University of Cambridge Wellbeing Working Group

1. University of Cambridge Wellbeing Working Group Rodger Needham Building, 20 November 2017 Mental Health and the Workplace Dame Carol Black Expert Adviser on Health and Work NHSE and Public Health England Principal, Newnham College Cambridge

2. What are our aims ? Healthy, engaged resilient workers Well-managed safe organisations • A high-performing, workforce • Enhanced productivity Contributing to: • A well-functioning society • Better economic performance

3. The Power of the Workplace The potentialfor large-scale health impact: • 31 million employees in the UK • families of employees extend impact further. Advantages of the workplace: • a microcosm of society, as to age, gender, income, ethnicity • a culture of health at work can reinforce positive health behaviours • good employer/employee relationships can help sustain wellbeing and health • powerful communication possibilities • infrastructure for measurement of health outcomes is often in place.

4. Benefits of Work • Health (with the right type of work, the right job for the right person) • Financial • Social • Status • Discipline/routine • Opportunity We need to do more to : • prevent work from damaging health • promote health of those at work • promote work for those with health problems Galen (129-200) “Employment is nature’s physician and is essential to human happiness.”

5. Good Work • Stable and safe work - that is not precarious • Individual control – part of decision making • Work demands – quality and quantity • Fair employment – earnings and security • Reintegrates sick or disabled wherever possible. • Flexible arrangements – where possible • Opportunities – training, promotion, “growth” • Promotes Health and Well-Being– mental and physical • Prevents social isolation, discrimination & violence • Shares information - participation in decision making, collective bargaining, justice in conflicts (mixture of Marmot and The Work Foundation)

6. Nancy Hey Centre Director A mentally-healthy workplace can influence societal wellbeing Ripple effect : COMMUNITY SOCIETY FRIENDS & FAMILY WORKFORCE Good Corporate Citizenship Wellbeing - What Works at Work Courtesy Paul Litchfield

7. Good Work for ALL Top management • There is a link, in typical pyramid-shaped organisations, between poorer health and wellbeing (mental and physical) and lower motivation and engagement at work. • Recognition of this should inform management thinking about health and wellbeing to enhance productivity. • You need top-down and bottom-up activity. • Workers’ aggregate performance is essential to organisational success. Usually declining income and health Workforce, many more at the foot, is not uniform in health, wellbeing or motivation

8. A mentally-healthy Workplace Key features common to organisations that have improved Mental Health, well-being, resilience and engagement: • Visible senior leadership • Board-level or equivalent engagement • Accountable managers throughout organisation • Enabling engagement • Attention to both mental and physical health improvements • Empowering employees to care for their own health • Evaluation to ensure continuous improvement

9. Engagement • The top driver for employee engagement is how much employeesbelieve senior management has a sincere interest in their wellbeing. (Robertson and Cooper) • About 25% of the variation in reported levels of employee productivity is predicted by a combination of: • - psychological wellbeing • - perceived commitment of organisation to employee • - access to appropriate resources, and • - good communication. Donald et al, 2005 • High staff engagement is not sustainable without wellbeing.

10. NICE Guideline 2015 : Recommendations • Make H&WB a core priority for top management • Value the strategic importance/benefits of healthy workplaces • Encourage consistent, positive approach to H&WB for all. • All with remit for workplace health should address issues of : • physical work environment • mental wellbeing at work • fairness, justice, participation, and trust • senior leadership • line managers’ role, leadership style, and training • job design. National Institute for Health and Care Excellence

11. Understand the challenge So what is the size of the problem ?

12. Britain’s Healthiest Workplace • devised by Vitality Health, the health insurer • produced in association with RAND Europe, the FT, the University of Cambridge, and Mercer, human resource consultants. • The survey seeks to create awareness among employers and employees of the importance of workplace health and wellbeing, …. • … and to build an evidence base for : • - employers to make improvements, and - employees to engage with their modifiable risks. • This year the survey generated responses from nearly 32,000 employees in 167 organisations.

13. The BHW survey process • - online organisationalhealth assessment completed by a representative of the organisation • - voluntary online health assessment completed by employees, who each receive a personal report • - leading to a comprehensive report on the health of the organisation and its employees, benchmarked against others, with suggestions for interventions. • Some recent results : • 54% of employees reported at least one form of work-related stress • 36% were physically active for under 3 hours per week.

14. Sickness Absence (from BHW) Additional days per year lost after an employee reports a new condition, the overall results show on average : - 0.8 days for a musculo-skeletal condition - 2.6 days after insufficient physical activity - 4.0 days after diagnosis of a chronic disease - 5.0 days after being bullied at work - 5.8 days after new money worries - 31 days after reporting moderate or severe depression. Preventing mental ill-health in the workplace is currently our biggest challenge. Financial Times supplement

15. Thriving at Work : Stevenson/Farmer review of mental health and employers Facts that have emerged : (Oct 2017) • 15% of workers have an MH condition • 300,000 with long-term MH problem lose their jobs each year • cost to employers > £33bn per year • cost to State over £24bn per year • cost to whole economy > £73bn yearly. “ It is massively in the interest of both employers and Government to prioritise and invest far more in improving MH.” “ Deloitte’s analyses of cases where investment has been made in improving MH show consistently positive return …”

16. Thriving at Work : Core Standards • “ … a framework for a set of actions which we believe all organisations in the country are capable of implementing quickly.” • Produce, communicate and implement a Mental Health at Work plan • Develop MH awareness among employees • Encourage open conversations about MH and the support available for struggling employees. • Provide staff with fulfilling work, with purpose, and some control. • Promote effective people management through line managers and supervisors. • Routinely monitor staff Mental Health and wellbeing. • Annex A has guidance, suggestions and tools to help implementation.

