Fit for purpose

Don’t underestimate the impact healthy employees can have on your organisation’s productivity. The introduction of the ‘fit note’ is a government initiative to get employees back to work more effectively but there are many other steps businesses can take to improve employee well-being. By Katie Pattullo

According to the Working for a Healthier Tomorrow report conducted by Dame Carol Black in 2008, absence from work due to illness costs the British economy £100bn each year. This is likely to have had some bearing on the introduction, on the 6th April of the ‘fit note’, the idea being that it replaces the old ‘sick note’ and aims to provide more useful information on how your employee’s condition affects what they do and how they might be able to return to work. A doctor will give a ‘may be fit for work’ statement if they think your employee’s health condition may allow them to work – as long as you give them the appropriate support.

The benefits are obvious, the primary aim being to cut down on the days lost through sickness and encourage employees back into the workplace. The biggest challenge to the success of the fit note is the shift in attitude required from GPs – they are being given far greater responsibility in employee health with little or no knowledge about an employee’s work situation. Aside from the fact they are only getting one side of events, there must be a question over how much, if any, contact they will have with a patient’s workplace, let alone the issue of time involved. Many GPs are
already under considerable pressure to fit enough appointments into their daily schedule. 

Dr Michael Fitzpatrick, GP at Barton House Group Practice in London, thinks any initiative that aims to get people back to work as quickly as possible has got to be a good thing both for the individual and the organisation.“Work is a therapeutic thing for people, just getting out of the house in the morning is very good. One of the worst things for people is prolonged inactivity. It is easy to see how the structure of people’s lives can corrode when they’re not at work,”
says Fitzpatrick.

“But there’s a wider problem,” he adds, “over the last 20 years or so the construction of subjectively determined disease labels means that if somebody says they’ve got chronic fatigue or back pain and that they’re incapable of working, there’s no objective way of confirming that this is the case one way or the other.”

Richard Roberts, group director of employee engagement with facilities and energy management specialist GSH, agrees with Fitzpatrick that fundamentally the fit note is a step in the right direction: “I think overall it’s a good idea. But to me the essence of engagement is the trust between manager and employee. I would like to think if that was working well there wouldn’t be a need for the GP to intervene because the employee would be discussing rehabilitation with their manager anyway.”

But as with any new initiative there are likely to be teething problems. Graham White, director of HR at Westminster County Council, thinks there are many hurdles still to overcome for managers. “Some are still sceptical that it will delay returns rather than accelerate them and they fear GPs will be unable to move away from solely being patients’ advocates. With good engagement, including contact with GPs, employers can be helped to move from seeing it as a negative challenge to an option for positive engagement.”

Keeping active
Perhaps the solution to any sickness ambiguity is not to get sick in the first place. In May 2008 the National Institute for Health and Clinical Exellence (NICE) released guidelines on workplace health and how to encourage employees to be more physically active.

Some advice includes introducing flexible working policies and incentive schemes to being more physically active. They also advise introducing policies to encourage employees to walk, cycle or use other modes of transport involving physical activity to travel to and from work as part of their working day. Information on how to be more active and on the health benefits of such activity should be easily accessible to all employees by their employers. This could include information on local opportunities to be physically active (both within and outside the workplace).

NICE also recommend that organisations offer their staff a confidential, independent physical health check administered by a qualified practitioner.

Mental health
It’s not just physical sickness that can affect the productivity of an organisation, psychological well-being plays an important role and can be a major contributor to long-term illness. WHO (The World Health Organization) have estimated that by 2020, depression will become the greatest cause of work-related disability and second only to heart disease as the leading cause of disability in general. On top of this they have found that each case of stress-related poor health leads to an average of 30.9 working days lost each year.

“The big areas of expansion of work-related absence are in psychological areas, and in chronic back pain and fatigue – these are the biggest differences in long-term disability over the last 20 years,” explains Fitzpatrick. “There are very important cultural and social forces that have encouraged this trend. Any individual GP is in a very difficult situation to combat them.”

