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Creating a healthy workforce

29 March 2012

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A wealth of evidence shows that a healthy, engaged workforce brings clear benefits for all. I believe that GP practices, which are of course small businesses, are well placed to lead by example and would want to show leadership on health improvement and promoting healthy lifestyles among staff.

What is not in dispute is that workplace environments and management culture have a major impact on employees’ health and wellbeing. But what is often not seriously considered, or attended to, is the impact that poor employee health has on productivity and business.

The case was clearly made by Dr Steven Boorman’s 2009 review, NHS Health and Well-being.(1) He showed clear links between staff health and better productivity, with, among other things, “improved patient satisfaction, higher levels of staff retention and lower rates of sickness absence.”(1) While this review focused on the NHS, its findings have clear lessons for any organisation – no matter what their size or business. As we move towards the new commissioning structure, the value of prioritising health and wellbeing at work will become even more important to the new clinical commissioning groups (CCGs).

Responsibility Deal
In March last year the government launched the Public Health Responsibility Deal, which is all about harnessing the largely untapped potential of organisations to improve public health through their influence over alcohol, food, health at work, and physical activity. Public health is everyone’s responsibility and government alone cannot solve the major public health challenges we face. Of course, individuals must take primary responsibility for their health, but the way we work together in shaping the environment, including the workplace, is key.

The way the Responsibility Deal works is that organisations sign up to a commitment to take action to improve public health. Practice managers can do this by supporting the health and wellbeing of their staff. This action is expressed as a ‘pledge’. To become a partner you sign up to the principles of the Responsibility Deal, along with at least one of the pledges. Ideally we would hope you commit to several of the ‘health at work’ pledges, as well as considering the ‘physical activity’ pledges, which may also be appropriate (see Resource).

To give some examples, one of the pledges recognises the importance of measuring and publishing sickness absence rates, as well as reporting on the health and wellbeing of employees, for example on your website.

But sickness absence is not the whole picture. “Presenteeism” – being at work but not being able to function to maximum capacity, whether due to the workplace environment, poor managerial relations or unsupported health issues – is often a greater problem. This is why health at work isn’t just about supporting staff who have declared health problems, it should also be about safeguarding and promoting the health and wellbeing of all staff. Employers must reach further and strengthen the preventive function of occupational health.

Managing staff with long-term conditions
Working in health we are all well aware of the impact of chronic health conditions on services and the economy. But this also presents employers with a major challenge, as we are all faced with a growing number of staff with these conditions. This means employers will need to gain experience in the management of staff with obesity, heart disease, diabetes, arthritis, asthma and treated cancers.

We have developed two guides for employers and employees in managing long-term conditions (LTCs), which take a common-sense approach reflecting the least to be expected in a trusting and respectful line-manager/employee relationship. Research shows that getting back to work is often helpful to people recovering from LTCs and reduces the impact of the condition on their health and wellbeing.(2)

The pledge is about embedding the principles of these chronic condition guides within the HR procedures you use. Nowadays, most patients fully understand their condition and will usually know what they need to help them cope, but may be reluctant to speak about what they need to accommodate them. It will help you both to have an open discussion about more flexible working or what adjustments can be made to meet their needs.

Reaching a balance can help improve their productivity and attendance, and the quality of their work, as well as help improve their health and make them feel valued. For example, this may include making simple ergonomic adjustments in the workplace, changes to working hours or more flexible working practices, such as allowing them more breaks or a phased return to work after sickness, adjusting performance targets or redistributing work.

In many cases, such changes are cheap and easy to make. Where a medical condition causes disability, grants may be available to help employers make such adjustments. And ideally, employees should not normally be required to take leave for medical appointments.

Promoting healthy lifestyles
Practices will fully appreciate the importance of encouraging staff to stop smoking. Another pledge is about facilitating onsite stop-smoking services or encouraging staff to attend local services during working time without loss of pay.

Three 15-minute smoking breaks cost employers 195 working hours a year for each employee.(3) Many NHS stop-smoking services run stop-smoking groups or Quit Clubs in the workplace. The cost and employee time of running Quit Clubs is easily offset against the cost borne by employers of employees’ smoking.

There are also a number of physical activity pledges, such as promoting more active travel (walking and cycling) and increasing physical activity in the workplace, whether through modifying the environment, promoting workplace champions or removing barriers to physical activity during the working day. The Responsibility Deal pledges offer a simple and pragmatic way for practices to structure and deliver their approach to improved workplace health.

Staff are our most vital resource and, along with other health organisations, GP practices are very well placed to promote health and wellbeing and lead by example. This is only really successful if it is seen as integral to their work – enabling practices to enhance the service they provide to their community, which includes their employees.

Twenty-seven million of us go to work every day. Many people spend more time working than doing anything else. The workplace offers us a major opportunity to encourage and influence health improvement. And if you’re thinking, “Can we afford to invest in this area of work?” my response would be: can you afford not to?

Dame Carol Black is Expert Adviser on health and wellbeing at work to the Department of Health. She chairs the Responsibility Deal health at work network, one of five networks working collaboratively with business and other organisations to voluntarily improve public health.

1. Boorman S, leading Independent Review Team. NHS Health and Well-being Review. London: Department of Health; 2009. Available from:…
2. Waddell G, Burton AK. Is work good for your health and well-being? London: TSO; 2006. Available from:
3. McGuire A, et al. An Economic Analysis of the Cost of Employee Smoking borne by Employers. London: LSE; 2008.

Responsibility Deal Programme