Keep Britain Working

 Keep Britain Working is the final report of the Mayfield Review into the issues surrounding ill-health and disability in the workplace. Earlier this year, I wrote, with Ian Tasker of Scottish Hazards, a paper for the Jimmy Reid Foundation, Tackling the Causes of Working Age Ill Health, covering similar ground.

We share a common understanding of the problem. As the report says, "Over one in five working-age adults are out of the workforce, substantially because of health problems. Mental ill-health among young people is rising sharply. Older workers are leaving too early. Disabled people remain locked out of work at twice the rate of non-disabled people." It is also true that other countries do better. 

We also have common ground in diagnosing the problem. He found three persistent problems:

• a culture of fear, that is felt by employees and, differently, by employers, especially line managers. This creates distance between people and discourages safe and early disclosure, constructive conversations and support just when they are needed most
• a lack of an effective or consistent support system for employers and their employees in managing health and tackling barriers faced by disabled people. This lack of support is sometimes compounded by a ‘fit note’ system that is not working as intended
• structural challenges for disabled people, creating barriers to starting and staying in work. Compared to international comparators, the UK lacks systemic levers to support disabled people in work, leaving them disproportionately excluded and talent wasted.

The Mayfield solution is "a fundamental shift from a model where health at work is largely left to the individual and the NHS, to one where it becomes a shared responsibility between employers, employees and health services." This includes a recognition that employers need to do more. This was the core message in our paper. Sadly, the Mayfield Review paints too rosy a picture of existing occupational health provision. As we pointed out, very few employers (as low as 3%) invest in the wider range of services that occupational health professionals can provide. For too many employers, the solution to ill health at work is increasingly punitive absence management systems and dismissal. The review also almost entirely ignores the role of safety in the workplace and cuts to the HSE.

The Healthy Working Cycle recommended in the report is fine, as far as it goes. The major failing in the report is the lack of a structural change to ensure it actually happens. His solution is "the development of a Workplace Health Provision (WHP) which is built from the range of existing provision but looks to amplify, expand and improve the availability of it."

The report's delivery option is "a flexible, market-led solution, with employers funding the provision and choosing certified providers that meet their needs. Providers will be assessed against national standards – possibly stewarded by government – giving employers access to a wide range of trusted options." There is very little stick and a marginal carrot in this solution, other than "Over time we would expect that this provision would be formalised and certified." The question any reasonable person would ask is, when we look at where we have got to under the current arrangements, what makes you think employers and their totally inadequate occupational health providers will change?

I don't disagree that employers should fund improved occupational health, as it is their statutory duty, albeit one that is little enforced. However, we recommended "An integrated approach to working-age health, underpinned by including occupational health and vocational rehabilitation in mainstream health care, which no longer relies on inadequate private sector providers." This could be funded in a similar way to the Apprenticeship Levy, which ensures that all employers, regardless of their performance, contribute.

The Mayfield Review claims its changes are ambitious. Sadly, they fall well short of that. Having correctly diagnosed the problem, their recommendations are a hope that employers will change their ways. The cultural change that is needed should have a statutory underpinning; otherwise, in another ten years, we will be asking the same questions, with thousands more workers excluded from work due to ill health. The taxpayer will be picking up the bill, with economic growth a pipe dream.

The future of work

I have been helping to review the HR policies of a charity as it considers a return to normal operations after the pandemic. We had a false start last year, although the return to work arrangements are still broadly relevant. I did an HR review a couple of years ago, and there was significant opposition from middle managers to the flexible working proposals. Almost all of which subsequently proved to be doable during the pandemic!

 

This is a charity that wants to be viewed as a progressive employer. Sadly, as the recent TUC survey shows, one in ten staff have been put under pressure to return to the workplace contrary to current government guidance. As they say, it is "the tip of the iceberg" of employers ignoring their health and safety responsibilities.  A recent survey found that out of 4,553 office workers in five different countries, every single person reported feeling anxious about the idea of returning to in-person work. A Scottish study also found a wide range of concerns. Official figures show that nearly one in five adults in employment experienced depression at the start of this year. The top causes of return-to-work stress included being exposed to COVID-19, the loss of work flexibility, the added commute, wearing a mask while in the office, and a need for childcare. 56% of respondents reported that their organisation hadn't asked for their opinions about return-to-work policies and procedures. That was the number one priority in the plans we put in place.

