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Let’s practice what we preach

Fancy a wee sweating with your boss?

This could be something that employees in Germany will have to add to the “interests” section on their CV according to the weekly magazine Die Zeit. At the local branch of Sparkasse a regional bank in Bad Kreuznach employees are encouraged to participate in a kind of hopscotch that involves jumping over a “river” on their way to the toilet. Apparently only 20% cheat – peer pressure in action. At Deutsche Messe in Hanover the world’s foremost trade fair company employees are encouraged to use stairs and at every level they are informed about the calories they have just used.

None of this is really new or radical and the evidence that workplace activity schemes can work – at least in the short-term, sustainability seems still to be an issue – is growing both in the UK (see e.g. NICE recommendations) and internationally.

From the evidence it is also clear that the efficacy of programmes varies but pretty much all conclude that there aren’t any silver bullets and that there is no gain without pain i.e. an increase in weekly physical activity. For example, a study by Transport for London concluded that “the most significant finding is that an increase in physical activity of over one hour per week (e.g. 90 minutes), easily achieved through walking or cycling to work, would be expected to lead to a measurable reduction in levels of absenteeism”.

There is also a pretty strong case for such interventions – the majority of us spend most of our waking hours at work; obesity levels are on the rise; and absenteeism costs the UK tens of billions of pounds every year.

But there is one more reason why I personally think that wellbeing firmly belongs in the workplace. I work for the NHS and so do 1.4 million colleagues. Our business is health, with an ever-growing emphasis on prevention.  We will stand no chance of achieving this for our patients if we can’t do it for ourselves. I therefore don’t think it is unreasonable to expect the NHS to be a beacon of excellence in workforce wellbeing.

And yet, it is not. That is not to say that nothing is happening, there have been plenty of schemes over the years and some trusts do better than others (see e.g. a study on London NHS employers). But I have yet to come across radically transformed workplaces that go beyond subsidised gym membership fees or cycle schemes as a matter of course not the exception. The same goes for nutrition and NHS canteens. A Department of Health report estimates that approximately 300,000 of NHS staff could be classified as obese and a further 400,000 as overweight yet there are currently few effective interventions to support NHS staff with sustained weight loss.

Is it therefore time to have a meaningful debate about workforce wellbeing? This requires careful positioning given how sensitive this can be (see e.g. recent discussion on obesity) and should include not just physical but also mental wellbeing.

There are some who bemoan the fact that unlike in the US or continental Europe where employers pay health contributions there are few incentives for employers to play their part in promoting health in the UK. “Free riding” is indeed one fundamental downside of a national health system that is free at the point of delivery (though if the absenteeism number are remotely right there should be at least some incentive).

The NHS could be a fantastic living laboratory to develop robust, evidence-based and economic workplace wellbeing schemes. Despite the existing evidence, we still need that innovation at scale to ensure sustainability and it will require more than gentle nudging. Would it be legitimate to expect providers of weight loss programmes (including surgery) to improve the health of their workforce as part of their contract perhaps?