Health-of-the-Workplace by qingyunliuliu


									The Aviva UK Health
Health of the Workplace
Report – Issue 4
October 2010

Now in its fourth year, Health of the          The sometimes worrying findings from our
Workplace is Aviva’s annual study that         research provide an insightful view into
canvases GP, employer and employee             the challenges faced by GPs and help to
opinions on topical issues in order to         highlight the factors the Government should
uncover and raise awareness of important       consider when tackling these issues. We
matters relating to health. This information   also look at how people can play a role in
is then used to suggest solutions that will    maintaining their own health and wellbeing,
help both employers and employees.             which helps GPs to focus on those that really
                                               need their support.
To achieve this we work with a specialist
research agency to survey 200 GPs, 200
employers and more than a thousand             Section 2 – The employee
employees. The Health of the Workplace 4       and business leaders’ view
research took place in April 2010.
                                               This years’ business leader and employee
This year, we have divided the report into     study explores whether work relationships
two sections:                                  have replaced the traditional family support
                                               network. It focuses on the role leadership,
                                               effective communication and social
Section 1 - The GP’s view                      networks play in morale, motivation and
This section presents the findings from our    wellbeing in the workplace.
research with UK GPs and explores how
                                               We are committed to helping to develop
their role has changed in recent years.
                                               as broad an understanding as possible
It highlights the challenges doctors face
                                               of the key health-related issues faced by
and shows the increasing role web-based
                                               employers, employees and GPs and we are
information plays in both their own, and
                                               pleased to present our fourth Health of the
their patients’ lives.
                                               Workplace report.
The coalition Government’s recent
announcements about the changing roles
of GPs in the new NHS structures mean that
the views of GPs are now more influential
than ever.

2 Health of the Workplace 4 Report
Section 1 – GP findings

Key trends identified in this report:         l	   Online tools are increasingly being
l    GPs are under increased pressure              used to aid diagnosis
     with nearly half of otherwise well       l	   GPs still see themselves as role models
     patients visiting them more than              but relationships are no longer as
     five times a year                             strong between them and their patients
l	   They have less time to spend with        l	   There’s still limited awareness about
     their patients than five years ago            Fit Notes and a lack of belief in the
l	   Current arrangements mean that GPs            ability of the new Fit Note system to
     have less time than they feel they            meet its objectives.
     need to properly assess their patients

GPs are under increased pressure
Although evidence shows that doctors are                           Despite it being current practice to schedule
working 17% less hours than they were six                          doctors’ appointments for 10 minutes each
years ago when the new GP contract was                             GPs feel they need more time with their
introduced1, our research shows that nearly half                   patients. Nearly all of the GPs we questioned
(45%) of otherwise well patients visit their GP                    (97%) say that they would like to spend 11
five times or more a year. We are therefore not                    minutes or more with each patient. Moreover,
surprised to learn that over half (57%) of the                     nearly seven in ten (69%) GPs would like
GPs we questioned say that they have less time                     up to 15 minutes to see each patient and a
to see their patients than five years ago.                         quarter want 16 minutes or more.

                      In an ideal world, how much time would you like to set aside to see each patient?

   70%                                                68.63%






   10%                7.35%

                  10 mins or less                   11 – 15 mins         16 – 20 mins               Over 20 mins

Source: Health of the Workplace 4, GP research, April 2010.

  Only 7% of GPs say that
  lack of time with their patients
  has no effect on their ability to
  do their job properly.
  Source: Health of the Workplace 4, GP research,
  April 2010.

   ‘General Election 2010: Conservatives pledge better access to
GPs’, The Telegraph, Laura Donnelly, 10th April 2010.

4 Health of the Workplace 4 Report
Worryingly, this situation is leading to a fall                     time they have with their patients affects
in the perception of the service given. Over                        their ability to provide a detailed diagnosis
half of GPs (51%) admit that the lack of                            and offer wider healthier lifestyle advice. This
time definitely affects their ability to do their                   is a concern as there is a strong connection
job. Moreover, 43% say that the limited                             between lifestyle and future illness.

               Does having less time with your patients affect your ability to do your job properly?


  45%                                                                                                 42.74%







                     No it does not                           Yes it does           It doesn’t affect my judgement but
                                                                                    it has affected my ability to provide
                                                                                    a detailed diagnosis and offer lifestyle advice.

Source: Health of the Workplace 4, GP research, April 2010.

  63% of patients feel that
  NHS appointments are
  always rushed.
  Source: Aviva UK Health’s Delayed Diagnosis consumer
  research, April 2010.

The impact of technology and
the media
Doctors are increasingly using online tools                        The majority of GPs (83%) use the internet
to help them in their role, with nearly every                      as a resource to aid diagnosis. The days
GP we spoke to (96%) saying that they use                          of doctors relying on their memory alone
search engines in their daily working life and                     are long gone. They are clearly embracing
over half (65%) using other online services                        technology to help them keep up to date
and net forums.                                                    with developments and to support the
                                                                   service they provide to their patients.
Online support is used for a number of reasons
including networking with colleagues (29%),
learning about new techniques and finding
best practice advice (49%).

            Which of the following best represents why you use Google, net forums etc in your work?




   50%                                                                         49.02%


   30%                                          28.92%



             As a resource to support   To network / communicate    To learn about new techniques /   I don’t have time to read up /
             diagnosis                  with colleagues             best practice                     consult colleagues

Source: Health of the Workplace 4, GP research, April 2010.

  93% of people say that their number
  one priority is knowing what’s wrong
  with them when they are unwell.
  Source: Aviva UK Health’s Delayed Diagnosis consumer
  research, April 2010.

6 Health of the Workplace 4 Report
Technology and the
‘worried well’
Interestingly, it’s not just doctors who are                            While media coverage and resources such
using online tools in relation to health.                               as the internet can undoubtedly play an
Our ‘Delayed Diagnosis’ research conducted                              invaluable role in health and wellbeing
in April 2010 shows that individuals are                                education, the combination of self-diagnosis
also increasingly turning to the internet for                           and heightened awareness of health issues
immediate health-related advice                                         may be fuelling additional visits to the GP.
and support.
                                                                        Our ‘Delayed Diagnosis’ research shows
Over half of the individuals we questioned                              that the majority of GPs are trying to tackle
(54%) have worried themselves by                                        these behaviours, with only a quarter (26%)
self-diagnosing on the internet, leading                                saying that they wouldn’t raise the issue of
nearly half (49%) to worry that there might                             constant visits from a patient following
be something seriously wrong with them.                                 self-diagnosis on the internet. However, a
Indeed, recent research in the Journal of                               similar number (24%) said that they wouldn’t
Bone and Joint Surgery highlights that visiting                         raise the issue if they suspected that anxiety
‘Dr Google’ can provide people with vastly                              was leading to hypochondria.
differing levels of quality and can lead patients
to misinterpret the information resulting in a
wrong or inaccurate diagnosis2

  31% of people have gone to their                                        “Web based technology has
  GP after seeing a TV character with                                     revolutionised the way we all
  symptoms similar to their own.                                          work and fast access to high
  Source: Aviva UK Health’s Delayed Diagnosis consumer                    quality information can be an
  research, April 2010.
                                                                          invaluable support for patients and
                                                                          professionals. Ultimately, however,
                                                                          there is no substitute for a
                                                                          thorough assessment by a qualified
                                                                          GP. This requires adequate time;
                                                                          something that the GPs in our
                                                                          survey don’t feel they have.”
                                                                                                           Dr Doug Wright,
                                                                                      Principal clinical consultant, Aviva UK Health

   Quality and Content of Internet-Based Information for Ten
Common Orthopaedic Sports Medicine Diagnoses, James S.
Starman, F. Keith Gettys, Jason A. Capo, James E. Fleischli, H. James
Norton, and Madhav A. Karunakar. Appeared in Journal of Bone
and Joint Surgery, July 2010.

Relationships between doctors
and their patients
Despite the trend to larger group practices                               and when combined with the apparent time
and targets set by the Department of                                      pressures, the situation can be worsened.
Health, people believe that their relationship
with their GP is generally good, although                                    60% of people said they’d turn to their
they feel that they don’t really know their                                  partner if they had a problem with their
doctor. Given the high incidence of people
                                                                             health, compared to just 33% who
visiting their GP more than 5 times a year,
there appears to have been a decline in the                                  would turn to their GP.
traditionally strong relationship many people                                Source: Health of the Workplace 4, employee research,
have with their family doctor. This could                                    April 2010.
be attributed to the lack of time doctors
now have with their patients. Worryingly,                                 Nearly all the doctors we spoke to (95%)
a quarter of people we spoke to don’t feel                                feel that it is important to lead by example
that their GP takes them seriously. This                                  when it comes to living a healthy lifestyle. In
increases to 41% for the 18-24 age group.                                 general, GPs say they personally do this well,
                                                                          with just over a quarter (27%) feeling that
The continuing trend for the greater use of                               they practice what they preach. While over
technology during a consultation may also be                              a third of doctors (38%) admit that they are
playing a role in the breakdown of this                                   overstretched, this increased pressure does
relationship. It is already known that patients                           not appear to be affecting their own health,
and doctors can find the computer a distraction                           unlike the employees surveyed in our Health
                                                                          of the Workplace 3 study.