 

The UK Government is creating a one-stop-shop watchdog for enforcing employment rights. Responsibility for tackling modern slavery, enforcing the minimum wage and protecting agency workers, currently spread across three different bodies, will be brought under one roof. As the TUC says, the new body looks "heavy and spin, but light on action" as there are no plans to legislate or make new funding available. The TUC action plan offers a more credible enforcement approach. The Scottish Government has made another bid to have employment law devolved as part of its new poverty strategy. This would have more credibility if they used the powers they currently have, including procurement. NHS Education for Scotland recently awarded a contract to Amazon. They confirmed to my FoI request that the Scottish Government Fair Work criteria were NOT applied to the evaluation of bids for this contract. This reinforces the criticisms of Fair Work in the recent Reid Foundation paper.

The return to something approaching normal after the pandemic is an opportunity to think about the future of work as part of a Build Back Better approach. I was pleased to see that Angela Rayner will be looking at this as part of the UK Labour policy review. This has been widely welcomed in recognition of the changes the pandemic will bring, not least a hybrid model of working. It wasn't that long ago when I was making at least a monthly trek from Glasgow to London for meetings, but that world is thankfully gone.

 

Having said that, we should be careful about how we manage this change. The pandemic measures were hastily put in place in most organisations. There has been minimal discussion around what day-to-day working lives might look like, how the benefits of flexibility might be successfully realised, and the longer-term challenges. There is good evidence that employees are more productive, but there are also additional costs. Another study found that only half of the workers felt their employers had adequately supported them in this additional outlay. There are also concerns about a two-tier workforce developing and fears of insecurity and outsourcing. As someone who worked from home before the pandemic, I have some sympathy with the view of anthropologists who have been telling us that it's often the informal, unplanned interactions and rituals that matter most in any work environment. According to a 2017 Co-op and New Economics Foundation report, the cost of loneliness to UK employers was estimated at £2.5bn every year. A guide published by the UK Government identifies five key themes in addressing loneliness at work. 

 

The future of work also has to address other fundamental changes like artificial intelligence and 'spy' technologies at work. The loss of old-style supervision in the workplace is being replaced in some organisations by technologies that allow managers to track workers' keystrokes, mouse movements and the websites they visit. They can take screenshots of employees to check whether they are at their screens and looking attentive, or even use webcam monitoring software that measures eye movements, facial expressions and body language. The organisation I have been working with decided to adopt an 'ethics of care' approach that reviews their surveillance practices and opens a dialogue with workers and their trade unions about the impact. Through collective organising in trade unions, workers can help shape how technological change is implemented in their workplace, and there are some positive examples of this. There is also a need to update the regulatory standards.

 

While we can take some short-term actions to manage a good work approach to the post-pandemic working environment, the future of work needs a long-term approach by governments, employers and trade unions.

Return to work planning - some issues to consider

I have been helping one medium size organisation with its HR challenges in recent months, and this week, we were looking at plans for a return to work for the majority of staff who have been furloughed.

We were all too aware that the pandemic has been anything but the claimed ‘great leveller’. This is also true for the tentative return to work planning.  Those of us on the Zoom call have been able to relocate their screen-based work to home. However, as this morning’s commuter pictures from London show, others are now cramming into overcrowded buses and trains, to do mostly low paid work. This is what inequality looks like.

While the Scottish guidance is still discouraging a return to work, it is likely that the disconnect with the guidance in England will be short-lived. As the First Minister has said: Scottish businesses would be able to reopen "as soon as they can safely do so" and predicted that they would not need to wait for "long periods of time".

My starting point is always the legal basics. That begins with the employer’s duty to protect the health, safety and welfare of their employees and, as is sometimes forgotten, other people who might be affected by their business. While this is a UK wide statutory duty under the Health and Safety at Work Act, there are also common law duties. 

