How occupational health can support employees through the credit crunch

What effect will the economic downturn have on the UK workforce’s health and wellbeing? And what can OH do to get through the tough times ahead? Nic Paton reports.

On this page:
Presenteeism
Extreme working
Self-service information
Stress, anxiety and absence
Spending on occupational health
Incapacity Benefit.

Whatever the next 12 months hold for the UK economy – and most forecasts continue to be unwaveringly grim – whether the recession will be like the sharp shock of the 1990s, the longer grind of the 1970s or, heaven forbid, a catastrophic re-run of the 1930s, the fallout for occupational health is likely to be substantial.

People’s health and wellbeing tends to be linked inextricably to how good they feel about their work and home life, their job security and the amount of money they have in their pocket. So, given that we’ve all got used to the good times during a decade of boom, what will even a short downturn mean for workers’ emotional and physical health and their ability or willingness to come into work, assuming of course there is even a job for them to come in to?

What’s more, while workplace health has never had a higher agenda than in the past year, what will the tougher economic climate mean for the hard investment decisions that often need to be made around occupational health and rehabilitation? Occupational Health takes a look at some of the key issues.

Presenteeism

In September, Occupational Health’s sister title Personnel Today reported that sick police officers in Lancashire were using annual leave to take time off, for fear that officially reporting their illness would ruin their promotion prospects.

Sadly, as the downturn bites, it looks as though this sort of response to taking time off will increase, with more people struggling into work despite being ill and, more worryingly, more employers and managers expecting them to do so.

A report in October by health insurer HSA found that more than four out of 10 workers felt they were less likely to take time off during a slowdown, with three-quarters of HR professionals agreeing that employees were less likely to take time off sick as a result of job security worries.

Its Healthy Working Report also found a fifth of workers polled would be less inclined to act on lingering or background health issues in tougher economic times.

One-third of HR professionals polled claimed their company encouraged employees to continue picking up e-mails and perform basic tasks while absent from work through illness. A further 15% admitted that, while they didn’t officially encourage staff to do this, it probably took place.

Extreme working

And three-quarters of HR professionals were aware of “extreme working” within their organisation, where employees continued to work through incapacity and illness rather than take a day off sick.

The HSA poll echoed one by AXA PPP healthcare in September which found that nearly three-quarters of workers normally struggled into work, despite feeling so ill they could legitimately stay at home.

As well as not wanting to let colleagues down, a key reason for this was fear, with 15% worried their sick leave records could be used against them if their employer started making people redundant.

“As the economy slows, people are more concerned about how it will be interpreted if they do not come into work,” agrees Richard Halley, head of sales at HSA.

But this sort of presenteeism creates its own array of problems, with workers more likely to pass germs around the office and struggle to be fully productive, meaning that someone else may later have to pick up the pieces. It may also take them longer to recover than if they had stayed at home.

In the current climate it is hardly surprising employers are reporting increased presenteeism, argues Gill Weston, employee assistance programme consultant at Bupa Psychological Services. What employers and occupational health professionals need to be doing, therefore, is ensuring workers and managers are aware of the sources of help that they can turn to, such as an employee assistance programme (EAP), a counselling helpline where staff can get support on work or domestic worries. “It is about positioning the EAP not just as a counselling service but as a coaching one too,” she points out.

Self-service information

The number of people accessing self-service information through AXA PPP healthcare’s EAP has risen by 55% in the past few weeks, estimates healthcare employee support business manager Eugene Farrell, with most of the queries focused on debt and mortgage information.

“The fallout from all this is going to large,” he says. “There has been a mad rush by some clients to set up debt support areas. People are coming to work ill, people are worried about their job and so presenteeism is becoming a massive issue,” he agrees.

With a culture of “last in, first out” still prevalent in many organisations, it will often be younger employers who will be most susceptible to presenteeism, although older workers nearing (expensive) retirement may also feel themselves to be vulnerable, argues HSA’s Halley.

“OH’s role, therefore, is to be setting clear guidelines about what is expected. If the message is stay at home and get fit then you should not be coming back until you are 100% fit,” he says.

Finally, with managers themselves under strain, there is a danger that OH will come under increased pressure to rush people back to work sooner than they feel comfortable with.

Stress, anxiety and absence

Alongside people struggling into work come what may, there are also signs that worries about money, mortgages and job security are having the opposite effect – leading to a surge in levels of stress and anxiety, and prompting more people to call in sick.

Absence management firm FirstCare said in October that the economic crisis was resulting in record levels of staff sickness, with more than 380,000 people calling in sick each day.

Stress was not the only reason, however, with the numbers phoning in sick with flu-like complaints doubling and those suffering from gastrointestinal problems up by one-third. Yet it is likely to be a factor in the background, argues chief executive Aaron Ross.

What is also likely, given that it can sometimes take a while to come out, is that OH will begin to see more stress cases manifesting themselves 12 months down the line, he argues.

According to a survey by Bupa UK Health Insurance in October, more than two in five workers believe stress levels have increased at work since the financial crisis began, with almost a quarter claiming they are now working longer hours to ward off the risk of losing their job. More than one-third were concerned for their jobs as the credit crunch bit, it added.

