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UNISON Scotland
Health & Safety Conference October
2007
Workplace Health
A report aiming to highlight the importance
of workplace health to improve the health and wellbeing of workers
in the public sector in Scotland
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:
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Occupational Health, together with an indication
of whether this is provided in-house or is outsourced
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Counselling service, again seeking information
on whether the service is offered in-house or is outsourced
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Stress – policies available and whether these
incorporate the HSE Stress Management Standards
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Health Promotion such as healthy eating and
fitness programmes
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Bullying and harassment policies
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Alcohol and drug use policies
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Mental health provision
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Suicide prevention strategies
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Driving at work policies
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Health & Safety policies
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.
2. SCOTTISH GOVERNMENT POSITION
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
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Expanding the advisory services on health
and safety for employers and employees
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Developing and promoting worker involvement
in workplace health and safety
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Extending the provision of specific information
and guidance on the protection of public service workers.
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.
4. HEALTH AND SAFETY
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.
5. OCCUPATIONAL HEALTH
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:
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Prevention of injury or damage to workers’
health
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Health surveillance and screening
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Fitness for Work
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Health education and counselling
Problems that can arise from Occupational Health
Services include:
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Recommendations not acted upon
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Competent staff not appointed
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No follow up measurements
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Ineffective workplace monitoring
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Inappropriate health checks
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Ineffectual remedies suggested
6. COUNSELLING SERVICES
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:
"The reaction people have to excessive
demands or pressures, arising when people try to cope with
tasks responsibilities or other types of pressure connected
with their jobs, but find difficulty, strain or worry in
doing so."
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:
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Demands, such as workload, work patterns and
the work environment
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Control – how much say the employee has in
the way they do their work
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Support – such as the encouragement, sponsorship
and resources provided by the organisation, line management
and colleagues.
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Relationships – such as promoting positive
working to avoid conflict and dealing with unacceptable behaviour
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Role – such as whether people understand their
role within the organisation and whether the organisation
ensures they do not have conflicting roles
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Change - such as how organisational change
(large or small) is managed and communicated in the organisation
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.
8. MENTAL HEALTH AND RECOGNISING SUICIDE
RISKS
Closely associated with stress, but not
always connected, is the issue of mental health. NHS Scotland
describes good mental health as a:
"basic component of positive health and
well-being. It is necessary to help us manage our lives
successfully, and provide us with the emotional and spiritual
resilience to allow us to enjoy life and deal with distress
and disappointment,"
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:
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Recognising that all staff have mental health
needs
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Raising awareness of what people can do to
look after their own and others’ mental well-being
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Identifying and addressing factors that can
affect mental health in the workplace
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Building a working culture in which mental
health issues are not taboo.
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Providing support mechanisms which are confidential
and do not stigmatise
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Reviewing work practices to ensure that staff
with a history of mental health problems are not excluded.
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.
9. BULLYING AND HARASSMENT PROCEDURES
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:
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Staff being constantly criticised, having
responsibilities removed or given trivial tasks to do
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Staff being shouted at
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Regularly making one person the butt of jokes
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Constantly attacking someone in terms of their
professional or personal standing
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Regularly and deliberately ignoring or excluding
individuals from work activities.
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.
10. ALCOHOL AND DRUG POLICIES
Again, most employers have alcohol and
drug policies, often combined, which allow employers and employees
to benefit, by providing fair and consistent procedures, health
education and assistance for those with alcohol problems.
Statistics still show that75% of problem drinkers
are in employment and that 25% of accidents are reported as
being alcohol-related, with 6-14 million working days in the
UK estimated to be lost each year due to alcohol-related sickness
absence
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.
11. DRIVING
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.
12. MUSCULO SKELETAL
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:
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Fewer injuries and accidents, leading to lower
insurance and compensation claims
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Reduced absenteeism
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Improved employee morale and staff retention
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Employees more receptive to and better able
to cope with change
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.
16. NEXT STEPS
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.
Branches should encourage workers to become involved
with their employers in working towards the Healthy Working
Lives awards by participating in healthy eating and fitness
programmes. This can be publicised via joint bulletins and newsletters.
17. CHECKLIST FOR SAFETY REPS
UNISON Safety Representatives have a key role
to play in the provision of occupational health services that
operate in their workplace. In particular to ensure that OHS
operates as a team and there is effective accountability and
control. The following checklist provides a starting point.
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Does your employer have an occupational health
policy?
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Do you know who is in charge of occupational
health and safety?
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Do you know how they are provided?
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Were you consulted on the type of services
and who provides them?
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If outsourced have you been consulted over
the contract specification?
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What scrutiny is undertaken of the qualifications
and experience of OHS staff?
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What monitoring takes place to ensure OHS
staffs comply with the Faculty of Occupational Medicine’s
Guidance on Ethics?
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Do you know the type, content and frequency
of health assessments?
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Do you get copies of reports produced by the
occupational health service and are the reports analysed for
trends?
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For example can you identify work related
health issues that have been identified to you Safety Committee
by your OHS?
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Do the occupational health services and health
and safety staff work together?
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
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Scotland's
public service union 
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