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“2020health is an important and thoughtful contributor to the health debate”

Dr Sarah Wollaston MP, Chairman, Health Select Committee


2020health Roundtable 'Health, disease and unemployment' Report Launch

Jul 01. till Jul 01.

Health, disease and unemployment: The Bermuda Triangle of Society

A 2020health roundtable discussion attended by Dame Carol Black.

July 1, 20102010-07-01T08:30:00 - July 1, 2010 2010-07-01T10:00:00
8:30 AM 2010-07-01T08:30:00 - 10:00 AM 2010-07-01T10:00:00
Church House, Westminster

These are the summary notes of a discussion that took place on 1st July 2010 welcoming the 2020health's 'Health, disease and unemployment' report. We will be exploring further the development of health and wellbeing at work throughout 2011.

This event was a culmination of a series of interviews and workshops that looked to examine the relationship between work, ill health and employment – the Health, disease and unemployment: The Bermuda Triangle of Society.

After a presentation by the lead author, Jonathan Shapiro, on some of the key findings of the report, attendees discussed some themes from the report, while also explaining their respective experiences in this field. The objectives of the roundtable were:


a.       To facilitate a substantive discussion among attendees on the topic of ‘valuing work as a public health outcome’ or ‘the Bermuda triangle of society’ – including identifying challenges and examples of best practice in the move towards a more work-focused NHS and more health-aware workplaces.


b.      To identify areas of difference and agreement in terms of the findings and recommendations of the report.


  1. Ben Wilmott, CIPD
  2. Bob Grove, Sainsbury Centre for Mental Health
  3. Abi Levitt, Tomorrow’s People
  4. Charlie Easmon, Number One Health Group
  5. Louise Aston, Business in the Community
  6. Len Gooblar, Abbott
  7. Dame Carol Black, DH/DWP
  8. Lynn Young, RCN
  9. Ailsa Bosworth, NRAS
  10. Brendan McLoughlin, Commissioning Support for London
  11. Nick Kendall, KendallBurton
  12. Charlotte Santry, HSJ
  13. Jonathan Shapiro, 2020health/University of Birmingham
  14. Julia Manning, 2020health

Event Summary

Roundtable discussion – Key themes and conclusions


1.       Work as an outcome

·         Being able work as an outcome of medical assessment and treatment was identified as being absolutely essential.

·         Many of the attendees noted that medical training needs to include to a greater extent the notion of work as an outcome.

·         It was noted that cutting benefits is not the correct way to get people to return to work (it was clarified that the report notes that cutting benefits should follow a return to work, rather than the other way around).

·         Change needs to happen within workplaces on the one hand, and within the NHS if we are to recognise work as a legitimate outcome of successful treatment and care.

·         What changes do we need to implement in practice to make work an indicator for the NHS?

·         We need to incentivise commissioners to consider wider cost benefits beyond the NHS – i.e. in work and pensions and social services.

·         “Employment is a health intervention”.

·         Abbott is delighted have been able to provide sponsorship to support independent research in the area of health and work, and in particular, a more outcome-focused approach to supporting work participation.


2.       The importance of early intervention and ‘rescuing’

·         The core function of HR/OH should be case management – the person should be at the centre and HR/occupational health should fit in around this. This was identified as being important for employers and patients so as to ensure that the minimal impact of illness was felt by both parties.

·         It is difficult to tackle welfare reform due to the problems in the Labour market, but we can improve the conditions in which people work.

·         This report is in keeping with the prevention agenda, but an important question for the report is what steps we need to take to rescue individuals from the Bermuda Triangle. This ‘rescue’ will be different for each person.

·         There is further work to be done to understand the interventions that could best help lift the 2.6 million people out of the benefits trap.

·         Tomorrow’s People provide a service that gives people more time with an advisor, and is based on a comprehensive assessment of an individuals circumstances. It is essential to develop a trusted setting where we can rebuild the confidence of those that are out of work. Job Centres time constrained appointments have no real capacity to help people and no link to the benefit system. Need to recognise that a person’s confidence is key and need time to build that confidence.

·         The key to improving the return to work rate is in building trust with clients over a period of time. The process cannot be rushed. The arbitrary time based nature of state-led interventions can hinder success.

·         Recognises the benefits of spending money early to avoid later consequences.

·         Small case load and co-creation model is more time intensive – this is costly and there is therefore a need to invest.

·         We have a problem in dealing with medically unexplained symptoms.

·         The long term sick are more likely to have experienced a poorer quality education. The time that is spent on sick leave should be used for extra training and skill development. We need investment now, rather than suffer later consequences.


3.       The role of employers and HR services

·         It was clear to most of the attendees that employee management needs to improve, particularly so that employers are more acutely aware of the concept of health and work. Many of the attendees noted that some employers currently have a poor mindset towards the health and work and do not cater for their employees appropriately in this respect.

·         The role of the line manager was identified as being essential in making sure workplaces account for ill health and early intervention.

·         As part of employers improving their role in accounting more appropriately for employee wellness, HR services need to develop so that they have a broader remit.