                                       How healthy would you consider yourself to be?
   40%                                                                38.24%



                                        16.67%         16.18%


    5%                                                                                                                             3.92%
         Well – I      Well – I        Well – I’ve   Good – I’m     OK, but I am    Poor - I      Poor – I        Poor – I’m     Poor – I
         work hard and practice what   got a         in great shape overstretched   drink a lot   take            stressed       often find it
         play hard     I preach        great life,   for my age                                   recreational/   all the time   hard to sleep
                       regarding       car, family                                                prescription
                       health and                                                                 drugs

Source: Health of the Workplace 4, GP research, April 2010.

8 Health of the Workplace 4 Report
The impact of Government
initiatives – Fit Notes
April 2010 saw the introduction of a new
Fit Note (medical statement) to replace the
traditional sick note that has been used
by GPs for the past 60 years. Introduced
in 1948 to protect the vulnerable, the sick
note system gave GPs the authority to sign                           “When it comes to making
people off work for the first six months of                          Fit Notes work in practice,
incapacity before they move into the state                           the Government is missing an
incapacity benefits system.                                          important trick by ignoring the
                                                                     important role group income
     48% of GPs admit that they’ve been                              protection and occupational
     asked to falsify a sick note in the past                        health services that aid
     Source: Health of the Workplace 4, GP research, April 2010.
                                                                     rehabilitation can play in their
                                                                     success. Currently occupational
The introduction of the Fit Note aims to                             health practitioners are the
change the ‘sick-note culture’ to one that                           missing piece of the jigsaw
encourages GPs and employers to work                                 but can perform a potentially
together to help people with a medical                               crucial support role in bridging
condition to return to work faster. Under the                        the knowledge gap between
new Fit Note initiative, line managers and HR
                                                                     employers, HR, managers, GPs
professionals will have an increased
                                                                     and workers. Without this
responsibility in the decisions taken to
support an employee’s rehabilitation back
                                                                     engagement, the introduction
into the workplace. Whilst they aren’t
                                                                     of Fit Notes may cause more
obligated to take the GPs recommendations,                           problems than it solves.”
they can use them to help bring the                                                                Dr Doug Wright,
employee back into the business faster,                                       Principal clinical consultant, Aviva UK Health

which benefits both parties. The initiative
aims to help reduce the impact long-term
sick leave has on UK businesses, which is
estimated to cost the UK economy nearly
£17 billion a year3.

     Source: CIPD/Pfizer Absence and Workplace Health Survey 2010.

GPs are unconvinced of the
benefits of Fit Notes
Worryingly, more than half of GPs (65%)                        1% increase from the 2009 Health of the
taking part in our Health of the Workplace                     Workplace study. When asked about the
4 study say they feel ill-equipped to provide                  effectiveness of Fit Notes, 68% of GPs say
Fit Notes to the UK workforce. Despite                         they feel that Fit Notes won’t cut absence
the initiative now being live, this is only a                  levels. This compares to 54% last year prior
                                                               to their introduction.

                                  How far do you agree with the following statement?
                                  “I feel Fit Notes will help control sickness absence.”





    5%              3.92%

                 Strongly agree               Slightly agree          Slightly disagree    Strongly disagree

Source: Health of the Workplace 4, GP research, April 2010.

Employers and employees
are unconvinced too
Aviva UK Health’s ‘Early Intervention                          One in ten thinks that Fit Notes will be hard
Prevention’ research conducted in January                      to administer and 68% have little or no
2010 demonstrates that employers and                           knowledge of the change and how it will
employees are equally sceptical about                          work for them. On the employee side, the
the effectiveness of Fit Notes. Of the 500                     majority of the 1,000 respondents (57%) do
employers we questioned, just 5% say they                      not think that their doctor is in a position to
think Fit Notes would reduce absence rates.                    say if they are fit enough to work.

10 Health of the Workplace 4 Report
Future Government policy
At the time of writing this report it’s clear    Health Secretary Andrew Lansley, has called
that the new coalition Government’s primary      a halt to NHS reconfiguration in London
focus is on the recovery of the economy and      – meaning the NHS in London will need
their future health policy is yet to be fully    to find an alternative means of saving the
defined.                                         £5.1bn funding gap it estimates its Primary
                                                 Care Trusts will face by 2016-17. The
Earlier this year, the coalition announced its
                                                 Healthcare for London (Darzi) plan involved
programme for Government (The Coalition:
                                                 shifting care out of hospitals and into GP-led
our programme for Government, 20 May
                                                 centres or ‘polyclinics’.
2010) which promises that health spending
will increase in real terms. Policies that       In June, the Government subsequently
directly affect GPs focused on a number          announced its high level plans to review the
of key themes; improving accessibility,          existing NHS operating framework and GP
increasing choice and quality of care,           budget holding, signifying its intentions to
prevention and wellness management:              make prompt changes to the NHS.

                                                 Principles of GP Budget Holding (as described
NHS                                              by Andrew Lansley on the 24th June) include:
l   Develop 24-hour urgent care across           l   GPs to hold a budget to enable them to
    England, including GP out-of-hours               have control of commissioning decisions
                                                 l   GPs to be supported in their decision
l   Patients to register with any GP they            making by an autonomous NHS
    want, regardless of where they live              commissioning board

                                                 l   The NHS commissioning board will have
Public health                                        a focus on quality standards that are
l   Give GPs greater incentives to tackle            integral to effective commissioning.
    public health problems                           This ‘quality’ measure will be aligned to
                                                     standards used by the CQC.
l   Improve access to preventative care in
    deprived areas

l   The NHS is exploring the possibility of
    using financial incentives to encourage
    people to lead a healthier lifestyle.

In addition to this, the revised operating                         Commenting on the changes, Andrew
framework aims to scrap the 18-week target                         Lansley said:
for hospital waiting times, the 4-hour A&E
                                                                   “These are standards not diktats. It is not
target and the 48-hour target for GP access.
                                                                   politicians establishing these – I am not
Instead the Government is recommending                             picking them out. If I started doing that I
a series of new evidence-based quality                             would be distorting clinical standards.”4
measures to help the NHS in England
                                                                   In July 2010, the coalition Government
improve patient care. Andrew Lansley
                                                                   released the white paper, ‘Equity and
recently unveiled the standards for the first
                                                                   Excellence: Liberating the NHS’. They identify
three areas - stroke, dementia and blood
                                                                   three key themes that are integral to their
clots - that were put together by NICE in
                                                                   vision for the NHS:
consultation with doctors and patients. It is
anticipated that the Government is likely to                       l    Patients at the heart of all new
publish a set of quality measures for over                              policy - the plans are to give patients
150 different areas of care over the next                               more control over their care and
five years.                                                             increase access through allowing more
                                                                        choice – ‘no decision about me, without
It is proposed that the new quality guidelines
will be used when services are commissioned
by managers and GPs when they take on                              l    Increased focus on clinical outcomes
responsibility for managing local budgets.                              - this underlines the coalitions desire to
                                                                        move away from targets and with the
Patients will be able to use the standards
                                                                        introduction of more evidence-based
to ensure they receive the best quality of
                                                                        outcome measures, there are plans
care. To help facilitate this, those services
                                                                        to remove any targets with no clinical
that do not meet the standards will
struggle to attract funding. Unlike Labour’s
targets, there will be no requirement for                          l    Empowerment of health
hospitals and other services to report to the                           professionals - announcements in this
Government that they have met them, or                                  area have created passionate debate,
explain themselves when they do not.                                    particularly around commissioning, with
                                                                        the primary theme on doctors and nurses
                                                                        using their professional judgement to
                                                                        make decisions for their patients.5

   Source: ‘New goals to replace NHS targets’, Nick Triggle, BBC   5.
                                                                      Source: Equity and Excellence: Liberating the NHS, Department of
News Online July 2010.                                             Health (2010)

12 Health of the Workplace 4 Report
Although there is more detail to be
published on the proposals, the white
paper has already sparked much debate.
The responses have been both positive
and negative. Anna Dixon from the Kings
Fund states the reforms will “create a
healthcare system, unique internationally,
that gives groups of general practitioners
unprecedented control over public funding”6
whilst Dr David Price of Edinburgh University
argues that it will remove the Government’s                            “We would welcome the
duty to provide a universal healthcare                                 scrapping of this target, as it
service7 and senior clinicians are critical                            will give GPs greater flexibility
about the lack of inclusion of the acute
                                                                       to organise their appointment
sector in the commissioning review8.
                                                                       booking system in a way that
                                                                       best suits their local patient
Aviva’s response                                                       population.”
We welcome the proposals to put patients                                                             Dr Laurence Buckman,
and carers at the centre of the plans for the                                                     of the British Medical Association9
NHS. The intention to allow patients more say
in their care and promote understanding of
                                                                       “While the coalition
their health status could be an important step
in addressing some of the health challenges
                                                                       Government has outlined its
faced by the nation. Furthermore, the aim to                           health policies focusing on
achieve world-class clinical outcomes in the                           improving access to GPs and
NHS is a positive development that can only                            offering a wider choice of
benefit patients. The scale of the reforms has                         doctors, both patients and GPs
surprised many commentators in the media                               are clearly demanding a better
and led to considerable debate, especially                             GP experience, and access times
around the plans for GP commissioning.
                                                                       and choice are just one piece of
Whilst this debate is important, we hope that
the focus on patients and health outcomes
                                                                       this jigsaw.”
will not be lost and continue to drive the                                                                   Dr Doug Wright,
reform process.                                                                         Principal clinical consultant, Aviva UK Health

 NHS Reform? Great, Thanks for warning us, David Aaronovitch,

The Times 15/7/2010.
 We cannot allow the end of the NHS in all but name, Seumas

Milne, Guardian, 14 July 2010.
 Consultants criticise white paper’s lack of acute focus, Claire
8.                                                                 9
                                                                    Source: ‘GP waiting time target ‘scrapped’, Nick Triggle, BBC
Lomas, HSJ Online, July 2010                                       Online. 21st June 2010.

