Ageing Well in Work A Public Health England and GMPHN Project Sam Haskell Healthy Adults Policy Implementation Manager Public Health England (PHE) 27 January 2015 Continuing to Work event (Inclusion)
http://www.kingsfund.org.uk/sites/files/kf/media/how-is-the-new-nhs-structured.pdf
Public Health England Regional focus Four regions, fifteen Centres Eight Knowledge and Intelligence Hubs London South West South East West Midlands East Midlands North West North East, Yorkshire and the Humber East Other local presence ten microbiology laboratories field epidemiology teams Centre for Radiation Control units 3
It is the working man who is the happy man. It is the idle man who is the miserable man. Benjamin Franklin, C.18 Being in good employment is protective of health. Conversely, unemployment contributes to poor health. Marmot Review, 2010 4
The Existing Evidence Base Is work good for you health and well-being?, Waddell & Burton (2006) Vocational Rehabilitation What Works for Whom and When, Waddell, Burton and Kendall (2008) Working for a Healthier Tomorrow, Dame Carol Black, (2008) Fair Society, Healthy Lives, Michael Marmot (2010) Various NICE Guidelines, including: - Promoting Mental wellbeing at Work (PH22) - Managing Long-Term Sickness and Incapacity for Work (PH19) - Workplace Interventions to Promote Smoking Cessation (PH5) - Promoting Physical Activity in the Workplace (PH13) 5
Ageing Well in Work - The Context 1 in 6 pensioners (1.8 million or 16% of pensioners in the UK) live in poverty, defined as 60% of median income after housing costs Low income in retirement is often linked to earlier low pay, or time out of employment i.e. due to caring responsibilities, disability or unemployment Basic state pension and other benefits assist with this to some degree ALSO to enjoy the health benefits of a good job 6
Changing UK Demographics UK demographics 2008-30 Increasing number of people aged over 65: 2010 4.5m people (1 in 6) 2030 10 m 2050 19 m (1 in 4) 1 in 5 workers do not expect to retire until they are over 70 1 In 3 UK workers will be aged over-50 by 2020 7 7
Less than 50% of people disability-free at 65 years 8 8
Long-Term Conditions and Unemployment 40% employment penalty (adjusted for qualifications & demographics) Impact on health (cumulative) and employment prospects Impact on families (e.g. 19% live in poverty versus 15% for whole population) 9
Other Potential Challenges? 10 10
Key Interventions Ageing Funding Access to Work Grant Legislation Equality Act Guidance 11
Ageing Well in Work: Testing Strategy Concepts Jan Hopkins Ageing Well in Work Project Manager 12
Aims Of Ageing Well in Work Programme To emphasise the role and importance that work plays in recovery and condition management To explore ways of helping people to remain active in work as they age (even if they have chosen to retire) so they can secure the health benefits of remaining active To optimise the number of healthy years an individual has after retirement and reduce the numbers of people who leave work because of health issues 50+ Understand role of employers and HCP in supporting workers to remain healthy and active 13
Holistic definition: work includes caring, volunteering, self employment, fostering, mentoring and wider civic engagement 4 Themes: o Workplace Adaptations o Retirement Choices o Managing Chronic Conditions in the Workplace o Managing an Older Workforce 14
Illustrative Strategy Strategic Change Operational Change Work is an important determinant of health Work can aid recovery and improve condition management Early intervention may improve the health & wellbeing of the population, delay retirement and encourage active citizenship Managing health conditions in the workplace Addressing needs of an ageing workforce Promote health and wellbeing of the whole workforce e.g. via Workplace Wellbeing Charter Specific Interventions FFWS NHS Health Checks Health Trainers Expert Patients 15
Early Intervention: Think Across The Life Course 16
Old age is like everything else. To make a success of it, you ve got to start young Theodore Roosevelt 17
A Life Course Approach Source: GM Strategy 18
Prevention Is Better Than Cure Keeping people healthy and in work is easier, more cost effective and better for health and wellbeing than getting long term unemployed back into employment or allowing individuals to slide into inactivity Older people take on average longer to regain employment Inactive retirement may have a -ve effect on health The journey to inactivity begins with a period of sickness Sickness absence (all causes) can tip into inactivity and those are off sick for 4-12 weeks have a 10-40% risk of still being off work at one year Work adjustments usually made after sick leave. Volunteering improves cognitive functioning, healthy behaviours and life satisfaction, delays early retirement and aids transition into out of work. 19
Why Is Work So Important? 20
Work Is A Determinant Of Health It is very important that your workplace is a healthy place that you are in good health to be in work. So work and health are very connected and you really can t have one without the other. Work is a real determinant of your health. Dame Carole Black 21
