1. INTRODUCTION

There is more and more emphasis being placed on health and wellbeing in the workplace, which now takes a much broader view of workplace health than the traditional occupational health issues, envisaged in legislation such as the Health & Safety at Work Act, 1974 and subsequent European legislation.

Many employers are coming to recognise that addressing some of these wider issues can create a more productive workforce, with less absenteeism and greater retention of employees, whilst at the same time enabling their workers to lead more full and satisfying lives. Despite this the UK has the lowest level of occupational health provision in the developed EU and one of the worst records in Europe for the return of employees to work after long-term illness.

UNISON Scotland has identified several aspects of workplace health and has carried out a freedom of information request of all employers in those areas of the public sector where UNISON organises, asking them to provide information and any policies they may have on the following topics:

This report aims to look at the latest developments and research in these and other areas, such as musculo-skeletal diseases, (often associated with the use of Display Screen Equipment); identify best practice and assess how these are being applied across the public sector in Scotland.

Governments in both the UK and Scotland have recognised the importance of promoting health and wellbeing for all those in work. In March 2007 the Scottish Executive (now Scottish Government) published its Health & Safety Action Plan. The Plan acknowledged that Health & Safety at Work was a reserved issue but the then Justice Minister, Cathy Jamieson said that the Scottish Government had an important role to play in promoting health and safety, in partnership with the STUC, with employers across all sectors of the workforce in Scotland.

The Action Plan had been developed by the Partnership on Health & Safety in Scotland (PHASS), and organisation set up in 2005 by the Health & Safety Commission (HSE), supported by UK and Scottish Ministers, to implement their strategy for workplace health to 2010 and beyond in Scotland.

Commitments in the Plan included

A £1.2m investment was allocated for 2007-08 to provide additional services to employers and employees primarily through the Scottish Centre for Healthy Working Lives.

3. THE SCOTTISH CENTRE FOR HEALTHY WORKING LIVES

The Scottish Centre was established in 2003 to improve the health of working age people in Scotland by ensuring healthier and safer workplaces, promote healthier lifestyles and to develop the field of employability throughout Scotland. The Centre originally operated the Scotland's Health at Work Award Scheme, (SHAW), transformed in February 2007 into the Healthy Working Lives (HWL) Awards.

Building on the success of the SHAW awards, the programme encompasses a wide range of topics enabling organisations to select those that are most relevant to the workforce, including health promotion, occupational health and safety, health and the environment, mental health and well-being, community involvement and employability.

SHAW was a national health partnership comprising CBI Scotland, STUC, Scottish Enterprise, Highlands and Islands Enterprise, COSLA, the Health & Safety Executive, the Federation of Small Businesses, the Scottish Executive, NHS Health Scotland and the 15 NHS Boards. The programme, aimed to encourage and support workplaces to make the active promotion of good health an integral part of Scottish corporate culture, through a network of specialist workplace advisors, based within each NHS Board.

The Centre also has the responsibility for implementing the Scottish Executive's strategy ‘Healthy Working Lives - A Plan for Action', published in 2005. The starting point for implementing the strategy was to join together and unify the SHAW national award scheme, Safe and Healthy Working and the business and employability strands of Scotland Against Drugs for national delivery under its overarching banner.

The promotion of health and wellbeing in the workplace will not be effective, however, unless it is part of a comprehensive approach to Health & Safety.

Employers, together with workers and their representatives, have a statutory duty under the Health & Safety at Work etc., Act 1974 and later regulations under that legislation, together with more recent European regulations, such as the Management of Health and Safety at Work Regulations 1999, which required employers to carry out risk assessments on all of their workers and to introduce measures to minimise the effects of any hazards which may be present.

Measures and policies introduced under the legislation and subsequent regulations must be reviewed regularly, with trade union representatives, who can make valuable contributions about any improvements needed in a workplace. Under the Health & Safety at Work, etc. Act, safety representatives have a wide range of rights and functions and regular meetings of health and safety committees are the ideal fora to discuss issues of mutual concerns.

As would be expected, all of the employers in our survey had Health & Safety policies, as required under the 1974 Act.

