Welcome to my Blog

I was the Head of Policy and Public Affairs at UNISON Scotland until my retirement in September 2018. I now work on several policy development projects, so all views are very definitely my own. You can also follow me on Twitter. I hope you find this blog interesting and I would welcome your comments.

Thursday, 3 January 2019

2019 - the big challenges ahead

Happy New Year! Traditionally a time to think ahead and a good time to consider the big challenges facing Scotland and the wider world.

At present, Brexit dominates the policy discourse and, within Scotland at least, the constitutional implications for devolution or another independence referendum. Important though these issues may be, they are, in military parlance, grand tactical issues. We also need to think about the strategic challenges facing Scotland over the next ten to twenty years.

I was reading Nicholas Timmins biography of the welfare state; ‘The Five Giants’, which captures the mood of the post-war period and Beveridge’s five giant evils – Want, Disease, Ignorance, Squalor and Idleness. You can easily make the case that these evils still abound in Scotland and the rest of the UK. However, it got me thinking about what those ‘giants’ might be today.

For me, there is one overwhelming evil – inequality. One million people in Scotland live in poverty, including 230,000 children and 140,000 pensioners. If you are disabled or a member of a minority ethnic group, you are significantly more likely to be in poverty. Poverty is not just a condition, it is a matter of life and death. Healthy life expectancy can vary by as much as 28 years between the most and least deprived areas of our country. 

Almost all political parties accept that poverty is a bad thing. The difference is when you discuss not just poverty, but inequality. Scotland’s richest 1% have more wealth than the bottom 50% put together. As Rebecca McQuillan points out in today’s Scotsman, it’s the same worldwide. We have an economic system that is designed to make the wealthy few richer, at the expense of the many. 

The Tories argue that you can address poverty without worrying about inequality. I have noticed a concerted right-wing effort to challenge the seminal work on this issue, ‘The Spirit Level’, which explains why more equal societies do better on almost every measure. Despite all the evidence, trickle-down economics is still championed by some. 

At the recent Living Wage awards, an SNP minister quoted The Spirit Level favourably, so this should point to a consensus on the direction of travel. The problem is that the SNP government has been unwilling the take the necessary radical action.  There has been plenty of processes, but policy measures have generally been timid. Being better than England is not enough.

My second modern giant would be climate change. The latest UN report says we have twelve years to simply limit a climate change catastrophe, by keeping the increase in global warming below 1.5C. As today’s Scottish Environment Link report shows, our diverse fauna and flora, as well as wildlife, are also at risk, with consequences for food and pollination. As with other challenges the international response has been too timid and Scotland could do more - including the Climate Change Bill currently going through Parliament.

My third modern giant would be disempowerment. The UK is over-centralised and London sucks in too much power and resource. While devolution has been an important step forward, too many powers stop at Holyrood and others are taken from local government. Economic power continues to be grabbed by big corporations, largely unchecked by regulation or industrial democracy. Devolving power must be accompanied by new forms of deliberative democracy, which give citizens a real say in how our society is run. Strengthening collective bargaining could have a similar impact in the workplace.

My fourth modern giant would be a broken society. Too much emphasis is placed on economic performance and too little on the impact on human beings and the communities of place and interest they live in. Much has been written about the economic impact of an ageing population, without considering the opportunities. Automation at work is used to exploit the workforce rather than liberate them. Isolation, intolerance and our consumer culture are contributing to a broken society, where we patch and mend the mental health consequences, rather than tackle the root causes. We need to focus on creating a good society.

The policy challenge with these modern evils is that governments tend to work in departmental silos. I know from my own work experience how difficult it is to agree, let alone deliver, solutions that cut across departmental boundaries. For example, health inequality has little to do with a health department that is focused on managing the NHS. It requires cross-cutting action on housing, social security, employment and the environment. Even the four modern giants I have suggested above, cut across each other in so many ways. 

Chasing solutions without fully understanding the causes of the problems that face our society is a process doomed to failure. So, in 2019, let’s try and raise our vision beyond the immediate challenges and look at the long-term measures needed to create a more equal Scotland and work with others for a better world.

