The woman charged with making Britons happy to go to work looks every inch an advertisement for a healthy workforce. With an early morning three mile run round Regent’s Park under her belt, Professor Dame Carol Black, National Director for Health and Work and author of the report, Working for a Healthier Tomorrow, comes across as somebody who has got their work/life balance just right.
But this is a description she rejects as inaccurate. “We all talk about work/life balance as though work is not part of life. I think we should turn talk about work/home balance, because work is part of life,” says Black.
Black points out that the belief that good work is good for people is a relatively new concept in this country, and one that GPs in particular have been slow to take on board. It is this desire to bring an occupational health facility to the interact with the NHS and other state bodies that has informed the outcome of her recent review.
That review set out the scale of the problem in no uncertain terms, putting the economic costs of sickness absence and worklessness at over £100 billion a year – greater than the current annual budget for the NHS and equivalent to the entire GDP of Portugal. Yet as she also identified early on in her investigations, the evidence base to support the business case for investment in the health and is poorly understood by employers.
She also highlighted that the current sickness certification process focuses on what people cannot do, thereby institutionalising the belief that it is inappropriate to be at work unless 100 per cent fit and that being at work normally impedes recovery.
“There is insufficient access to support for patients in the early stages of sickness, including those with mental health conditions,” she says. “GPs have inadequate options for referral and occupational health provision is disproportionately concentrated among a few large employers, leaving the vast majority of small businesses unsupported. The GPs often see themselves as the patient’s advocate and not ready to have conversations with employers. And yet unless you have conversations with employers, you can’t have progress.”
Black’s review was published several months ago, and its acceptance in government means that DWP and Department of Health ministers have flagged pilots of its proposals in Bills put before Parliament. The principal proposal is a business-led health and well-being consultancy service, to be called Fit for Work, offering tailored advice and support and access to occupational health support at a market rate. Black says this should be geared towards smaller organisations.
Black wants to see all companies have access to what good employers already get through the private sector, something that should be seen as an endorsement of the work that many workplace health consultants are currently doing.
Her particular concern with what is already on offer from the private sector is knowing whether it represents value and it is this that has driven the research she commissioned from PricewaterhouseCoopers into building the business case for workplace health and wellbeing solutions.
“How would any employer know what they buy in is good? A lot of people flagged this up as a concern. They say where is the Corgi mark?” says Black. “I could set myself up today offering employee assistance programmes, or even, with difficulty, set myself up as an occupational health consultant. But who knows how good I am?
“Very often employers are saying what they are being offered is not tailored to their needs, that it is a package that is being sold to me,” she says.
What many advisers would want to have seen from a review of the way health and wellbeing solutions are promoted in the workplace is some real pressure on government in terms of fiscal incentives, and the removal of often contradictory disincentives, to promote a healthy workforce. Black says she sees a willingness in government to take the wellbeing agenda forward, but stresses that she was specifically steered clear of financial issues by ministers when the report was set up.
So what is her view today on whether financial incentives would prime the pump of private sector wellbeing provision?
“In fact they steered me very clear of that sort of issue. I don’t know what the pros and cons are or what stops the Chancellor from making changes but I do know that it came up enough for us to say this is a real issue. I am not an expert on tax, but in the review incentives came up a lot, both in the written submissions and when we went around the country. We highlighted in the report the anomaly that if you put a gym in your place of work that is okay, but if you pay your employee to have a reduced membership of a gym, that is taxable. It is that sort of thing that I would like to see changed.”
Tax breaks and financial incentives are not the only fiscal matters that Black has been kept away from in her report. Many in the industry have questioned who will pay for the Fit for Work project, and while she confirms that the Department for Health will fund the pilots of the scheme, she says that issues relating to the funding of a nationwide scheme were not part of her remit and will be looked at by government after the pilot.
With a long and distinguished career in state medicine behind her Black is more aware than most of the complexities surrounding the current debate on private sector health top-ups. For her the jury is still out on whether or not they should be allowed, but she defends the NHS’s record on killer diseases and thinks the issue needs a public hearing.
“I just want the public to understand that you might only gain three months at best with these drugs and be aware of what you might have to give up to get that, and the effect that will have on your family. I feel the whole discussion is much more complicated than people think and I would like to see it really discussed in public.”
Part of the reason for the UK’s low ranking on cancer success rates is the way British men in particular approach their own health. “The rates are not because we do not have the equipment but for example one reason is that our men tend to present later than those in other countries. We do have good investigation where we do have good pathways to cancer care, but we often diagnose late. So our results don’t look very good. But that is as much to do with how health-conscious we are in this country compared to other countries.”
While intermediaries may have wished Black had been allowed to take a closer look at fiscal incentives for employers to offer health and wellbeing, they can at least be content to see her work as having strengthened the evidence base for much of what they have been doing for years. ncorporate adviser october 2008
Professor Dame Carol Black is the National Director for Health and Work, chairman of the Academy of Medical Royal Colleges and chairman of the Nuffield Trust.
She read history at Bristol University followed by a diploma in medical social work. Entered medical school as a mature student in Bristol, qualifying in 1970.
She became Professor of Rheumatology at the Centre for Rheumatology in the Royal Free & University College Medical School.
She enjoys long distance walking, running, music, especially opera, reading and travel.
Building the business case for health & wellbeing
Following Black’s review, ‘Working for a healthier tomorrow’, the DWP has developed a tool to help businesses understand the impact of investing in employee health and wellbeing.
Developed in conjunction with Business in the Community (BITC) and PricewaterhouseCoopers, the tool is designed to help employers quantify the costs of illness to their business and the financial benefits of wellness programmes. It also aims to help assess the business case for investing in employee wellness programmes, and lead to better, informed decision-making regarding wellness initiatives.
Black hopes the tool, ‘Business HealthCheck’, will catalyse debate on employees’ health and wellbeing, and transform it into a boardroom agenda item. BITC intends to use this tool as part of its wider health promotion campaign.
Black says: “It was clear from my review that there is a compelling business case for investing in employees’ health. Many organisations have already recognised how important it can be to their bottom line by improving employee wellbeing and productivity and reducing sickness absence and staff turnover. But it’s also clear that if we are to make health and wellbeing an issue for financial directors and CEOs, not just HR directors, we need to go further. Organisations need to be able to measure the impact of their wellness programmes and also be able to identify costs if they fail to manage health conditions.”