Public: Wellbeing | Public

How to cope with stress - before it's too late

Mon, 14 Jun 2010 10:20:59 GMT

A retired senior manager looks back at his working life and the stress he came under that led to a heart bypass at 54

I was fit at 50. At 54 I had high cholesterol, high blood pressure and a quadruple heart bypass.

I didn't consider myself to be particularly stressed at work. Sure there were efficiency initiatives, demanding performance targets, a management restructuring to deliver and the usual disciplinary hearings, complaints and MPs' letters. But - and this is the point - that was the usual stuff that you have to deal with as a manager in the public sector and I had been dealing with it for years. I had accepted this as normal.

When my GP asked if I had a stressful job I said "not particularly". I thought stressful meant struggling to cope, not being able to sleep the night before an important meeting, replaying decisions over in my head, worrying about dismissing someone or having deadlines I might not be able to meet.

I didn't doubt my abilities and I genuinely thought there was nothing that my working day could throw up that I hadn't dealt with before, so nothing would justify being stressed.

I didn't realise the pressure and stress I was under until it stopped.

Three months after retiring early, I now accept that work dominated my life. Things that seemed so important at the time now seem fairly insignificant. Much of the pressure was self-imposed. It was me who squeezed in an extra meeting at the end of the day, who didn't leave enough travelling time between meetings or failed to put in adequate preparation time to work on that important presentation.

It was my desire to impress that led me never to decline invitations to join any working group. It was my naked ambition that led me to distant parts of England and, once, Wales, to put myself through gruelling assessment centres, trial by sherry and beauty parades masquerading as a rigorous selection process.

Some pressures are self-imposed and it is important to have the insight to recognise this because you can do something about them. Other pressures are external and a new era of budget cuts, efficiency drives, compulsory redundancies, wage freezes and service reductions will increase the pressure on managers. These pressures may not give you a heart attack or stroke but they will increase the risk that you become preoccupied with work, lose contact with your friends and neglect your family.

So what can you do to manage the pressure and reduce the stress? Well if I knew then what I know now this would be my survival plan.

1. Take your full allocation of annual leave. Do not carry over annual leave to be taken at some point in the future. You need the break now.

2. Have a three week holiday as opposed to two weeks. This is all about getting people to do things in your absence rather than waiting till you get back. It will also reduce your emails. You get fewer if you are away for three weeks rather than two; this may be hard to believe, but it is true.

3. There should be no meetings booked in your diary first day back at work. This is catch-up time and if you do don't do it now you will spend the next two weeks doing it, at the end of which you will feel like you have never been away.

4. Take a lunch hour. You probably got in early and are staying late. You will be more productive and less tired if you have a break away from the office. Yes it is hard to do but modern management is about what you deliver not the hours you put in.

5. Stay an extra hour in the office if it means you won't have to take work home. With any luck the traffic will have died down and you will have a quicker less stressful journey home.

6. Try leaving the briefcase at work. If you take it home you will be tempted to open it later in the evening and do some work.

7. It is very convenient being able to access emails and reports at home on your laptop but don't fall into the trap of extending your working day into the evenings or weekends. Instead negotiate a regular working from home day. If senior managers can't negotiate this for themselves because of the "culture" in the organisation, this is a weakness. If senior managers are doing it then that gives permission for other managers to do it.

8. Delegate. With increased spans of responsibility the modern manager cannot micro manage. Your job is to explain what needs doing and ensuring they have the skills, knowledge and resources to do it.

9. Don't do urgent; only do important. It is surprising how few things are important. Embrace this approach in your expectations of your staff; in other words something is not important simply because it came from you.

10. Reduce your email. I altered my machine to bounce back any emails into which I was copied. These were mostly people covering themselves by telling me what they had already done. Overnight I reduced my emails and my blood pressure.