In Scotland, the law of delict imposes on employers a duty to promulgate and operate a reasonably safe system of work. Failure can result in civil legal action - commonly known as personal injury claims. A similar duty can also be implied in the contract of employment, and therefore a material breach can result in unfair (constructive) dismissal claims. In short, there are criminal and civil legal consequences of not delivering a safe system of work, and the pandemic does not remove these requirements.

The weakness of these provisions is that they are mainly ‘after the fact’ remedies. The HSE Management Regulations attempt to address this with principles of protection that set out a hierarchy of prevention and control. Importantly, employees can stop work immediately and proceed to a place of safety if they are exposed to serious and imminent danger. Section 44 of the Employment Rights Act 1996 provides workers with the right to withdraw from and refuse to return to a workplace that is unsafe. It is automatically unfair to dismiss employees who use these ‘stop the job’ provisions. 

In addition to legal consequences, employers will want to adopt return to work strategies that reflect their values and broader workforce policies. They will also be aware of reputational risk. Something Wetherspoons, Britannia Hotels, First Direct and Virgin have struggled with during this crisis! Today’s Guardian carries a horror story about Irish meat plants, with one worker saying; “If the disease was in the animals, they’d have closed the place. But for workers, the factories can do what they want.”

In a practical sense, these duties are delivered by undertaking risk assessments to identify potential health and safety hazards. Employers are required to act on the assessment and minimise risks in the workplace. The employer I have been advising has well-established risk assessments processes, but we needed to think about what additional issues needed to be addressed in the circumstances of a return to work. Risk assessments should be prepared in consultation with Workplace Safety Representatives who understand the practicalities of the workplace better than anyone. 

The first decision to be taken is should workers be asked to return to the workplace. I found the three key tests published by the CIPD a helpful starting point – essential, safe and mutually agreed.

• Is it essential? If people can continue to work from home, they must continue to do that for the foreseeable future. If they cannot work from home, take the time needed to put safety measures and clear employee guidance and consultation in place. 
• Is it sufficiently safe? Employers have a duty of care to identify and manage risks to ensure that the workplace is sufficiently safe to return to. Use gradual returns to work to test health and safety measures in practice and ensure they can work with larger numbers before encouraging more of their workforce back.  
• Is it mutually agreed? It’s vital that there is a clear dialogue between employers, workers and their trade unions so concerns, such as commuting by public transport, can be raised and individuals needs and worries are taken into account.  

The UK Government guidance for England is slowly emerging, despite the decision to encourage a return this week. There is the official overall guidance and eight sets of sector-specific guidance. Frankly, ‘Stay Alert’ has to be the most vacuous piece of safety guidance I have heard for a long time. The inconsistencies in the English guidance are being highlighted daily, so we can only hope there will be revisions. In fairness, the sector-specific guidance is better, although even here we found some weaknesses. The TUC has described these as a ‘step in the right direction’, and they emphasise the need for specific COVID-19 risk assessments.

The HSE also has some helpful workplace safety guidance on this issue. We found the ‘face masks – face fit test’ particularly useful, given this is a piece of equipment managers and workers are not familiar with.

The TUC has issued some helpful guidance on the pandemic and return to work proposals, along with sector-specific guidance from individual trade unions. One issue highlighted by the TUC is the use of biometric and similar surface systems. The manager in one department had produced an excellent risk assessment but forgot that everyone touched the same screen at some time during the day. 

One key issue is the risk for public-facing workers. USDAW has highlighted the risks retail staff face and there have been shocking examples of people spitting and coughing at nurses and others. The case of Belly Mujinga, a ticket office worker, who died of COVID-19 after being spat on, is appalling, but also a lesson for managers on how not to handle staff concerns.

Working at home, along with other flexible practices, has been less difficult than some anticipated. I helped with a flexible working policy in the same employer last year. Many managers said it was impossible to deliver work this way, yet it is now happening every day. I also think the pandemic will change other work cultures, not least enabling more autonomous working.

Coming out of lockdown is going to be more difficult than going in. Employers and trade unions need to work together to design the safest possible workplaces. However, at this stage of the pandemic start with the questions – is it essential, can we do it safely and what does the workforce think?

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.

Health impact of shift working

The health impact of shift working is not well understood. We need more research and better risk assessment to protect workers.


