Committee discussion

For an explanation of the evidence statement numbering, see the evidence reviews section.

The committee (Public Health Advisory Committee E) was mindful that self‑employed people are not included in this guideline. However, many self‑employed people are also line managed, for example on a fixed‑term contract or for a particular project. The guideline applies to the line management of contract, temporary and agency employees where appropriate.

The committee acknowledged that the relationship between line management and employee wellbeing is complex and can vary by occupation, organisation size, sector and a number of other factors.

The committee acknowledged the different cultures and working practices between organisations. These can vary widely by organisation size, from large multinational organisations, small and medium‑sized enterprises to micro-organisations. These differences will affect how recommendations are implemented.

The evidence reviews showed that studies conducted in different countries often yielded similar results. The applicability of findings to the UK were taken into account.

All the findings showed a positive association between all interventions and employee health and wellbeing. Causation could not be determined by the studies included in the qualitative reviews.

The committee considered whether employers should be required to promote 'traditional' workplace health interventions such as exercise, healthy diet and stopping smoking. However the committee felt it was not appropriate to mandate employers to do this.

The consequences of implementing workplace health policies or interventions need careful consideration because they may have unexpected (and often undesirable) knock‑on effects on other employees. The core principle of workplace health policies or interventions is to 'cause no harm'.

The committee acknowledged that people management is as important as task management. The committee noted that organisations committed to workplace health and wellbeing consult employees and perform needs assessments. The committee also noted the importance of health and wellbeing as a consideration during business planning and any organisational change, given the possible impact this may have on all staff.

The committee agreed the importance of good management and acknowledged that a number of leadership styles are discussed widely in the literature. The evidence reviews for the guideline reported findings for both positive and negative leadership styles including transformational, authentic and self‑centred leadership. Although the committee has recommended the need for line managers to develop a positive leadership style, it does not endorse any particular positive leadership style.

The committee recognised that in most organisations promotion opportunities normally involve increased management responsibilities. However, some people with excellent technical skills do not have (or do not want to develop) the necessary 'people skills' to line manage. The committee noted that these people may benefit from alternative promotion and development opportunities.

The committee recognised that line managers, like the employees they manage, may experience life crisis events such as grief or bereavement, relationship problems or financial difficulties. The committee noted that at such times line managers will seek and receive staff support services that are available to all employees. Furthermore, the committee noted that line managers could also seek support for themselves with any mental health or physical health issues they are experiencing.

The legal obligations of employers were also acknowledged, such as health and safety responsibilities, sight tests, supporting those who are visually impaired or otherwise disabled and providing safety equipment. Employers may find it useful to use Health and Safety Executive codes of practice and Equality and Human Rights Commission codes of practice and technical guidance.

The committee noted the important work of the Advisory Conciliation and Arbitration Service (ACAS) in helping prevent and resolve workplace problems. Members agreed that employers may find it useful to use ACAS codes of practice and guidance.

Most of the studies identified in the evidence reviews report short‑term outcomes. The committee felt that a long‑term focus is also needed when commissioning and planning further research. There is a need for more longitudinal studies to investigate sustainable effects over longer follow‑up periods.

The committee recognised that there was a need for a national database on the effect of new activities, policies and organisational change on health and wellbeing. National recommendations of this kind are outside the scope of this guideline. However, the committee discussed that it would be useful for employers if such a database included productivity and business outcomes, cost information and the general and economic benefits of providing a healthy workplace. It also noted that there was a need for qualitative data and evidence on what works for whom and when. The committee also discussed the fact that employers, practitioners and researchers on workplace health may provide a useful contribution to this nationwide database.

Economic evaluation

Some key benefits of improving the health of employees through improved workplace practices are hard to measure quantitatively. These benefits include a feeling of increased safety and satisfaction, greater loyalty, and improved societal reputation for employers, and are associated with increased productivity of workers. There is consistent evidence that relatively small investment in line manager training (and its effects on their attitudes and those of their employees) can lead to worthwhile improvements in worker satisfaction, which in turn are linked to gains in productivity for the organisation. The modelling done for this topic shows that these productivity increases will usually be at least as large as the benefits of reducing absenteeism, presenteeism and employee turnover, and may be many times larger. However, it may take some time to recoup the initial investment.