To back this up, data from the Department of Work and Pensions shows a steady increase since 1996 in claims for incapacity benefit in relation to mental and behavioural disorders.The benefits to the company of their employees having higher psychological well-being, according to business psychologists Robertson Cooper, are that these individuals see ambiguous events less threatening, are less hurt by unfavourable feedback and use less contentious interpersonal tactics.In challenging times the effect of work-related stress undoubtedly has an effect on an organisation’s productivity as employees contend not only with work issues – such as the constant worry of redundancy and taking on extra work from recently departed colleagues – but the stress of maintaining a standard of living at home. According to the Confederation of British Industry the top two causes of long-term illness for non-manual workers are firstly, non-work related stress and, secondly, work-related stress.

Gordon Tinline, director at Robertson Cooper, says: “There is a need to keep things in perspective, it is important to step back from current work-related pressures and consider the bigger picture in terms of what is truly important in your life. And as far as work is concerned, yes, there are demands of more with less, despite there being still only the same number of hours in the day. This is exactly the time to examine how organisations, teams and individuals approach and tackle their work; asking whether there are ways of working smarter to ensure time is spent on the right challenges – not dealing with hindrances and work that produces very little.”


Nutritional benefits
All employees eat, but how many eat well? Busy schedules, long commutes, indulgent business entertainment, skipped breakfasts, nutritionally impoverished canteens and vending machines, all make it increasingly difficult for employees to find the time to prepare, cook and eat a balanced healthy diet.

Can organisations actually change their employees nutritional patterns/lifestyle through what they offer at the workplace canteen and, by way of this, how they eat at home? There was much publicity around Jamie Oliver’s ‘Feed Me Better’ campaign in schools where he heroically persevered in his efforts to shift the mindset of both pupils and canteen staff from turkey twizzlers to tomato and thyme pasta. Despite the proven effects of a healthier eating programme on behaviour, he came up against a huge amount of resistance not just from children but, surprisingly, from their parents.
So, can it work in the workplace? Can you force your employees to lead a more nutritious lifestyle? Robin Collie, managing director of Food@Work who run a corporate nutritional wellness programme, is adamant that for organisations to be able to achieve actual change they need to go far beyond what’s on offer in the canteen.

“Our recommendations to organisations is that having healthy and nutritious food in the canteen is almost a default. On top of that you have to encourage or engage people in wanting to make nutritional change so they can see the benefits of what change is going to do for them,” says Collie.There are a number of ways organisations can encourage a more nutritious lifestyle. Organising live events for your employees in the form of a half-day healthy eating workshop – with or without hands-on cooking – is just one of the options available. Some companies use print material, such as leaflets or guides. DVDs can also be provided electronically on corporate intranets. Employees themselves can download apps for their iPhones to monitor calorie intake and consumption through exercise and daily activities.

“The secret to a successful nutrition wellness programme,” explains Collie, “is a combined multimedia strategy that is planned at least 12 months in advance. It should be benchmarked at the beginning and include a series of live, interactive, electronic and print initiatives. And then you need to measure it at the end of that period. You will be able to see what improvements have been made and what areas need to be worked on in the future.”

Link to engagement
A study by Harter, Schmidt and Hayes in 2002 looking at nearly 8,000 separate business units in 36 companies found a definite relationship between increased engagement/well-being and business unit performance – as defined by customer satisfaction, productivity, profit and employee turnover.

Not all organisations have the budget or the space to install gyms or have their own canteens offering organic, fresh produce to energise their workforce but there are many low-cost and effective ways to encourage a sense of well-being and health consciousness in today’s workforce. Whether it is organising out-of-work team sport activity, discounts to a local gym or yoga sessions in the company meeting room at lunchtime, the rewards in terms of productivity and engagement are clearly worth the extra effort.

As Sam Smith, colleague relations team leader at food retailer Asda, explained: “What we’re trying to do is raise awareness, but we don’t want to force people into a healthy lifestyle if they don’t want to do that. It’s about raising awareness and giving them better choices within the store. People are with us for eight to nine hours a day so it’s important we should try and educate them where we can.”

Whatever budget or guidelines companies have for the well-being of their staff, at the end of the day it is up to the employee themselves to decide how they sustain it in their own lifestyle. This employee responsibility and their involvement in the construction of the programme will be key to the success of any well-being programme.