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The next phase of Medways Workplace Health Programme

Contents 1 2 3 4 5 6 7 Our Approach What is Workplace Health? Costs & Drivers for Change Benefits & Partnerships Case Studies The Way Forward Making it Happen
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There is considerable evidence that health and well-being programmes produced economic benefits across all sectors and all sizes of business: in other words, good health is good business
Working for a healthier tomorrow, HM Government (2008)

1. Our Approach
The Challenge
Medway Public Health asked TONIC to conduct a rapid options appraisal for the future of their Workplace Health programme 1. Clarify the current picture 2. Explore the level of ambition 3. Test the market 4. Develop options 5. Options appraisal

Methodology
To achieve this, we took a formative research approach Qualitative: 40+ Interviews with key stakeholders from public health, Council regeneration & HR, business leaders, delivery partners and national leads Quantitative: Gathering relevant data and performing analysis to inform the business case and options. Many estimates used in this report come from extrapolations from national reports and local data, and from the use of a range of issue specific calculators (Annex E) Evidence: A scan of the latest literature on workplace health in the UK

Workplace wellbeing programmes are defined as an organised, employer-sponsored programme that is designed top support employees as they adopt and sustain behaviours that reduce risks, improve quality of life, enhance personal effectiveness, and benefit the organisations bottom line Harvard Business Review (2010)

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2. What is Workplace Health in Medway?

Medway has run a Workplace Health (WPH) programme since 2008, starting with the PCT & Council, then including external businesses from 2010 There is great potential in the programme, including: a wide offer of quality provision accessible at no additional cost; numerous businesses in the area; some large companies engaged in WPH with ongoing demand for activity; and goodwill amongst engaged companies and delivery partners Locally collected data gives a reasonable understanding of the needs of Medways workforce but this is fragmented and has not been brought together for analysis Some potential companies have been lost through a slow response, whilst others are not aware that they are formally part of a programme The visible WPH activity for Council staff is not a cohesive, co-ordinated programme
Health & Safety Statutory regulations Government requirements H & S Managers Managing Ill Health Occupational Health Absence management Disability management HR Deptartment

Wellness
Public Health Prevention and Promotion Health promotion Work-life balance and stress management Career/personal development Primary care

40

organisations involved since 2010

33%
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25 5

involved at present

Medways WPH programme concentrates on prevention of poor health and promotion of good health and wellbeing, rather than Health & Safety and Occupational Health elements

more in the pipeline

Clinical - Chronic disease - Genetic factors - Mental health

completed 6 month review CONCLUSION: There is plenty of potential in the current programme & a wide offer of direct services, support, training & access to other services. However, the current programme is under used, does not have a clear progression for organisations involved, no outcomes or outputs are measured, and it does not have a widely recognised identity

Work-related causes - Physical hazards - Psychological climate - Job design/quality Lifestyle - Exercise - Diet - Smoking/alcohol - Debt

Employee health and wellbeing

Measurable business impact

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Chains of casualty Influences on employee health and wellbeing

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3. Costs & Drivers for Change The Medway Economy

Medway Businesses by Type
Medways economy is worth

6,425
Construction Professional, scientific & technical Retail Production Accommodation & food services Business administration & support services Arts, entertainment, recreation & other services Other (Health, ICT, Transport, Wholesale)

2.8bn 52m
10,000

Breakdown of Medway businesses by size

per year

businesses in Medway

586,000
Cost of absence in Medway

days lost to absence

Micro 0-9 employees Small 10-49 employees Medium 50-249 employees Large 250+ employees

86,200

per year

jobs are located in Medway

Medway jobs by sector Numbers

Agriculture, forestry & fishing AND Mining 1,900 Manufacturing 7,300 Construction 7,000 Motor trades 1,500 Wholesale 2,800 Retail 10,500 Transport & storage (inc postal) 3,900 Accommodation & food services 5,200 Information & communication 1,300 Financial & insurance 2,500 Property 1,200 Professional, scientific & technical 3,200 Business administration & support services 5,600 Public administration & defence 4,400 Education 10,100 Health 13,300 Arts, entertainment & recreation 4,400 0% 5% 10% 15%

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120,000 employed people living in Medway