  Focusing on health                          Rather than having to wait to see
                                              their GP, customers are referred to
  outcomes - Back-Up from
                                              the Back-Up service to speak to a
  Aviva                                       dedicated case manager who conducts
  Evidence now shows that tailoring           an in-depth assessment and offers
  treatment plans to the individual’s         practical and clinical advice and support.
  personal needs, has a far better out-       A personalised rehabilitation plan is then
  come for all parties. Back-Up, which is     tailored to their individual needs. Where
  just one of a number of new specialist      the customer is part of a group scheme,
  case management initiatives introduced      the case manager can also work with
  by Aviva UK Health, reflects the need       their line manager to advise how
  to move away from a traditional ‘one        they can be helped safely and effectively
  size fits all’ approach to private health   at work.
  insurance claims management to              Key results from Aviva’s customers include:
  offering customers an expert-led service
  tailored to their exact needs.              l    50% of employees say the service
                                                   prevented them going absent or
  Developed with the UK’s leading                  restricting their duties
  professional rehabilitation provider
  HCML, Back-Up, which utilises evidence      l    Of the 25% who were absent
  based medical guidelines for managing            prior to using the service, 100%
  back and neck pain, has proven to                successfully returned to work
  significantly improve the speed of               through Back-Up
  recovery and return to work rate for        l    Physiotherapy sessions have been
  customers. In addition, the number of            reduced by 37.5%
  physiotherapy sessions required has been
  greatly reduced with far fewer people       l    At least a 15% saving on treatment
  needing to be referred to a specialist.          costs

                                              l    98% rated their treatment as
                                                   excellent or very good*
                                              * Percentage of customers giving a rating of between 7 and
                                              10 out of 10.

14 Health of the Workplace 4 Report
Our research shows that GPs are over            The role of education
stretched and this can affect the quality
of support they are able to offer their         Our ‘Delayed Diagnosis’ research clearly
patients. Web based technology has              shows that an individual’s number one
revolutionised the way we all work and          priority is to find out what’s wrong with
fast access to high quality information         them when they are unwell. Technological
can be an invaluable support for patients       advances have led people to expect quick
and professionals. Ultimately there is no       responses and if they can’t access the
substitute for a thorough assessment by         information promptly from their GP, they are
a qualified GP. From our research this is       instead turning to the internet for solutions.
clearly not happening in all cases. We urge     While self-diagnosis on the internet is no
the new coalition Government to support         substitution for a thorough assessment
and work with key stakeholders to ensure        by a GP, the internet and media could
delivery of the right care for patients,        provide a useful source of information to
whether it is via GPs or a wider network of     enable individuals to self-manage simple
medical professionals. This network could       conditions once their GP or another medical
include pharmacists, nurse practitioners        professional (such as NHS Direct or a GP
and third party providers, such as specialist   Helpline provided by their medical insurer)
rehabilitation companies and occupational       has ascertained what is wrong with them.
health providers. The move to put GPs at        People therefore need to be educated to
the heart of decision making in the NHS will    choose the right support services for their
help to drive this agenda forward.              own personal circumstances. This in turn
                                                will help to enable GPs (and indeed our
While improved access times and increased       A&E departments) to focus on providing
choice are one part of the solution, there      the appropriate advice and support to the
are many other challenges that need to          patients who need it most.
be overcome. These include tackling the
current health problems driven by the
aging population, lifestyle, behavioural
and environmental issues. We believe that
improved education and health promotion
can play a key role in this.

  “The health of the nation is                                   Health promotion is by no means a new
  a crucial issue to address. As                                 concept, and one which the previous
  the largest insurance services                                 Government took steps towards through its
                                                                 Change4Life programme. However, while
  provider in the UK we are more
                                                                 the NHS is exploring the use of financial
  than aware of the impact of
                                                                 incentives to encourage people to lead a
  lifestyle choices and lack of                                  healthier lifestyle, the Government’s focus
  awareness on people’s long-                                    on the economy’s recovery means it is
  term health. We are committed                                  unlikely that the previous investment we’ve
  to raising awareness of the                                    seen for mass marketing campaigns will
  benefits of leading a healthier                                continue. Indeed, recent announcements on
  lifestyle to help improve the                                  the Change4Life programme – which will
  nation’s health and wellbeing.”                                see central investment being scaled back and
                                     Dr Doug Wright,             more involvement from the private sector –
                Principal clinical consultant, Aviva UK Health   confirm this view.

                                                                 It’s therefore important that other
Wellness Management                                              stakeholders continue to engage and
                                                                 encourage individuals to take more
In its simplest form, health promotion is                        control of their own health by promoting
about adopting a more pro-active approach                        the benefits of leading a healthy lifestyle
to health that focuses on positively                             and communicating the message that
managing the healthy so that they are                            prevention is better than cure. This can
less likely to fall ill, rather than treating                    be achieved through a number of means,
symptoms once they have occurred. Such                           including education and advice delivered
an approach should focus on an individual’s                      through primary care facilities such as GP
mental and physical wellbeing. Wellness                          surgeries, industry sponsored activity days
management should not just be associated                         and promotions, a continued focus on more
with someone who doesn’t have an illness,                        responsible food labelling and healthier
but rather a positive state of good physical                     content, and new product and service
and mental health and wellbeing. A person                        development. For an employer, there is the
with diabetes, for example, can effectively                      opportunity to provide wellness initiatives in
manage their condition and lead a healthy                        the workplace that also contribute to this
lifestyle with the right education, mental                       wider public health imperative.
attitude and support.

16 Health of the Workplace 4 Report
 How is Aviva helping?                         Aviva’s ambition is to not only provide
                                               products to support customers health,
 Aviva has been proud to be the No 1           but to positively change peoples,
 sponsor of UK Athletics since 1999 and        behaviours and attitudes to health.
 is committed to developing the sport at       We are encouraging our customers
 every level from the playground to the        to lead a healthier lifestyle, through
 podium.                                       regular customer communications and
 Each year we put on six world-class           MyHealthCounts.
 athletics events on home soil and help        Designed by medical experts,
 the Aviva GB & NI junior, senior and          MyHealthCounts contains a wealth
 paralympic teams as they prepare for          of invaluable information including a
 all major events and championships.           health assessment tool and an online
 Through the Aviva UKA Academy it is           coach offering personalised advice on
 our aim that by 2012, we’ll have given        the simple steps individuals can take to
 every child in the UK the opportunity to      improve their health.
 get involved in athletics.

 Since July 2009, Aviva has also promoted
 Change4Life through our UK Athletics
 grassroots programmes, which has
 included information sent to all schools
 in the UK and at the indoor season
 athletics events.

                                             Aviva is in support of Change4Life through our
                                             sponsorship of UK Athletics and by promoting
                                             Change4Life messages that align with MyHealthCounts

The role of business leaders
in managing health
As we have seen, the Government has          and pro-actively encourage employers to
already taken steps to encourage employees   help their employees to lead a healthier
and indeed GPs, to help people return        lifestyle - preventing them going off sick
to work following ill-health through its     in the first place. We discuss this further in
introduction of the Fit Note. However,       the summary of our research with business
to have the biggest impact, we feel that     leaders later in this report.
they should take this one step further

Potential benefits for all
Whilst managing wellness is never going                               levels could fall as fast as morale, loyalty and
to completely eradicate absence or visits                             productivity rise. Evidence also indicates that
to the GP, companies who look after their                             there will be significant benefits to other key
staff by promoting health and well-being                              stakeholders - long-term sickness will fall
effectively and consistently could see a                              generating potential savings on incapacity
positive impact on their organisation. Staff                          benefit and reducing the direct health costs
turnover, absenteeism, accidents and stress                           borne by the NHS10.

  Source: ‘Building the case for wellness’, PriceWaterhouseCoopers,
4th February 2010.

18 Health of the Workplace 4 Report
Section 2 - Business leader
and employee findings

Key trends identified in this report:            l   Over half of social events include
l   Productivity and profit continues to             alcohol, but nearly as many business
    be prioritised above employee health             leaders say they would worry they
    and wellbeing, yet the two are                   were having a damaging effect on
    intrinsically linked                             their employee’s health if they called
                                                     in sick the next day
l   Business leaders are generally happy
    with the atmosphere at work –
                                                 l   Over half of employees and around the
    although pressures are still evident             same amount of business leaders don’t
                                                     really enjoy these events but attend
l   Business leaders are still rewarding staff       them because they feel they should
    but the majority focus on the short-term
    gains from staff social events, rather
                                                 l   Business leaders believe they have an
    than investing in their employees’               open relationship with their employees.
    long-term health and wellbeing                   However, there’s a distinct lack of
                                                     communication between employees
l   Business leaders recognise the                   and employers when it comes to
    important role work/life balance and             personal problems or health issues.
    teamspirit can play in their employees’
    health and wellbeing

When we conducted our third Health of the        As expected, the nations stress levels
Workplace report a year ago, the outlook         continued to be a much-covered topic
looked less than positive with both GPs          throughout 2009. Findings from the
and business leaders predicting stress levels    CBI/Pfizer 2010 absence and workplace
would soar in the year ahead. Worryingly,        health survey show that mental illness
employee behaviours were already beginning       continues to be a leading cause of sickness
to demonstrate that their predictions could      absence for UK industry. In fact, analysis
be correct.                                      of Aviva’s own employee assistance
                                                 programme has shown that the number of
Nearly six in ten workers said that their
                                                 work stress cases have doubled between
work environment was making them feel
                                                 2008/9 and 2009/10. There was also a
stressed and under pressure. Employees
                                                 50% increase in the number of fact sheets
were working longer hours, taking fewer
                                                 accessed on topics relating to redundancy
lunch breaks and spending less time on
                                                 and changes at work in the same period
leisure activity. Moreover, instead of turning
                                                 and the number of calls directly relating to
to their employers for help, they were
                                                 the credit crunch doubled.
smoking, indulging in a poor diet and
drinking alcohol to help them deal with
the stress. The situation was already
having an adverse effect on employees’
health and wellbeing, with nearly half of
workers struggling to sleep due to work
related-stress and a third suffering from
neck and backache.