The numbers of staff working shifts is increasing and there has been a marked increase in those working night shifts. While traditionally more men than women have worked shifts, that is changing with most of the new shift workers being women. Scotland has always had a higher proportion of shift workers than the rest of the UK and a range of UNISON’s public service workers are involved including the emergency services, hospitals, social care and in the energy sector.


I was in Stirling today, outlining the health implications to our police branch stewards and discussing how we can help members by designing work better to address these issues.


The research on this issue has identified a number of risk factors associated with shift workers. They are more likely to be obese, suffer from diabetes, smoke (particularly women) and eat less healthily. Interestingly, they are also more likely not to drink alcohol. While there is a statistical correlation between shift workers and these conditions, it is less clear what the causal link is. Shift workers are also more likely to be in lower income groups, who generally have poorer health.


Likely explanations focus on the disruption to circadian rhythms, the body’s internal clock. This can disrupt the workings of the hormone Melatonin, which can lead to poor sleep. We know that the lack of good quality sleep has been linked to obesity, depression, diabetes and heart disease.


A particularly worrying study showed that women working on night shifts for more than 30 years are twice at risk of breast cancer. This is thought to be linked to less Melatonin, which has cancer protective qualities and increased Oestrogen that has the opposite effect.


Another issue is a 40% increase in the risk of cardiovascular disorders. The causal reasons are unclear, but again the disruption to the circadian rhythm, damage to family and social life, stress and poor diet are obvious contributing factors.

So what can be done to limit the risks?


One health site gives the unhelpful advice of ‘get another job’! Although impractical and drastic, it may well be good advice for the over 40’s and those who have worked on shifts for many years. Some behavioural solutions help, such as establishing a stable sleep environment and schedule. Eating small health snacks on shift rather than a large meal, together with exercise and limiting stimulants like caffeine and energy drinks.


We should also be revisiting risk assessments with employers. This involves evaluating shift schedule design - avoiding split shifts, excessive 12 hour shifts and rotating shifts forward. There should be at least 48 hours between shift changes to allow the body to adjust. Occupational health should identify and treat workers who have sleep disorders and ensure more regular health checks from age 40 and those who have worked shifts for more than ten years.


Finally, we need more research to understand the causal links between shift work and ill health. In the meantime there needs to be better awareness of the risks and the actions workers and employers can take to minimise the risks.

100 public service workers assaulted every day in Scotland

42,400 recorded incidents of violence towards public sector workers in Scotland last year is a shocking figure – over 100 incidents every day. What's even more shocking is that this is just the tip of the iceberg with huge levels of under reporting.

I was at UNISON Scotland's annual safety conference in Stirling today, presenting the findings of our annual survey on violence at work. We ask employers for the total number of assaults which have been reported in the latest year for which they have information. The aggregated returns for 2017 show 42,421 assaults - an increase of 1,255 compared with 41,166 in our 2016 survey.

Local Government assaults have risen to 22,006 - an increase of 4,401 over the previous total 17,605. In Health Boards there has been an increase of 2,054 from 17,116 in 2016 to 19,170 in the 2017 survey.

Our first survey of public sector employers in 2006 reported just over 20,000 violent incidents in the NHS and local government - so the total had already more than doubled in the decade to last year - and it continues to increase. This increase is partially due to greater awareness and better reporting, but we still have significant under reporting.

Astonishingly, the two services that consistently fail to provide proper data is police and fire. They don't have proper systems and therefore can't easily produce data. If you are not monitoring violence, you can't be doing anything about it.

A big concern articulated by safety representatives today, is the failure to record incidents. Sometimes that's because members are reluctant to report incidents involving cared for persons. In other cases managers are not recording incidents, a particular problem in schools. The absence of near miss reports is particularly telling.

The numbers also show inconsistencies between similar employers that can only be explained by inadequate systems or management culture. There is a particular problem with education and social care. In education, it's more about culture. In social care it's also about lone working and the absence of work bases for staff. There is a real concern that so called 'agile working' is adding to the problem.

