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Health Works: A Review of the Scottish Government's Healthy Working Lives Strategy



"The health of Scotland's population is key to the wellbeing of individuals and communities and to future economic success. The Scottish Government will continue to develop policies that support a healthy, productive and motivated workforce for the 21st century."
- Nicola Sturgeon MSP, Cabinet Secretary for Health and Wellbeing, June 2009

Ill-health in the working-age population has been estimated to cost the British economy £100 billion a year in lost productivity, lost tax and increased health and welfare costs 1.

The then Scottish Executive published Healthy Working Lives - a plan for action2 in August 2004. This set out a vision for improving the health of the working-age population through promoting health and wellbeing in the workplace and supporting into work those who are unemployed with health conditions. A healthy working life was defined as "one that continuously provides working-age people with the opportunity, ability, support and encouragement to work in ways and in an environment which allows them to sustain and improve their health and wellbeing".

Since 2004 there have been a number of policy developments around health and work which have prompted a review of the healthy working lives approach. These have included: the publication of the Great Britain-wide Health Work and Wellbeing strategy; the review of evidence on health and work, Is work good for your health?3; Dame Carol Black's review of the health of the working-age population of Britain, Working for a Healthier Tomorrow; and the responses to the latter by the Scottish, Welsh and UK Governments 4, 5, 6.

The evidence that informed Dame Carol's review, in particular, has significantly strengthened the case that, for most people, being in work is better for their long-term health than being unemployed, and that unemployment can severely damage health in the long-term. There is also a growing body of evidence to support the business case for employers investing in the health and wellbeing of their workforce.

Demographic changes are also impacting on the current and future working-age population. Scotland has an ageing population with a growing proportion of the workforce over 50, a trend that will continue for a number of decades. In addition, people are living longer, with more choosing to work later in life.

These changes will present challenges for the future. Public services, particularly health, will need to address demand for support to help people with conditions associated with older years to remain in work. Employers, too, will need access to advice on the measures they can take to maximise the health, wellbeing and productivity of an older workforce.

The Scottish Government wants as many people as possible to share in the rewards of work, because satisfying work is the best route for most people to a fulfilling life and to good health and wellbeing. In essence the Health Works approach is to ensure that health is not a barrier to work for as many people as possible.

Government's Economic Strategy

In addressing some of the causes and effects of ill-health in the working-age population of Scotland the Health Works strategy can make a significant contribution to delivering the Scottish Government's purpose targets and to economic recovery. Therefore, the strategy is consistent with, and is indeed a key element of, the achievement of the central Purpose of higher and sustainable economic growth.

For example, the strategy will contribute to improved health and wellbeing which is crucial to people's ability to engage in education and training, and to increase their participation in the labour market.

The report 7 from the Scottish Council of Economic Advisers has identified improving productivity as a critical contributor to sustainable economic growth. There is strong evidence that employers who invest in promoting the health and wellbeing of their employees see significant benefits to the bottom line through improved attendance, better motivation, increased productivity and better staff retention. Research by PWC8 looked at 55 organisations in the public and private sector, with between 50 and 100,000+ employees and covering a wide range of industries from pharmaceutical manufacturing, engineering, financial services, utilities, education, the NHS and local and central government. These cases showed returns ranging from £1 to £34 for each £1 invested in a variety of activities to promote and improve health and wellbeing over periods of between 6-12 months.

Higher productivity will (other things being equal) mean lower unit costs of production and lower output costs in general. Improved productivity will, therefore, increase the competitiveness of Scottish industry.

Work is, for most people, good for long-term health outcomes. Maximising the number of working-age people who are in work and promoting health through the workplace will contribute to improving the healthy life expectancy of the population of Scotland. By offering support to those whose ability to work is compromised by health problems, we can improve their health and reduce the negative impact of unemployment on health.

In the current economic climate, it is more important than ever for employers to maximise their competitiveness and the Health Works strategy should be seen in that context. Businesses need our support to recognise the significant productivity and profitability benefits they can gain by improving support available to all employees through the development of workplace policies and practices to promote and improve workforce health and wellbeing. We wish to encourage greater understanding and commitment from the business community to embrace and adopt better practices in this area.

The working-age population of Scotland is approximately 2.7 million. This figure includes all those over 16 years of age, but excludes students, homemakers, those on long-term or temporary sickness absence and the retired.

Source: Labour Force Survey, 2009 9 ( ONS)

Estimated prevalence and rates of self-reported illness caused or made worse by work, by type of illness, for people working in the last 12 months (Great Britain)

Bone, joint or muscle problem


Stress, depression or anxiety


Breathing or lung problems


Source: Labour Force Survey, 2008 10 ( ONS)

Occupational accidents and ill-health, 2007-08


Great Britain

Suffering illness caused or made worse by work



Workers killed at work



Other injuries reported ( RIDDOR)



Source: Health and Safety Executive/Labour Force Survey, 2008 11 ( ONS)

Incapacity benefit claimant levels and rates by reason
(for Scotland's working-age population), November 2008



Total IB Claimants



Diseases of musculoskeletal system and connective tissue



Mental and behavioural disorders



Diseases of the circulatory or respiratory system



Diseases of the nervous system



Source: DWP, 2009 12

Inequalities in health can be reduced by helping people back into work. This will contribute to the solidarity and cohesion targets through both improving income levels in more deprived communities and improving the labour market participation gap in those areas. This requires improvements in collaborative working across health, employability and other agencies that support people into work. The Scottish Council of Economic Advisers has recommended that the civic consortium model already operating in Glasgow, Dundee and Edinburgh is adopted more broadly in Scotland where economic inactivity is a problem.