The outlook for the insurance industry also
looked challenging. Whilst few companies
had cut spending on private medical
insurance (12%), group income protection
(8%), group life (7%) and counselling
services (9%), there were few signs of new
investment, with just 1% of businesses
planning to introduce new health and
rehabilitation benefits in 2009.

20 Health of the Workplace 4 Report
New era, new opportunities
A year on from our Health of the Workplace
3 report, we’re officially out of the recession
and embarking on a new political era. Whilst
there’s some cause for optimism, our Health
of the Workplace 4 research shows that
business leaders are still facing the same        “While employers are making
dilemma that they were a year ago - the           some very positive moves
need to balance the cost of investment in         towards fostering a healthier
employee health and wellbeing with the            workplace environment, the
financial priorities for the businesses.          overwhelming priority is still
Whilst business leaders recognise the
                                                  on chasing profitability. In the
importance of a healthy happy workforce,          short-term, this strategy can
they are still prioritising productivity and      sustain a business through a
profit over staff motivation and work-life        difficult trading period, but
balance.                                          it will undermine business
                                                  performance in the longer term
l   Nearly a third (31%) want maximum
    profitability for headcount
                                                  by damaging staff morale and
                                                  allowing conditions like stress
l   Two in five (39%) demand a highly             to flourish.”
    productive team who are flexible and
                                                                               Dr Doug Wright,
    can respond to change.
                                                          Principal clinical consultant, Aviva UK Health

That said, it’s good to see that there is
evidence of paternalism in some companies,
with over a quarter (27%) saying that their
main priority is to create a motivated team
who enjoy working together and a quarter
(25%) saying that their number one priority
is achieving a friendly company with a good
work/life balance.

Bigger isn’t always better
Consistent with the findings from our Health                             This paternalistic approach appears to be
of the Workplace 3 report, our research                                  reaping rewards. Our employee research
shows that company size plays a key role                                 shows that focusing on creating a healthy,
in business priorities. Smaller companies                                happy working environment has a knock-on
appear to place a stronger emphasis on                                   effect to employees’ morale, with nearly a
paternalism and nurturing strong                                         third (29%) working for companies with up
inter-personal relationships in the workplace.                           to 249 employees saying that they work in a
The smaller the company, the more important                              friendly company with a great social life.
work/life balance appears to be, with half
of companies with less than nine employees
citing this as their number one priority for
their business. This falls to just 12% for
companies with over 100 employees.

                     What do you consider to be the main priorities for your workplace to achieve?

  40%                                                                39.22%


  20%                                                                                    18.63%




            Maximum            Award winning      Creating a         A highly           Creating a            A friendly         A flexible /
            profitabilit for   service offering   motivated team     productive team    vibrant office        company with a     creative
            head count                            who enjoy woking   who are flexible   life, where staff     good work / life
                                                                                                                     .           environment ready
                                                  together           and can respond    willingly give 110%   balance            to respond to
                                                                     well to change                                              new challenges

Source: Health of the Workplace 4, business leader research, April 2010.

22 Health of the Workplace 4 Report
How do employees feel about
their workplace?
When asked about the atmosphere in their          A quarter (24.5%) say that the workplace is
office the responses are generally positive       friendly enough but admit that they don’t
with only 2% of employees stating that they       have much social life. This answer was
don’t find people at work friendly.               favoured most by people aged between
                                                  25-64, with the highest proportion of those
l   A quarter (24.8%) of employees were
                                                  in agreement in the 45-54 year age group
    generally happy saying that they worked
                                                  (31%). Only 13% of those aged 16-24 and
    in a friendly company with a great
                                                  65 or older agreed with the statement.
    social life.
                                                  Our research re-confirms that there are two
This was particularly true for those aged
                                                  distinct types of people – those who see
16-34 years. Interestingly, this was also the
                                                  their work life as an integral part of their
most popular answer for those aged 65
                                                  social life and those who see it purely as a
years or more, with around a third (32%)
                                                  vocation. These findings reflect the long-held
saying that they work in a friendly company
                                                  view from behavioural psychologists that
with a great social life. In fact, our research
                                                  people fall within one of two categories;
revealed that nearly a quarter (23%) of this
                                                  those that are tasked focused – putting
age group considers their work to be their
                                                  emphasis on getting the job done as the
only social life, suggesting that people may
                                                  highest priority – and those more concerned
continue to work post retirement for reasons
                                                  with emotion and wellbeing.
other than financial.
                                                  There is a general belief that if people are
In comparison, there is another group of
                                                  happy they will be motivated and loyal. In
people focused less on atmosphere at work
                                                  addition, it is also thought that they will
and more on the task in hand with one in five
                                                  take ownership for their work and will plan,
(21%) saying that they ‘get the job done’ and
                                                  monitor and improve much of what they
go home. The proportion of people giving this
                                                  are doing. Understanding the significance
answer was fairly well balanced across the age
                                                  of work in a person’s life can lead to more
groups, with the 16-24 year olds (24%) and
                                                  successful leadership. It can also improve
65 and over (27%) showing a slightly higher
                                                  staff motivation, morale, productivity and
preference to the answer.
                                                  wellbeing. Moreover, by understanding what
                                                  motivates their employees, employers can
                                                  adapt their management style and rewards
                                                  strategy accordingly.

                               Which of the following best reflects the atmosphere in your job?

    25%        24.80%                                                                                                24.50%





           It’s a friendly       We get the job     I have a core of    I don’t find           We work hard,   It’s friendly enough
           company, with a       done and go home   good friends        people very friendly   play hard       but we don’t have
           great social life                        at work but         at work                                much social life
                                                    dont socialise
                                                    as a team

Source: Health of the Workplace 4, employee research, April 2010.

How are employers                                                      However, as with most things, there’s also
                                                                       another side to the story with nearly one
contributing to the
                                                                       in five (19%) employees saying that their
atmosphere?                                                            boss creates a stressful atmosphere and one
When asked if their manager does a good                                in five saying that their boss makes sure
job at maintaining health and happiness                                that everyone pulls their weight. Perhaps
in the workplace, a high proportion of                                 more worrying, nearly a quarter (22%)
employees say that their boss is having a                              of employees say that they don’t think
positive effect on the atmosphere:                                     that their boss has any control over the
                                                                       atmosphere suggesting that they too are
l    Nearly a third (30%) agree that their                             under pressure.
     boss ensures that they have a good
     work/life balance
                                                                         45% of business leaders say they were
l    Nearly one in five (19%) say that their
                                                                         more stressed at work than at home.
     boss takes a personal interest in how                               Source: Health of the Workplace 4, business leader
     each person is performing and makes                                 research, April 2010.
     sure they are not overloaded.

24 Health of the Workplace 4 Report
Relationships in the workplace
Friend versus colleague
When asked about relationships with                                 l    Nearly three quarters (72%) of
colleagues, findings from the business                                   employees say that they have close
leaders’ and employees’ research are very                                friends either at work, or that they’d met
similar. Not surprisingly, our research shows                            at work
that the workplace still plays a key role in
nurturing personal relationships for the
majority of business leaders and their staff:                       l    One in five (20%) business leaders like
                                                                         to keep their home life and work life
l   Nearly three quarters (73%) of business
                                                                         completely separate
    leaders say that they would consider
    a few of their work colleagues to be                            l    A quarter of employees say that they
    personal friends                                                     keep their work and home friends
                                                                         completely separate.
l   A third (33%) of employees say they
    have two to three work friends who they
    love to socialise with

                            Would you consider any of your colleagues to be personal friends?





      25%                                24.70%




       5%                                                                             2.79%
               Yes, I have a          I have a number    No, I have only just    No, I don’t like        No, I like to keep
               couple of friends      of friends who     joined the company      where I’m working       my work and personal
                                      I met at work      so I haven’t made any   and wouldn’t consider   life seperate
                                                         friends yet             any of my colleagues
                                                                                 a friend

Source: Health of the Workplace 4, employee research, April 2010.

How often do employees
socialise together?
The general trend across the whole sample        Fewer employees have a role model (39%)
shows that it is commonplace for employees       and it’s evident that home life plays an
to socialise with their work colleagues every    even greater role in defining employee
few months (23%). This increases in the older    behaviours:
and younger segments, with one in four
                                                 l     Nearly a third (32%) say their mum
(20%) 16-24 year olds, and nearly a quarter
of those aged 65 or over, saying that they       l     27% say their dad
socialise with their colleagues every week.
                                                 l     14% say their partner.
Of the one in six (15%) who say they never
socialise with their work colleagues, men are    Worryingly, only 4% say their current or
more likely to keep their home and work          a former boss is their role model, despite
life separate, with one in four (19%) saying     47% of business leaders feeling that they
they never socialise with their colleagues       are good role models. This demonstrates a
compared to one in ten (12%) women.              contradiction between how business leaders
                                                 perceive themselves and how employees
                                                 perceive them.
Role models
Despite the high profile of many of today’s          47% of business leaders think that
business leaders and the increased time              they are good role models yet only 4%
many employees are spending in the                   of employees cite a current or previous
workplace, it is apparent that home life still       boss as their role model.
plays a greater role in defining people’s            Source: Health of the Workplace 4 business leader
behaviours and beliefs. Interestingly, 44%           research, April 2010.
of business leaders say that they don’t have
a role model in their life and less than 4%
mentioned another well-known business
leader. Of those who cited a role model:

l   A quarter (25%) say their mum

l   One in five (19%) say their current or a
    former boss

l   15% say their partner.