·         There is a question whether there is such a thing as ‘good work’ as it is arguably an academic concept, but good management is something we should be delivering.

·         We need better management systems, a greater employee voice and improved people management skills for line managers.

·         The MacLeod Review on people engagement sets the right strategic framework.

·         Government managers from across the public sector should be targeted in the drive to increase skills, and to make better use of existing training budgets.

·         There is excellent NICE guidance on healthy and productive workplaces, and the Management Standards are already in place but need to be used more. The HSE needs to take a tougher stance towards businesses that don’t implement such standards and should be more involved in risk assessments for stress.

·         We are in a situation where businesses are trying to do more for less.

·         Emotional health is critical in terms of workability.

·         The role of the line manager is critical in driving a case management approach.

·         The private sector appears to be more focused on occupational health and helping their employees return to work than the public sector.

·         One of the answers lies in high quality HR management. The problem is that some organisations are ‘toxic’. A person’s working environment is essential to their wellbeing and this needs to be examined by all organisations.

·         There is a link between employee wellness and the success of the organisation. The quality of the HR function is a barometer for the organisation.

·         The problem is that a lot of businesses that are small don’t have a HR department.

·         It is difficult for small companies to cater for ill employees. The impact on a small company of a person being off sick is much more substantial compared to a larger company.  There is no easy answer to this challenge.  If the employee is valued they will be more likely to get support.


4.       The broader role of occupational health and medicine

·         Occupational health needs to be transformed as it is not currently fit for purpose.

·         Many of the attendees identified occupational health as being important players in realising the relationship between employers, patients and HCPs. Occupational Health were identified as having the potential to play in designing government policy that is suitable for employers, HCPs and patients.

·         Models to help people back to work are not appropriate to all scales and contexts

·         Employers can have a poor mentality in regard to occupational health.

·         Equally Occupational health can often have trouble reporting accurately back to top level managers. This is because the OH are often directly employed by the top level managers and do not want to criticise company practices.

·         Health and wellbeing needs to be a more central component of the HR role, rather than just remuneration, training and benefits.

·         There is a tension in terms of who is being served by the occupational health provider – the employer or the employee. Who the provider is ultimately accountable to makes a difference.

·         There are cases where sub-optimal treatment is provided – particularly within the NHS

·         We need to change the mindset of the employer – if they spend money on employee health they will easily make a return on their investment. Employers and should not always wait and rely on the NHS to deal with work place ill health, employers can make smart investments themselves.

·         There is a disconnect between HR, occupational health and health & safety.

·         We need to encourage occupational health to help the Deans of the medical schools to make this happen. However, it is quite a complicated process to change the curriculum. There is no resistance from the top level of the medical colleges, the challenge is converting those that design the medical training programmes. There needs to be a high quality occupational health offering, but the current provision of occupational health is not suitable – it has not developed in tandem with the needs of the population, especially in terms of mental health.

·         We need a service that encourages vocational rehabilitation and the occupational health services need to take a lead in this. Government won’t legislate on the issue.

·         The Fit Note is not always used by GPs but, when it is, it works. The Royal Mail is an example of an organisation where the Fit Note has been used effectively.

·         Making health professionals more work-focused isn’t a complicated issue, it’s about asking simple questions about work status and what kind of support could be offered.

·         We need to establish a dialogue between patients , GPs and employers to support work participation.

·         Some clinicians are not following best practice guidelines which means that patients are sub-optimally treated.  This needs to be addressed – it would support work participation.


5.       The importance of cross departmental collaboration

·         This is required to realise savings across the board. The attendees agreed that cooperation between the departments needs to be encouraged even more on the ground.

·         Organisations need to better understand the business case of the benefits of implementing such standards.

·         Talking therapies are important.

·         There is a role for the Department of Business Innovation and Skills to show to chief executives the benefits of investing in workplace health, and to ensure that chief executives appropriately account for occupational health and HR.

·         The Health, Work and Wellbeing team have been speaking to the General Medical Council and medical schools to try to encourage them to account for work as an outcome in their medical training.

·         Cross departmental working is already in operation and there has been a vast improvement in this recently. The signs given by Ian Duncan Smith, Lord Freud and Andrew Lansley show that this cross departmental working is likely to continue.

·         We also need to include the education sector and join up with children’s policy.

·         Examples of this include the ‘Health and Wellbeing’ programme, the ‘Change for Life’ programme,  the ‘Coalition for Better Health’ and the Boorman Review.

·         In terms of budgets, we need to realise that while there would be an immediate benefit to the DWP by making certain investments, this would have a direct and immediate cost to the DH.

·         The American College of Environmental Medicine had fed into Obama’s welfare reforms. UK professional organisations have the chance to do the same for UK policy.

·         It is important to align more with Andrew Lansley’s Public Health agenda – this issue is central to the public health debate.

·         “Occupational medicine is public health in the workplace”

·         Total Place is a good model which should be further development (shared local targets and budget sharing).

·         Cross departmental working should include budget sharing – but will it?