3. Costs & Drivers for Change: Overlapping & Shared priorities

MEDWAY BUSINESSES & ORGANISATIONS
COSTS Poor health at work and sickness absence impacts on business: Lost sales Lost customers Inability to take on new contracts Inability to fulfill existing contracts Cost of absence: 495 - 600 per person per year1 Cost of staff turnover: 1,500 per person that leaves2 Main causes of ABSCENCE: Mental Health (including stress & anxiety) account for 1/2 of absences, with spells averaging 21-24 days3 Musculoskeletal Disorders (e.g. back pain) Other causes of absence include: Obesity, Alcohol, Physical Inactivity, Smoking: e.g. each smoker loses an avg. 6 days per year in smoking breaks PRESENTEEISM Where staff attend work but are not in a fit state, creating costs in lost productivity or accidents/injuries. This has been estimated to cost businesses 2-7 times more than the cost of sickness absence4 DRIVERS FOR CHANGE An ageing workforce Changing workforce demographics, inc. increased migrant workers, women and move away from manufacturing, has lead to changing expectations, e.g. support from employer, better work-life balance Although absence rates are declining, there are rising business costs of dealing with absence & poor health External Government & business pressures e.g. CSR, competition for talent, accreditation 50% orgs do not measure absence 75% do not calculate cost of absence Larger organisations have larger rates of absence Top wellbeing goals for UK businesses: (i) increasing employee morale and engagement (ii) improving staff productivity and reducing presenteeism (iii) reducing absenteeism STAFF EXPECTATIONS Medway survey (600+ employees) shows: 1/2 want information on stress management & looking after wellbeing 1/2 want to attend weight management clinics at work 15% smoke, 2/3 of these want help to quit at work 8.5% are increasing risk drinkers 1/2 rate their energy levels as fair to very poor 1/3 rate their general health as fair to very poor

MEDWAY PUBLIC HEALTH

COSTS Lifestyle factors contribute to risk of chronic disease & longer term conditions: Smoking: 23% of adult population Alcohol Unhealthy eating Obesity: 30% of population are obese Physical Inactivity: 61% of Medway adults do not exercise Mental Health Stress, anxiety, depression Musculoskeletal Disorders (MSD) It is much cheaper to avoid or delay onset of these conditions through action to identify issues & take preventative actions DRIVERS FOR CHANGE Ageing population: By 2024, 50% of 5 adults will be aged 50+ Unemployment drives poor health Department of Health, DWP & Public Health England want Public Sector employers to lead the way on health at work Settings based approaches to public 6 health have proven effectiveness

MEDWAY ECONOMY
COSTS 52m Sickness Absence 586,000 days lost to absence 17m lost productivity by smoking 7 employees 52m lost productivity linked to staff stress and other mental health issues Unemployment creates a drag on the local economy 39,000 economically inactive people in Medway, 13,800 of whom want to work 4% JSA claimant rate in Medway is higher than nationally & regionally 888 unfilled job centre vacancies in 8 Medway DRIVERS FOR CHANGE Drive for regeneration in Medway Attracting new businesses to Medway Creating sustainable employment (Impress & Employ Medway schemes) Council support for small businesses

Unemployment is an important factor driving the health and well-being of a population and this is likely to be playing a key role in the health inequalities seen in Medway. Medway JSNA

Ageing of the population is likely to result in a substantial increase in costs to the health and social care system Medway JSNA

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There is evidence to suggest that the health of the population and thus the workforce will deteriorate in the coming decades. Levels of disease in the workforce will increase, due partly to lifestyle. Coupled with an ageing workforce this represents a major challenge for the economy.
Health at Work An independent review of sickness absence (Dame Carol Black & David Frost, 2011)

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4. Benefits of WPH Programmes & Partnerships

BUSINESSES & ORGANISATIONS
Instituting a workplace health programme in your organisation can achieve: 1.81 to 10.1 return on investment Much of the intervention delivery is free to businesses and organisations Outcomes can be realised from 6 months to 2 years Cashable savings: e.g. 30-40% cut in 9 absence & 20-25% cut in staff turnover Increase productivity through raised morale and attendance and cutting presenteeism Good benefits-costs ratio on investing in WPH programmes Demonstrating Corporate Social Responsibility Competition to acquire talent, win new business, showcase your company (PR) and increase market share Meet workforce expectations Helps to achieve related accreditation: Workforce Wellbeing Charter, Investors in People, Responsibility Deal, Mindful Employer etc. Getting employees more physically active could save Medway employers 10 14m

LOCAL ECONOMY
The potential benefits to the local economy are longer term, and include: Can help to promote Medway as a place to invest, grow businesses and regenerate Residents will be supported as part of the local workforce Contribute towards sustainable employment by increasing staff retention
For the regions and communities More social mobility Less social exclusion Reduction in social deprivation and child poverty Increased productivity Higher employment Less burden on public services For the economy Assisting the conditions for business success Higher productivity Supporting economic performance