26 Health of the Workplace 4 Report
Role models in the workplace
When asked specifically about role models in
the workplace:

l   One in five (20%) business leaders say it
    is their boss or line manager

l   18% say a senior colleague                  “Role models play an
                                                important role in an individual’s
l   16% say their colleagues / peers.           behaviour, particularly when it
When asked if they are a good role model        comes to health. If parents lead
43% say that they don’t know, which is          an unhealthy lifestyle, it’s likely
concerning considering the importance of        that their children will too,
good leadership in the workplace.               meaning that they are likely
In addition:                                    to suffer from similar health
l   Nearly a third (29%) feel that they
                                                issues. The workplace can also
    are good role models because they’ve
                                                play a key role in employee
    sacrificed a lot to get to where they are   behaviours. Worryingly 45% of
                                                business leaders admit that they
    Nearly one in five (18%) say they are
                                                are more stressed at work than
    good role models because they’ve built
                                                at home, and it’s evident that
    their company up from nothing.
                                                this is affecting their employees.
Despite specifically asking about role models   Employers recognise what they
in the workplace, nearly half (45%) of          have to do and they now need
employees say they didn’t have a role model     to lead by example.”
at work. Of those that say they do have one,
                                                                              Dr Doug Wright,
the closer the employee is to the person in
                                                         Principal clinical consultant, Aviva UK Health
seniority, the greater the influence:

l   Nearly a quarter (24%) say a colleague/

l   Nearly one in five (17%) say their boss/
    line manager

l   Just 2% say their company CEO – slightly
    less than motivational books.

Behaviours and leadership
When asked if they behaved differently         When asked specifically about their stress
at home than at work, over a third of          levels, we saw similar results for both
business leaders (37%) say that they are       business leaders and employees:
more dominant at work than at home. 61%
                                               l   45% of business leaders say they are
of employees feel that they were equally
                                                   more stressed at work than home,
dominant at work and at home.
                                                   compared to just under half (47%) of
Interestingly, when this is split by gender,       employees
both male and female business leaders
                                               l   Only one in ten (10%) business leaders
feel that they are more dominant in the
                                                   and employees say that they are more
workplace. However, when we asked
                                                   stressed at home.
employees the same question, stereotypes
came into play with women tending to say
they are more dominant at home (27%) and
men feeling that they are more dominant at
work (21%).

28 Health of the Workplace 4 Report
Staff motivation and reward
Employee benefits
Despite the challenging economic
environment, just over half of business
leaders (51%) offer one or more of the key
health and group risk benefits. With nearly
a third offering private health insurance,
it continues to be the most popular
employee benefit, followed by group life
(29%) and group income protection (14%).
Interestingly, less that one in five (18%)
offer an employee assistance programme,
despite rocketing stress levels in 2009.

                           Do you have any of the following in your employee benefits package?
   50%                                                                                                                  49.02%



   30%         29.41%


   15%                               14.22%


              Group Life        Group Income           Group Critical   Employee Assistance   Group Private           None of these
              Assurance         Protection/Permanent   Illness          Programme             Medical Insurance
                                Health Insurance

Source: Health of the Workplace 4, business leader research, April 2010.

Wider initiatives to motivate
and reward employees
When considering the wider motivational                                    despite business leaders funding socials,
initiatives and rewards package, employee                                  the responsibility for arranging the events
communications and engagement featured                                     is given to their employees. Over a third
highly, with around a third of those we spoke                              (37%) of employees say that they and their
to saying that they run an employee newsletter                             colleagues arrange things informally between
(31%), operate an intranet site (37%) and                                  themselves. Just one in ten (12%) say that
recognise the importance of giving staff a                                 their boss arranges their social events.
voice through an employee council (28%).
                                                                           Given this, you’d expect employees to value
Monetary reward appears to be less widely                                  and enjoy these events but our research
offered with just over a quarter of business                               suggests otherwise, prompting the question
leaders saying that their company operates a                               whether the motivational budget allocated
bonus scheme (28%) or runs an ‘employee of                                 to these events could be better spent
the month’ or similar reward scheme.                                       elsewhere. We explore this more in ‘The
                                                                           value of social events section’ of the report.
Overall, social events prove to be the most
common means to motivate staff, with
over half of the business leaders we spoke                                  31% of business leaders arrange social
to saying that their company organises                                      events every few months
regular ‘get togethers’ to help build team                                  20%        rarely, or never have socials
spirit. Interestingly, our research shows that                              Source: Health of the Workplace 4 business leader
                                                                            research, April 2010.

                        Thinking about building team spirit, do you offer any of the following?

   30%                                                      27.94%            28.43%

   20%                                                                                       18.14%                          18.14%




          Organise regular Run an employee   Operate an   Operate (PRP)/     Awards /      Teambuilding   Employee         None of these
          socials          newsletter        intranet     bonus              employee of   games          council /
                                                                             the month                    representation

Source: Health of the Workplace 4, business leader research, April 2010.

30 Health of the Workplace 4 Report
The most popular social                                            The role of alcohol
activities                                                         Although many social events are held in
When we asked business leaders what form                           pubs, only 45% of business leaders say that
their social events take, going to the pub                         there’s no obligation to drink alcohol at
for drinks (57%) or out for a team lunch                           these events. In fact, over a quarter (26%)
(60%) are by far the most common ways of                           admit that they don’t mind their staff having
socialising. In comparison, only one in five                       a few drinks, as long as they don’t get out
(23%) run teambuilding days and just one in                        of hand.
ten (13%) participate in sporting pursuits.                        Our research shows that alcohol is seen as a
As expected, the findings from the employee                        way to encourage employees to relax with
research reflect those from the business                           just over one in ten (13%) saying that a few
leaders with:                                                      drinks helps people come out of their shell.

l    Over half (52%) of employees say that                         A similar amount (12%) of business leaders
     they go to the pub for a drink                                even admit they get the inside track on the
                                                                   workplace once their employees have had
l    Over a third go out to restaurants (37%)                      a drink.
l    Less then one in ten (7%) participate in
     sporting activities.

                               Which of the following do you regularly do on work socials?


    60%     57.35%




    20%                               18.63%
                                                                             10.78%                                9.80%

          Go to the pub   Gym /       Cinema /     Team       Restaurant /   Watching   Quizzes /      Other,    I do not take
          / bar for       sporting    theatre      building   team lunch     sporting   games and      please    part in work
          drink           pursuits                 days                      fixtures   competitions   state     socials

Source: Health of the Workplace 4, business leader research, April 2010.

 Despite doing little to discourage their                                            The same amount would worry that
 employees from drinking alcohol, it is clear                                        employees may think it is acceptable to take
 that business leaders don’t see excessive                                           ‘sickies’ following a work night out.
 alcohol consumption as an excuse for
                                                                                     40% of business leaders say they would
 absence. If this happened, over a quarter
                                                                                     worry that they were having a damaging
 (27%) of business leaders would be
                                                                                     effect on their employees’ health if their
 unsympathetic, saying that employees
                                                                                     employee called in sick the next day.
 should be able to handle their drink.

                          If most of your social events involve drinking, which one of the following
                                              best reflects how you feel about it?





   15%          13.24%

    5%                                                             2.94%
           A drink helps bring        I am all for a few    I would like to vary   We work very hard,   People should be able There’s no
           people out of their        drinks, but don’t     what we do but the     and are due a chance to take drink if they obligation to drink
           shell                      like things to        team enjoys going      to let off steam     want to fit in here   alcohol on our socials
                                      get out of hand       to the pub

Source: Health of the Workplace 4, business leader research, April 2010

                              Which of the following best reflects how you’d feel if an employee
                                             called in sick after a work night out?


                                                 26.96%                                                                          26.47%

                  16.67%                                                                              17.16%



             I’d find it amusing          I’ve got no sympathy-      I’d be concerned that     I’d wonder if it was       I’d worry that other
             - as long as it didn’t       they should be able to     work organised events     sign of a bigger problem   employees might get the
             happen too often.            handle their drink.        could be having such a    for the employee.          idea that it was OK to take
                                                                     negative impact on                                   sickies!
                                                                     their health.

