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Dr Bill Gunnyeon
Former Chief Medical Adviser, Department for Work & Pensions
Dr Bill Gunnyeon

Reflections on the health and work policy landscape

Authors: Dr Bill Gunnyeon

21 October 2014

Perhaps it is no coincidence that the launch of The Work Foundation’s Health at Work Policy Unit comes nine years after the Health, Work and Wellbeing Strategy was published. And what a nine years it’s been! Back in 2005, we still hadn’t developed the evidence base showing the positive health benefits of good work and the negative health effects of worklessness – it was almost a year later before Waddell and Burton published their seminal work 'Is work good for your health and wellbeing?'. Most people still felt work was likely to be bad for their health and if you were in any way unwell or had any disabilities you shouldn’t work. The old 'sick note' encouraged absence from work to be the norm and the Black Review of 2008 hadn’t even been conceived..

The degree of change achieved in this time is substantial. We’ve seen:

  • The groundbreaking review by Carol Black 'Working for a Healthier Tomorrow' and the initiatives from that which include the Fit for Work Service pilots
  • The introduction of the new “fit note”, now in electronic format as well
  • The independent review of sickness absence, 'Health at Work' by Carol Black and David Frost
  • The introduction later this year of Fit for Work, the new health and work service, across Great Britain
  • A gradual but highly significant change in culture and behaviour in relation to health and work across employers and the healthcare community

Despite this progress, there is still much more that should be done and many challenges ahead for employers and policy makers. We in the western world have an ageing and shrinking workforce supporting an increasingly elderly population. A workforce whicho will also be shouldering more caring duties both for elderly relatives and for grandchildren. And will themselves face increasing long term health conditions due to the natural effects of ageing and longevity and from lifestyle related factors. At the same time, our healthcare systems are under increasing pressure. It is fundamental that our health care systems allows people of working age:
   

    • To be treated quickly
    • To get the best possible functional outcomes
    • To have their long term health conditions managed in a way that will allow them to continue to work
    • To have access to healthcare at times convenient to work
    • To have easy access to simple mental health intervention

People themselves will need to be able to work longer to encourage active ageing and also to make financial provision for an increasingly long retirement And of course to support our elderly population we’ll need a dynamic economy which will in turn will depend on an available and productive workforce.Therefore, there are some significant issues facing us all:

For employers: to organise work in a way which will meet the needs of older workers; to facilitate early recovery and return to work; and to optimise the health benefits of work

For the healthcare system: to determine whether or not to give some priority to working age people; to ensure the best possible functional outcomes from treatment and interventions; and to ensure the management of long term health conditions supports continued working wherever possible

For policy makers: to improve social care provision to ease the burden on those who work; to improve the understanding of people about the health benefits of work; and to ensure we don’t lose our focus on preventing work related illness and injury

There is therefore much more still to do! Which is why I welcome the timely creation of The Work Foundation’s new Health at Work Policy Unit. Government has led much of the groundwork in promoting and developing the health and work agenda without which much that has happened almost certainly would not have. But for the agenda to progress to the next stage, it feels like now is the right time for there to be an independent and credible body that can act as a focus for new evidence-based policy deliberation and to which employers, healthcare bodies, employee / patient groups, and policy makers can turn to and engage with.
 
There is certainly a lot for the new unit to focus its attention on. Let’s see what can be achieved in the next nine years.