The multi-million cost of stress-related absence to the Post Office Ltd (POL) has highlighted to UK plc the importance of monitoring and tackling the impact of organisational change on workforce health.
Mental ill-health accounted for 26% of total absence at the POL in the past year, with the number of days per 1,000 employees increasing by 7% to 312 days. The organisation’s HR director told the spring meeting of the Society of Occupational Medicine that this costs POL in excess of £180,000 per month.
Debbie Moore described how the transformation of the POL from a traditional public sector service provider to a more commercial business meant “we expected our employees to behave differently”, resulting in “very, very different” metrics for success and a high number of stress and anxiety cases.
Moore has overseen the implementation of a number of tools to tackle the problem, working closely with consultancy Atos. This includes stress management and awareness training, stress audits and a dedicated helpline for managers.
Healthcare advisers and occupational health (OH) providers told Health Insurance that employers should not underestimate the impact of restructuring on the mental health of the workforce or the potential effect on absence levels.
“Staff engagement is essential in the current economic climate,” said Sheila Payne, health management consultant at intermediary ADVO Group. “Employers are reviewing levels of productivity and recognise the need to communicate with staff consistently with key messages of what is in it for them. Where we do that we can see things are implemented in a more timely fashion and potentially the fall-out is less.”
“You need to have absolute recognition that during that period of change you are creating uncertainties in large numbers of individuals,” said Dr Doug Wright, principal clinical consultant at Aviva UK Health. “That means being very clear in your communications strategy, and setting timescales for different sequences.” He highlighted monitoring absence as “typically the biggest improvement organisations can make”.
While the government hopes that the introduction of the “fit note” this month, giving GPs greater responsibility for integrating patients back into the workplace, will reduce absence levels, Moore’s presentation highlighted its limitations.
“If they [the employee] get a fit note that says they can return but they can’t sell, that will not work for us,” she said, acknowledging that POL still has “quite a high number of grievances and appeals”, some of which it has had to overturn. Changes put in place include a change in the ill-health retirement policy which means employees have a level access lump sum if they cannot return to the organisation.
Richard Colver, group risk and healthcare director at the UK employee benefits consultancy division of Willis, said some of his clients were “terrified” by the prospect of the fit note.
“The problem is that GPs are not OH specialists,” he said. “If they recommend that an employee returns to work the liability then falls directly on the shoulders of the employer to fulfil their duty of care and ascertain what their staff members can safely do at work. OH providers could start making an awful lot of money.”
“We can absolutely see the challenge,” said Margaret Murray, OH manager at insurer and OH provider CIGNA. “We had one company who said up front that they did not have the capacity to make reasonable adjustments. Over the years we did keep chipping away at them and helped them adapt some roles so they could be used for people coming back to the workplace. It can be done.”
ADVO’s Payne said that redeployment could be considered for stress cases but that it was easier to implement workplace adjustments.
“It’s important to talk to that individual and find out what tipped them over the edge and what support they could have,” she said. “Could counselling or cognitive behavioural therapy help? They need to develop skills to be able to face that challenge again and get their confidence up. If you redeploy them into an administrative or clerical role that is not going to help them or the business.”
Payne said that N HS waiting times for talking therapies meant the business case for investing in access to them was “quite clear”.
During her presentation Moore also highlighted the 25% of stress absence cases not referred to OH as an ongoing challenge for the organisation. Advisers expressed a range of views on how to tackle this.
Charlotte Bray, a consultant at national intermediary Aon Consulting, said organisations often had problems sourcing good OH provision.
“They don’t quite trust the quality of the service, or they buy provision on cost, rather than actually looking at what would be the best service to suit their needs,” she said. “Very often the person that is involved in sourcing provision has not got much knowledge around OH provision. If you want to prevent and intervene and provide proactive measures, you need to have a good OH service in place and have measures in place so you can begin to manage the performance of OH service and demonstrate the return on investment.”
This is a key area in which consultants can demonstrate their value to clients. Bray has a background in OH and Willis’ Colver described brokers as the lynchpin” for employers trying to tackle workplace stress.
“The broker has the knowledge of what facilities the employer actually has access to and will give you the integrated solution that insurers cannot,” he said. Willis offers clients access to an OH specialist who can advise on sourcing various services.
CIGNAs Murray said that referral rates could be improved by providing management information that shows if line managers are complying with referral guidelines.
While acutely aware of the costs to business of stress cases, advisers were keen to stress the positive effects of the recent recession.
“A lot of organisations are thinking it is a really good time to consider changing the way all benefits are delivered,” said Aon’s Bray. “For example, some banks had a big culture of never recording absence – managers could not find the time to record it. Quite a few were beginning to find the time to use really robust absent tools and changing the culture within the organisation. Then of course once you do that you are getting to intervening really early, which can very easily trigger into OH services.”
ADVICE ON SOURCING OCCUPATIONAL HEALTH
■ Know what components the service should be covering: an employer might buy case management and health surveillance but what about pre-employment checks?
■ Specify what service the employer wants and the key performance indicators it will be monitored against
■ Tailor the service to suit what the client needs
■ Send the client to visit the OH provider so that HR can understand how the service will actually work
■ For the first time in the UK there are now standards of performance for OH services, developed by the Faculty of Occupational Medicine, which is also developing an accreditation system to underpin them. Is your supplier complying with them?
■ Monitor the performance of the provider