Wednesday, 21 November 2018

Health and care integration report card - could do better

Audit Scotland tries hard to use building language in their reports, but it was obviously a real challenge when it comes to health and care integration.

Audit Scotland has recently published their assessment of the progress with health and care integration in Scotland. Helpfully, as I was preparing a presentation for an English conference on how we tackle this issue in Scotland. You could be forgiven for missing this report as it came out on the day of the Brexit resignations.

As usual they introduce the report with a helpful infographic which captures the key challenges. Integration Authorities (IAs) manage a huge proportion of the Scottish budget (£9bn) and are supposed to achieve £222.5m of savings - an increase of 8.4%.

The positives are that IAs have started to introduce more collaborative ways of working and there are a number of case studies in the report that highlight best practice. This shows that the system can work, however, yes you knew there would be a but, “there is much more to be done”. 

The building language then starts to break down.

They main problem is that financial planning “is not integrated, long term or focused on providing the best outcomes for people who need support”. This is caused by the financial pressures on health boards and councils, compounded by health boards not including their acute services to the process of budget shift. Long term planning is difficult when budgets are set annually, with little medium term, let alone long term, strategic planning. However, an overall underspend by IAs of nearly £40m, does not inspire confidence either.

This doesn’t mean that there is no resource shift because the ISD cost data published yesterday shows a loss of 429 hospital beds. This data also shows that community services are getting more resources, with only a 0.1% increase in hospital spending as against 4.8% in the community sector. GPs have pointed to the fall in the amount devoted to GP services, but this may be related to service redesign. Either way, while there has been some shift from acute to community, progress is slow because of the overall financial position. 

The report also highlights a lack of collaborative leadership and strategic capacity, not helped by a high turnover in IA leadership teams and squabbles over governance arrangements. Cultural differences between partner organisations is another barrier to achieving collaborative working along with the necessary skills to work in partnership. This was predicted, and has been a problem all over the world (see Petch et al) with care integration.

Another lesson from the international evidence is that change cannot happen without meaningful engagement with staff, communities and politicians. Something the report says has not yet been achieved in Scotland. Honesty about the scale of change needed is indeed challenging, particularly when it can involve closing hospital services. Lengthy and technical IJB papers have not helped to engage members on these boards.

Workforce planning is crucial to the success of care integration. While the National Workforce Plans have now been published, they are still largely at the process stage, particularly in social care. There needs to be a better understanding of future demand, how this is likely to be met and what it will cost. Needless to say, Brexit looms large over this issue. Attempts by some IA leadership teams to promote the privatisation of services has not helped to build confidence. As UNISON surveys have shown, the procurement rules are not being followed properly. If they were, the two-tier workforce provisions (s52) would end this nonsense.

Data sharing and incompatible IT systems are another problem. There are too many local fixes rather than considering a single national solution. Interestingly, the report points to bringing staff together under one roof, rather than solely relying on IT. This is something that the Quality Care Commission recommended in 2015.

Many of the challenges facing care integration in Scotland can be fixed as local best practice shows. There are some national actions that can help, but there is nothing in this report that wasn’t predicted or points to unresolvable structural failure. The underlying problem is austerity - making big service change is doubly difficult when the budget simply isn’t keeping up with increased demand.

Sunday, 11 November 2018

Commemorating the sacrifices of the First World War

This is a very special Armistice day, marking the centenary of the end of the First World War. It ends four years of anniversaries that commemorate the events of that terrible conflict.

There can be little doubt that we are more aware of the First World War as a consequence of the huge effort that has gone into events marking the centenary. Financial investment from the Lottery, Arts Council and governments have been supplemented by books, films, TV and radio programmes. But has that investment challenged some of the common myths, or done enough to recognise that the conflict didn’t just affect young white men on the western front? 

The Scottish Government’s Commemorations Programme has attempted to widen the subject with events covering the sinking of the SS Tuscania off Islay and the Quintinshill rail crash. A conference and exhibition celebrating the work of Dr. Elsie Inglis was an example of highlighting the role of women – the Serbian post office even produced commemorative stamps. However, despite these efforts, the abiding memory will be of Scots who died in the battles on the western front – important of course that those events were.