Blair McPherson was until recently a director in a large local authority

NHS: something's gotta give - either targets or services

Thu, 27 May 2010 10:06:12 GMT

Following a recent report on stress levels in the public sector, Eifion Rees reports from the NHS frontline where the pressure to meet targets is having a detrimental affect on services - and employees' health

Working in the public sector can seriously damage your health. That is the conclusion of research published recently in the European Heart Journal.

Conducted among 10,000 Whitehall civil servants, it found people who daily work three hours overtime or more were 60% more likely to suffer a heart attack than those working normal hours. Streamlining and cost-cutting have taken their toll: stress levels in the public sector are now said to be higher than in the private sector.

Public expectation

Anne Gibson, head of HR at Norfolk county council and vice president of the Public Sector People Managers' Association, puts the increased potential for stress down to an increased number of challenges. "In terms of outcomes to deliver, there is certainly a greater demand to work faster and on a more complex range of issues," she says. This is partly down to an increase in public expectation about what they should get in terms of services, fuelled by changes in the commercial world, such as online banking.

Whatever the cause, the results include greater pressure than ever on senior managers in the public sector. One NHS manager says the work-life balance in her London PCT began tipping heavily in favour of the former some 18 months ago. She regularly works 50-hour weeks, spending lunch breaks in front of her computer or in meetings, and occasionally works at weekends.

"We're expected to do whatever is required to get the job done," she says. "In most NHS organisations, people leave and their responsibilities are shared out on an 'interim' basis among colleagues – that this becomes a permanent arrangement seems to be an unwritten rule."

Contributing to the atmosphere of stress, she adds, is a tendency towards "buck-passing" and away from taking ownership of tasks. Communication is also a factor, with a feeling that some managers are being "set up to fail" by being given too much work and not enough training.

"The NHS used to be a more pleasant place to work, but over time has become more challenging and politically driven, with minimal flexibility for negotiation over target delivery. We try to keep up morale and make time to chat, but with many gaps in the service and few resources to fill them, something will have to give, either targets or services."

Reduced to tears

Or, indeed, people. One community services manager in the south of England ascribes her stress to restructuring within her organisation, overseen by an interim chief operating officer with a "very abrasive, bullying" management style. "Clinicians who are also managers, as I am, are not always valued or supported to make the development change into whatever new type of manager our leaders want," she says. Management meetings became increasingly difficult as efficiency and productivity goals were pursued, she adds, with colleagues sometimes reduced to tears.

Regularly working 10-hour days or more since September, this manager began experiencing breathlessness and incipient feelings of panic, and was eventually diagnosed with work-related stress and signed off by her GP. She believes many public sector managers are unaware they, too, may have work-related stress. "If people are on edge, anxious about their futures and unsupported in their jobs, they can't focus on patient care," she comments. "Procedures are suffering, and a growing culture of interims means an increasing focus on upping performance to the detriment of forming relationships with colleagues and loyalty to the local areas and organisations.

"The public sector has changed – my colleagues and I used to laugh a lot more and go out for lunch together, which was always a supportive time. The caring aspect has reduced as we strive to meet targets."

Stephen Chaffey, a solicitor at law firm Dundas & Wilson, says work-related stress may have legal implications, as well as impacting an organisation's "bottom line" by increasing sickness absence and reducing productivity. "While there is no UK legislation focused solely on stress, employers are obliged under the Health and Safety at Work Act to provide a safe working environment for their employees," he points out. "They will be potentially liable for a breach of that duty if an injury to physical or mental health occurs related to stress."

Management standards issued by the Health and Safety Executive offer guidance in distinguishing between positive and excessive pressure, he adds.

Whitecollar workers should cut overtime

Wed, 12 May 2010 11:42:23 GMT

Research into civil servants shows 60% increase in heart-related illness

A long-running Whitehall study, which has followed the health of more than 10,000 civil servants since 1985, has concluded that working overtime is indeed bad for your health.

This latest analysis from a study, reported in the European Heart Journal, looked at the working patterns of more than 6,000 people, aged 39-61, over an average of around 11 years.

