Reflections on health, work and worklessness I am Manuel Ramos, Healthy Adults Manager. I work on workplace heath and health-related worklessness. Manuel Ramos Healthy Adults Manager Manuel.ramos@phe.gov.uk

Overview Context of Health and Work Context of Health and Worklessness Future of Health and Work I would like to give you an overview on health and work, worklessness and the future of health and work.

About Public Health England We protect and improve the nation's health and wellbeing, and reduce health inequalities. Locally-focussed 4 regions, 9 centres 8 K & I hubs Other local presence  Key roles: System leadership Health protection Local support Government Public Health England Local authorities NHS The organization that I work for is Public Health England. We were established in 2013. Our mission, as this slide shows, is to protect and improve the nation’s health, but also, specifically, to help reduce inequalities.

Context of health and work

Context of employment in England Business count by region (thousands) Employment rate (16-16yrs) trend 2011-2016 Year on year growth in number of businesses over last 3 years. Significant geographical variation in business density, highest in London and lowest in the North East. Between April to June 2016 and July to September 2016, the number of people in work increased and the number of unemployed people decreased.  The employment rate (the proportion of people aged from 16 to 64 who were in work) was 74.5% in Jul-Sep 2016. Self-employed people account for 4.79 million of the workforce and is increasing. ONS (2016)UK business; activity, size and location: 2016 ONS (2016) UK labour market: Nov 2016

Supporting healthy & safe workplaces Healthy Workplaces Voluntary approach Supporting leadership and recognition of the business case e.g. Local Enterprise Briefing Employer led action e.g. Business in the Community Programme on Ageing in the Workplace Local government support through local workplace health & wellbeing accreditation schemes e.g. Liverpool Workplace Charter PHE supporting through developing business to business toolkits for Mental Health, Musculoskeletal disease, Suicide Prevention, Suicide Post-vention PHE Strategic Partnership on health and work, partnership with NGO developing specific projects including needs assessment tool and promising practice case study collation Promoting public discussion e.g. Infographics with Work Foundation on work and health Health & Safety Legislation Health & Safety Executive Public reporting of accidents/injuries Significant year on year reduction in occupational injury & mortality Public Sector as Exemplar NHS 1.3m employees Quality improvement programme on staff health & wellbeing Civil Service 600,000 employees Permanent secretary champion, cross-CS action plan What is government doing to support healthy and safe workplaces? Our work focuses on 3 main areas: Health and safety – keeping workplaces safe for employees Creating healthy workplaces in order to keep people in work - e.g. support evidence-based tools to encourage employers to improve Public sector as an exemplar – importance of practicing what we preach

How are workplaces affected by health?

How are individuals affected by health and work issues? Presentation title - edit in Header and Footer

BITC/PHE Mental Health Toolkit for Employers Includes prevention as well as supporting positive inclusion and response/signposting Included case studies from SME and large business, public and private sector organisations Downloaded over 4,000 times in first six weeks To be published in Spring 2017: MSK Toolkit Suicide Prevention Suicide Post-vention PHE is working with businesses to develop workplace health tools, which improve workplace health. This include the BITC PHE Mental Health Toolkit for Employers. Aimed at businesses of all sizes. Included case studies from SME and large business, public and private sector organisations We will be publishing in the next couple of weeks: MSK Toolkit Suicide Prevention Suicide Post-vention l

Local & Sectoral Workplace Wellbeing Accreditation Schemes Workplace wellbeing accreditation schemes can provide a useful roadmap for employers to implementing NICE Evidence Base and good practice Opportunity to link employers with local public health offer and reduce replication of provision of services e.g. smoking cessation About 60% of local authorities have a scheme in place and some emerging sector specific schemes e.g. Police Another key action to improve workplace health is PHE supports all local evidence based workplace accreditation schemes. These schemes can provide a useful roadmap for employers to implementing NICE Evidence Base and good practice Opportunity to PHE published National Standards that form the baseline for local schemes and these will be refreshed in 2017 alongside commissioning guidance for local government

Challenges and opportunities in workplace health Lack of UK published evidence for impact of workplace interventions for employee health and wellbeing Limited evidence of business impact on productivity, some on sickness absence and some on presenteeism but variable and rarely published or peer reviewed Need for stronger industry consensus on data, evaluation and impact

Context of health and worklessness

Context of unemployment in England Unemployment rate (16-16yrs) trend 2011-2016 Unemployment measures people without a job who have been actively seeking work within the last 4 weeks and are available to start work within the next 2 weeks. The unemployment rate is the proportion of the economically active population (those in work plus those seeking and available to work) who are unemployed. The unemployment rate for people for the latest time period, July to September 2016, was 4.8%, the lowest since July to September 2005. The proportion of people, aged from 16 to 64, not in work and neither seeking nor available to work is known as the economic inactivity rate.  Four main causes for economic inactivity are: Studying (2.32m) Caring for family member (2.23m) Ill health (2.01m) Early retirement (1.15m) Economic inactivity rate (16-16yrs) trend 2011-2016 The unemployment rate for people for the latest time period, July to September 2016, was 4.8%, the lowest since July to September 2005. The economic inactivity rate is 21% which includes people who study, carers, ill health and retirement. ONS (2016) UK labour market: Nov 2016