Discover Opportunities is the Dundee Partnership's Employability Programme.

The Dundee Partnership includes, amongst others, Dundee City Council, Jobcentre Plus, Skills Development Scotland, Careers Scotland, Dundee Community Health Partnership and the community and voluntary sectors. The Partnership recognises that organisations working together in partnership in a joined-up way are better able to meet the needs of the citizens of Dundee than working separately.

The Dundee Partnership deals with a wide range of issues affecting the lives of people in Dundee and the Employability Programme delivered through Discover Opportunities aims to:

  • Reduce the number of people in the city on working-age benefits;
  • Increase the number of people in work and who are able to stay in work.

The Discover Opportunities Centre brings together staff from various organisations to provide a joined-up service to help people progress into employment, education or training. The Discover Opportunities Centre team offers advice on jobs and careers, money matters, childcare, and health.

Through the current economic climate, those who find themselves out of work may be at increased risk of poorer health as a consequence. Those who develop health conditions will find it harder to return to work and risk the health and other consequences of long-term unemployment for themselves, their family and their community. We need to step up action to support people to maintain their health and wellbeing until they can return to work.

Policy Context

In Better Health, Better Care: Action Plan13 the Scottish Government committed to re-energising the healthy working lives agenda. This particularly recognised the important contribution that NHS Boards can make to enabling people to retain or return to work through partnerships and through delivering the recommendations of the Delivery Framework for Adult Rehabilitation14.

The importance of obtaining and remaining in work is recognised as a key contributor to reducing health inequalities. The Scottish Government and COSLA health inequalities strategy, Equally Well15, describes a series of actions to improve health and wellbeing in the workplace and help those out of work to access services to help them find employment.

Mental health and wellbeing is a particular cause for concern amongst the working-age population, being one of the major contributors both to sickness absence and to reasons for claiming work-related welfare benefits. Towards a Mentally Flourishing Scotland16 sets out actions to promote good mental health and wellbeing and to address poor mental health in the working-age population.

Alcohol misuse has a significant impact on economic output, reducing the productivity of those at work and contributing to absences, unemployment and premature mortality. The total cost to the Scottish economy is estimated at £800m each year. This cost is one of the reasons why the Scottish Government is seeking to implement a range of actions in Changing Scotland's Relationship with Alcohol: A Framework for Action17, including the promotion of management-led workplace programmes in tackling alcohol misuse.

The welfare benefits system is reserved to the UK Government and is the responsibility of the Department for Work and Pensions ( DWP). The DWP has undertaken a series of reforms of the welfare system, aimed at supporting more people into work. Jobcentre Plus provides services for the unemployed, including job seekers and those on incapacity benefits. The Pathways to Work programme aims to provide help to those on or at risk of going onto incapacity benefits and includes the Condition Management Programme to help people manage their health conditions so that they can return to employment.

Incapacity Benefit ( IB) was replaced by Employment and Support Allowance ( ESA) in 2008, which provides more focus on what people can do rather than what they cannot.

Workforce Plus, an Employability Framework for Scotland18, sets out actions for national and local partnerships on what is needed to achieve an effective and coherent employability service across Scotland. Workforce Plus recognises the essential role of the health services. This includes relevant forms of treatment and also reaching clients in receipt of inactivity benefits who are not currently making active use of employment services.

The Scottish Government has a range of policies aimed at improving the health and wellbeing of the wider population. In particular, those aimed at smoking cessation, alcohol and substance misuse, physical activity and healthy eating recognise that there is a role for the workplace in promoting healthy choices and in providing information on healthy lifestyles.

The 2004 Action Plan

The 2004 Healthy Working Lives - a plan for action identified a set of actions to improve delivery of support for better health and wellbeing in the workplace, and for helping back into work those excluded due to health conditions.

The key action was the establishment of the Scottish Centre for Healthy Working Lives (the Centre) within NHS Health Scotland, bringing together a number of earlier initiatives aimed at improving health, safety and wellbeing in the workplace. The Centre has developed as a delivery body providing a range of advice and information on workplace health, safety and wellbeing, and promoting the Healthy Working Lives award scheme.

Other notable deliverables have included setting up a number of vocational rehabilitation pilot projects; the establishment of a stakeholder advisory group, comprising representatives from business organisations, enterprise, health, local government, trades unions and the third sector; and running pilot projects in the agriculture and construction industries.

Activities from the 2004 plan that require further work are development of national standards for occupational and health and safety providers; reviewing the international evidence base on health and work; and identifying future research priorities, including the build up of a library of best practice case studies, in order to develop the business case for the adoption of healthy workplace cultures. These issues will be picked up later in this document.