There has been an effort to acknowledge the role of the four million non-British soldiers that fought in the conflict – David Olusoga’s TV series and this week’s focus on the Indian Army are good examples. There has also been more about the home front and local histories. However, in the main, they have been drowned out - the western front, poppies and Tommies remain the most familiar iconography.

Other important fronts get very little coverage. I suspect very few people understand the role the Macedonian campaign played in ending the war, even though it involved two British Corps. With Serbian and French troops they advanced as far as Austria. Let alone the huge battles on the eastern front, Italy and the Middle East – and lesser-known campaigns in Africa and the Far East 

On many of these fronts, the war and its consequences didn’t end on Armistice Day. The crumbling of empires, the Russian Civil War and the related Polish-Soviet War went on until 1921. The Greek-Turkish War resulted in the ethnic cleansing of 1.6 million people. For many countries, November 1918 marks independence or the dismembering of their state. Hungary lost half its population and two-thirds of its territory. 

Many of these events have a bearing on the Europe we live in today. As Guardian columnist Natalie Nougayrede put it; 

“The point is not that a unified narrative should be imagined. Rather, it is that we would all gain from better awareness of the mosaic of European memories of 1918. The Europe we live in today still has its roots in that past.”

The same is true for the wider world. The British and French ended the war with even bigger empires in the Far East, Africa and the Middle East. These created the conditions for future conflicts and were certainly a poisoned chalice for Britain.

Our perspective of the First World War has changed over the years. In the 1920’s the monuments used the language of glory, honour, dominion and power. As the war poet, Wilfred Owen said: “The old lie: Dulce et decorum est; Pro patria mori”.

At the other end of the spectrum, I was brought up in the period of, ‘Oh What a Lovely War!’ and the ‘Lions led by donkeys’ view of WW1 generals. There have been some revisions of that view and lessons were learned as the war progressed and generals unlearned the lessons of the last war. The BBC ‘100 days to Victory’ series covers some of this.

The BBC History Magazine asked two historians of the conflict the question, Was it Worth It? 

As Professor Richard Evans says, it is not the job of historians to tell people in the past what they got wrong, but rather to explain how and why things happened. However, he reminds us that millions of British soldiers who fought in 1914 didn’t have the right to vote – so it wasn’t a war for democracy. He argues that it actually ended progress towards greater democracy in many countries and replaced it with brutal and corrupt dictatorships. Much of this was caused by the economic disaster that was another consequence of the war.

On the other hand, Professor Gary Sheffield argues that imperfect though the world undoubtedly was in 1919, it would have been much worse if there had been a German victory. Even if the Royal Navy kept Britain free from occupation, it would have faced the nightmare of a hostile continental Europe and the end of liberal democracies. 

Whatever view we take of the historical events, it remains the case that millions gave their lives in the conflict and afterward, for a cause that, at the time, most people supported. They made the ultimate sacrifice and it is right that we should remember them - red or white poppy, in the way we each deem to be appropriate.

Friday, 9 November 2018

Living Wage Week

This is Living Wage Week, another opportunity to promote the benefits of the real living wage and fair work more widely.

The week traditionally starts with the announcement of the new Living Wage rates, which this year have increased to £9 per hour and £10.55 in London. The Resolution Foundation has published a briefing on how the rate was calculated this year. Wider inflation was obviously a key factor in the increase. In addition, some policy changes act as a downward pressure on the rates, for instance, the increase in the personal tax allowance and additional childcare support. Other policy changes create upward pressure including the ongoing freeze in working-age benefits.

I was at the Living Wage Expo at the Tynecastle Stadium in Edinburgh yesterday. Peter Kelly from the Poverty Alliance reminded the audience of how much progress had been made with the Scottish Living Wage - £216m into workers pockets, 34,000 workers getting a pay rise and more than 1300 accredited employers. We should also remember that many other workers have benefitted outwith accredited employers, due to procurement and collective bargaining.

It was good to see a public sector employer (even if they try to hide the fact!), Scottish Water Business Stream, getting the employee choice award. The nomination included a positive statement from a worker who explained what fair wages meant to them and how it changed their perception of the employer. 