Focusing on closing the disability employment gap This graph shows the disability employment gap in stark terms. The employment rate for those with no health conditions is 78%, where as for those with mental health it is only 42% and MSK 58%. But not just about a gap, this is about people being able to get the right healthcare and help and support so they can be the best they can be. Economic inactivity due to ill health is significant individual, social and economic burden that is potentially preventable. We are taking a social model of disability, i.e. the lack of appropriate supported work disables the person with the impairment from finding sustainable employment. This requires action by employers as well as through health and social care services to change the social context and aspiration of people living with health conditions.

Health-related welfare in England Having people on ill health costs us a lot of money, which we cannot afford. Presentation title - edit in Header and Footer

Work Capability Assessment Unemployment support Job Centre Plus Work Capability Assessment ESA support Group The Work Programme Fit for Work Service If you’re unemployed at the moment, there is a lot of support which you can get to help you get back into work.

Green Paper on Health and Work: Improving Lives Joint green paper between DWP & DH Consultation runs tomorrow, 17 Feb 2017 https://consultations.dh.gov.uk/ workandhealth/consult/ Government is interested in enabling and supporting disabled people and people with long term health conditions to reach their full potential, which is why it published in October the ‘Improving Lives The Work, Health and Disability Green Paper’. There has been an extensive consultation, which closes tomorrow. How many have heard of this green paper? How many have responded? If you have any questions or comments, please feel free to email me.

This slide summarises the vision of the green paper. The focus in on how we as a Government and as a wider society can enable and support disabled people and people with long-term health conditions to reach their full potential. Key messages are: o Disability and health conditions are every day issues: over 3.3 million disabled people are in now work . But despite a record-breaking labour market, 4.6 million disabled people and people with long-term health conditions are out of work. o We have high ambitions for disabled people and individuals with health conditions and what they can achieve. It is time to focus on what disabled people can do and provide support for those that need it. o We know that the appropriate type of works supports good health. We need to recognise this in the way that we give care; and for our systems to reflect the benefits that work can bring. ‘Having the right type of job and appropriate support can be a really positive factor for people with a long-term condition.’ o Employers can better support productivity by looking after all of their workforce and making sure new appointments are open to all. Presentation title - edit in Header and Footer

Some of the key themes Employer led action Role of the NHS Role of Occupational Health Evolution of the role of work coaches How big a role can we expect employers to play? How can we develop better occupational health support right across the health and work journey? How can work coaches play a more active role for disabled people and people with health conditions? What will it take to reinforce work as a health outcome in commissioning decisions and clinical practice?

Challenges and opportunities Moving to a social model of employment disability i.e. opportunity is the barrier not the impairment Potential for more synergy and collaboration between support providers Need earlier intervention and potential to reframe narrative about work for people with long term health conditions for patients and professionals Some of the challenges and opportunities include: Moving to a social model of employment disability i.e. opportunity is the barrier not the impairment Potential for more synergy and collaboration between support providers Need earlier intervention and potential to reframe narrative about work for people with long term health conditions for patients and professionals

Future of health and work

Changing nature of the workforce Increasing number of people working into later life as life expectancy increase Increasing challenge of more of that longer life is spent with ill health and disability 6sec decision making of the Facebook generation 1 in 3 children aged 5yrs today, will reach their 100yr birthday Britain’s workforce is changing. 1 in 3 children aged 5 today, will reach their 100 year birthday. As a result: an increasing number of people will have to work into later life as life expectancy increases There is an increasing of more of that longer life is spent with ill health and disability

Changing nature of work 5 jobs that will exist by 2025 Rewilding strategist Virtual habitat designer Genetic designers Vertical Farmer Digital death manager Changing nature of work Evolution of digital and service sector Crowdsource business networks Globalisation Millennial value emphasis on experience and connection 5 jobs that didn’t exist 10yrs ago Zumba Instructor Digital Marketing Specialist Cloud service specialist Android Developer Data scientist The nature of work is changing. We will see this through the evolution of digital and service sector, crowdsource business networks and millennial value emphasis on experience and connection.

Looking ahead Upstream integration of health and work issues into undergraduate and postgraduate education Integration of work as a clinical outcome into healthcare professional practice Promote sector as well as locally led approaches , nationally and globally Build national employer led narrative on workplace health, productivity and public health Some of the key actions for PHE in this space are: Increase upstream integration of health and work issues into undergraduate and postgraduate education Integrate work as a clinical outcome into healthcare professional practice Promote sector as well as local locally led approaches, nationally and globally Build a national employer led narrative on workplace health and productivity

Evidence into action Just to conclude and with the permission of Cardiff University, I would like to play this video as for me it’s a real reminder of why addressing workplace health and health-related worklessness is so important.

Thank you Manuel Ramos National Lead for Adult Health and Wellbeing manuel.ramos @phe.gov.uk