Managing absence is already one of the key areas where group risk professionals can deliver genuine productivity benefits to employers. For delegates at the recent Corporate Adviser/Aviva round table Absence Management – Defining What Good Looks Like, patience and a focus on securing buy-in at senior level were seen as cornerstones ofan effective health and wellbeing programme.
For any advisers looking to develop their expertise in the area of absence management, Group Risk Development (Grid) spokesperson Katharine Moxham pointed to National Institute for Health and Care Excellence (NICE) draft guidelines that indicated that the process should start at the top.
She said: “It’s amazing how much this is about line management, and the main focus is choosing and training line management. NICE is basically saying the aim is to promote leadership that supports line managers and helps develop the business case to develop the line manager’s role. It will take quite a long time.”
Delegates agreed that health and wellbeing is a concept whose time is coming, and its use in managing absence is becoming more widespread by the day. And while the impending launch of the Fit For Work Service may not change the world, it can only serve to push the topic of rehabilitation further into the public eye. So what does best practice in the field of absence management actually look like? What works, what could be improved on, what is just window-dressing and how can advisers really help organisations change their behaviour?
JLT Benefit Solutions head of healthcare & wellbeing Richard Colver cautions that the sorts of changes that absence management strategies aim to deliver do not happen overnight. This makes the consultants role wider than simply choosing products. He said: “It’s cultural and it’s about changing the behaviour of the individual person, and that’s never easy. How long did it take to change the behaviour of people wearing seat belts? All that sort of thing has to be ingrained in the way you walk, talk and think, and that isn’t quick.
“It must also come from the top down. At BT the chap who ran health and wellbeing stated that it was a board directive pressing down through the company and that it would happen. The company had realised it had around 80,000 employees and the impact of just one extra day per person being at work was huge. So it made decisions on how it was going to deal with it and actually formed an entire programme around looking at itself as a business and enquiring where its risks were.”
Lark Employee Benefits divisional director Samantha Mistry, who deals primarily with SMEs, agreed that a cultural change was needed but pointed out that engaging management at her end of the market involved an added layer of difficulty.
She said: “I think intelligent people within SMEs can see the benefits and there is a genuine belief within these companies that people are their most important resource, but there’s nothing behind it. There are just so many calls on their time and there is no real training for line managers. Even in my own business if someone is really good at sales they become a manager but they may not have any man-management skills.”
Aviva head of group risk Steve Bridger stressed the importance of obtaining compelling industry-wide data to quantify the benefits of health and wellbeing programmes to interest both employers and government.
He said: “It hasn’t been tackled at an industry level and certainly not by Grid and the ABI (Association of British Insurers) together, and that collaboration is a real key as one can’t do it without the other. We’ve got a bit of data but it’s not statistically credible. So it’s a real challenge.”
Moxham pointed out that there was also a significant communications challenge. She said ”It’s no good having the numbers if there’s no engagement in the service, so you need employers to make sure people engage with actually using the services available to make the numbers effective.”
Insurers’ communications material clearly had a valuable part to play and, as Moxham pointed out, a landmark Financial Ombudsman Service (FOS) ruling on a group critical illness claim should count positive in this respect. The FOS ruled that information on the employer’s intranet had explained clearly that a pre-existing condition had been excluded.
But would intermediaries feel comfortable allowing insurers to communicate with their clients directly? After all, it could create problems if the intermediary wanted to switch elsewhere further down the line or if the client decided to deal with the insurer directly. Mercer head of health and benefits consulting John Matthews said he was now less concerned about this issue than he had been in the past.
He said: “There has generally been an attitude shift and things have moved on for a whole raft of reasons. Employers want more direct contact anyway and they are looking for different things. Technology means communication is easier, and it’s a cost issue for us as well.”
Mistry felt that it would certainly help if insurers provided suites of generic information that could be used for SMEs but pointed out that “It is face-to-face contact that really works”. In this respect she highlighted the problem of how intermediaries could get paid for communications work as smaller companies are not used to dealing on a fee-paying basis. She also poured cold water on the suggestion that intermediaries operating at her end of the market could be doing more to help communicate flex benefits.