The research shows a 60% increase in heart-related illness such as non-fatal heart attacks and angina in those who work for three hours or more longer than a normal seven-hour day.

One or two hours' overtime made no difference to people's health, the researchers from University College London and the Finnish Institute of Occupational Health found. But three or more hours led to a 60% increased risk of coronary heart disease.

One of the explanations might be to do with the type of people who work long hours, who are classified within the Whitehall study as evincing "type A" behaviour – aggressive, competitive, tense, time-conscious and generally hostile.

Another factor could be psychological distress in the form of depression and anxiety, and possibly not enough sleep, or not enough time to unwind before going to sleep. The overtime workers could also be the sort who are more likely to carry on working while unwell, or may have high blood-pressure during office hours which does not show up at the GP surgery.

But none of these things fully explain the raised heart disease risk. Dr Marianna Virtanen, an epidemiologist in Helsinki who worked on the study, added that they had not measured what happens if people reduce their hours.

"One plausible explanation for the increased risk could be that adverse lifestyle or risk factor changes are more common among those who work excessive hours compared with those working normal hours," she said. "Another possibility is that the chronic experience of stress (often associated with working long hours) adversely affects metabolic processes. It is important that these hypotheses should be examined in detail in the future."

The authors also warn that their civil servant cohort was exclusively white-collar and public sector, and therefore the findings cannot be extrapolated to people in blue-collar jobs or in the private sector.

The road to recovery

Fri, 07 May 2010 09:15:00 GMT

While celebrities may check themselves into an expensive rehab clinic for a 'miracle cure', recovery for most people struggling from an addiction is long and hard - which is why they need all the support they can get

Ask any member of the public how to beat a drug or drink problem and, chances are, they'll say; you first check into an expensive rehab, you learn to abstain, you exercise, you eat healthily, and a few months later you emerge all fixed and ready to go and take your place in the world again.

This is the media story of the 'recovered' celebrity. Strong disapproval is dealt out to those in the limelight who are deemed to have 'failed' to get better. No recognition is given to the possibility that they may be struggling with an addiction.

And this is the reality for the many, the road to recovery is long and hard. People need a lot of support. It can take years for them to turn their lives around.

Treatment is inevitably a complex process

For it to work treatment is inevitably a complex process that is tailored to the individual. Each person needs committed and caring support as they move forward step by step. And they can at any point relapse and disappear but the hope is they will come back. There really is no simple, short sharp shock solution and there are no absolutes. Far too much talk about recovery focuses on the media celebrity model.

Until an open discussion about what recovery really means takes place - putting people with drug and alcohol problems in the driving seat - the media' s mythical one way route to salvation will remain.

The people we see and work with at Addaction have complex lives and their problems are not just with drugs and alcohol. They often have difficulties with relationships, family, education, employment, mental health or housing.

Some of these may be the cause of their drug use, others may have been caused by it – but for someone to truly recover, each of these needs to be addressed.

One of the first steps along the way is, without a doubt, to reduce the harm that someone's drinking or drug use is causing to their health, the way they live, and the distress to those around them. Some people can stop immediately, the majority can't; but that doesn't mean they can't still be helped.

In my discussions with services, users trust is a critical factor in this journey. People need to feel safe and supported in order to begin the journey to recovery. For many this first step is engaging with a service such as one of our 'needle exchanges' - all of which are part of community projects.

Like methadone and substitute prescribing this is not the goal it just a start. We run the risk of failing to truly support people if we do not have as our ultimate aim of getting people free of their addiction.

We owe it to everyone person who seeks our help, in what ever service, for whatever addiction the belief that they can recover completely and, on the way, rediscover the family, friends and relationships they once had.