The committee agreed that an emphasis on employee health and wellbeing is equally important during a recession or financial crisis, as in times of economic growth. A focus on health and wellbeing can sustain and develop a strong workforce for the future.

Committee discussion about older employees

The committee (Public Health Advisory Committee D) agreed that recommendations covering older employees should be considered as part of a wider approach to promoting all employees' health and wellbeing. They were therefore incorporated into the existing public health guideline on this topic. This would simplify and support the process of implementing both sets of recommendations.

The committee noted that workplace policies and practices could also affect other groups such as people with disabilities or minority ethnic groups. Although actions could be taken to address the needs of these groups, the aim of extending this guideline was to incorporate recommendations on older employees in line with the referral from the Department of Health.

The committee noted that older people are more likely to be unemployed or economically inactive than younger people, and tend to find getting back into work after absence more difficult.

Unpaid workers are included in the recommendations because the committee was aware of the many benefits (to volunteers, organisations and wider society) gained from older people's participation in unpaid work. The committee's view was that much of the evidence is likely to be applicable to these volunteers.

Changes to workplace health and safety and other relevant legislation are not part of the guideline scope. The committee had hoped to make recommendations to help increase employers' awareness of the legislation and support its implementation, in particular related to the needs of older employees. Although this is out of scope, members recognised and reflected on its importance in their discussions.

Committee members noted that NICE's guideline on alcohol-use disorders: prevention makes only limited reference to the workplace. This was because there was only limited evidence about alcohol interventions at work at the time it was published. The committee noted that the workplace is now recognised as an important setting for delivering brief advice on alcohol. Making general health promotion recommendations is outside the scope of this work, but the committee wanted to recognise its importance here.

Issues for older employees

The committee agreed that the benefits of working can extend beyond financial remuneration. Actively participating and making a worthwhile contribution at work can improve health and wellbeing. Working (including volunteering) can also be an important way of socialising and making friends.

But members also agreed that not everyone benefits from work. For example, work that makes excessive physical and mental demands on a person can be detrimental to their health and wellbeing. The committee recognised this by recommending offering re‑training opportunities (recommendation 1.9.5) to enable them to continue working if their job role changes.

The committee discussed changes to the state pension age and the abolition of the default retirement age, including the potential health implications of a later retirement. But the effects of these changes have not yet been reported in the published literature. Lack of evidence meant that interventions on planning and preparation for retirement could not be included. They also noted that self‑employment and the use of zero‑hours contracts (in which the employer is not obliged to provide any minimum working hours, and the worker is not obliged to accept any work offered) were not considered by the published literature.

The committee noted that as people age their caring responsibilities change, and this is likely to become more common as more people survive into older age. Some employees may be caring for their children and their parents at the same time, while others may have caring responsibilities for their grandchildren. Bereavement also has a significant impact, particularly if it involves loss of a partner. As the working age extends it may become more likely that people will experience bereavement while they are still working.

The committee reflected this need in recommendation 1.10.5. The evidence for this recommendation included 13 studies [1 high quality (++), 9 moderate quality (+) and 3 poor quality (−), ES6.1a] including surveys and qualitative studies on older workers, which covered attachment to work, and factors that help and hinder flexible working for older employees. There was also evidence from a range of other studies [ES6.4a, ES6.4b and ES6.4c] from surveys, qualitative data and mixed methods approaches on flexible working and on retirement decisions and financial planning [ES6.8c]. The committee recognised the limitations of the study types in terms of bias. But it agreed that the results were in line with its own experience and expert consensus. It also agreed that making recommendations about these issues was important to support older employees in the workplace.