This theme continued with a panel discussion involving Heart of Midlothian FC staff. They all described how the living wage meant they could afford what most of us regard as essentials, like holidays, transport etc. One young worker in the hospitality department highlighted the difference between £5.90 on the age-related minimum wage and £9 on the real living wage. The motivation of these workers was very apparent. Well done Hearts - time for other football clubs to follow!

The Minister for Business, Fair Work and Skills, Jamie Hepburn MSP set out the Scottish Government's aim of making Scotland a Fair Work nation. He rightly made the point that more equal societies do better on all tests, not just economically. He accepted that Scotland could do more as there are still one in five employees who are not yet receiving the living wage. I would point him to procurement, where policy has not always been matched by best practice.

The Outstanding Leadership Award went to Standard Life Aberdeen, who I would agree have been real private sector champions, not just with the living wage. They make the business case for the living wage, and in their sector, the wider benefits of trust and how it is a good measurement of company behaviour.

The living wage isn't just about big employers. One of the real successes of the living wage movement in Scotland has been the engagement from hundreds of small companies. Sarah Roberts from Healthy Nibbles is a good example of such a company and she set out the benefits for her firm and their workers. Importantly she emphasised the wider fair work agenda of her business. Other SMEs that have become accredited employers this year and were recognised in the awards as well.

As women are disproportionately represented in low pay workplaces, the living wage is also important in closing Scotland's gender pay gap. Anna Ritchie from Close the Gap pointed to the similarities in the business case for tackling the gender pay gap and the living wage.

Tess Lanning from the Living Wage Foundation reminded us that the living wage campaign started as a community campaign. This is something the campaign in Scotland is seeking to build on with the living wage place initiative. Including outsourced workers has also been important to the campaign, which has encouraged innovation in the workplace and extended the living wage beyond the core workforce. A good example is South Lanarkshire Council, who won the anchor institution award. They have increased the percentage of the workforce across the council area who are paid the living wage using the levers available to every local authority. I would also highlight North Ayrshire Council who were quick off the mark to commit to paying the new rate this week.

Dave Moxham from the STUC made the point that voluntary initiatives like the living wage are important in delivering real benefits to workers and promoting a different economic model. It supports the campaign for a higher statutory minimum wage and abolishing the age-related rates. Richard Leonard reiterated Scottish Labour’s commitment to a £10 per hour minimum wage this week.

Finally, I was very honoured to receive the Lifetime Achievement Award. It does seem like a lifetime since we kicked off the living wage campaign in Scotland, but actually, a lot has been achieved in a short time. Like others, I have burnt out a few PowerPoint projector bulbs pitching the case, but my role has often been to tear down fallacious legal barriers and find ways around EU and other procurement rules. There is still a lot to do, but the campaign is in good hands.

Wednesday, 7 November 2018

Let's make this the last major anniversary of rail privatisation

This week marks the 25th anniversary of the legislation that privatised British Rail into a complex series of franchise arrangements. 

This is not an anniversary to celebrate. As Aslef’s Scottish Organiser Kevin Lindsay said; 

“Today is the 25th Anniversary of the great railway rip off, when John Majors Tory government rushed through the unnecessary, unwanted and plainly unworkable rail privatisation. It’s time for the UK and Scottish governments to take action and to return the railway to public ownership.”

Sadly, neither government appears to be heeding that call, which is supported by the other rail unions. A call that comes from the people who represent the workers who really understand the railway. The editorial in this month’s ‘Modern Railways’ paraphrases the Joni Mitchell song to say that the government has:

Looked at the railways from both sides now
From win and lose and still somehow
It’s life’s illusions they recall
They really don’t know railways at all.

The Scottish Government has the power to end this franchise early by using the break clause in 2020 which would see the franchise end in 2022. However, in a recent letter to the public sector bid stakeholder reference group, Transport Secretary Michael Matheson said he “fully expects the current franchise to continue to its planned expiry date of 2025”. 

