What do pink elephants, Yammer, free cups of coffee, window clings and eating your PPE have in common? They all feature in National Grid's global wellbeing strategy.
"There are two related elements to our approach," says Andy Buxton, the company's health and wellbeing manager. "There is the occupational health (OH) side of things: what we do regarding health surveillance and assessments and fitness for work. Then there is the wellbeing side: how we help people become healthier and happier and more productive at work, as well as heading off some of the chronic diseases associated with the workforce becoming older and less fit."
Until 2011, National Grid's integrated programmes largely focused on physical health. They included statutory health surveillance -- mainly for operational engineers exposed to vibration, dust and noise -- health assessments to check fitness to work, cardiovascular risk assessments, fast-track physiotherapy, weight management and nutritional advice, and provision of workplace wellbeing kiosks that measure health parameters such as weight, height and blood pressure.
This approach produced impressive results and was well received by employees, producing a reduction in sickness absence among the 10,000-strong workforce that saved £8.9m from 2008 to March 2011.
"In 2011-12, we made a further step change," says Buxton. The National Grid board signed up to a new global strategy that included not only physical health and wellbeing, prioritising issues such as weight management, diabetes and cancer, but also fully recognising the importance of mental wellbeing. "It's well known that, alongside musculoskeletal disorders, mental health problems are a major source of sickness absence," Buxton says.
National Grid owns and operates the gas transmission network in Britain and the electricity networks in England and Wales. In Scotland, it operates but does not own the electricity network. Of the firm's 10,000 staff, 6,000 are in office-based jobs and 4,000 in operational engineering roles. It also has a large gas and electrical transmission and distribution business in the northeast US.
To kick-start its mental wellbeing campaign, entitled "Don't ignore the elephant in the room", the company used a stealthy approach. This included window clings (plate-size adhesive panels) displaying a pink elephant -- strictly speaking, a white elephant on a pink background -- the campaign name and the phone number for the employee assistance programme (EAP).
"A lot of our offices have glass walls on two sides, so around the offices we put up the clings but didn't give any context around it," says Buxton. "The idea was to get people talking; we didn't want to manage it."
For a month in 2012 this approach continued. "We'd just started an internal Yammer social media network," he says. "In week six we were going to stimulate a conversation on there, but well before that [the campaign] had stimulated its own debate and we didn't really have to intervene."
Buxton's team had recently taken over responsibility for the EAP from the human resources (HR) department, which had previously run it as a crisis management service.
"We wanted to use it as part of the wellbeing strategy," Buxton says, "so we could be proactive and help and support people before the things that potentially go wrong -- whether financial, relationships, or work-related -- cause mental health issues down the line."
Part of the aim of the campaign was to stimulate use of the EAP. According to the service provider, average use of EAPs is 5% to 5.5% of a workforce. "We are running at between 9% and 10% since we ran our campaign," says Buxton. "So it is embedded. It's ahead of the average, though there is still room for improvement."
The EAP offers basic psychological counselling. If employees have more significant problems with anxiety or depression, OH staff can refer them to another external provider, RehabWorks, which provides cognitive behavioural therapy and medium-term support.
"We can shorten return-to-work [times] quite significantly," Buxton says. "If our employees were waiting for the equivalent support via their GP, depending on where they live, it could take six to nine months before they were assessed and could access this type of service. We can get them in within a week or two at the most."
The business case for providing these services is strong. Health and Safety Executive (HSE) data shows someone with a stress-related condition has on average 29 days off work and the average cost of mental ill health is £1,035 per employee, whether or not they have a diagnosed condition.
"Across our business of 10,000 employees, that's more than £10m just on psychological challenges," Buxton says. "The cost of those services is perhaps between £500 and £1,000 at the most for each case. In reality that's less than a week's salary so it's sort of a 'no-brainer'. For every pound we spend on EAP or these psychological supports, we get back between £2 and £5."
Some people were reaching a point where they were physically unfit for work
The mental wellbeing campaign includes bespoke guidance for managers and a range of training courses.
