ON THE PANEL: Peter O'Donnell - chief executive, Unum; Tony Jackson - Head of HR, Macmillan Cancer Support; Nick Bacon - Professor of human resources, Cass Business School; Nikki Gatenby - MD, Propellernet; Ian Wylie - special projects editor, Management Today; Dr Maurice Lipsedge - chair of the Royal College of Psychiatrists' occupational psychiatry special interest group; Alison Dunn - head of treatment, Transport for London; Damien Marmion - UK managing director, Bupa; Ben Willmott - head of policy, CIPD.
Ian Wylie: What issues keep business leaders awake at night when they think about the health of their employees?
Nick Bacon: Big demographic changes. We know about the ageing workforce, about the increase in contract work and insecure work, about underemployment and financial stress. The big question for me is, what are employers doing to help employees cope with those issues? What can they do to try and ensure that employees have more satisfying working lives and more security at work, and beyond work?
Good mainstream, well-funded employers will do the right thing and develop good services. But so many other employers are not engaging with this agenda, particularly smaller and medium-sized firms. Increasingly, it seems to be that the state has to legislate to push this agenda forward.
Peter O'Donnell: But there has to be something in it for the employers. To try and persuade them to do something for the greater good of society is a tough ask. If you can say to them that by caring about health and wellbeing at work they get a more engaged workforce, that their absences will be down, that their key employees are more likely to be at work and they will get more motivated staff, then they will begin to see a direct correlation with business results.
Tony Jackson: We also need to put ourselves in the shoes of owners of small businesses. What is the thought process you go through if someone comes along with a medical condition? One: shock, fear, grief - it is likely to be a close friend as well. Two: I want to do the right thing. Three: I don't know if I can afford to do the right thing. Four: gosh, the last time I spoke to HR, they said I have to treat everyone the same, but I want to do the right thing for this individual. These are all the thought processes that owners will go through.
Nikki Gatenby: There is a culture of fear that means you are paralysed into doing nothing sometimes, which is the worst possible scenario for everybody involved. We need to remove fear, and I am not quite sure how you do it. My experience of HR has been that it is more about avoiding tribunals. I apologise if that offends anyone, but I believe it should be more about how we can help things get better.
Damien Marmion: I am not sure that employers really see the business case for healthy employees. When we go and talk to large corporates, they absolutely do not get it. And I worry that more and more is being spent on wellness in an inappropriate way. There is not enough evidence to actually produce the ROI.
Nikki Gatenby: If you show them that their sick days and staff turnover will reduce, that will give them ROI. Our sick days are the lowest in any business that I have ever worked in.
Alison Dunn: What works in one organisation does not always work in another. Increasingly, we look for an evidence base so we know what will achieve the maximum benefit. At the moment we are looking at how to encourage employees to change their health-related behaviours. So the first thing we are going to do is a small piece of research to find out what employees think the barriers are and what will help them to change their health behaviours.
Peter O'Donnell:That is a great point. If you think about the typical benefit package, it was designed in the 1960s and 1970s for a population that was going to live to an average of 73. Your house was your investment and that was going to pay off your mortgage. You were going to have a state pension that would give you a good return. It is a completely different world we live in now. And yet, benefit packages are primarily the same.
Ben Willmott: Benefits are important, but the starting point has to be good-quality leadership. We know that where you have good-quality line managers who have a trusting relationship with the people they manage, when those people go off for long periods with illnesses like cancer, heart disease or musculoskeletal problems, they are more likely to make a successful return to work.
We also know that how people are managed on a day-to-day basis will depend on the extent they feel stress and are able to juggle competing pressures, whether it is work pressures or outside work. We did some research asking people to categorise their mental health from very good to very poor. Of those employees who said they had very poor mental health, some 70% said the cause was a combination of work and home pressures. How your manager treats you then becomes incredibly important.
Maurice Lipsedge: As an occupational psychiatrist, I feel very comfortable with a referral from, say, an occupational health doctor who asks me about the management of an old-fashioned sort of mental illness, which I would regard as real mental illness: schizophrenia, manic-depressive disorder, compulsive disorder etc. I feel extremely uncomfortable with what is far more common - a referral for work-related stress, mainly because there is very little I can do about it. It is the workplace that has to take responsibility for dealing with it, so my recommendation is mediation.