Occupational Health Schemes have a major part to play in preventing ill-health through work and in ensuring that people can return to work as quickly as possible after an illness.

The Health and Safety Executive has identified two elements to occupational health. Firstly, in the effect of work on employees' health and the health of others, by identifying what can cause or contribute to ill health in the workplace; by determining the action required to prevent people being made ill by work and by introducing suitable control measures to prevent ill health, such as back pain. Secondly to ensure that people with health conditions, or who have a disability or impairment are not unreasonably prevented from taking up job opportunities and by adapting work practices so that people at work are fit to perform required tasks.

There has been greater emphasis on the latter element, due to the requirements of the Disability Discrimination Act and to the Government's attempts to cut the amount of people claiming Incapacity Benefit by encouraging them to engage in rehabilitation programmes and returning to work. Specifically through Workplace Health Connect a government funded service on return to work issues.

The Scottish Centre for Health Working Lives can offer a variety of free and confidential occupational health and safety services through their network advisers. The service allows organisations and individuals to better recognise and address occupational any health and safety problem or workplace issue that they may be experiencing. Components of the service include an advice line; a website with free downloadable material and an email enquiry service and a network of advisors who visit workplaces and can carry out a free and confidential workplace assessment and provide an action plan for the organisation, where required.

The rise in Occupational Health Services has come about mainly to address issues of sickness absence which has become a great concern of organisations, both in the public and private sectors.

Most of the employers in our survey either had their own occupational health network or employed commercial enterprises to provide a service. Many offered a mixture of both. Those who preferred in-service provision often had their own doctor, an occupational nurse and in certain places, physiotherapists. One also employed the use of a Cognitive Behaviour Therapist to assist with mental health and stress issues.

The public sector in Scotland has to a large extent, however, followed the private sector in outsourcing what are seen as non-core functions and this has meant a huge growth in the provision of external occupational health services, which is expected to grow by 35% over the next five to ten years in the public sector. Occupational health is now required to deliver a wide range of services, including health promotion schemes, advice or involvement in the handling or psychosocial health issues, employee assistance programmes, counselling, etc.

In many cases external services will replace the existing in-house provision. However, despite external providers being able to make a better business case for their services, there are many disadvantages to outsourced services, and even the perceived financial savings might be short-lived. When you out-source, you lose control over the service and once you have lost your internal expertise it is often difficult to get it back again. An external contractor may offer a good contract, offering considerable cost savings, but when it comes to renegotiating the contract, and the contractor knows that your in-house provision has gone, they are then in a position to charge much more and the employer will have to pay it. Losing control can mean that you have lost the ability to do things in-house and can be receiving a worse service for more money. Certainly, in-house provision is shown to be the best option when you have a large number of staff located at a single site, when any travelling costs for in-house OH practitioners will not be incurred.

It has also been found that it can take up to two to three years for an external provider to gain an understanding of the workforce and its activities and develop trust with staff.

Employers have also to be aware that any external provider they may contract to advise them on occupational health issues, particularly if they use them to advise whether or not staff are unfit for service, cannot be regarded as independent under superannuation regulations to determine ill-health retirals.

This reflects wider staff concerns over the independence of contracted OH services. These contractors are inevitably focused on contract renewal and as a consequence are more likely to value the requirements of employers offering the contract than staff who are the recipients of the service. The need to offer the lowest price can also impact on the quality of the service. UNISON Scotland is increasingly concerned over the number of cases referred to the union that reflect less than satisfactory occupational health services. We will be undertaking further membership surveys on this point and advising branches to scrutinise more closely the training, qualifications and experience of occupational health staff and monitor that they are complying with the Faculty of Occupational Medicine's Guidance on Ethics.

A good Occupational Health Service should cover many elements, including:

Problems that can arise from Occupational Health Services include:

Counselling services are being used more and more by employers to provide a free and confidential mechanism for employees to discuss a variety of issues including general and specific illnesses, such as cancer; mental health, stress, equality or discrimination issues, etc.

