13 March 2007

Lord McKenzie

Public Services Forum: Improving the health of the public sector workforce

Tuesday, 13th March 2007

[Check against delivery]

First of all, I want to say how much I welcome this event.  I have a very close interest in your discussions today. First, I chair a Task Force on Health Safety and Productivity in the public sector.  And secondly, I lead for the Department of Work and Pensions on our Health Work and Wellbeing strategy.  This event, and the work of the PSF in support of our approach, gives us an opportunity for an informed and valuable discussion on issues that are close to our hearts – we want world class public services delivered by a productive and well motivated work force.

There is a good deal of focus on the “sickness absence” agenda in the public sector.  The media and other commentators are keen to make comparisons of the apparent differences in the number of working days lost in the public and private sectors and the knock on effects on costs, efficiency and productivity.   There is no getting away from the fact that these are real concerns for all of us. 

But the public debate does not always take account of the broader context in which public sector leaders, managers and staff operate.   The public sector employs around 5.8 million people – 22% of the workforce.  And we are often reminded by surveys, notably those undertaken by the CBI and Chartered Institute of Personnel and Development (CIPD) that absence rates are higher in the public sector. 

There are several factors that can account for these apparently marked variations.  First, size matters.  Larger organisations tend to have higher rates of sickness absence than small ones, and most public sector businesses are large compared with private sector businesses, which include smaller firms.  We also know that women and older workers tend to take more sickness leave, and that the public sector has higher proportions of women and older workers than its private sector counterpart. HSE’s 2005 Survey on Workplace Absence, Sickness and Ill Health indicates that when organisational size and differences in age and gender profiles are taken into account, the difference in public and private sector sickness absence rates is actually very small.

But my key point today is that a narrowly based approach on sickness absence itself is not going to deliver results - and this is something that we have recognised throughout in the work of the ministerial Task Force and in the challenge we set out in the Health Work and Wellbeing strategy for the public sector to lead by example.   You have looked at what can be done and some of the barriers.  The odd thing about all this is that, in general, we all seem to know what works.  We all know that it is not “rocket science”.  But it does seem difficult to make a difference.  It might be helpful if I give my own perspective on some of the challenges.

Of course, the first stage is to make sure that work itself is not a cause of ill health, and where people are unavoidably absent, to help their recovery and return.  As part of its response to the Task Force and Health, Work and Wellbeing, the Health and Safety Executive, with its partner organisations, has just completed a programme of over 60 workshops for public sector practitioners on best practice in attendance management, with a focus on the use of  management standards for work related stress.    There are two points that are worth making about this work - apart from the fact that stress is the most significant cause of ill health among our work force.

First, the emphasis is on the fact that these are managementstandards.   Good managers and well-managed organisations are likely to have well motivated staff doing good jobs - I will come back to this in a few minutes. 

And secondly, the use of the management standards recognises the need to obtain the views of the people who matter - those likely to be affected. The standards help organisations to assess key issues that can give rise to unacceptable pressures, such as: whether their roles are clear; whether demands on staff are balanced; how change is managed;  and the extent of control that people have over their work.  Consultation and staff views are key aspects of the process of identifying the issues and putting in place the right management mechanisms to control them.  It is therefore important that public sector organisations use these management standards and take up the help that is available to support them through the process. 

On a related point, we hear a lot about the contribution that flexible working patterns can make.   The public sector workforce is demographically different to that of the wider economy - we tend to employ larger numbers of older workers, women and part time workers, for example, many of whom have responsibilities outside work that add to the day to day  pressures they face.  So helping people to achieve a sensible work life balance is part of the picture. But it is also part of the management challenge given the need to provide services at times and in ways which meet customer needs.

Health, Work and Well-being

This is one aspect of how we as employers can contribute to the wider health and wellbeing of our work force.  We have been working with the Department of Health and HSE to develop the Health Work and Well-being strategy. 

The Strategy recognises that if we are to meet the challenges we face and help people with health conditions and disabilities to remain in or return to work, we need to pay more attention to the health and well-being of people of working age.