Unsurprisingly, levels of stress and anxiety have been particularly acute within the City of London and the financial services sector, with independent London mental health hospital Capio Nightingale warning in October that it was seeing a worrying increase in the number of City workers suffering from “Square Mile Syndrome”.

The hospital had witnessed a surge in treatment enquiries since July, with the number of people seeking advice for mental health disorders such as anxiety, depression and stress up by one-third. There was also evidence of increasing dependence on drugs and alcohol, with enquiries up 30%, and a 27% surge in bulimia cases.

“Most of it is stress that is coming in from outside work,” points out Dr Bill Shanahan, Capio Nightingale medical director.

Managers need to know how to react and respond and be able to spot common symptoms of stress and anxiety, he advises. “That is where OH can come into its own in terms of having all the angles covered. It is about getting people to understand people’s responses to stress and what to do, how and when to access help,” he says.

“We have had a surge in enquiries from companies wanting to know what they can do about stress in the workplace; we have had as many queries in the past three months as we have had in the past three years,” agrees Bupa’s Weston.

What employers can be doing in this environment is communicating well and providing reassurance, emphasises FirstCare’s Ross. As well as dealing with stress directly, OH can be taking a more proactive role in promoting good health generally, including healthy eating initiatives and running health and exercise promotions.

Spending on occupational health

The good news is that, as yet, the downturn does not appear to have put any significant brake on spending on workplace and occupational health, though it must be emphasised it is still early days. Many employers review their benefits budgets – which can include spending on areas such as PMI – between January and April, and so the crunch may be yet to come.

However, a snapshot survey of nearly 40 members by the Commercial Occupational Health Providers Association in October  found nearly six out of 10 reporting no change in new business enquiries and nearly half reporting no change in companies enquiring generally.

Nearly a quarter did report a reduction in enquiries from small and medium sized businesses, against a 10% increase in enquiries from large firms. And more than half said they had not yet seen any reduction in the amount of work from existing clients.

Slightly more worrying, nearly one-third said they expected to see a slowing in revenue growth next year, though nearly a fifth expected no change whatsoever.

The possible bad news for OH is that, in tougher times, we are likely to see a much more rigorous oversight of spending decisions, much more requirement to justify and report on return-on-investment and, worst of all, HR being much more proactive in sticking its oar in.

AXA PPP’s Farrell, for example, suggests there is already increased demand for return-on-investment models that can illustrate the worth of a specific intervention or investment. And HSA’s Healthy Working poll reported that HR professionals were under increasing pressure to justify the choice and value of their healthcare benefits in the current economic climate.

Of the 250 companies it polled, almost half said they would be looking for corporate healthcare benefits that provided much more tangible results. Yet, positively, more than a tenth said they were actually planning to increase the range of benefits offered over the next 12 months.

“Employers will want to look at how the health benefits stack up and just what is the justification for spending this money on occupational health, or whether it would be better spent on something else completely different,” points out HSA’s Halley.

“For OH it will be all about arguing the case that this is where the investment needs to be going at the moment, and why,” he adds.

“What I think we will find is that for the next couple of years the softer side of wellbeing, so things such as foot massages, fruit bowls and so on, will be a much harder sell,” agrees Ingolv Urnes, chief executive of Active Health Partners.

The robustness of data gathering, collation and reporting will become a much more important issue, he predicts. “If you are going to make redundancies you want to be confident that have a robust system for tracking absence and the reasons for it. For example, have they been absent because of persistent sniffles or because they are pregnant?

“For occupational health it will be very much about delivering value. Unless OH is able to document the kind of progress that is being made better, then it is not going to be able to articulate the business case in front of finance directors,” he stresses.

Incapacity Benefit

One potentially significant complication of the economic downturn, as yet not much discussed, is what is it likely to mean for all those people the government wants to get off Incapacity Benefit (IB), or Employment and Support Allowance (ESA) as it is now be called, and back into work?

The government’s intention is over time to reduce the number of people on incapacity benefits by a million by getting people with long-term illnesses or health conditions back into work and preventing others from developing long-term illnesses through early intervention. Occupational health is likely to play a key part in making that transition a reality.

Yet, with thousands already losing their jobs between now and Christmas, and thousands more jobs predicted to go next year – not to mention the fact that even firms not laying people off are certainly unlikely to be hiring much at the moment – this is now looking like a deeply challenging ambition, to put it mildly.

This is despite the fact that Prime Minister Gordon Brown, no less, has emphasised that welfare reforms must be “intensified” to help deal with the fall-out from the looming recession.

As yet there is no clear answer. But FirstCare’s Ross points out that, with the government’s finances already hugely stretched, it is likely there will be a much greater onus on what employers can do and should be doing rather than simply throwing money at the problem.

Another OH practitioner, who did not want to be named, argues that, in a situation where there are many more people to choose from, the only likely answer is that employers will need to be given a clear incentive, possibly a financial one, to take people on who have previously been on IB or ESA.

“The government is going to have to find ways to make sure that organisations are motivated to do it. There is only one solution: employers can either be forced to do it or incentivised to do it,” he adds.