While the statutory sector has made significant progress in recent years, the same is not true of the voluntary sector where you all too often hear the refrain, 'it's just part of the job'.  We have therefore recently published an action toolkit called ‘Not Part of the Job’ to help community and voluntary sector employers who want to address this issue. There are some deep seated attitudes in the sector at a senior level, which will take some time to tackle.

One of the reasons we do an annual survey is to raise awareness on this issue, but that is only part of the solution. The next stage is to put adequate reporting and monitoring systems in place. There has been good progress on systems, with a growth in on-line processes that make it easier to analyse data, although there are challenges for some groups of staff. Finally, employers should be introducing measures to minimise the risk of violence, including better training.

In addition to the common law we have the Emergency Workers (S) Act that gives some additional legal protection for a limited group of workers. A Labour MP is introducing similar legislation at Westminster for England and Wales. Useful though this legislation is, typically 300 convictions a year in Scotland, it has limited scope. Most victims of violence are not covered by this legislation and the Crown Office has very limited data on how they use the common law to protect workers.

The massive scale of the problem of violence against public sector workers, including those in the community and voluntary sector, has slowly begun to emerge over the last decade. It is now time for action by employers and stronger legislation, regulation and oversight by government to end the epidemic.

Let's splash the Scottish Plan for Action on Safety and Health

The UK has one of the best safety records in the world, but far too many people are injured and die at work, and much more needs to be done about ill health at work.

I was at the Health and Safety Executive's (HSE) engagement event in Glasgow today, including the launch of the Scottish Plan for Action on Safety and Health (SPLASH)*. The aim is to link up the HSE plans with those of the Fair Work Convention and other partners. This in itself is progress, as historically HSE has had a poor focus on the different approaches in Scotland. It is the devolved NHS Scotland that picks up the cost of failure.

Two and half million days are lost because of ill health caused by work in Scotland, which costs the Scottish economy around £600m, to which we can add £500m due to injury. Those who argue that health and safety regulation is just a burden, should at least focus on the human and financial cost of inaction.

The public health focus on health inequalities is also relevant to improving health at work, something less well understood in a health and safety context. NHS Scotland research shows that some occupations and industries are associated with consistently better health outcomes; others the opposite, including caring, process and customer service occupations of particular interest to UNISON Scotland. Work is being done on a single gateway to access services, as well as links to the devolved social security service.

The GB HSE health and work strategy also recognises this link. HSE focusing on preventing work-related ill health, public health focusing on improving general health of the working population, and DWP extending employment health benefits to those currently not working. Of course there are more than a few sceptics regarding the UK government's commitment to all three, particularly the DWP!

Traditional HSE strategies have focused on communications through employers. With around a million workers in the gig economy, sector 'employers' have little commitment to their workforce and therefore new approaches are needed. Technological change is also shaping the future world of work including quantum computing, autonomous vehicles and synthetic technologies - to which I would add the people impact of excessive monitoring and control. There is a risk that we are turning people into robots, before viable automation even arrives.

The ageing workplace (it's doubled in recent years) also needs greater attention - focusing on health as well as the more obvious safety issues. Tomorrow's world may be unrecognisable from that of today - although I would argue that we should be wary of extravagant futurologist claims, based on historical experience.

A key focus is on stress at work, tackling the stigma as well as the causes. It is the biggest cause of ill health and the Scottish Government is about to publish a new 10 year mental health strategy.

The Scottish plan is based on the work of the Partnership on Health and Safety in Scotland (PHASS). It is seen as an opportunity for all those in the Scottish health and safety system to work together to improve workplace health and safety. There is a useful interactive map on the website that helps link up this network. It is a living plan that will evolve over time based on the latest evidence and practical experience, 

Initially there will be twelve action plans. The plans that will be of greatest interest to UNISON members include plans on stress, social care, driving and workforce engagement. In particular, we have huge safety challenges in social care, from lone working to violence.

There is a real willingness to join up health and safety in Scotland across devolved and reserved issues. Obviously there will some tensions with this, but as usual people can help break through institutional and political barriers. The real test is turning the strategic intention into practical action. Many of the organisations involved have big funding challenges, but hopefully the sum of the total will help bridge some of that gap.

*http://www.hse.gov.uk/scotland/pdf/scottish-plan-health-safety2016.pdf