Source: Health of the Workplace 4, business leader research, April 2010

 32 Health of the Workplace 4 Report
The value of social events
Our research shows that business leaders                       l   One in five (21%) admit that they don’t
appear to accept socialising with staff as part                    like socialising with work colleagues
of their role, although nearly nine in ten (87%)
                                                               l   16% say they don’t mind socialising
said that they socialised with their friends and
                                                                   with their work colleagues once in a
family more than their work colleagues.
                                                                   while but resent them taking up any
Just under a half (43%) of business leaders                        more of their time
say that they really enjoy getting to know
                                                               l   15% feel obliged to show their face, but
their team in an informal setting. A third
                                                                   don’t really enjoy it.
say that they enjoy them but admit that
they can be a bit of a drag. Only one in ten                   These findings pose the question “could
(10%) feel obliged to attend socials to keep                   that money be better spent on something
their staff happy.                                             that adds real value to both the employee
                                                               and employer?” Typical cost-effective
Conversely, employees tend to enjoy
                                                               examples include an employee reward
socialising with their close work colleagues,
                                                               scheme, workplace wellness initiatives to
but over half (52%) aren’t particularly
                                                               aid employee wellness or an employee
enthusiastic about going out with their
                                                               assistance programme offering impartial
wider team:
                                                               support when it’s needed most.
  “While employers are
  attempting to make the lives of
  their employees more fun in a
  bid to foster a more harmonious
  workplace environment, their
  over reliance on alcohol is
  perhaps misguided. In the short
  term, this strategy can be a great
  way to relax and help colleagues
  let off steam. However, in the
  longer term, employers need to
  look for other ways to engage
  with staff to ensure everyone
  is involved and that unhealthy
  habits are not sanctioned in the
                                   Dr Doug Wright,
              Principal clinical consultant, Aviva UK Health

Improving employee health
and wellbeing
When asked what was the single action that                                                 Recognising the importance of a healthy
could make the biggest difference to staff                                                 workforce, one in ten (10%) of business
health and wellbeing, most business leaders                                                leaders said they’d encourage company
looked internally, focusing on cost-effective                                              wide fitness benefits and 7% said that
improvements they could make to their                                                      they’d discourage smoking and drinking
company culture and working practices:                                                     among staff. Whilst levels are still relatively
                                                                                           low, this is a positive step in the right
l    Over a quarter (29%) say that the
                                                                                           direction, particularly when you consider
     biggest improvements to staff health
                                                                                           that our Health of the Workplace 3 research
     and wellbeing would be made if they
                                                                                           showed that people were working longer
     instigated a better work/life balance
                                                                                           hours, doing little exercise, smoking more
l    Nearly a quarter (24%) say the best                                                   and drinking more alcohol.
     single action would be to foster a good
     team spirit and encourage a support
     network among employees.

         What single action do you think could make the biggest difference to the health and wellbeing
                                             of your organisation?

                  30%      29.41%



                                                                  13.24%                              12.75%


                        Instigate a        Discourage         Encourage company Foster team         Tackle stress   Introduce new      I don’t think I
                        better work life   drinking / smoking wide health and     spirit and        head on         benefits such as   can do anything
                        balance            among staff        fitness initiatives encourage a                       private medical    to affect the
                                                                                  support network                   insurance          health and wellbeing
                                                                                  among staff                                          of the workplace

Source: Health of the Workplace 4, business leader research, April 2010.

34 Health of the Workplace 4 Report
  “With budgets being tight it                                 see a counsellor or GP for extra support.
  may be better for employers to                               By contrast, 14% of business leaders feel
  consider allocating this money to                            that it is not their position to pry, showing
  initiatives that benefit both their                          there’s still more work to do around this
  employees and their company.                                 topic. Hopefully initiatives such as MIND’s
  Supporting the holistic and                                  ‘Taking Care of Business’ campaign will help
  physical wellbeing of their team                             change the stigma associated with stress
  through workplace wellness                                   and encourage more employers to take
  programmes for example,                                      pro-active steps to help their employees
  can be equally as effective in                               overcome their issues.
  engaging staff and building
  morale and team spirit. For a
  relatively low cost, not only can                             MIND’s ‘Taking Care
  workplace wellness programmes                                 of Business’ campaign
  such as Aviva’s MyHealthCounts
  for Business help employers                                   objectives
  improve the health of their                                   l   Businesses to make it a corporate
  workforce, but they’ve also been                                  priority to address mental health in
  proven to have a positive effect                                  their workplaces
  on staff morale and loyalty.                                  l   Employers to recognise that all staff
  What’s more, as employees                                         are vulnerable to developing mental
  become healthier and happier                                      health problems and need to be well
  their productivity should rise as                                 supported
  sickness absence levels fall.”
                                                                l   An end to mental health stigma at
                                   Dr Doug Wright,                  work. Employers and employees
              Principal clinical consultant, Aviva UK Health
                                                                    should stop seeing mental health
                                                                    problems as a sign of weakness and
                                                                    start finding solutions for the good
Workplace Stress
                                                                    of our workforce and businesses.
Our research also shows that employers
have a growing awareness of the benefits
of tackling issues such as workplace stress,
with 13% saying that they’d tackle stress
head on. The good news is that 35% of
business leaders say that they would take
an employee aside to discuss the issue
and 28% would advise the employee to

Workplace Communications
Communicating with the
Although nearly a third of business                                               benefits include at recruitment phase in the
leaders (32%) believe that face-to-face                                           offer letter (18%), during a staff appraisal
communication is still the most effective                                         (17%) and in a reward statement covering
way to engage their employers. They are                                           all benefits (15%).
increasingly favouring online communication
                                                                                  Despite investing in employee benefits,
with nearly two thirds of employers
                                                                                  many business leaders admit to either not
believing that new web-based technology
                                                                                  pro-actively communicating the benefits
enables them to communicate much more
                                                                                  to their staff, choosing for HR to hold
cheaply and effectively with their workforce.
                                                                                  the documents instead (11%), or not
The company intranet plays a key role in                                          communicating the benefits because there’s
the communication of employee benefits                                            no demand from staff.
with nearly one in five (17%) business
leaders holding details of their employee
benefits on their intranet site. Other
popular ways to communicate employee

        Which of the following best reflects the way you communicate employee benefits to your staff?

         18%     17.65%
         16%                                                                                                                                 15.69%


         12%                                                            11.27%




          4%                                                                                                    3.43%
                                                                                      0.49%                                    0.49%
                At             We offer a   We include    We mention   HR has        Hi tech      I haven’t   I don’t        I don’t          No demand
                recrutiment    reward       this          this at      documentation application got round    think it’s     communicate from staff
                phase          statement    information   appraisal    which         - i.e.       to it       necessary to   this as I fear
                i.e. in        for all      on out        meetings     employees     iphone App /             communicate    staff will abuse
                offer letter   benefits     intranet                   can access if social media             this           it if they know too
                                                                       required      feed                                    much about the

Source: Health of the Workplace 4, business leader research, April 2010.

36 Health of the Workplace 4 Report
Breakdown in communication
Despite their best intentions, this years’                                           l    Over two in five employers (41%) say that
Health of the Workplace study uncovers a                                                  they have an open door policy and pride
communications gap between employees                                                      themselves on being open and supportive
and employers that could jeopardise an
                                                                                     l      Four in ten (40%) make a point of
employers ability to support their employees
                                                                                            keeping their ear to the ground and
when they need it most.
                                                                                            speaking to staff who appear to be
When asked whether they feel that they are                                                  having issues
good at spotting issues, employers feel that
                                                                                     l      Only 4% of employers think that it is
they are good at spotting personal problems
                                                                                            an HR issue or don’t feel that it is their
and recognise that it is their responsibility to
                                                                                            business to ‘snoop’ on employees.
do so in their team:

                      Do you think that you are good at spotting potential personal/professional
                                            problems amongst your team?






         10%                                 8.82%

           5%                                                                                  3.92%                                    3.92%
                Yes, I make a point     I found it easier      Yes, I have an open       I don’t see it as my   I am looking for   This is an HR issue
                of keeping my ear       when the company       door policy and           business to snoop      ways to capture
                to the ground and       was smaller, now       pride my self on          on my employees        the information
                speaking to any staff   I have to rely on my   being open and                                   better
                who look / appear to    managers to keep       supportive.
                be having issues.       me updated.

Source: Health of the Workplace 4, business leader research, April 2010

  The role of new media
  Social media is increasingly being used as a tool to support business leaders in their
  daily role:
  l    70% are using social networking tools to communicate with colleagues
  l    A third (33%) are using them to learn about new developments/best practice
  l    One in five (20%) use them as a resource for decision-making
  l    6% use social networking tools as they don’t have time to read up or consult with

However, while employers feel that they
have an open door policy and are easy to                                                    Only 17% of employees would turn
approach, our employee research paints a                                                    to their employer for help if they had a
different picture. When asked who they’d                                                    health-related or personal problem.
                                                                                            Source: Health of the Workplace 4, employee research,
tell if they felt that one of their colleagues
                                                                                            April 2010 .
was unwell, stressed or has a drink or
drug problem less than one in five (17%)                                                  This situation not only opens employers
employees would encourage their colleague                                                 up to potential duty of care risks, but also
to speak to their employer. Instead, nearly                                               highlights another potential issue with the
six in ten (59%) would speak to the person                                                Government’s Fit Note introduced earlier
direct and more worryingly; over a quarter                                                this year. Lack of employee engagement
(26%) would do nothing.                                                                   will hinder an employer’s ability to intervene
When asked the same question about                                                        early and offer their employees the right
themselves employees gave a very similar                                                  support at the right time.
answer with 60% turning to their partner,
a third (33%) to their doctor. Only 4%
would turn to their line manager for help.
Just 1% would look to their HR department
for support.

       If you suspected that a colleague was unwell, stressed, had a personal problem, or alcohol or drugs
                                 issue which one of the following would you do?

