the next seven years Replacing much of the complex range of poor value existing provision

36 Why will the Work Programme be better? Delivered by providers with complete freedom to tailor support to the needs of the individual and the local labour market Providers paid primarily for supporting claimants into employment and helping them stay there for longer than ever before. Providers incentivised to help hardest-to-help customers

37 Overall, the beneficial effects of work outweigh the risks of work, and are greater than the harmful effects of long term unemployment or prolonged sickness absence. Work is generally good for health and wellbeing IS WORK GOOD FOR YOUR HEALTH AND WELLBEING? Waddell and Burton 2006