Fit for recovery

In their attempts to drive the UK’s economic recovery, Ministers and their Shadows have underestimated the importance of better healthcare. Healthier companies are more productive and profitable; better health is a winning advantage in the economic survival of the fittest. More effort from employers would mean reduced demand on the NHS budget – which would be greeted with joy by Ministers given the historic hole in the public finances. And the UK’s largest employer – the NHS itself – can show the way, and save billions of pounds in the process.

Without fanfare, UK employers are solving basic problems of modern healthcare that have defeated the Department of Health in recent years. Employers are providing fast access and health checks on demand. They are identifying poor mental health early and intervening quickly. They are motivating their staff towards better health. And they are engaging all members of the community, regardless of traditional health inequalities.

Employers are doing this for a number of reasons. The result is increased revenues, reduced costs and lower absence. This success is particularly important in a recession, when greater output from experienced staff could be the difference between a firm’s success and failure.

Market forces will drive employers towards better health. But Ministers can help employers in one way: by eliminating the bias in the tax system against workplace health.

The NHS has much to learn from the success of employers. Its efforts to improve the health of its staff have barely begun. At 4.5 per cent, its average sickness absence rate is fifty per cent higher than the private sector. If the NHS could improve its sickness absence rate on the private sector model, it would save £1 billion a year – a substantial gain given the forthcoming years of austerity. The NHS should aim to become the nation’s model employer in regard to workplace health.

The wider implication for public health programmes is that incentives matter. Government policy remains focused on national spending, national advertising campaigns and “command-and-control” measures such as a minimum price for alcohol. But while these approaches send a general signal, they are too broad brush and they fail to create a new sense of responsibility among individuals. A tax on fatty foods, for example, would not target unhealthy eating in the way that, for example, a tax on cigarettes targets smoking.

The better way is to look to incentives – to move from exhortation to motivation. The whole idea of “public health” should change to “personal health” – with the aim of making individuals responsible for their own health, with employer support. This report recommends a greater use of incentives at different levels:

For individuals – through creative use of direct payments, of bonuses for healthy living and of charges for healthcare. The most forward looking health insurers already provide healthy living bonuses for their customers.

For GPs – to develop new programmes for prevention and health promotion.

For Primary Care Trusts – to improve the long term health of their populations. Previous Reform research has recommended giving full control of NHS budgets to PCTs (and new competing organisations), so that they can see the benefits of greater investment in prevention.

This wider effort will see benefits for unemployed people just as for employees. Unemployed individuals are more likely to die early, suffer from obesity and smoke. The unemployed show between four and ten times the prevalence of depression and anxiety. Unemployment is accompanied by general poor health of lower socio-economic groups. The cost of this unhealthiness is felt not just by the individuals and their families but taxpayers throughout society.

More responsibility for individuals and employers, better health and greater productivity go together. Healthier individuals and workplaces will ameliorate the effects of the recession and advance the recovery. Greater personal responsibility will make individuals healthier and reduce the burden on government. The result will be a new culture of both health and enterprise in the UK.