Stereotypical assumptions about older employees

The committee discussed the need to avoid stereotypical assumptions about older employees, such as assuming that they are unwilling to change or unwilling to learn (recommendations 1.4.3 and 1.4.4; [ES6.2a, ES6.2c, EP9, EP11]). That is because such assumptions risk marginalising this group, and could prevent employers from making the best use of their potential.

This is the case even when the assumptions are positive (for example, that older people may be more reliable and loyal). Making such assumptions may imply, for example, that younger employees are less reliable and less loyal.

Workplace health interventions for older employees

The committee noted that poor health can have a direct impact on a person's ability to work. Other factors related to poor health, such as the time needed for health appointments, and the need to take medication at work or to manage any adverse effects of treatment, will also have an impact. The committee agreed by consensus that providing health interventions at work, such as flu vaccinations for the over‑65s, may be helpful for employees who find it difficult to attend health appointments during the day, although this would only cover a small proportion of the workforce. However, the committee decided that offering a general workplace health promotion service may not increase uptake of these services in older employees.

The committee agreed on the need to raise awareness of health‑related issues and recommend signposting to relevant services (as in recommendation 1.6.2), such as free eye tests for people over 60. However, it noted that some services are also available to younger age groups and it would be important to ensure that all employees are helped to access appropriate services.

The committee considered comments on the importance of communication issues relating to sight and hearing loss. These can have a significant impact on people, both at work and in other areas of their lives. However, no evidence was found relating specifically to sight or hearing issues. The committee noted that equalities legislation requires employers to make reasonable adjustments to the workplace to accommodate the needs of people with visual impairments. However, the committee felt it was not necessary to recommend compliance with a legal requirement.

The committee looked at recovery from shift work and the role of physical activity and diet programmes in supporting recovery. The evidence base identified by NICE's commissioned review was limited. Evidence supported the committee's view of the potential impact of shift working on health [ES6.1a, ES6.1b]. Weak evidence from 1 poor quality (−) before‑and‑after study was found on rotation of shift and its impact on older employees [ES4.1]. The committee felt that considering the impact of shift work in the recommendations was warranted (recommendation 1.10.6), although the evidence did not allow a recommendation to be made about the type or frequency of shift patterns specific to the needs of older workers. Evidence from 1 moderate quality (+) randomised controlled trial (RCT) showed positive outcomes in mental health and decreased daily work strain from a physical activity intervention. Another moderate quality (+) RCT of a worksite vitality intervention (comprising exercise and yoga sessions, free fruit and visits from a coach) had a beneficial effect on recovery after work in employees aged over 45 years [ES4.6]. The committee recognised the limitations of this evidence but considered it plausible that physical activity and improved nutrition could have a beneficial effect on recovery, and may also have other broader health outcomes (recommendation 1.10.7).

The evidence for older employees

The reviews examined evidence relating to employees aged over 50. Two reviews looked at the effectiveness of interventions and were limited to evidence published since 2005, and to evidence from OECD (Organisation for Economic Co‑operation and Development) countries. They excluded older employees with pre‑existing health conditions. Studies were included that were aimed at employees aged over 50 or addressed entire workforces where at least 51% of employees were aged over 50.

Full details of inclusion and exclusion criteria are in the evidence reviews.

Little evidence was found on the effectiveness and cost effectiveness of interventions for older employees that aim to:

  • improve their health and wellbeing

  • extend their working lives

  • help them prepare and plan for retirement.

A third review (of qualitative research) was restricted to the UK, Australia and New Zealand.

Evidence about the general workforce is likely to be more extensive, but the referral from the Department of Health was specific to older employees and the literature search reflected this.

The evidence identified focused on older employees. It did not identify any head‑to‑head comparisons between the needs of older and younger employees so the committee couldn't determine whether different interventions are needed for older and younger employees. The committee recognised that the evidence identified may apply equally to younger age groups, and have developed the recommendations to recognise this where possible.

Economic modelling

Economic modelling was carried out from an employer's perspective because they will be paying for the interventions to maintain and improve older employees' health and wellbeing. Because every organisation is different, the committee wanted the modelling to take the form of a cost calculator that could be used by individual organisations.