MEDWAY COUNCIL
Focusing the WPH programme internally (i.e. for Council employees) could return significant dividends, generating savings that could fund expansion of the scheme 40% of your staff want to take part in wellbeing activities at work especially to help with their key 11 concerns of stress and MSD Businesses often pay private companies (e.g. BUPA, AXA) to deliver WPH - there may be potential for this scheme to become income generating on a small scale in future Raising Medway Councils profile and reputation in supporting its own staff and Medway employers and employees DWP want public sector organisations to lead the way on health at work

PUBLIC HEALTH
Give Medway Public Health the opportunity to access hard to reach, priority groups (e.g. young males, manual workers) & deliver a SettingsBased Approach with good evidence of effectiveness Potential to grow sustainable capacity and reach to deliver interventions through training HR, Occ. Health and Line Managers Help achieve Public Health delivery and a number of outcome & delivery targets Build on & link to national initiatives: Workplace Health Charter (Public Health England re-launching April 2014), DH Responsibility Deal, Investors in People Create new networks for delivering Change4Life and other national public health campaigns (e.g. Stoptober, Dry January) through B2B comms channels Improve local partnerships across A Better Medway, Medway Business Awards, Making Every Contact Count Develop better partnerships with the business community and leaders, and contribute to Regeneration efforts

Benefits of supporting people to be healthier and in work

For businessess More motivated and productive workers Less working time lost to ill-health Better staff retention Greater competitiveness Higher profits For the individual Empowerment, increased selfconfidence, greater dignity Better general health (mental and physical) Financial security Better living conditions Opportunities for development More productive

Improved brand Reduced sickness

Improved retention

Fewer accidents

Business benefits of a healthy workforce

Improved resilience

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Higher productivity

Higher commitment

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For families and children Better living conditions Better general health (mental and physical) Less likelihood of experiencing disadvantage in education Better living conditions

Business benefits of a healthy workforce

There is good evidence of effectiveness for workplace health & wellbeing promotion programmes
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5. Case Study: Medway Council

NEEDS
Public sector has higher than average rates of absence - 50% higher than private business The South East has the highest rates of absence in England

COSTS
No costs or annual trend data were supplied, so our estimated costs to Medway Council are: Absence working days lost

BENEFITS
Introducing a workplace health programme for staff, Medway Council could save:

50,192

1/3 of these from long-term conditions Directorate variations in rates of absence from 7 to 12 days per FTE The Council is largest employer in Medway Medway Council has average (9.4%)12 Key staff concerns staff are stress & MSD13

16.3%

Absence

staff turnover - higher than public sector

Smokers

4m 479k 894k 5.8m 11m 5.2m

of direct costs

(estimate based on 2012-13 figures)

staff turnovercosts overtime paid (actual 2012-13)

(actual 2012-13)

1.6m 180k
staff turnover

from reduced absence saving from reduced

1m in reduced absence and improved staff retention by promoting physical activity18 If Medway Council concentrated 80k cost of WPH programme on its own staff, return on investment could be

agency staff spend of indirect costs in lost

145k - 800k
current external WPH offer

19

productivity from cigarette breaks17 Alcohol 1m in lost productivity from presenteeism related to drinking too much

This could be used to improve and grow the Staff feel valued, with improved health, leading to increased productivity & morale

45% of male staff have higher than

recommended blood pressure14

52% higher than recommended body fat

15

the night before

40%

of your staff want to take

part in health & wellbeing activities at work16

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EXAMPLE: Public Health Directorate lost 255 days to absence in the first six months of 2013, at a cost of 23,000 in staff time

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CASHABLE SAVINGS
SHORT TERM: Reduced use of agency staff, overtime spend & recruitment costs LONG TERM: Reduction in overall staff headcount

5. Case Studies
Case Study: Small retail business Case Study: Large manufacturing Business

For an employer with WPH programme could save:

30 staff, engaging in a
in reduced sickness absence from

over 200 days lost Reduce working days lost by at least

13,680

productivity

by reducing stress and anxiety related loss of productivity Scaleable programmes offer benefits to different sizes of organisation

11,000 3,840 7,500

2.8%

by promoting physical activity

by reducing smoking related loss of

For an employer with programme could yield savings of:

1,000 staff, a wellbeing

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456k 250k 128k 126k

in reduced absence on mental health issues on smoking related loss of productivity on obesity
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6. The Way Forward: Options

You will need to consider and choose one or more of the following

1
SMALL BUSINESS OFFER
Develop a scaleable offer to support small businesses that are not currently accessing WPH support through low cost interventions and access to resources