The UK Government has commissioned the Williams Review - the Transport Secretary’s response to the fiasco of the May timetable changes. As the interim Glaister report concluded, ‘Nobody took charge’ – a clear recognition of the damage fragmentation has caused. The review will look at the ‘most appropriate organisational and commercial framework for the sector’.  

The timetable for the review is as slow as our privatised railway – steam trains were quicker on some routes! (an excellent solution in my personal view 😊  – with CCS of course!). A white paper next autumn and an unlikely implementation ‘from 2020’, which points to a few cosmetic changes. There have been 30 such railway reviews since 2007. 

So how are our railways doing?

There was a small 3% increase in freight traffic last quarter, but that was mostly down to an increase in coal traffic caused by a spike in gas prices. Hardly a sustainable future for freight. Some innovative work is being done on promoting rail for log transport in Scotland and sidings for timber boards and mineral water, but overall there are few signs of a significant shift to rail freight. For example, the lack of long crossover loops on the Inverness line makes rail 30% less efficient than it should be. We should remember that rail generates around 30% of C02 emissions of road haulage per equivalent journey, nearly 90% less small particulate matter (PM10) and up to fifteen times less nitrogen oxide (NOx). 

Passenger demand for rail remains strong. 23.9m journeys were made on ScotRail in the last reported quarter, up 1.5%. Passenger journeys increased 3.1% nationally last quarter, despite the timetable issues, possibly driven by a 15% increase in the price of car fuel.
Scotrail’s poor performance is rarely out of the news with punctuality reaching breach level for the last two reporting periods and significant fines. Their management of rolling stock has been equally shambolic, with the new Hitachi trains delivered 10 months late and their new refurbished High Speed Trains expected to be introduced without Controlled Emissions Tanks, meaning effluence will be discharged directly on to the tracks. While services have plummeted, fares have spiralled. As of next year, commuters will be paying 10% more for their ticket than they did at the start of the franchise. 

In parts of the industry, Scotland’s attempts at integrating trains and track through the ScotRail Alliance is seen as a move in the right direction, if not quite a template. However, all is not well at senior levels as reported in today’s Scotsman. They report one industry source saying: “There is a lot of discomfort about how much control of the railway has been handed to the train operator [ScotRail].”

It does at least highlight one of the benefits of devolution and the Scottish Government is calling for the devolution of Network Rail. There is certainly a case for that, although integration requires more than just trains and track and this focus on powers avoids the bigger issues.

Which leaves us with the question of ownership. 

Many industry figures argue that only when you have created a working railway network should you consider ownership. I don’t dispute the importance of structure, but the idea that this can be done without addressing ownership and accountability is fanciful. We have the ludicrous situation where the majority of our railways are in foreign state ownership, sending profits back to support their domestic rail operations. We should also recognise the impact the short-term profit motive has on the management of any service. Management culture and accountability is an important issue that the ‘structure before ownership’ lobby ignores.

The TSSA/Common Weal report is a useful starting point for a debate on the merits and methodology of creating a publicly run railway in Scotland. There are some legislative barriers that could be circumvented to avoid a franchise bidding process, although that would be complex and legally challenging. Labour’s commitment to bringing railways into public ownership across the UK, provides the best platform to take this forward and that should include a discussion about further devolution. A policy that the polls show has widespread public support.

And then, inevitably, there is Brexit. Current EU rules would not allow a future Labour government to reinstate a national rail monopoly. The EU Commission’s Fourth Railway Package would astonishingly foist the UK model on the rest of the EU. There are also problems with EU Single Market rules on procurement and State Aid, which Mick Whelan of Aslef has outlined in the Scotsman and Scottish Left Review. 

Others argue that there are ways of introducing greater public ownership within EU rules as is done in Spain, Netherlands, Germany and Italy – using separate state-owned companies. Although even this retains the market framework. 

While more work is needed on the detailed structure and Brexit implications, the direction of travel towards an integrated railway under public ownership should be clear. Mick Whelan sums up the case this anniversary week when he said; 

“Privatisation has, demonstrably, failed to deliver. Fares have soared, rolling stock got older, and our trains are more crowded. Private companies talk about investment and risk. But there is no private investment – the money for investment comes from the taxpayer – and there is no risk because the companies hand back the keys when they can’t make the profits they want.”