17. Progress ? • Have we made progress ? YES • Progress by whom ? (often in combination) • Individuals speaking out • Employers • Trade Unions • Government and its agencies • Health professionals • Third sector (charities etc)

18. Prince Harry speaks out … Prince Harry ‘spoke to shrink’ over Diana’s death … … saying that he endured two years of ‘total chaos’ some 20 years after he ‘shut down’ emotions following the death of his mother Princess Diana. He took up boxing because he ‘was on the verge of punching someone, and doing it with pads was easier’. Sir Simon Wessely, president RC Psychiatrists, said the prince had achieved more in communicating MH issues than Wessely had in a 25-year career. “He has a reach across the world that people like me can only dream of.” Three royals spearheading an MH charity Heads Together

19. UK Employers and Mental Health • Examples of positive activity for and by employers: • Continued growth of Mindful Employer • Mental Health First Aid – more aiders, more instructors • Workplace Wellbeing Charter – MH component. • Advice from PHE, NICE etc • City Mental Health Alliance – London-based initiative • NHS – new H&WB programme for staff • BiTC’sLeading on Mental Wellbeing • MIND’s new Workplace Wellbeing Index

20. Leadership in the NHS • Simon Stevens said in his inaugural address on 2 April 2014 : “If like me you believe in a tax-funded NHS you’ll want the Health Service to play its part in growing our nation’s economy, precisely so that we can sustain public health services for generations to come.” “To do this, NHS employees will need to be healthy, both mentally and physically, have good well-being, and be fully engaged in their work towards improved outcomes for patients.”

21. Sub-set analysis : 22 NHS Trusts Mental Health : Of all NHS participants, • 19% had below-average MH and wellbeing scores. • younger staff had slightly poorer rates, as did Ambulance personnel and Nursing or Healthcare Assistants. • 12% of NHS staff report being bullied at work ‘at least some times’ (average 11.6% for the Leadership organisations,12.4% for the matched organisations). • Among all BHW participants the proportion is 6.5%. Obesity : • 31% of workers classified as overweight, 24% as obese (older workers generally have higher levels of weight)

22. NHS Action Project started January 2016 • Eleven NHS organisations, with 55,000 staff, are leading implementation, committed to six key actions, providing: • Board-level director lead, and senior clinician champion • Training for all line managers, Mental Health mandatory. • Health checks for staff aged 40 or over • Staff access to physiotherapy and MH therapies • Healthy options in food sources on site • Physical activity - Cycle to Work, walking groups, yoga. • Plus full implementation of NICE Guidelines on workplace health, and a CQUIN (a financial incentive to promote Health and Wellbeing).

23. Barts Hospital, London : Psychologically Safe Manager Workshops Q.9 What will you start to do differently after the workshop? (example responses from participants in one workshop) Courtesy Dr Attfield, Barts NHS Trust

24. H&WB CQUIN Staff Survey : Progress against targets NHSE require 5% improvement year on year Courtesy Dr Attfield, Barts NHS Trust

25. Collaborative working PHE and Business in the Community “ an interconnected suite of toolkits for employers to support employees’ mental health and wellbeing” They address difficult issues : - taking the first steps towards an open, healthy and supportive workforce – helping to build a culture that champions good mental and physical health. Training on MH for line managers

26. BiTC : Line Managers – recommendations • Recruit/promote those with strong interpersonal skills • Induct them on organisation’s approach and facilities • Incentivise them to act as role models for wellbeing … • … and encourage open culture around mental health. • Include interpersonal skills as key training component. • Include in appraisal : wellbeing of their people. • Equip them to look after their own mental wellbeing. • Develop simple pathways to further support.

27. Progress in different sectors NHS Fire Service Each sector defining its own needs. Construction The City (Mental Health Alliance) Police Service

28. Mates in Mind Suicide kills far more construction workers than falls –let’s get construction talking. We know the pressures in construction, and we know that people are people, whoever and wherever they are. Life changes, and families, friends and workers in construction all need a helping hand from time to time. Mates in Mind is a charitable programme to improve and promote mental health in construction – with partners promoting awareness and understanding

29. Success • Many examples of good action BUT • Evaluation of interventions and schemes is still lacking • Need to concentrate on evaluation, and sustainable outcomes. Cambridge should lead the way !

30. Impact of Mental Health interventions on workplace outcomes • Synthesis of 14 systematic reviews evaluating impact - increased productivity, less absence, reduced costs. • Overall found moderate evidence for the value of Mental Health interventions in relation to workplace outcomes. • Most studies linked MH interventions with improvements to MH functioning, but did not explore workplace outcomes. • Further research, linking interventions to workplace outcomes, is necessary. Wagner SL et al. Int J Occup Environ Med 2016; 7: 1-14

31. Evaluation • Collect data on participants in a consistent way – management information for many programmes is deficient, making assessment much more difficult. • Have some comparisons – RCTs are preferable, but any form of control, e.g. between areas or over time, enables data to be set in context. • Ensure that there are clear outcome measures at the outset, and collect data to assess them. • To get useful evidence interventions must be consistently applied over time, and not keep changing. • In conversation with Jim Hillage

32. Wellbeing Strategy, Cambridge U New website: www.wellbeing.admin.cam.ac.uk Wellbeing Strategy Statement, June 2017 • … commitment to an integrated approach to staff wellbeing that creates: • a sense of belonging • an environment and culture based on shared values and trust … • … where staff wellbeing is integrated into day-to-day practices • …. that recognises skills and encourages personal development. • Priorities for 2017-18 : • Mental Health awareness • managing work demands • developing new website. • Operational Health and Wellbeing Working Group tomeet for the • first time in November 2017.

33. Continue to promote change We are on an unfinished journey