"We already had online training that we'd developed with Business in the Community but we wanted to bring it to life and make it face-to-face," says Buxton. There are now two resilience training programmes: a one-day course for managers and a half-day course for individuals to build their personal resilience. "These tend to get focus when we go through organisational change," he adds. "We promote them then."
National Grid also provides mental health first aid training, an externally accredited international course that helps people to identify and understand mental health issues. In the first 12 months in 2013-14,300 managers and employees, including safety representatives, completed the course, and a further 300 have taken it since. (For more on mental health first aid see our feature at bit.ly/2iRCx1j)
In 2014, an executive sponsor was appointed to the programme. "We brought together a steering group of senior managers, HR staff, safety and trade union representatives, and specialists to work out how to move to the next stage," says Buxton.
The group put together terms of reference to improve the company's mental health support. These included: raising line managers' confidence and competence to manage various conditions; working with HR to adjust and review procedures that could have an impact on mental health; and to continue to engage with bodies such as Public Health England and mental health charity Mind.
The group is now working with HR to ensure the department's procedures and policies are mindful of mental health. "We are just talking about that at the moment," says Buxton, "looking at how we approach it." The team is also reviewing its leadership capabilities framework globally. "This is about what we expect managers to be skilful at," he stresses. "In the next 12 months, we will be mapping the HSE's management competency framework across our training framework, looking for gaps and how these might be closed."
One of the first things to come out of the steering group was a decision to sign the "Time to change" pledge, part of a government-led initiative to remove the stigma associated with mental health (www.time-to-change.org.uk). National Grid's chief executive signed the pledge, as did the executive sponsor for the mental wellbeing group. "We asked employees to make a pledge of their own," says Buxton. "And we had about 500 people sign up."
Staff also agreed to share their mental health stories. Buxton adds: "We had a couple of life stories from the leader of our steering group and another senior manager, as well as 25 other employees who came forward."
The government initiative promotes a "Time to talk" day on the first Thursday in February each year.
"In year one, we offered advice about how to start a conversation and asked people to have those conversations," says Buxton. "If they did, we paid for them to have a free coffee or tea."
More than 350 people took up the offer. "Obviously we couldn't monitor the quality or content but we know they had a conversation," he adds. The aim is to move the theme on each time. This year the company asked its line managers to take time to have conversations with employees.
In 2015 35% of employees had a body mass index (BMI) of greater than 30, classed by medical authorities as obese
Alongside mental health, Buxton and his team have been looking closely at the related issues of obesity and diabetes. Obesity costs the UK economy an estimated £47bn a year, an annual loss equivalent to 3% of GDP, according to a study in 2014 by the McKinsey Global Institute (bit.ly/1pH4f4i). "We know we reflect the demographic of the UK as a whole," says Buxton, "which means two-thirds of our employees will be overweight, significantly overweight or obese."
The company ran a weight management pilot a few years ago, targeting those most at risk. "We had data to say there were about 330 people who might be suitable for the programme [the firm was larger at that point]," Buxton explains. For the pilot, the company's medical adviser invited them to join, explaining that it would be managed under a medical protocol and would benefit them and help the firm understand how to support employees. "It went well but we didn't really move it through because at that time we became more focused on mental health," Buxton says.
Obesity came to the fore again in 2015-16 when an analysis of data from the health surveillance and assessment programmes suggested some people were reaching a point where they were physically unfit for work: digging holes, climbing towers, wearing breathing apparatus. Buxton gives the example of electrical distribution engineers who have to climb poles. "They have buckets on the vans to get up to the poles," he explains. "As far back as 2008, they were talking about how people met the weight criteria for the bucket but when they added the tools they overloaded it. So they could go up the poles but couldn't take up the tools." The solution at that time was to re-engineer the equipment, but Buxton believes tackling the issue from the other side is critical if the workforce is to stay healthy, fit and productive.
"We're going from being in a position where we're asking or encouraging people to make behaviour and lifestyle changes to address their weight to saying, 'You can't do your job now because you're too heavy or your weight is significantly impacting on your other conditions'. What we're now looking to do is to identify those employees who have the most significant issues -- and those who are likely to become fitness for work issues."