Thursday, 25 October 2018

NHS Scotland faces huge challenges, but don't forget the underlying causes

"The performance of the NHS continues to decline, while demands on the service from Scotland's ageing population are growing. The scale of the challenges facing the NHS means that decisive action is needed now to deliver the fundamental change that will secure the future of this vital and valued service.”

If this was said by a politician it would be dismissed as political rhetoric. In fact, it was said by Caroline Gardner, Auditor General for Scotland, when launching this year’s overview of NHS Scotland.  The report does not make happy reading and ought to be a huge wake up call.

The main message is that the NHS in Scotland is not in a financially sustainable position. NHS boards are struggling to break even, relying increasingly on Scottish Government loans and one-off savings. The report was prepared before the Health Secretary accepted this reality and announced that these loans were to be written off. 

Health boards did achieve an unprecedented £449m of ‘savings’, but many of these are one off savings and that is not sustainable. In 2017/18, 50% of all savings were one-off (non-recurring), up from 35% in 2016/17, and 20% in 2013/14. In 2018/19, eight boards predicted at the start of the year that they would be in deficit at the end of the year.

Although health funding has increased over the past decade, funding per head of population has increased at a slower rate. We should also remember that ‘real terms’ is based on the government’s optimistic view of inflation, which has little basis in reality for the economy as a whole, let alone higher health inflation rates.

The financial position is unlikely to improve soon as health costs are projected to increase. Scotland’s ageing population means that more people will be living longer with multiple long- term conditions. Other cost pressures, such as increases in drug spending, are also projected to intensify and there is a significant maintenance backlog. Some progress has been made in reducing agency staff and medical locums, but they have still increased by nearly 40% in the last five years.

There is a medium-term health and social care financial framework, but the auditors are as unclear as everyone else how this relates to the government’s financial strategy. This was part of the analysis recently published by John McLaren and highlighted in Brian Wilson’s Scotsman column. In particular, this analysis shows that Scotland is expecting to make double the efficiency savings than in England.

The report also highlights declining performance. The NHS met only one of eight key national performance targets in 2017/18, and performance actually declined against all eight. No board met all eight targets. NHS Lothian did not meet any targets. NHS Grampian, Greater Glasgow and Clyde, Highland, and Tayside each met one target. 

In the final quarter of 2017/18, 93,107 people waited more than 12 weeks for their first outpatient appointment, an increase of 6% on the previous year. The number of people who waited more than 12 weeks has increased by 215% in the last five years. People waiting more than 16 weeks increased by 16% last year, and by 558% over the last five years. People waiting more than 12 weeks for an inpatient or day case procedure increased by 26% last year to 16,772 people, and by 544% over the last five years. 

Those who do receive treatment continue to rate their care and the staff who deliver it highly. Staffing levels are at their highest level, but vacancies remain high, particularly long-term vacancies. Huge challenges are on the horizon, including Brexit. Sickness absence has increased and nearly half of staff report in the staff survey that they couldn’t meet all the conflicting demands on them.

As always with these reports, the analysis of where we are is stronger than the solutions. Auditors like process and the report recommends a number of changes to these. In fairness, it is not the Audit Scotland’s job to address the challenges – it is the Health Secretary who has to lead on this. And, as they say, any solution has to start with an understanding of the challenges.

In financial terms, much will depend on the Scottish Government receiving additional funding from the Barnett consequentials of English health spending. However, this report rightly warns that we don’t yet how the UK Government plans to fund increases in English health expenditure and the options chosen may affect the amount available to the Scottish Government. 

The report also highlights the number of leadership vacancies, joint posts and confused governance. We have new layers of planning, but it is unclear what progress is being made. The limited training, skills and performance management of non-executive board members are highlighted as a concern in the report. There was a review of targets and indicators last year, but no progress on the recommendations.

The report highlights slow progress in health and care integration while recognising the challenges. It welcomes the workforce planning initiatives, but recognises that these describe processes, not what the medium to long-term workforce will actually look like.