Bridger said: “The reasons behind offering flex have been changing. Originally it was about reducing costs but now one of the biggest benefits of being able to flex cover up and down is the way it engages employees. But how many intermediaries embrace this? We don’t see a lot of evidence of it happening on a larger scale.”
But Mistry said: “We don’t do flex much as we find that people don’t seem to buy or flex much else other than holiday. With the size of employer we deal with there are no cost savings from flex because of platform costs, so we struggle massively. It does come down to education but how do you get education across?”
However, flex was far from being the only technology to be discussed in conjunction with health and wellbeing. A range of new wellness tools were now beginning to make their presences felt, and two attendees were actually wearing one of these around their wrists. Both Matthews and Colver were wearing Jawbone bands, which monitor daytime movement and sleep patterns and calculate whether they are sufficient.
Colver said: “Health and wellbeing isn’t just about the seven, eight or nine hours you are actually in the office, it’s actually about your 24 hour life. It’s about things like whether your sleep is interrupted and whether you are getting proper sleep or light sleep. I found out from Jawbone that I’m getting an hour and a half less sleep than I should be.”
Bridger had reservations about whether interest in such devices could be sustained over the long term once they were introduced into a corporate environment.
He said “My question is probably how do you get it to stick? After a year or six months on with Jawbone you might get 20 per cent usage and the ones who use it are the fit ones. That tells you nothing other than that you’ve got a fit element. The challenge is the longevity, so it needs to keep evolving, whether it be Fitbit or Jawbone or the telematics where you put something on your iPhone and have an ECG. The unit cost will fly down as a result of more engagement.”
“If you are engaged in these things it shows a motivation for life and for work, which is the biggest challenge in income protection claims, and certainly for musculoskeletal and mental health claims. But generally it would take years for health and wellbeing to influence group income protection claims, so that’s why for me health and wellbeing is not a group income protection issue.”
Colver didn’t entirely agree, pointing out that people could use such devices to avoid becoming ill. If, for example, they learned they were two or three months away from getting type 2 diabetes this could red flag it for them and enable them to do something about it.
Bridger also revealed that Aviva is looking into whether technology could be used to avoid the hassle of going to see a doctor in an age when many people work a long way from their GPs and the concept of a family doctor had disappeared. So why shouldn’t someone have a conversation with a doctor on their phone which is Skyped and recorded?
“You can have your medical records on there,” he explained, “and you can attach pictures of the bits that are hurting, and the doctor can see it and make a referral on the back of it. Why wouldn’t an income protection claimant want something like that? By definition you are in a period of your life when you are sick or injured and vulnerable and you are probably seeing your doctor quite a lot, which might be inconvenient. It could also be used for the whole workforce, not just for income protection claimants.”
Mistry lent some credibility to the idea by revealing that she had already benefited from receiving telephone and online advice from Aviva’s back clinic. A physio had emailed her video links of exercises she needed to do and she had experienced no further problems.
She said: “I thought it was brilliant but the majority of people in that situation would have gone to the doctor. Everyone has an iPhone or an Android and no-one talks to you anymore, they just text you, so using the technology makes sense.”
In a straw poll of delegates at the event, 50 per cent thought employers were currently spending too much on cure and not enough on prevention, whilst the other half thought the split was about right.
Matthews said “I don’t think much has been spent on prevention until recently but it’s going up the agenda for a variety of reasons. The government is pressing a healthy workplace as well as trying to get people off benefits, it’s on everyone’s agenda and I think that most of the right types of employers are understanding that a fit and engaged workforce is much more productive and therefore much more cost-effective.
“It’s back to how do you convince a finance director about return on investment? Many of them have a budget for insurance and may know they need to spend something on occupational health, so you must convince them that if they spend on this they save elsewhere. If you’re an employer who currently doesn’t have income protection but has some money to spend I would suggest that
these days that money is probably better spent on trying to keep people at work.”