The cost calculator assumes that employers are concerned only with profits. This is not necessarily the case, so it is likely to underestimate the range of potential benefits to the organisation (such as loyalty and active participation in reaching organisational goals).

To estimate whether an intervention is worthwhile, the organisation inputs its details, including number of employees, annual staff turnover, absentee rate and the gross cost of the intervention. The assumptions made can be modified to model 'what if' scenarios. The calculator then estimates the net cost of the intervention.

The basic cost calculator does not include healthcare costs, but users may add this aspect. The model assumes the intervention will reduce the sickness absence rate.

Employers will need to use their own judgement about how well the assumptions in the model reflect their own circumstances.

In addition, the cost calculator does not take account of any positive or negative effects on third parties. For example, it does not calculate any potential reduction in road collisions, third party injuries or hospital care needed as a result of interventions to improve the performance of older employees who drive as part of their work. [new 2016]

Evidence reviews

Details of the evidence discussed are in the evidence reviews.

The evidence statements are short summaries of evidence, in a review, report or paper (provided by an expert in the topic area). Each statement has a short code indicating which document the evidence has come from.

Evidence statement (ES) number 1.1 indicates that the linked statement is numbered 1 in review 1. ES 2.1 indicates that the linked statement is numbered 1 in review 2. ES 2.1 (1) indicates that the linked statement is numbered 1 in review 2 and relates to key question 1. EP1 indicates that expert paper 'Ipswich Building Society' is linked to a recommendation. EP2 indicates that expert paper 'People matter' is linked. EP3 indicates that expert paper 'Workplace practices to improve health' is linked. EP4 indicates that expert paper 'Expert testimony: Dr Maria Karanika‑Murray' is linked. EP5 indicates that expert paper 'Expert testimony: Sarah Page, Prospect Union' is linked. EP6 indicates that expert paper 'Health in older workers: an introduction' is linked. EP7 indicates that expert paper 'Some evidence on impact of Age Management and Work Ability Programmes' is linked. EP8 indicates that expert paper 'Extending working life, pensions & retirement planning' is linked. EP9 indicates that expert paper 'Employers' attitudes and practices towards older workers. Policies and approaches to combat barriers for older employees and support extended working lives: an international perspective' is linked. EP10 indicates that expert paper 'Work Ability model and index' is linked. EP11 indicates that expert paper 'Extended and extending working lives: your experience of the health and care sector. An international perspective' is linked. EP12 indicates that expert paper 'Healthy workplaces group (Age Action Alliance) and your work with the Employers Network for Equality and Inclusion'.

If a recommendation is not directly taken from the evidence statements, but is inferred from the evidence, this is indicated by IDE (inference derived from the evidence).

The evidence statements from 6 reviews are provided by external contractors.

Section 1.1: ES1.1, ES1.3, ES3.2d; EP1, EP4; IDE; modelling report: economic analysis of workplace policy and management practices to improve the health of employees. [2015]

Section 1.2: ES3.2d; EP2, EP4, EP5; IDE [2015]

Section 1.3: ES1.1, ES2.1, ES3.1c, ES3.2b, ES3.2c, ES3.4; EP1, EP4, EP5; IDE [2015]

Section 1.4: ES3.3; EP4, EP5; IDE [2015]

Section 1.4: ES6.2a, ES6.2c; EP9, EP11; IDE [new 2016]

Section 1.5: ES2.4, ES3.1d, ES3.2c, ES3.3; EP2, EP4; IDE [2015]

Section 1.6: ES3.1a, ES3.1e, ES3.2a, ES3.2b, ES3.2c, ES3.2e, ES3.2f; EP1, EP2, EP4, EP5; IDE [2015]

Section 1.6: IDE [new 2016]

Section 1.7: ES1.1, ES2.4, ES3.1a, ES3.1d; EP4, EP5; IDE [2015]

Section 1.8: ES2.4, ES3.2a, ES3.2b, ES3.2c, ES3.2e, ES3.2f, 3.5; EP2, EP4; IDE [2015]

