The next phase of Medway’s Workplace Health Programme

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Contents

1 Our Approach2 What is Workplace Health?3 Costs & Drivers for Change4 Benefits & Partnerships5 Case Studies 6 The Way Forward7 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 picture2. Explore the level of ambition3. Test the market4. Develop options5. 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

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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 organisation’s bottom line” Harvard Business Review (2010)

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2. What is Workplace Health in Medway?

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

organisations involved since 2010

4025involved at present

33% completed 6 month review

5more in the pipeline

Wellness

Prevention and PromotionHealth promotionWork-life balance and stress managementCareer/personal developmentPrimary care

Health & SafetyStatutory regulationsGovernment requirements

Managing Ill HealthOccupational HealthAbsence managementDisability management

• 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 Medway’s 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

Chains of casualtyInfluences on employee health and wellbeing

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

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Clinical- Chronic disease- Genetic factors- Mental health

Lifestyle- Exercise- Diet- Smoking/alcohol- Debt

Work-related causes- Physical hazards- Psychological climate- Job design/quality

Employeehealth and wellbeing

Measurablebusiness impact

H & S Managers

Public Health

HR Deptartment

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3. Costs & Drivers for ChangeThe Medway Economy

Medway’s economy is worth £2.8bnper year

6,425 businesses in Medway

86,200jobs are located in Medway

Medway Businesses by Type

Construction

Professional, scientific & technical

Retail

Production

Accommodation & food services

Business administration & support services

Arts, entertainment, recreation & other services

Other (Health, ICT, Transport, Wholesale)

10

,00

0120,000 employed people living in Medway

Breakdown of Medway businesses by size

Micro 0-9 employees

Small 10-49 employees

Medium 50-249 employees

Large 250+ employees

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Agriculture, forestry & fishing AND Mining

Manufacturing

Construction

Motor trades

Wholesale

Retail

Transport & storage (inc postal)

Accommodation & food services

Information & communication

Financial & insurance

Property

Professional, scientific & technical

Business administration & support services

Public administration & defence

Education

Health

Arts, entertainment & recreation

0% 5% 10% 15%

Medway jobs by sectorNumbers

1,900

7,300

7,000

1,500

2,800

10,500

3,900

5,200

1,300

2,500

1,200

3,200

5,600

4,400

10,100

13,300

4,400

Cost of absence in Medway £52m per year

586,000days lost to absence

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

COSTSPoor 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

PRESENTEEISMWhere 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

MEDWAY BUSINESSES & ORGANISATIONS

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 EXPECTATIONSMedway 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

COSTSLifestyle 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

adults will be aged 50+ 5 • 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 health have proven effectiveness 6

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

MEDWAY ECONOMY

COSTS• £52m Sickness Absence• 586,000 days lost to absence• £17m lost productivity by smoking

employees7 • £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

Medway8

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

“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)MFIT

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4. Benefits of WPH Programmes & Partnerships

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

absence & 20-25% cut in staff turnover9

• 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 £14m10

BUSINESSES &

ORGANISATIONSThe 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

LOCAL ECONOMY 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 concerns of stress and MSD11

• 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 Council’s profile and reputation in supporting it’s 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 Settings-Based 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

There is good evidence of effectiveness for workplace health & wellbeing promotion programmes

Business benefits of a healthy workforce

Improved‘brand’

Business benefits of a healthy workforce

Improvedretention

Improvedresilience

Highercommitment

Higherproductivity

Feweraccidents

Reducedsickness

For the individual• Empowerment, increased self-

confidence, greater dignity• Better general health (mental and

physical)• Financial security• Better living conditions• Opportunities for development• More productive

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 businessess• More motivated and

productive workers• Less working time lost to

ill-health• Better staff retention• Greater competitiveness• Higher profits

For the economy• Assisting the conditions for

business success• Higher productivity• Supporting economic

performance

For families and children• Better living conditions• Better general health (mental and

physical)• Less likelihood of experiencing

disadvantage in education• Better living conditions

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Benefits of supporting people to be healthier and in work

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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

• 50,192 working days lost

• 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 16.3%

staff turnover - higher than public sector

average (9.4%)12

• Key staff concerns staff are stress & MSD13

• 45% of male staff have higher than

recommended blood pressure14

• 52% higher than recommended body fat15

• 40% of your staff want to take

part in health & wellbeing activities at work16

BENEFITSIntroducing a workplace health programme for

staff, Medway Council could save:

• £1.6m from reduced absence

• £180k saving from reduced

staff turnover

• £1m in reduced absence and improved staff

retention by promoting physical activity18

• If Medway Council concentrated £80k

cost of WPH programme on it’s own

staff, return on investment could be

£145k - £800k19

• This could be used to improve and grow the

current external WPH offer

• Staff feel valued, with improved health,

leading to increased productivity & morale

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COSTSNo costs or annual trend data were supplied, so

our estimated costs to Medway Council are:

• Absence £4m of direct costs

• £479k staff turnovercosts

• £894k overtime paid (actual 2012-13)

• £5.8m agency staff spend

• Absence £11m of indirect costs

• Smokers £5.2m in lost

productivity from cigarette breaks17

• Alcohol £1m in lost productivity from

“presenteeism” related to drinking too much

the night before

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

(estimate based on 2012-13 figures)

(actual 2012-13)

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SHORT TERM: Reduced use of agency

staff, overtime spend & recruitment costs

LONG TERM: Reduction in overall

staff headcount£CASHABLE SAVINGS

Case Study: Large manufacturing Business

For an employer with 1,000 staff, a wellbeing programme could yield savings of:

£456k in reduced absence

£250k on mental health issues

£128k on smoking related loss of productivity

£126k on obesity

5. Case StudiesCase Study: Small retail business

For an employer with 30 staff, engaging in a WPH programme could save:

£13,680 in reduced sickness absence from over 200 days lostReduce working days lost by at least 2.8% £11,000 by promoting physical activity

£3,840 by reducing smoking related loss of productivity

£7,500 by reducing stress and anxiety related loss of productivity

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Scaleable programmes offer benefits to different sizes of organisation

6. The Way Forward: OptionsYou will need to consider and choose one or more of the following

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Additional funding for programme

development, officer time, marketing &

delivery

Additional funding for programme

development, officer time, marketing &

delivery

No additional funding

required, if developed over

the coming 6-12months

Additional funding for

development and delivery - dependent on level of ambition

Organic growth in numbers engaged,

measurable outcomes,

more coherent offer

Extend Public Health reach

& delivery capacity.

Potential for small income generation longer term

Cashable savings from reductions in agency staff, recruitment

costs & overtime

2GROW

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

3GROW

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

4IMPROVE CURRENT OFFER

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

5CREATE

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

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Reduce JSA numbersIncrease

sustainable employment.

E.g. 17:1 benefit cost

ratio of Tower Hamlets

“Work it out” programme

1SMALL

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

COST

Small amount of additional

funding to develop and

promote resources

COST COSTCOSTCOST

BENEFIT

Extend reach of current WPH programme to

new groupsSupport

Council aims

BENEFIT BENEFITBENEFITBENEFIT

There is a strong case for further action. Medway’s 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

6. The Way Forward: Recommendations

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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

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

•Day-to-daydelivery of WPH programme•Measure outcomes•Build marketing presence

£30k Budget for marketing and providers

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“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

6. The Way Forward: Example TimelineImmediate (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

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

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

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7. Making it Happen

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

Develop implementation plan, detailing priority high need and high impact organisations to target with high impact evidenced interventionsActions inc: Stakeholder mapping, engagement, review evidence

Design & Test new programme &/or make improvements to existing programme

Develop & Adapt new &/or existing programme in line with findings

Scale Up & Roll-Out new programmes internally &/or externally

Evaluate findings and improve programme - including ROI

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

0-3 Months 3-6 Months 6-9 Months 9-12 Months 12-24 Months +24 Months

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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

Annex A: The Progressive Model

1 ENGAGEMENT• Clear, simple, attractive &

Concrete offer• Target for maximum capacity

& priority reach• Progression through an

identifiable programme• Tailored business case / tools• Comms channels developed

(B2B)

2 INITIATION• Baseline measurement• 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

3 PROGRESS• 12-24 month programme of

delivery from Medway Council , partners & organisation itself

• Interim outcome measures taken at regular intervals

• Work towards specific accreditation or schemes

• Recognition in comms

4 GRADUATION• Outcome Measurements

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

5 SUSTAINABLE• Support from council is

stepped down• Outcome Measurements

continue• They offer support to smaller

companies or new companies• Help us recruit more through

case study & B2B networking

Awareness Attention Achievement Advocate

Action

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A Progressive ModelB Measuring AbscenceC NICE GuidanceD Work Place Health Case StudiesE WPH ToolsF Outcome measures

Annexes

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Written by Matthew Scott, Director, TONICDate: October 2013

Status: Draft for Discussion

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