2
GROW INTERNAL PROGRAMME
Develop, test, adapt & roll-out a comprehensive, co-ordinated WPH programme for all Council staff in partnership with Public Health, HR & H&S managers. Extend to Council contractors

3
GROW EXTERNAL PROGRAMME
Develop, test, adapt & roll-out a comprehensive, co-ordinated and more formalised WPH programme for priority organisations to maximise impact and grow capacity

4
IMPROVE CURRENT OFFER
Introduce improvements to current programme: measure outcomes & activity, use a progressive model, link to accreditation, raise visibility etc. Meet current targets

5
CREATE SUSTAINABLE EMPLOYMENT
Tailor and target the WPH programme at those out of work on JSA who want to work but need support. Link to IMPRESS and Employ Medway schemes to create sustainable employment

COST

BENEFIT

COST

BENEFIT

COST

BENEFIT

COST

BENEFIT

COST

BENEFIT

Small amount of additional funding to develop and promote resources

Extend reach of current WPH programme to new groups Support Council aims

Additional funding for programme development, officer time, marketing & delivery

Cashable savings from reductions in agency staff, recruitment costs & overtime

Additional funding for programme development, officer time, marketing & delivery

Extend Public Health reach & delivery capacity. Potential for small income generation longer term

No additional funding required, if developed over the coming 6-12months

Organic growth in numbers engaged, measurable outcomes, more coherent offer

Additional funding for development and delivery - dependent on level of ambition

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Reduce JSA numbers Increase sustainable employment. E.g. 17:1 benefit cost ratio of Tower Hamlets Work it out programme

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6. The Way Forward: Recommendations

There is a strong case for further action. Medways WPH programme has potential to impact positively on the health of hard to reach priority groups, achieve public health targets, and have cash saving and productivity increasing benefits to local employers and the economy enhancing the reputation of the Council. This should continue, developing and growing incrementally through a triple-track approach: (i) Sustaining the current scheme (ii) Developing a clear, improved, progressive internal WPH programme for Medway Council (and, later, contractors) This should deliver sufficient savings to fund: (iii) Improvement & expansion of the external WPH offer
Strategic Manager 0.2 FTE WPH Programme Manager 1 FTE Project Officer 0.5 FTE

Senior stakeholder & partner engagement Champion the programme Set strategic direction

80% of working age people in work, spending 37% of their waking hours, for around 40 years of their life at work. The workplace offers the opportunity to influence the behavious of large numbers of people GLA Business Case 2012

Programme design, development, testing and adaptation Co-ordinate delivery partners Stakeholder management

Day-to-day delivery of WPH programme Measure outcomes Build marketing presence

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Budget for marketing and providers

30k
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6. The Way Forward: Example Timeline

Immediate (2 weeks) Hit 2013-14 target of 40 businesses involved prioritise engagement of Basepoint (circa 20 companies) in Chatham Dockyard & maintain current businesses Agree recommendations & options from this report to take forward & identify resource required Appoint suitable person for Strategic Manager role Short Term (2 weeks - 4 months) Create delivery structure using existing (circa) 80k budget some additional funding may be required for development, delivery and comms costs Engage Kent Business School for MA student to help with design and measurement/evaluation Recruit a programme manager with: Ability to engage senior stakeholders across council (SMT & councillors) and business (business leaders & organisations) Managing internal stakeholders & delivery partners Programme design: content, delivery, branding, marketing, comms, use of evidence base Evaluate impact, outcomes & feedback to adapt programmes and communicate findings Conduct stakeholder mapping exercise (to include business leaders, senior council staff in public health, HR and regeneration, a champion on the Health & Wellbeing Board and amongst the Councillors, delivery partners) Establish Governance structure to engage key stakeholders & Agree the broad priorities for WPH (internal and external inc. which types/sizes of organisation to target, bearing in mind larger companies are better suited to WPH programmes & Priorities Engage internal stakeholders (Public Health, HR & Regeneration) and delivery partners in agreeing outcome measures (Annex F), baselines & cost calculations for internal programme & setting the direction for Internal programme (steering group) Visit good practice areas Develop business case with HR and H&S Directors Use project officer capacity to sustain current programme and reach current target gathering feedback on current offer and scoping demand for future developments Create SMART delivery plan for next 2 years EXTERNAL programme: Engage key business and organisational leaders/ stakeholders in external WPH programme governance to generate goodwill and access to resources such as B2B networks inc. The top 3 components of UK WPH strategies are Employee Assistance Programme, cycle to work schemes and health risk appraisals, which are low to no cost benefits Set priorities and agreed outcomes measures Market testing: Gather and analyse deeper insights and demand for WPH tools (particularly absence management software and localised WPH business case calculators), support, social media communications, campaigns & delivery amongst priority organisations Consider introducing elements from the improved internal programme to the external programme to test their efficacy and reaction to them Explore Health Check/MOT approach to baselining & outcome measurement (e.g. Wellbeing People) Longer Term (12 - 24 months): Develop external programme from findings of engagement and market testing, coupled with testing and outcomes of internal programme Test external programme on currently engaged businesses for 6 months, gather feedback and outcome measures communicate success! Review outcomes and feedback after 6 months Adapt programme for scale up Finalise improved external programme Consider requiring all Medway Council contractor organisations to join the WPH programme as savings and productivity improvements would benefit the Council & Residents Long Term (24 months+): Launch and promote external programme Consideration of income generation strands Explore best location for delivery provision of both internal and external programmes
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Medium Term (4 - 12 months) INTERNAL programme: Develop first draft programme to trial on a small, rapid scale with one experiment directorate (selecting a control directorate with similar demographics for comparison) include reviewing evidence of what works, creation of resources, brand identity, & comms materials Review outcomes and feedback after 3 months Adapt programme Continue Trial adding another experiment directorate for a further 3 months Review outcomes and feedback after 3 months Adapt programme for scale up across Council Implement finalised live programme across Council Continue to take measures, gather feedback and adapt the programme calculate savings potentially attributable to the programme to use as investment funding to grow and develop the external programme (which will require further manager and officer capacity) Recognise external & internal people/organisations who made good WPH progress in Medway Business Awards