We should not forget the underlying causes of many of the pressures on the NHS – health inequalities. We had another warning on this today in the EHRC report ‘Is Scotland Fairer?’. Sadly, this probably won’t get as much consideration as the Audit Scotland report, but it is crucial to understanding the pressures on our NHS. The report highlighted differences in educational attainment, health, work opportunities and living standards among social groups and concluded that progress has stagnated.

In summary, this report pulls together many of the warning signs that have been around for some time. Nothing in the Audit Scotland report should detract from the great outcomes that NHS Scotland staff deliver every day in difficult circumstances. Neither do they indicate that the system is fundamentally flawed. However, the report does lay bare the challenges facing NHS Scotland and the focus should be on real action to address them and the underlying causes of poor health.  

Wednesday, 24 October 2018

Real action on mental health in the workplace

Poor mental health affects half of all employees, but only half of those who experience problems talk to their employer about it.

I have been working with an employer on improving their approach to tackling mental health in the workplace. Their sickness absence statistics highlighted a growing problem and a management consultant produced a plan. The safe response from many Chief Executive's would be to tick the box and report the action taken to the board. Credit to this organisation that they didn't do that. The CEO wasn't convinced that the actions proposed would tackle the scale of the problem and asked me to review the plan.

The hard-nosed case for taking real action is economic, with mental ill health-related absences costing at least £26 billion per year. However, the human cost is even greater for the sufferer and their families, with the ultimate human cost being loss of life through suicide.

In some ways, the increase in reported mental health absence is a positive sign that the stigma is reducing. A British Chambers of Commerce survey showed a 30% increase in the last three years and a 33% increase in the length of absences. Even in NHS Scotland, between 2015/16 and 2017/18, the number of stress-led staff absences has rocketed by 17.6% - the equivalent of more than one million working days lost.

However, another survey undertaken by BHSF indicated that 42% of UK employees who have called in sick and claimed they were physically unwell were actually covering up a mental health issue. Another estimate by the ‘Time to Change Employer Pledge’ says, 95% of employees calling in sick with stress gave a different reason.

It’s not just absence either. Surveys show that poor mental health affects performance in the workplace including concentration, decision making, avoiding certain tasks and conflict with colleagues and customers.

Given the moral and economic case for acting, what should employers and unions do?

The plan I reviewed had a number of worthy elements. There was some awareness training for managers, but not for front-line staff. They also planned to deliver mindfulness events and relaxation sessions. The fundamental problem was that the plan largely ignored work as a factor in poor mental health. The focus was on individual behaviour and health, rather than looking at the impact the employer was having on mental health. In other words, it was a reactive rather than a preventative approach to mental health at work. 

Most poor mental health is the result of a combination of problems at work and personal life, with work alone causing problems for a quarter of staff. While most staff recognise they have to address their mental health problems, they need a supportive work environment with well-trained line managers and an organisational response.

The positive news is that the issue is getting much greater attention and there are a range of resources to help employers. The ‘Time to Change Employer Pledge’ encourages a health check and sharing best practice across a growing number of employers - although some argue this doesn't go far enough. The CIPD has a number of useful guides as well as survey data. They broaden the issue to address ‘well-being’ at work. The mental health charity Mind has a range of resources and can help with training. Trade unions, including UNISON and Unite, run awareness or mental health first-aid courses for their stewards. UNISON also has a useful bargaining guide.

The employer I have been working with now has a comprehensive mental health at work plan, which starts with clear objectives that form part of the organisation’s strategy, not simply an HR add-on. It shows how they will identify the well-being of staff and the causes of poor mental health in the workplace. Then the measures they are taking to tackle the work-related causes and the support available inside and outside the organisation. Finally, how the plan will be evaluated.

We should also not forget the wider policy imperative to address poor mental health. As TUC research points out, while employment rates of disabled people with mental health problems have increased, they are still at very low levels. The economy cannot afford to miss out on the skills and talents of these people.

Taking serious action to tackle mental health issues in the workplace requires more than a few cosmetic initiatives. The good news is that more employers and trade unions recognise the problem and are prepared to take meaningful action to effect change.