Good Work Is Good For Health And Good Health Is Good For Business Preventing people from falling out of work, helping people to flourish at work and helping people get into work are all essential A third of new jobseekers allowance claimants reported that their mental health deteriorated, while those who entered work reported improved mental health. Employees with a mental health condition, who remain in work without the support they need, cost UK businesses around 15 billion a year. In the UK, stress-related disorders and mental strain is responsible for the loss of 6.5 million working days each year 22
Early exit from the workplace is a concern: Health Matters? 1 in 7 of the over 50s provides informal care which increases exit from the labour force due to caring responsibilities and carer ill-health. Poor mental or physical health whatever its cause is associated with early exit. Musculoskeletal conditions are the primary cause of exit. Older workers who report depressive symptoms are at increased risk of early transition out of work and might require specific and additional attention. 23
Age Management: Managing an older workforce 24
Evolving Concept Of Age Management 25
Typologies Of Age Management Decreasing Work Demands; Ergonomics, transition to part-time pension, quit night shifts Enhancing Individual Resource/Resilience; Training, work career guidance and health promotion Intergenerational Learning: management training around age management, double staffing, reciprocal learning e.g. seniors share craftmanship Life Course: age management applies equally to all staff, supporting wellbeing of all staff and individual based flexibility 26
The Value Of A Diverse And Healthy Workforce Foster intergenerational learning, they have corporate memory and they have different customer facing skillset. For the employer; greater productivity, a boost in worker morale, greater retention of staff, lower stress in the workforce and therefore less absenteeism. There can reputational +++ if protecting and promoting employee health is formally recognised by means of awards. Costs in terms of implementation. 27
Age Management Everybody s Business Age management needs to be addressed at the individual (seek good employers), organisational (e.g. age neutral recruitment) and societal levels (e.g address ageism). Plans need to be made with individuals early in their career in their 40s and be reviewed regularly. Successful implementation depends on buy in from relevant stakeholders including; businesses, management, trade unions and employees. 28
Workplace Wellbeing Charter: Health And Wellbeing For All A framework/tool to improve health and wellbeing of all staff not just older workers. Workplace perfect setting since we spend most of our waking day in that setting. Previously 30+ variations of the scheme across England Launched in June 2014, these provide core content for existing Charter schemes and a common baseline 29
Managing Health Conditions in the Workplace 30
Long Term Conditions 15 million people in the UK have a LTC incl 50% of workforce 4.6 million people in England have a physical health problem with a co-morbid mental health, with about 30% being long term conditions More prevalent in those over 60 (58%) than under 40 (14%). Class gradient: Poorest social class have 60% higher prevalence than those in least deprived People with LTCs account for 50% of GP contacts 31
Mental Ill-health Is A Particular Challenge Many people with severe mental illness want to work and estimates suggest 30-50% are capable of doing so, though only 10-20% are part of the workforce Even common mild mental health conditions can be an impediment to sustainable employment. Mental health service users face stigma and discrimination and this can seriously affect recovery and quality of life. Time to Change is a joint campaign to encourage agencies and individuals to work together to tackle discrimination. 32
Work for Health and Recovery Remaining in work can be good for one s MHWB, can to some extent aid recovery & condition management Recovery is not recovery from illness but staying in control of your life in spite of illness. Healthcare and associated professionals may not fully appreciate that work is often a necessary element of recovery. Airbus. 89% of referrals remained in work whilst receiving care 33
Interventions to resolve health and work must take a holistic approach Work related stress are often associated with the way work is designed and managed so workload, working hours, lack of control and poor career development are all influencers Stress reflects interaction with the wider context so poverty, debt, educational attainment, need for reskilling and training as four examples may impact individual resilience and response to stress Co-morbid mental and physical health problems 34
Next Steps Apply the evidence base to deliver interventions which will be tested in GM. Make recommendations and suggestions to influence national policy. 35
Thanks and Discussion jan.hopkins@tameside.gov.uk Sam.haskell@phe.gov.uk 36