Simon Antrobus is chief executive of Addaction

Weblink

National Treatment Agency for Substance Misuse microsite - explaining the benefits of supporting recovery and reintegration from drug addiction: guardian.co.uk/drug-treatment

Culture, champions and politics

Thu, 18 Mar 2010 12:16:36 GMT

There's no point dancing around the issue - arts and culture are hugely important to the nation's health and wealth and should be supported accordingly, says Gail Brown

Last month's Dance Summit fell at a curious time as there is much debate in the cultural sector at large, whether it is about funding the future of dance, supporting new talent or succession planning for creative leaders.

The Dance Champions have a target of getting 100,000 more people dancing by 2012 and they were enthusiastic, open to discussion and curious as to how they can a) achieve this and b) support the dance sector up to and beyond 2012.

The current picture of dance highlights national and regional dance agencies and Youth Dance England are firmly embedding infrastructure for dancers across the generations.

A collective approach to national dance delivery

Arts Council England is utilising the recent dance mapping research and leading a national arts debate, Big Dance has embraced a collective approach to national dance delivery working with key organisations such as Foundation for Community Dance, Central Council for Physical Recreation, Dance Champions, Youth Dance England and the National Association of Local Government Arts Officers.

Meanwhile, Allan Davey, chief executive of Arts Council England (ACE) continues to lobby for sustained investment in the arts.

Dance UK is leading us by example both in terms of joined up approaches to political lobbying across the world and by embracing new approaches to supporting dance, such as working with the Dance Champions.

This organisation provides evidence to the ever growing arguments for dance and culture to make the case that it deserves ongoing investment. Almost five million people participate in community dance each year, a total of 10,000 students are in training a year and the dance workforce is 40,000 people.

Furthermore dance is the second most popular physical activity for young people after football and the most popular physical activity for girls and there are 50 professional dance companies in the UK producing over 500 productions every year which are enjoyed by over one million people.

Last week, at the National Campaign for the Art's London Art Hustings, Lib Dem MP Don Foster said that of every "£100 that the government spends in and on this Country 7p of it goes to art and culture". Foster also stated that it would be "economic madness and cultural vandalism to even think about cutting this".

Art and culture are integral to place making

All political parties agree that culture addresses a variety of key local and national priorities such as health, education, reduction in crime and repeat youth offending. Art and culture are integral to place making, regeneration and the growth of capital infrastructure as well as creative industries.

There is a wealth of evidence to illustrate where we are spending large amounts of money on continued problem areas. For example within the last year alone Birmingham Total Place findings highlighted that a high contact family costs up to £250,000 per year. Nationally we recognise that the average cost of a young person being held in a youth offending institute is £100,000 per year and the obesity epidemic is costing the country millions of pounds.

An average youth arts project for young people, in the first instance aimed at addressing one of the many social issues such as social exclusion, high truancy rates, bullying, low academic achievement, isolation and crime as well as encouraging growth in confidence, communication skills, self esteem and empowerment could cost as little as £150 a day (working with between 10-30 participants).

It is time to invest in the front line, the engine room, the artists, producers, spaces, consistent education across all key stages and succession planning for cultural leaders of the future. We must maintain investment in local authorities arts development and arts development teams.

Culture and art make an extraordinary contribution to this country and we must continue to create a climate for improvement, including all elements of culture. This is the arena that requires champions. If all cultural champions, including dance truly want to help the sector then they will assist by utilising the afore mentioned facts and evidence to support culture at both a local and national level.

Together cultural champions and the arts/creative sector can lead the UK to a healthy, successful, creative and dynamic future by recognising that culture must be held firmly in your palm and the palm of the political party that will next lead this country up to and beyond 2012.

Gail Brown is arts manager of the Kent Arts Development Unit

Executive stress in the NHS

Fri, 05 Mar 2010 09:19:00 GMT

Keeping a cool head when others around you are in panic-mode takes a certain type of personality. NHS chief executives, by their nature are resilient creatures - and the best are also good at creating a 'pressure positive' in their organisations

NHS chief executives will be facing many challenges over the next year. Leadership agendas will need to shift to ensure the delivery of more with less; and at the same time, employees will need to be motivated in this context of scarce resources.