Figures from assessments show that in 2015 35% of employees had a body mass index (BMI) of greater than 30, classed by medical authorities as obese -- the National Health Service places healthy BMI in the range 18.5 and 24.9.
"We have quite a robust process of messaging, educating and supporting people who need to act to deal with this, encouraging better nutrition and increased activity levels," Buxton stresses. OH staff contact those who agree they need help and provide them with extra advice.
In future, the team plans to go further for staff who develop capability problems. "Our thoughts are that if people refer into OH with a bad knee or bad back -- but part of the contributing issue is around weight, with perhaps a BMI of more than 35 -- we would start to offer sponsorship support to a range of weight management or educational programmes." This would be monitored and there would be an agreement with the individual about the outcome. "It's about help and feedback. But rather than just being a nice-to-have for the individual, it becomes more of a work issue."
There are separate programmes encouraging staff who are outside the normal BMI range, either overweight or underweight. One of these was an inventive campaign to focus employees' minds on healthy eating. Entitled "Eat your PPE", and supported by workshops for field and office staff, the campaign explained the importance of a diet rich in plants, proteins and essential nutrients.
"It played on our very strong safety culture," Buxton says of the initiative's name.
In another healthy eating campaign, Take 5, launched in early 2016, local wellbeing champions were appointed to develop employees' understanding about nutrition and encourage behavioural changes, "not just the usual weight loss and weight gain cycle".
Board on board
Buxton has three pieces of advice for other organisations. The first is never to underestimate the importance of strong leadership: "You need senior executives sharing stories and leading programmes. While we are advising on the process, they are running it."
When National Grid put together its global wellbeing strategy in 2011, it included diabetes as a priority for attention. This was based on data from the firm's medical insurance provider in the US, which showed it had pockets of employees developing type 2 diabetes because of diet and lifestyle.
In the UK, most of the work on this part of the strategy took place in 2016. The company's physical wellbeing adviser, who is a nutritionist, took the lead on the programme, entitled "Diabeat It".
"We've talked about diabetes and the impact of diet at our major staff conferences and safety stand-down days, as well as in general workshops and meetings," says health and wellbeing manager Andy Buxton. "Our nutritionist estimates she has spoken in front of more than 2,000 people so far."
Employees were encouraged to contribute "life stories" outlining their experiences with diabetes. National Grid also worked with Wellpoint, which provides interactive wellness kiosks, to develop the facility for employees to score themselves for risk of the condition.
"This advised people to contact their GP where necessary and provided a printout giving further information," says Buxton. "We know one in 17 people have diabetes in the UK and that one in five doesn't know they have it, so we're trying to get to those people. Across the UK business, we know perhaps 700 people had diabetes but probably 130 didn't realise."
National Grid is now gathering data on how many people the programme has helped. But Buxton is confident the level of awareness has gone up significantly. "We've already had a few people come and say they have been to their GP and been fully diagnosed."
His second tip is to run sustained campaigns. "We began designing our diabetes campaign 15 months ago; it started at Christmas in 2015 and ran the whole year." The campaign had distinct stages of development, starting with awareness-raising, then persuading them to take measurements, and then feeding back the improvements people had made. "There were a few other health initiatives during that time but diabetes was the major campaign, he says. "We were really trying to get into the nuts and bolts of it."
The "Elephant in the room" campaign has run for almost five years and Buxton sees it continuing for at least five more. "A continuous focus on your main issues is critical," he says, "so you might have to reject requests to do different things and be a bit picky about what you do. In the past, we may have done ten or 15 things through the year, but they come and go and don't register with people."
His final advice is to run integrated campaigns that fit well with wider business objectives and employee concerns. "That way, you create something that complements and supports other communications. We sometimes link our campaigns with the company's chosen charity." For example, another element of the global strategy was cancer awareness. When Macmillan Cancer Support became the firm's charity partner, it held workshops at the company's larger sites, and National Grid's health portal added links to Macmillan's resources.
National Grid's next step is to create a broad set of wellbeing principles. "We are just starting that process," he says, "and asking for thoughts from our various business groups." Some of these principles will be personal, such as "we will be conscious how we use technology out of hours" or "we will ensure we take our breaks and annual leave".