              60%                 58.96%

              30%                                                                                                                                         27.69%
              25%                                                                                                                         22.91%
              20%    17.13%                                                                                16.73%
                                                                                           5.18%                            4.38%
                    I would      I’d try to   I’d point      I’d keep        I don’t      I’d cover      It depends        It depends        I’d         Encourage
                    inform my    speak to     them in the    an eye on       think it’s   up for         what’s            on what’s         encourage   them to
                    employer /   them.        directions     them but        my place     them as        wrong with        wrong with        them to     talk to friends
                    HR           They might   of our         wouldn’t        to pry       I wouldn’t     them.             them. I’d         see their   and family
                    department   need a       intranet /     step in                      want their     I’d have          inform            GP          outside work
                    It’s their   shoulder     support        unless things                job to be at   to inform on      senior staff
                    welfare      to cry on    websites /     seemed to be                 risk because   them if I         if they were
                                              helplines      getting worse                they’re not    thought they      stressed / ill but
                                              which could                                 well           had a drink or    would try to hush
                                              help them in                                               drugs problem     up a drink/drugs
                                              confidence                                                 but be discreet   problem as they
                                                                                                         about a serious   could get the sack
                                                                                                         health problem

Source: Health of the Workplace 4, employee research, April 2010

38 Health of the Workplace 4 Report
What’s causing this
Our research shows that employees                                                job prospects. This situation could also be
prefer to keep their personal problems to                                        contributing to the scepticism in the 12%
themselves with nearly a quarter (23%)                                           of employees who say that they don’t trust
saying that it would be their own personal                                       their employer.
business – despite it potentially affecting
                                                                                 Worryingly, nearly one in five (18%)
their work, and also an employer’s duty of
                                                                                 employees don’t think that their employer
care requirements. Less than 4% would turn
                                                                                 would be best placed to answer their
to their employer for help.
                                                                                 questions, despite many offering employee
Unsurprisingly, the economic climate is                                          benefits such as employee assistance
driving some of these behaviours, with                                           programmes, private health insurance and
24% of employees saying that they would                                          occupational health services. This once
worry that telling their boss about a                                            again highlights the need for employers
personal problem may affect how they are                                         to effectively communicate their employee
treated in the workplace or their future                                         benefit and rewards package.

                           Who are you most likely to turn to if you are worried about your own
                                        health or you have a personal problem?





                                                         4.98%                                                     5.08%      5.88%
                                                                    1.10%                   1.00%      1.99%
         Partner   Family       Friends /   Employer / Website / Anonymous       Family   HR         The          A           None of
                   (parents /   extended    line       forum eg helpline - AA,   doctor   department occupational colleague   these
                   childrens)   family      manager    Mumsnet, occupational                         health
                                                       net. doctor health                            specialist
                                                                                                     at work

Source: Health of the Workplace 4, employee research, April 2010.

         If you would not turn to your manager/employer for help if you had a health or personal problem
                                     which of the following best reflects why?

   24%                                                                                 22.91%
   18%                                                                                                                                17.03%
    8%      7.67%

    4%                                                                                                               3.59%
          Don’t want to   I would be     I’d not be     I don’t think   I wouldn’t    It’s my own   I don’t trust   I don’t want   I would turn
          be labelled     worried that   given         they’re best     want to add   personal      my employer     to burden      to my emplyer /
          fragile and     it might       challenging   placed to        to the        business. I                   my             manager
          treated with    affect my      jobs to do    answer my        concern of    don’t want                    colleagues     for help
          kid gloves      career                       questions        the company   my employer/                  with lots of
                          prospects                                                   manager to know               extra work
                                                                                      that I’m sick

Source: Health of the Workplace 4, employee research, April 2010.

  “The breakdown in communication between
  employers and their staff means that health
  risks such as stress in the workplace are not
  being effectively managed. Lack of employee
  engagement will also hinder an employer’s
  ability to intervene early and offer their
  employees the right support at the right
  time. With the help of providers such as
  Aviva, employers can start to break down
  these communication barriers by ensuring
  that they have specialist support networks
  and services in place for their employees. “
                                                                          Dr Doug Wright,
                                              Principal clinical consultant at Aviva UK Health

40 Health of the Workplace 4 Report
This year’s Health of the Workplace               Workplace report are likely to continue
research findings clearly show that the           throughout 2010. Indeed, our recent ‘Early
work environment remains challenging              Intervention Prevention’ research shows that
for both business leaders and employees.          stress continues to be an on-going issue.
Whilst there’s some cause for optimism,           Almost a quarter (23%) of businesses claim
many employers are still facing the same          that the recent economically difficult times
dilemma that they were a year ago - the           have taken a lasting toll on employee stress
need to balance the cost of investment in         levels, which has led to an inevitable rise in
employee health and wellbeing with the            absence rates.
financial priorities for the businesses. Whilst
                                                  The good news is that despite the difficult
employers recognise the importance of
                                                  conditions, the atmosphere in the workplace
a healthy, happy workforce, they are still
                                                  appears to be good in many cases. The
prioritising productivity and profit over staff
                                                  findings suggest that employers recognise
motivation and work-life balance. Nearly a
                                                  that staff motivation, morale and productivity
third (31%) want maximum profitability for
                                                  are intrinsically linked and while expenditure
head count and two in five (39%) demand
                                                  continues to remain under the spotlight, many
a highly productive team who are flexible
                                                  employers are taking steps to instil a friendly
and can respond to change.
                                                  work culture and encourage their employees
While employees should be able to cope            to have a good work/life balance.
with the associated pressures of this ‘task
focused’ approach in the short-term,
                                                  Right sentiment, wrong
sustained pressures could have a negative
impact on their long-term health and              approach?
wellbeing. This in turn could have a knock-       However, our research highlights that the
on effect to their motivation and ultimately      methods employers are commonly using to
their productivity. This means that unless        foster teamspirit may not be delivering the
employers allocate funds to invest in the         value they hope. Events to help motivate staff
appropriate support for their staff, they         often take place in a pub or a restaurant.
could be creating a self-fulfilling prophecy      And, while just under half (45%) of employers
and fall short of their business objectives.      say that there’s no obligation to drink alcohol
This continued focus on results means that        at these events, over a quarter (26%) admit
the UK workforce is likely to face another        that they don’t mind their staff having a few
challenging year. So it’s not unrealistic         drinks, as long as they don’t get out of hand.
to infer that the unhealthy behaviours
we witnessed in our last Health of the

While these events may be relatively low          Moreover, this lack of communication could
cost (depending on how much alcohol is            be opening employers up to unnecessary
consumed), the real value they deliver is         risks. Our research clearly shows that whilst
debatable. This is particularly true when         employers recognise the importance of
you consider that our research shows that         having an open door policy when it comes
while business leaders see socialising with       to their employees’ health and wellbeing,
staff as part of their role, over half (52%) of   just 4% of employees would approach their
employees say that they don’t really enjoy        employer with a health-related or personal
going out with their wider team.                  problem. Whilst many employees are
                                                  concerned that admitting to an issue may
With today’s economic climate making the
                                                  affect their future job prospects, nearly one
smart employee benefit choices even more
                                                  in five (17%) feel that their employer is not
important than ever, these findings raise
                                                  best paced to help them. This suggests that
the question “could that money be better
                                                  some employees may not be aware of the
spent on something that adds real value to
                                                  confidential, impartial support services their
both the employee and employer?” When
                                                  employers are often providing.
you also consider the impact excessive
alcohol could have on an employee’s health,       This situation not only opens employers
not to mention an employer’s absence              up to potential duty of care risks, but
rates, there’s a strong case to suggest that      also highlights another issue with the
employers may be better placed to look for        Government’s Fit Note introduced earlier
other ways to engage with staff to ensure         this year. Lack of employee engagement
everyone is involved and that unhealthy           will hinder an employer’s ability to intervene
habits are not sanctioned in the workplace.       early and offer their employees the right
                                                  support at the right time.

A need for more effective                         The apparent communication gap between
communication                                     employee and employer highlights the
                                                  importance of giving employers the
Employee benefits play a key role in staff        appropriate occupational health training and
motivation, morale and retention. While           support to be able to recognise changes
half (51%) of employers are already taking        in their employees’ behaviour. Coupled
positive steps to tackle health issues through    with the appropriate specialist occupational
benefits such as private health insurance,        health support and effective communications
group income protection and confidential          channels, this insight will help employers
helplines, our research suggests that few         pro-actively support their employees through
are pro-actively promoting their benefit and      personal and health-related problems. This
rewards package to their staff. This in-turn      in turn can help to prevent issues esculating,
could limiting their usage, effectiveness and     speed recovery and help control the amount
value to the employer.                            of time (if any) that employees spend away
                                                  from the workplace.

42 Health of the Workplace 4 Report
Tackling the issues before                           Cost-effective solutions
they arise                                           With the potential of such promising
However, effective communication is just             returns, you’d expect workplace wellness
one part of the solution. While pro-active           programmes to be costly. However, the
communication and early intervention are a           good news is that employee wellness
positive step in the right direction, employers      initiatives need not be expensive or
can go one step further by introducing               complicated. Evidence suggests that over
interventions that put the emphasis firmly on        time the benefits to employers far outweigh
prevention rather than treating issues once          the costs associated with establishing and
they arise.                                          running workplace wellness programmes.