Many employers incorporate their counselling services into their general Occupational Health provision, sometimes by the same provider. Most of the services are provided externally.

7. STRESS

Stress is now the second most common work-related illness, with over 500,000 people a year affected in the UK each year, although this is not always recognised by employers. However, a recent survey of HR professionals in the public sector believed that stress was the greatest threat to their employees.

The HSE defines work-related stress as:

Many organisations, including UNISON and the TUC, have published guidance on tackling workplace stress and in 2004 the HSE produced its Stress Management Standards in an attempt to persuade employers of the need and benefit to them of introducing the Standards into their health and safety practices.

Evidence shows that relatively low-impact measures to redesign work have disproportionately high effects on both business outcomes and the stress and mental health of their employees.

The main principles in the HSE Management Standards are:

Many of the public sector employers surveyed did have stress policies, but several of these were out of date and did not include the HSE Standards.

So everyone has mental health needs and according to the Office of National Statistics, nearly three out of ten employees will have a mental health problem in any one year (1995). In the workplace, difficulties can be compounded if those suffering mental health disorders are discriminated against.

There are several steps that can be taken to address problems caused by mental health in the workplace, which can include:

As mental health has not been recognised as an issue in the workplace until quite recently, it is not surprising that most of the employers surveyed did not have specific policies. Some did recognise it as an issue and referred to it in their occupational health and counselling policies. Only one or two had actual policies which covered the issue satisfactorily, and clearly this is an area for much more attention in the future. The Scottish Centre for Healthy Working Lives has introduced the Mental Health Commendation Award as part of its Award schemes, and one or two employers said they were working towards this.

Employers were also asked whether they had any policies on Suicide Prevention and not surprisingly, very few referred to the issue at all, although a few did refer to it in their occupational health and counselling policies.

Through its strategy and action plan, "Choose Life", the Scottish Government is attempting to highlight the issue, and decrease the rate of suicides in Scotland. UNISON's Scottish Committee together with the Health & Safety Committee are currently examining the policy, with a view to introducing a limited stewards' training programme to recognise people who may be at risk and to enable stewards to persuade them to seek further help from appropriate agencies.

Bullying and harassment on the other hand, have been recognised as workplace issues for some years, and most employers did have policies in place to deal with it, on both bullying and harassment, and, increasingly, Dignity at Work policies. However, it is a growing issue, particularly in the public sector and stewards and safety reps need to be vigilant, particularly as many people do not report it and it can remain a hidden problem which is accepted, or even encouraged by the culture of the organisation.

A new booklet by the TUC identifies a number of positive steps that safety reps can take to raise awareness of the issue and tackle bullying in the workplace. Posters and leaflets can raise the issue with members which may encourage them to discuss any problems with the steward. Routine safety inspections can also be used to speak to members about it. Surveys are another way of helping members to report problems.

Examples of bullying behaviour can include:

Bullying can have serious consequences for the individual in question, leading to stress and ill-health, with many consequential problems. In addition, employers can pay a high price for failure to address a bullying culture, both in sickness absence, low morale, leading to low productivity across an organisation, and often high turnover of employees who would rather leave than raise the issue. There are also financial penalties if a member of staff successfully pursues a claim against their employer.

Many employers are introducing Dignity at Work schemes and this is a positive development in tackling the underlying organizational culture.

Drugs can also interfere with the ability carry out work tasks, and it's not only illegal drugs like cannabis and ecstasy, which cause problems. Prescribed medicines and some over the counter remedies can impair tasks, such as driving and operating machinery. Some strong painkillers, tranquillisers, epilepsy or sleeping medications, as well as hay fever and cold remedies can also cause drowsiness.

Employers are increasingly turning their attention to the introduction of more stringent driving policies. In many public sector organisations, driving is the biggest risk to their workforce and increasing emphasis is being placed on managing this risk by the introduction of driver testing and fitness to drive assessments.

A few employers sent in driver policies and several indicated their intentions to introduce such policies in the near future, which were being prepared at present, together with Driving at Work guidance.  