Now is a good time for chief executives to reflect on their own capacity to meet these challenges and to plan how they will lead their staff in a way that enables their organisations to deliver the most testing objectives they have faced for years.

To achieve these goals, it is essential for a chief executive's own wellbeing and personal resilience to be in a positive state. Not surprising and no mean feat given the many pressures faced at the top of NHS Trusts, where there is always a risk of them resorting to a reactive style of management and leadership.

Behaviour will be mirrored by other staff

The first step is for NHS chief executives to realise their behaviour is likely to be modelled by their immediate executive team and then by employees in the organisation. So if they panic in response to a new demand from the Department of Health, the foundation trust watchdog, Monitor or the strategic health authority or make decisions without appropriate consideration, their behaviour may well be mirrored by their executive team and then ripple outwards to other staff.

If sustained, this kind of behaviour can threaten the wellbeing and engagement of senior colleagues, which in turn cascades down through the organisation.

However, the key is not just for them to avoid stress and burn out - although that is obviously important - it is about creating an environment where positive wellbeing and engagement is generated throughout the workforce.

The work of positive psychologists such as Martin Seligman and Barbara Fredrickson demonstrates that people who experience positive emotions regularly at work (eg feel inspired or determined) tend to broaden their capacity to meet difficult challenges and cope with them effectively.

The creation (or not) of this kind of wellbeing climate in NHS Trusts usually starts with the chief executive.

Keeping pressure positive is one of the most important aspects of creating a well-being climate in NHS organisations. There are two types of pressure that can be applied by leaders – this means that they need to understand how to create challenge pressures and minimise hindrance pressures.

While challenge pressures drive people on towards higher performance and well-being levels, hindrance pressures create barriers and potentially develop into stress. Critically, it is the response of leaders that determines whether new pressures or requirements become challenges or hindrances.

For example, a chief executive may respond to the Quality, Innovation, Productivity and Prevention agenda by challenging senior managers and clinicians to find innovative ways of improving patient services in a climate of increasing resource constraint.

However, if this is done without clear goals or without considering the workload involved, it may be interpreted as a hindrance. If this is the case, the management team is likely to be apathetic in response, rather than motivated by the challenge.

The chief executive needs to understand how to harness work pressures positively, while minimising the likelihood burn out - both for themselves, their senior teams and the workforce in general.

Generally, chief executives are very resilient – it comes with the territory. However, there is a risk that they take this resilience for granted because different people deal with pressure in different ways at different times in their lives.

While many at this level recognise that the pressures they face require them to raise their own game in response, they may not be able to easily draw on their existing experience to meet these demands.

Until now, very little investment has been made by chief executives to look after their own health and wellbeing. However, given the acute challenges ahead, now is the time for chief executives to examine their own resilience and learn new techniques that will enable them to develop their resilience to ensure they can lead and motivate their workforce in the face of new and unique challenges.

Gordon Tinline is a director of business psychology company Robertson Cooper

How personal coaching helps keep managers focussed

Jane Dudman — Wed, 03 Mar 2010 11:28:37 GMT

The way managers deal with stress can not only affect the outcome of an organisation, but also their own wellbeing, which is why personal coaching can be an invaluable tool, writes Jane Dudman

Paul Snell, acting chief executive of the General Social Care Council (GSCC), recently pointed out in Society Guardianthat the nature of leadership development in the public sector has changed.

Alongside formal leadership development programmes, he argued, it is the process of coaching and mentoring that has become increasingly linked with organisational effectiveness, personal transformation and a return on investment.

How does this translate into real leadership experience at the frontline?

John Fraser, interim head of strategy for the GSCC, has experience of personal coaching from a previous position in another regulatory body. At a highly-pressurised time, when the organisation was going through a merger, Fraser says personal coaching was immensely useful.