Section 1.9: ES1.1, ES2.1, ES3.1c; EP5; IDE [2015]

Section 1.9: ES6.2a, ES6.2c, ES6.3; EP11; IDE [new 2016]

Section 1.10: ES3.1c, ES3.1d, ES3.2c, ES3.4; EP1, EP2, EP4, EP5; IDE [2015]

Section 1.10: ES4.1, ES4.2, ES4.6, ES6.1a, ES6.1b, ES6.2a, ES6.2c, ES6.3, ES6.4a, ES6.4b, ES6.4c, ES6.8c; EP10; IDE [new 2016]

Section 1.11: EP1, EP3; IDE [2015]

Gaps in the evidence

Both committees identified a number of gaps in the evidence related to the programmes under examination based on an assessment of the evidence and stakeholder comments. The gaps relating to the original workplace guideline are set out below numbered 1–5, followed by the gaps relating to older employees numbered 6–15.

1. There were only 5 UK studies reported in the 3 evidence reviews undertaken for this guideline. There is therefore a need for more research in the UK. Furthermore, no cost‑effectiveness studies were found that could answer the research questions. So there is also a need for more economic and cost‑effectiveness data. More research is needed on how much training, and what kind of training, line managers should have to reduce worker absence and staff turnover cost effectively. There is also a need to identify the extent to which interventions designed to improve the wellbeing of employees can cost effectively increase productivity.

(Source: evidence reviews 1, 2, 3 and cost effectiveness review)

2. More evidence is needed from small‑ and medium‑sized organisations.

(Source: evidence reviews 1, 2 and 3)

3. No studies were found on the line management of unpaid workers such as volunteers and interns.

(Source: evidence reviews 1, 2 and 3)

4. More research is needed on the effective contribution of occupational health, human resources and health and safety to supporting line managers in promoting workplace health and wellbeing.

(Source: evidence reviews 1, 2 and 3)

5. There is a need for more accurate and detailed reporting of study methods to encourage transparency, ensure studies can be replicated and assess long‑term impact. Studies need to report what does not work as well as what works. There is also a need for journals to have editorial policies that invite and publish reports of negative, inconclusive or positive effects. The suppression of negative results can bias study effectiveness.

(Source: evidence reviews 1, 2 and 3)

6. There is a need for evidence on how different work conditions affect perceived workplace equity for older employees compared with the whole workforce.

(Source: evidence review 6)

7. There is a need for evidence on how workplace interventions for older employees affect health inequalities.

(Source: evidence reviews 4, 5 and 6)

8. There is a need for evidence on the effectiveness and cost effectiveness of interventions aiming to improve and maintain the health and wellbeing of older employees.

(Source: evidence review 4)

9. There is a need for evidence on the effectiveness and cost effectiveness of interventions to help older employees remain in work. For example, the impact of a change in job specification on retention.

(Source: evidence review 4)

10. There is a need for evidence on the effectiveness and cost effectiveness of interventions to help older employees plan and prepare for retirement.

(Source: evidence reviews 4, 5 and 6)

11. There is a need for evidence on the options for work, retirement and pensions on offer and the impact of these options on a person's decision whether or not to stay on at work. This includes providing flexible and part‑time work, or a change in job role.

(Source: evidence reviews 4, 5 and 6)

12. There is a need for evidence on the effectiveness and cost effectiveness of interventions to challenge stereotypes and change employer and general workforce attitudes to older employees.

(Source: evidence reviews 4 and 6, expert testimony 12)

13. There is a need for evidence on the transferability of interventions to support older employees across employment sectors.

(Source: evidence review 6)

14. There is a need for evidence on knowledge about and uptake of newer technologies by older employees.

(Source: evidence review 6)

15. There is a need for evidence on the health benefits and risks of extending working life and how these may vary according to the nature of the work.

(Source: evidence reviews 5 and 6)

Both committees made recommendations for research that they believe will be a priority for developing future guidelines. These are listed in recommendations for research.