Simon Dixon, Head of Policy and Influencing, Royal Society for Public Health

Every year, more than 300,000 people leave the workforce because of ill health – meaning we now have around 4 million people out of work because of their health conditions. All too often, these are people who have dropped out of work not because they want to, but because they weren’t able to access support in a timely manner.

Addressing this is key to fixing our productivity crisis. The Government has recognised this, and launched the independent Keep Britain Working review to consider what more employers can do to improve the health of the workforce, and keep people in work.

Earlier this month, we convened experts from the worlds of occupational health, business, and public health to discuss what the cornerstones of any new approach should be and feed into the Keep Britain Working review being undertaken by Sir Charlie Mayfield.

The Importance of Managers

For most people, their meaningful interaction with their employer is through their manager. HR departments and leadership – particularly in large organisations – can often be distant, with little impact on the day to day work environment. Despite that, most managers get promoted to that role because of their functional skills – rather than because they are great managers.

We know that having a supportive manager can be the difference between accessing support in a timely manner, and being forced out of work due to worsening health. There is training and support out there to support managers in this role, but take up is often too low. Shifting this dial – so that every manager is actively supporting their staffs health – is a vital first step in creating healthy work.

Health as Culture

Creating a health workplace isn’t just a matter of buying in external service in order to tick a box. While these services are valuable, we know that take up is often low. For example, the average Employee Assistance Programme is used by only 3% of eligible employees a year.

Instead, healthy work is something which is created by an organisational culture – starting with the way in which work itself is designed. The building blocks of good work – fair pay, autonomy, and control – all contribute to reducing stress and improving mental wellbeing, but they also create a culture where people are empowered to improve their physical health at the same time.

Joining Up Systems

The current fit note system is often seen as binary – people are well enough to work as normal, until they meet a threshold beyond which no work is appropriate. Rather than encouraging a gradual movement between systems, people often end up facing a binary choice where they are labelled unfit for work, rather than supported to do what works for them.

Fixing this means encouraging employers to engage in meaningful case management, with supportive absence management procedures. Underpinning this, we need a closer relationship between occupational health and management, where both sides understand the demands and offer of the other.

The Barriers to Change

The barriers to implementing these better systems are well understood. For many employers, health support is seen as a cost, with insufficient return on investment to justify the capital that needs to be put in. While many employers have seen the benefits of a more supportive approach, this is often hard to quantify, and businesses are wary of sharing data on issues such as absence rates.

At the same time, where an offer does exist, awareness and uptake are often lower than we would want. Changing this comes back to ensuring that everyone with management responsibilities is fully aware of – and comfortable with – the support available, and staff are actively encouraged to access the services that they need.

Finally, as Sir Charlie Mayfield has already identified in his review, there are sometimes perverse incentives in the system – making it seem easier or cheaper for an employer to just let staff go when they face ill health, rather than investing in keeping them healthy in the first place. If we want to move to a preventative system, this is one of the first things which needs to change.

Making the Change

These are not changes that can be achieved by Government regulation alone. Businesses who go above and beyond see better outcomes, so we need to spread this good practice voluntarily – creating a situation where employers compete to offer the best health support, rather than treating it as a drag on their resources.

The RSPH is committed to supporting this work – whether that is through offering mental health training for managers, or convening employers to share best practice. To get involved in this work, get in touch with [email protected]