"I was trying to manage the transfer of business into the new framework and there was a lot of uncertainty about people's jobs," he explains. "Personally, I had taken the decision not to join the new organisation, but my focus was on business continuity, and helping the new team establish a way of working."

Fraser was put in touch with a personal coach through a scheme run by his employer. "It forced me to find some space to think about what I was dealing with," he comments. "It helped keep me focused on the critical things that needed to be done for a smooth transition and the business benefited as a result."

Dyllis Faife agrees. Now regional programme director for personalisation and transformation of adult social care in the east of England, a job she believes she owes to personal coaching, Faife says the outcome of three personal coaching sessions were very specific for her: "I got the job I have now, which I really wanted and absolutely love doing," she comments.

"I believe the coaching sessions helped me prepare better for interview and perform better, because I was clearer in my mind about what I wanted, more comfortable about the whole process and therefore about to connect in a more relaxed, thought-through way."

Emotional intelligence

For Faife, personal coaching is about emotional intelligence: "The more one reads about what makes good leaders, emotional intelligence is so important," she comemnts. "I believed in it anyway, but may not have been practising what I preach, so it was good to thing about both personal fulfilment and ways in which to have a more positive, sustainable influence."

Both Faife and Fraser used personal coach Lynn White, of consultancy WDI, who has also worked with leaders in the private sector, including David Batchelor, chief executive of risk and insurance company Marsh.

Batchelor says that one of the benefits of using an external personal coach is that it provides a valuable method of personal brainstorming difficult work issues.
"I've always been someone who looks at my own personal development, and that can either be done through one's own organisation and through external resources, such as professional exams and so on, but as I have moved up in my career, I have found that while leadership programmes are value, personal coaching is much more intimate in dealing with things at a practical level," he says.

"Whether it is about an issue with colleagues, or a business issues, of something that's affecting your organisation, a good personal coach can help you organise the way you would tackle that issue. They won't give you immediate answers, but they develop a route map for you, and give you some objective, pragmatic views. When you move to the top of an organisation, it can be more difficult to openly discuss issues internally."

Batchelor says good coaching is applicable equally well to both the public and private sectors, and is valuable not just in outlining ways to tackle issues, but also to challenge leaders' existing ways of thinking. "Sometimes you can get a bit too narrow-minded," he says. "Coaching can open your mind to the impact of what you are proposing, in a confidental environment."

Jane Dudman

Striking out in a world of shifting labour markets

Thu, 11 Feb 2010 10:35:19 GMT

Back to work policies need more gender awareness, says a new report that claims initiatives for working age men are available - but in a sector dominated by women

The paper, Striking out: Shifting labour markets, welfare to work policy and the renegotiation of gender performances, [Critical Social Policy] details stay-at-home dads gaining skills and negotiating gender constructs to find work in the childcare sector, only to find their communities reluctant to offer childcare work to men.

Meanwhile, teenage dads are under-supported both in their new role as parents and in their position of responsibility as wage earners.

Since 1997, the government has been committed to the inter-related policy aims of reducing health inequalities and tackling social exclusion.

Initiatives have largely been focused on the supply side, aimed at potential employees, and have been 'gender blind'. The underlying assumption is that unemployed men and women can get back to work when they receive the right combination of training and support.

We used data from qualitative case studies of two interventions in the North-East of England. One study offered unemployed parents childcare training, and the other provided vocational and advisory support to young parents.

The first case study investigates a 'gender blind' intervention aiming to get the unemployed back to work, which encouraged unemployed fathers to carry out childcare training to pursuing careers in childcare.

The policy behind the intervention did not intend to challenge traditional gender roles. The participants found positive ways to deal with gender identities, so that they were able to envisage themselves gaining work in childcare.

Negative community attitudes

Unfortunately the intervention did not support the men in this, or in dealing with negative community attitudes to men working in childcare. The study highlights the oversight that in this labour market, working age men would be a target group for the intervention, yet the jobs available were in a sector dominated by women.