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7. Making it Happen

0-3 Months
Engage Public Health, HR and H&S managers and SMT to agree direction, choose options to take forward, set priorities, identify outcomes, locate resources, and build an agreed business case for change

3-6 Months
Develop implementation plan, detailing priority high need and high impact organisations to target with high impact evidenced interventions Actions inc: Stakeholder mapping, engagement, review evidence

6-9 Months
Design & Test new programme &/or make improvements to existing programme

9-12 Months
Develop & Adapt new &/or existing programme in line with findings

12-24 Months
Scale Up & Roll-Out new programmes internally &/or externally Evaluate findings and improve programme including ROI

+24 Months
Review progress & outcomes to identify: Who should best provide this service Potential for income generation Further expansion & investment

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Annex A: The Progressive Model

CRITICAL PROGRAMME SUCCESS FACTORS
Articulate a clear business case for investment & joining WPH Senior manager buy-in from organisations on WPH is vital to success Recognisable external identity: e.g. Brand as A Better Medway as an overtly Council programme may be off-putting for some businesses Menu of options for organisations to choose from turning into a clear and progressive programme that organisations graduate from A light touch approach - Must be unbureaucratic & Scaleable to different business sizes and ambition Services should be free (some may prefer to pay), quick, responsive & high quality Regular communication, Sharing of good practice & Recognition of efforts Generate Evidence of Impact: Measurement of outcomes and savings Link programme activity to national and local accreditation schemes Take opportunities to grow sustainable capacity by training Occ. Health, HR & Line Managers to deliver public health interventions & information Tailored programmes based on employee demands and health needs

Awareness

Attention

Achievement

Advocate

Action

ENGAGEMENT lear, simple, attractive & C Concrete offer Target for maximum capacity & priority reach Progression through an identifiable programme Tailored business case / tools Comms channels developed (B2B)

INITIATION aseline measurement B Initial needs assessment survey with staff Access to free tools, exemplars & support Free delivery, with choices from a menu - programme builder support Tailored & timelined plan with what we will do, what they will do, what is free & what has additional costs

PROGRESS 2-24 month programme of 1 delivery from Medway Council , partners & organisation itself Interim outcome measures taken at regular intervals Work towards specific accreditation or schemes Recognition in comms

GRADUATION utcome Measurements O taken Customer satisfaction taken Recognition in Medway Business Awards & Comms Future pledges for continuing programme and supporting others Potential: pay for continued support (cash or in kind) and involvement

SUSTAINABLE upport from council is S stepped down Outcome Measurements continue They offer support to smaller companies or new companies Help us recruit more through case study & B2B networking

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SPONSOR

Public Health Responsibility Deal

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Annexes

A B C D E F

Progressive Model Measuring Abscence NICE Guidance Work Place Health Case Studies WPH Tools Outcome measures

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Written by Matthew Scott, Director, TONIC Date: October 2013 Status: Draft for Discussion Company Details Company Registration Number: 06141892 VAT Registration Number: 971257702 D-U-N-S Number: 219603037 Registered Address: Gothic House Avenue Road, Herne Bay Kent CT6 8TG