Musculo-Skeletal disorders are the biggest cause of sickness absence in the UK, with back pain in particular being the most common. Most people who suffer back pain will not suffer any long-term problems, as most back pain settles quite quickly, although it can reoccur on future occasions and experts now recommend activity as the best remedy to make sufferers feel better. Most back disorders are blamed on the accumulation of months or even years of poor posture, faulty body mechanics, stressful living, loss of flexibility and a general lack of physical fitness.

A recent study by the British Chiropractic Association has shown that it is office workers who are at greatest risk of back problems than excessive lifting and carrying previously thought to carry the greatest risk. The sedentary posture of most computer-using office workers is contributing to their problems with lumbar problems.

In the workplace, employers and safety representatives must review risk assessments for Display Screen Equipment on a regular basis and ensure that staff are not being put at risk because of the work they do. Staff must be encouraged to report aches and pains as soon as they occur and management must take these seriously. Employers must introduce adjustments if necessary to help employees remain at work and if sickness absence occurs, help them back to work as quickly as possible.

The European Health & Safety Week, 2007 will concentrate on Musculo-Skeletal Disorders, including back pain, to highlight the problems caused to millions of workers across the Continent.

13. HEALTH PROMOTION

Very few employers had specific policies, however, most reported that they had achieved the SHAW awards at the various levels and were now working on converting these to the Healthy Working Lives awards.

Most employers reported that via Health Improvement strategies they encouraged staff to eat more healthily and had instigated fitness programmes, often in conjunction with their leisure and sports departments. The introduction of the Smoking Act has continued to highlight smoking cessation programmes and many employers encourage their employees to participate in these programmes, often with time being granted to attend.

14. VIOLENCE AT WORK

Closely linked to bullying, harassment and stress is the high level of violence both physical and verbal that public service workers endure every working day in Scotland. In September 2006 we published the most comprehensive survey on this issue (http://www.unison-scotland.org.uk/safety/violencesurvey.pdf) that showed some 20,000 reported incidents every year in Scotland in the health and local government sectors alone. We set out the actions that needed to be taken and will shortly be producing an update report on this issue.

15. CONCLUSION

Creating a healthy workplace can be of great benefit to both employees and the organisations they work for. How healthy a person feels affects their productivity and how satisfied they are with their job affects their own health, both physical and psychological.

Where organisations proactively improve their working environments, by organising work in ways that promote health, all adverse health-related outcomes, including absence and injuries, decrease.

There are, therefore, many benefits to both employees and employers of a healthy workplace, including:

Good occupational health schemes have a major part to play in preventing ill health through work and a greater priority and higher profile needs to be given to them. Public bodies must ensure that their employees have reasonable access to occupational health services that are not only cost effective but also maintain staff confidence in both their quality and independence.

This report is being launched at UNISON's Scottish Health & Safety Conference on 12 October 2007 for delegates to consider how they can assist in improving the health and wellbeing of their members in their workplaces.

UNISON Branches must work with employers to ensure that health and wellbeing at work policies are introduced and implemented throughout all public sector workplaces in Scotland. In particular, Health and Safety representatives must examine all of their employers' policies to assess whether they take into account the latest evidence and good practice in all areas, and if there is no particular policy, work with the employer to produce one.

UNISON has growing concerns over the accountability and control of OHS across the public sector. We will be undertaking further work on this issue in the coming months.

Further Information

UNISON Guide to Occupational Health Services

http://www.unison.org.uk/safety/doc_view.asp?did=177

TUC rehabilitation pages

http://www.tuc.org.uk/h_and_s/index.cfm?mins=260

Scottish Centre for Healthy Working lives

http://www.wellscotland.info/healthy-working-lives.html

HSE

http://www.hse.gov.uk/

British Occupational Hygiene Society

http://www.bohs.org

Faculty of Occupational Medicine

http://www.facoccmed.ac.uk/

For further information on this report contact:

Dave Watson, Scottish Organiser

d.watson@unison.co.uk

Diane Anderson, Information Development Officer diane.anderson@unison.co.uk

Policy and Information Team

UNISON House, 14 West Campbell Street, Glasgow G2 6RX