Teenage mothers often hit the headlines, but surprisingly little is known about their babies' fathers. Despite the common stereotype of an invisible or absent teen father, recent research suggests that large numbers of teenage fathers do play a positive role in their children's wellbeing.

The second intervention provided vocational and advisory support to young parents. Legislation's main focus has been on facilitating women's dual roles as both mothers and employees, despite recent policy moves to acknowledge the importance of fathers' involvement in re-conceptualising relations between parents and children.

The short-sightedness of 'gender blind' policies has been noted before, but a common assumption is that gender blind means 'male-centred'.

Our findings from the second case study suggest that interventions aiming to support young parents should consider the benefits of targeted support for young fathers in addition to that offered to young mothers. The first highlights the ineffectiveness of training the unemployed using a gender blind approach, such that their new skills may not be utilised.

It is important not to assume that policy biases which favour some men in some situations will necessarily favour all men in all situations.

Not only should policies take socially excluded men into greater consideration, but policymakers also need to "consciously and consistently reflect on the potential impact of all social policies on gender relations."

Although this may benefit more women than men, men cannot be ignored – not only because tackling inequality in gender needs their participation, but also because men's lives are often closely intertwined with those of their families.

The UK government is aware of the importance of gender to employment and social policy. A publication by the Social Exclusion Unit (1999) directly suggest that policy responses to some social problems need to be more sensitive to gender issues and the recent Equality Bill (2008) demonstrates a continuing awareness of the need for gender parity. This paper and other recent research suggest that this remains at best aspirational. Gender must be re-introduced and re-emphasised in social policy debate, and policies should be audited for their impact on gender.

'Striking out': Shifting labour markets, welfare to work policy and the renegotiation of gender performances by Katherine E. Smith, University of Bath; Clare Bambra and Kerry Joyce, University of Durham, is published in the February issue of Critical Social Policy, published by Sage

Healthy concerns

Mon, 08 Feb 2010 11:57:41 GMT

High levels of staff sickness within the NHS prompted a wide-ranging review into the millions of working days lost each year. A panel of roundtable experts asks if its recommendations offer the solution. David Batty reports

Reducing the amount of time its staff take off due to sickness is one of the biggest workforce challenges facing the NHS. The NHS health and wellbeing review (see below), published at the end of last year, made clear the vast scale of the problem, finding that 10.3m working days are lost through staff sickness every year.

This equates to an average of around 10.7 days a year for each employee, compared with a public sector average of 9.7 days and a private sector average of 6.4 days. The annual cost of this absence to the health service is £1.7bn.

The review, led by occupational health expert Dr Steve Boorman, surveyed 11,500 NHS staff, and was broadly welcomed in consultations with nearly 1,000 staff after the interim report was published last August. Following the publication of the review's final report, this roundtable event – held in association with Benenden Healtchare Society – gathered together occupational health experts, union representatives, senior NHS and independent healthcare managers and policymakers, to discuss the findings of the review and how its recommendations should be enacted.

The event was conducted under the Chatham House rule to encourage frank discussion, so this report highlights the issues debated without attribution.

Recommendations

The final report made 20 recommendations to improve the health and wellbeing of NHS staff. There was general backing for the first and third recommendations that make a link between NHS organisations working to improve the health and wellbeing of their staff and wider public health goals to tackle issues such as obesity, smoking and alcohol misuse. "If the NHS is to deliver a public health prevention agenda it needs to lead by example," one participant commented.

Furthermore, as the NHS is one of the largest employers in every area of Britain, it should be an exemplar in terms of encouraging and enabling staff to adopt healthier lifestyles. However, participants warned that staff should not feel stigmatised, and the message put across shouldn't be "if you are overweight, smoke or drink then don't come to work for the NHS".

It was suggested subtle changes could be made to improve levels of physical activity, such as ensuring all staff events offer the chance to participate in exercise.