And for every fitness-to-work certificate that says, 'This person cannot work because of stress at work', 'stress-related depression' or 'stress-related anxiety', GPs should be saying: 'This is a workplace responsibility. We can get this person to work.' The real issue is often something I've heard countless times from employees themselves: 'I know I am perfectly fit but I cannot possibly go back to work until I get an apology from my line manager', or 'I cannot possibly go back to work until such-and-such is sorted out.'
Alison Dunn: It is important that employers have a range of interventions for support in different ways. One of the things we have learned is that, as well as counselling, you need some practical interventions to teach people skills around building resilience and managing stress. Some of our biggest anxieties for the future are about obesity - and the proportion of our employees who are obese or overweight - and physical activity. They are two huge issues that will have the potential to cause even more problems later on.
Damien Marmion: There is much more of an interrelated nature to all of this. It may be that somebody has back pain. You may treat the back pain but they will come back next month and the month after until you have resolved the underlying problem of stress. We have to look at this as a whole. Employees are presenting things such as pain or stress, but there may be other causative, related factors. Why is somebody getting frequent colds? What are we doing about somebody's weight or BMI, or their diabetes?
Peter O'Donnell: Leadership and engagement are on every board agenda. Employee wellbeing is not an HR issue at all: HR just happens to facilitate the debate in a lot of big organisations. In fact, it's a CEO issue. It's not about whether you have a health and wellbeing strategy but what is your engagement strategy, and does health and wellbeing sit within that? Does it sit in your benefit packages? How do you approach it?
Ian Wylie: A statistic from the British Heart Foundation says 68% of employees say that their employer should take responsibility for their general health at work. Is that just nuts?
Alison Dunn: It has to be a partnership. We provide the opportunities, and it is then up to the employee to take them up and make the most of them. In terms of a lot of the support services that we offer, we expect people to use them in their own time, rather than in work time, or to make work time up. We supply the service and they contribute their time. It is a wasted resource if we take all the responsibility.
Nikki Gatenby: We talk about springboards and safety nets: 'We will give you as many springboards and safety nets as possible in this environment. It is your call whether you take them.'
We should evaluate people on outputs, not how many hours they sit at their desk and stare at a screen. If you can generate fantastic output because you have been in the office for three hours but running on the beach for two, that is amazing. I do not care how many hours you spend at your desk. It is irrelevant.
Ian Wylie: What are some of the strategies that you use in your own organisations, or that you have seen elsewhere that are proving to be successful?
Maurice Lipsedge: EDF has greatly reduced early retirement on medical grounds and also sickness absence. One of the ways in which it has done that is through early intervention.
Within a week or two of going off sick with any red-flag diagnosis like work-related stress or even psychosomatic conditions like irritable bowel syndrome or tension headache etc, each employee is invited to come up for review. Or someone will go from EDF to see them at home, although not punitively. The culture of the organisation is now, 'It is routine that you are going to be seen.'
Alison Dunn: One of the things we have in place is an automatic email to managers. When an employee is logged off sick with a mental-health or musculoskeletal problem, the manager gets an email after seven days to remind him or her what good practice is. Another thing we do is we measure the referral rates from different areas of the organisation, and we then go back to managers. Our statistics prove that the earlier you are referred for treatment for either of those conditions, the shorter your recovery time: it is a double win.
Tony Jackson: A few months ago, I decided we needed to have a look at how good we were on the wellbeing agenda. We just took the Business in the Community model, which has the four segments of what you should be looking at. We found that everything we already offer makes up a long list, so it was about making sure that people were aware of it and using it. It is that ability to pick the things that are right for you.
Ian Wylie: Is there any research that shows what strategies have the most impact?
Nick Bacon: Statistics show that over 50% of employees who have been off ill for five consecutive days do not even have a conversation with their manager when they return to work about why they had been off work, let alone what could be done to accommodate their needs in order to ease their situation back into work. Surprise, surprise, of course, a few months down the line, that person is off again. This notion of early intervention, then, is absolutely critical.
Ben Willmott: We need a collaborative brainstorm - policymakers, employers, representative bodies and small employers already doing this stuff - to work out how we can shift the debate so that it does reach that big rump of the unconvinced or those business owners who are just too busy with surviving to think that this might be important.