‘Workplace wellness’ has been a ‘buzz’               The lists of ‘wellness solutions’ available to
phrase for a number of years and our own             employers are as endless as the number
experience shows employers are becoming              of consultancies advocating them, but
increasingly interested in the topic. This is a      whatever is prescribed should be tailored
view supported by Buck Consultants’ third            to suit the company’s needs and culture.
annual global wellness survey, Working               There’s no ‘one-size fits all’ approach.
Well: A Global Survey of Health Promotion            Many of the leading providers now offer
and Workplace Wellness Strategies. This              wellness benefits as an integral part of
demonstrates that the fastest-growing                their private medical insurance and group
components of wellness initiatives around            risk policies, and a review of an existing
the world are expected to increase 100               employee benefits package may uncover
per cent or more over the next three years.          hidden wellness features such as online
These include technology-driven tools such           health management information, GP and
as web portals, online healthy lifestyle             stress counselling helplines and discounted
programmes, and personal health records.             gym memberships.
This comes as no surprise when you consider          Moreover, for a relatively low cost,
that physical activity programmes at work            employers can purchase complementary
have been found to reduce absenteeism                workplace wellbeing initiatives which
by up to 20 per cent in some cases: Well             not only help employers understand the
designed workplace wellness programmes               health profile (and associated risks) of their
can also increase employee job satisfaction          employees, but also give them the tools they
and reduce staff turn-over by between 10             need to fully engage their employees in the
and 25 per cent 11.                                  programme. Whether it’s support for cutting
                                                     back on alcohol and cigarettes or guidance
                                                     on stress management, doing exercise or
                                                     healthy eating, there’s a whole host of
                                                     information available.
  Source: NICE public health guidance, – Workplace
Business Case.

These resources can be complemented
with employer or employee funded health       A study by PricewaterhouseCoopers of 55
screening such as blood pressure, pulse,      companies with a wellbeing programme
BMI, blood glucose and cholesterol checks     revealed that 80 per cent reduced sickness
to help identify any health risks early and   absence; 32 per cent cut staff turnover;
enable employees to take steps to rectify     and 18 per cent raised productivity
                                              Source: PricewaterhouseCoopers – building the case for
them. Aviva’s MyHealthCounts for Business
                                              wellness report, Feb 2010
is a prime example of such a programme.

MyHealthCounts is a health risk assessment
service that can provide a tangible
return within one year, whilst providing
employers with all the appropriate tools
to help manage and improve the health
of their employees. The programme offers
employees the opportunity to find out how
healthy they are, get personalised advice
on improving and maintaining their
health, and receive rewards for doing so.
If a company’s health profile improves, in
addition to the potential improvements in
sickness absence, morale and productivity,
they can even receive a direct financial
benefit for their efforts.

44 Health of the Workplace 4 Report
Working together
At Aviva we believe that the more people        We will continue to lobby the Government
understand about their health, the easier       in this area and make recommendations
it will be for them to take active steps to     about the approaches they could take to
improve it. Focusing on the right areas of      encourage the wider take-up of occupational
health improvement means that companies         health solutions.
can benefit from a more visible impact
                                                We are committed to continue to work hard
on absence costs and overall productivity.
                                                to demonstrating the tangible benefits of
We believe that employers, providers,
                                                early intervention and workplace wellness
intermediaries and the Government need to
                                                and providing insurance and occupational
work collaberatively to raise the awareness
                                                health solutions. These not only support the
of the benefits of workplace wellness and
                                                Government’s objectives to get more people
formulate the appropriate solutions.
                                                off incapacity benefit and back to work, but
While there’s currently no fiscal incentive     also help keep employees healthy.
from the Government to encourage
employers to offer occupational health
initiatives we believe there should be.

  Aviva UK Health Case Study
  As a provider of health and wellbeing solutions, we want to extend our knowledge to
  our own staff. So when we launched our MyHealthCounts service to our customers, we
  also promoted it to our employees, giving them the opportunity to find out how healthy
  they are and get advice on the steps they can take to improve their current and future
  health and wellbeing. Staff were also invited to have a mini-medical to find out their
  key health measurements such as their blood pressure and cholesterol levels. The event
  was supported by Sally Gunnell, who rounded the day off with a motivational speech to
  encourage individuals to set realistic goals to help them meet their own personal health
  objectives. To keep the momentum going, similar activities will take place throughout
  the year.

  In addition to this, Aviva UK Health also offers its staff discounted gym membership at
  selected UK gyms, gives them access to a confidential employee assistance programme and
  also offers a choice of health related benefits as part of its flexible benefits scheme.

About the research:
Pollab Ltd carry out bespoke quantitative /       Employee Research
qualitative survey and research projects to
gather the views of consumer and other            The research was carried out online between
markets in the UK and globally on behalf of       2nd and 11th April 2010 amongst 1,004 UK
a broad range of brands. These range from         workers in full time employment. This is broadly
government departments and charities, to          representative of the working population across
private companies.                                age, gender, region, company size and industry.

Pollab adheres to the Data Protection Act
and follow the rules and conduct of the
                                                  About our health business
Market Research Society (MRS).                    Established in 1990 as Norwich Union
                                                  Healthcare and re-branded to Aviva in
                                                  2009, we provide a range of private medical
GP Research
                                                  insurance, income protection, occupational
Pollab recruited a panel of 204 General           health and group life products and services that
Practitioners from across the UK to complete      cover over 2,800,000 lives. We are one of the
a comprehensive online survey. This panel is      largest providers of income protection, group
representative of the 58,370 GPs in the UK in     life and private medical insurance in the UK.
terms of gender, ethnicity, practice type and
location, and reflects the regional proportions
of the UK. The research was conducted
                                                  About our occupational
between the 6th and 7th April 2010.               health business
                                                  Aviva Occupation Health UK Limited, a sister
Employer Research                                 company of Aviva Health UK Limited provides
                                                  occupational health solutions and services to a
The research was carried out online between
                                                  wide range of industry sectors. By utilising their
2nd and 11th April 2010 amongst a
                                                  large fleet of purpose built mobile clinics and
nationally representative sample of 204 UK
                                                  approved medical centres, staffed by a team
senior decision makers in micro, SME and
                                                  of experienced occupational physicians and
mid corporate companies. The sample is
                                                  nursing staff, the services are designed to meet
broadly representative of UK senior decision
                                                  the individual needs of clients.
makers across gender, region, company size,
industry and public/private sector.               Aviva Health UK Limited is authorised and
                                                  regulated by the Financial Services Authority
                                                  and is a member of the Association of British
                                                  Insurers and the Financial Ombudsman Service.

46 Health of the Workplace 4 Report
Aviva’s products and
At Aviva we understand the needs of our         Absence - modular solutions that allow
clients are varied and evolving, and we         employers to quickly and simply ease the
continue to provide innovative solutions        strain of employee absence on their business
to meet these changing needs. With the          and which can work as part of a broader
economic climate looking challenging for        solution that includes existing occupational
some time to come, many employers are           health programmes.
looking to affect the one area which they
                                                Being part of Aviva, the UK’s largest
retain control over – costs. This is why we
                                                insurer - rated AA- by Standard & Poor’s
have developed a whole range of products
                                                to reflect our business position, operating
to help meet our clients’ needs and budgets.
                                                performance, capitalisation and financial
The link between health, performance and        flexibility – means businesses can rely on
productivity has been well documented,          our strength and experience. We believe the
which is why our offering provides a varied     calibre of our teams and the passion of our
and modular menu of Health and Wellbeing        people to deliver excellent customer service
products:                                       is why we continue to grow our business.
                                                We are committed to providing our clients
Protection - a range of products providing
                                                with the tools and support they need.
private medical insurance, income protection,
group risk and cash plan products to assist
employers to mitigate against short and long-
term absence and help employees return to
work as soon as possible.

Wellness - a range of preventative health
products and services that aim to identify
potential employee health risks early on and
enable employers to put in place a range
of options that can help keep employees in
good health.

MyHealthCounts for
MyHealthCounts for Business is designed to     Employers receive a detailed report that
help companies with 250 or more employees      shows them how many people have
gain a clearer understanding of the health     participated in the programme and their
of their employees and offers a range of       company’s health status. The employee data
tools to help them tackle their company’s      is aggregated and anonymised to give them
key health risk areas and encourage their      a comprehensive picture of their company’s
employees to take pro-active steps to lead a   health, risk areas and improvements.
healthier lifestyle.
                                               The programme is supported by Healthy Life
Unique in the market, MyHealthCounts           campaigns consisting of online and offline
for Businesses includes tools to incentivise   internal communications material. These
both the employer and their employees          can be selected at any time during the year
to support maximum take-up and long-           enabling employers to pick the campaigns
term usage of the initiative. Employers can    most appropriate for their key health risks.
receive up to 100% discount off the cost of
                                               Aviva also offers a range of wellness tools
MyHealthCounts for Business the following
                                               designed to help smaller companies improve
year depending on the proportion of their
                                               the health and wellbeing of their employees.
employees who complete the online health
questionnaire and the average health score
achieved. Employees receive health and
leisure discounts as well as HealthPoints
which can be redeemed against health
management tools.

Employees complete an online health and
lifestyle questionnaire to discover how
healthy they are compared to 100 other
people of the same age and gender. An
online health coach then helps them set
realistic goals and offers them personalised
advice and support on the steps they can
take to improve and maintain their health.

48 Health of the Workplace 4 Report


50 Health of the Workplace 4 Report

Aviva Health UK Limited. Registered in England Number 2464270.
Registered Office 8 Surrey Street Norwich NR1 3NG.
This insurance is underwritten by Aviva Insurance UK Limited. Registered in England Number 99122,
Registered Office 8 Surrey Street Norwich NR1 3NG.
Authorised and regulated by the Financial Services Authority.
Aviva Health UK Limited, Head Office: Chilworth House Hampshire Corporate Park Templars Way
Eastleigh Hampshire SO53 3RY.

GEN3666 10/2010

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