In particular it is about:

• Improving general health;
• Preventing work related illness and injury and using the workplace as an opportunity for general health improvement;
• Intervening early when health problems arise, providing appropriate investigations and treatment, providing them quickly and providing them locally;
• Providing appropriate rehabilitation support for those who have been long term sick;
• And ensuring workplace adaptations and return to work support are available.

Employers have a key role to play in delivering the strategy as they take on board the business benefits of promoting a healthy workforce and preventing ill health from occurring in the first place.

All of this is part of the new health and safety agenda.  And here’s why.  First, work is good for people.  There is strong evidence that being out of work is linked with various adverse health issues, including increased obesity and reduced activity, increased risk of heart disease and increased psychological distress.

And we now have the recently published report, “Is work good for your health and well-being?” by Gordon Waddell and Kim Burton, which evaluated the scientific evidence on the relationship between work, health and well-being. This found that work is beneficial for health and well-being and that being in work can help people recover from both physical and mental health problems. 

So work is good for you, but equally failure to prevent ill health – especially that arising from work activities - is expensive.

Ministerial Task Force

I now see the work of he ministerial Task Force as being very closely aligned to helping the public sector respond the Health Work and Wellbeing strategy.  It can ensure that ministerial and management effort is devoted to securing a culture change in the management of wellbeing throughout public sector as it brings together ministers from departments who are big employers and those that “sponsor” large sections of the public sector.

We want to see management actions designed to make a difference in four main areas:

• Sustained leadership from the top of the organisation.  Without this an organisation will not be motivated to take action, and we still face challenges in this area;
• The right systems and data to support better absence management.  Without up to date and accurate information, managers cannot know enough about the problems and their causes;
• Training, support and encouragement for line managers.  Because their relationships with their teams are what can make a real difference;
• Regular and supportive contact with those who are absent due to sickness, whether short or long-term.  We know that this can have a major impact on the individual’s motivation to get back to work.  

Well managed organisations

The Task Force also recognised that absence levels are an indicator of overall organisational health. For absence levels to be reduced and kept low, people need to want to work in an organisation, and good management is key to this. So the Task Force, together with HSE, commissioned research from the Work Foundation into ‘the Well Managed Organisation.’ This research confirmed that an organisation-wide view is needed to reduce absence rates. And the promotion of an attendance culture is key, as this ensures that employees have a voice in change and makes them feel valued.  

And evidence indicates that well managed organisations have lower levels of sickness absence. For example, when we compared the Comprehensive Performance Assessment rating for local authorities with Best Value Performance Indicator data on sickness absence we saw a clear link between the overall rating and absence levels.  The better the CPA rating the lower the sickness absence.

Guidance on ‘the Well Managed Organisation’ has now been drawn up to provide support for Chief Executives, Heads of Human Resources, and practitioners as they implement the aims of the Task Force. 

Conclusion

I said in my introductory comments, there is more to do.  We know that there are plenty of examples of public sector businesses that are already leading by example.  The challenge is to help others to reach that standard - there are marked variations in performance within the public sector.  In 2005, the amount of time lost to sickness absence in the NHS as a proportion of the total time available varied from 2.8 to 6.0%.

In general, we know what works, and we know what to expect of a well managed organisation – but it is can be difficult to address underlying cultures and make a real difference.  Guidance and exhortation play a large part in this but I still think that we need to do more to really engage leaders at the top.

In the civil service, for example we are working closely with the Cabinet Office to develop appropriate mechanisms that will help the boards of departments and agencies to adopt organisation wide approaches.  But this needs to feature more prominently in performance management arrangements if interest from the top - and the gains we want to make - are to be sustained, and this is a model that we are keen to roll out to the wider public sector. 

This event itself has shown what can be achieved and some of the challenges we face.   It has helped to shed light on the barriers and suggest ways forward.  It is now important that we report back on this morning’s discussion and it’s conclusions to the PSF and Task Force. 

That will help us to understand the issues you face and the kind of support that we can provide to public sector leaders and managers.