The review was praised for not singling out lifestyle factors but also raising the importance of occupational health in reducing staff sickness. All participants backed the review's ninth recommendation that staff should have consistent access to early and effective interventions for musculoskeletal and mental health conditions – the main causes of ill-health in the NHS workforce.

Several panellists criticised the current state of occupational health across the NHS as highly variable. There was general agreement of the need for more access to physiotherapy and talking therapies for mental ill-health, such as cognitive behavioural therapy. Participants believed that trusts which invested in counselling or physiotherapy got a good return on the investment.

"A small amount of investment in occupational health services pays off," said one panellist. "It means many staff don't have to take time off work and those who are off come back earlier."

The question as to whether frontline NHS staff should take priority over patients on waiting lists emerged as a thorny issue. "In the outside world it's perceived as queue-jumping", said one participant. While acknowledging this was a risk, the panel agreed that it made little sense to have a lot of NHS staff on waiting lists. The participants agreed it made sense for staff to be given priority, as preventing their ill health or aiding their return to work would have the knock-on effect of reducing patient waiting times.

"It benefits the organisation, the staff and the patient," contended one panellist. Another way to reduce waiting times for unwell staff would be allowing them to self-refer for treatment, another participant pointed out.
Several panellists raised concern as to whether human resources would engage with the review's agenda.

One claimed HR had a rather narrow view of its role with regard to staff health and wellbeing. For example, not enough was being done to improve flexible working opportunities that could improve staff work-life balance and reduce the number of nurses who leave the NHS to become agency workers. Some panellists called for HR departments to become more strategic and share best practice.

The panel welcomed the review's recognition that the problem was not merely absenteeism but also with many staff coming into work when unwell. The review's finding that the highest rates of sick leave were found among those who worked the longest hours illustrated the high level of stress and pressure faced by frontline NHS workers. Several participants said the challenge of changing the strong culture of "carry on until you drop" should not be underestimated.

This made it essential to involve unions and other staff representative bodies in tackling staff concerns about workloads and fears about letting patients down if they took sick leave.

The panel concurred with the review that good management was critical to reducing sickness rates, backing recommendations six and seven that respectively call for training in health and wellbeing to be made an integral part of management training and that they have the skills and tools to support staff with mental health problems. Responsibility for the health and wellbeing agenda must "go down the line" so everyone from board level to the most junior staff is engaged.

Barts and the London NHS trust was put forward as an exemplar. Research had found that department at the trust with the least sickness and lowest turnover of staff was casualty – arguably the most stressful hospital department to work in – because it was very well managed, said one participant. Good management, including regular appraisals, did reduce absence rates, as staff felt more valued and respected, said another.

Savings mean better patient care

On the question of how to engage management with staff health and wellbeing, the Boorman review won praise from the panel for making the business case for reform, highlighting the massive savings to be made in terms of working days and money that could be channelled into improving patient care. The panel heard that the Department of Health has calculated that a £100,000 investment in occupational health by an NHS trust could lead to savings of £2m. However, another panellist questioned how robust the evidence was and called for further evaluations to build a more persuasive business case. Another suggested funding should be earmarked for such research.

The panel also agreed that commissioning must be another major driver to change, particularly given that no extra central government funding would be made available to implement the review's recommendations, something not explicitly recommended in the final report. "Commissioners should be ensuring providers have an engaged workforce that can provide quality care," said one participant. One participant suggested that a simple way to ensure NHS trusts followed the recommendations was to ask each of them what measures they were taking to achieve their share of the £555m possible saving identified by the Boorman review.

The panel heard that (in line with recommendation 16 of the review) measures to ensure NHS bodies, such as commissioning organisations and partner agencies, took on the Boorman agenda needed to be robust. This was particularly important, as the NHS was set to see a decline in the record levels of investment it has enjoyed in the past decade.

One participant summed up the consensus view: "The NHS is going to be facing significant challenges in the coming years, with financial resources dropping, so you really need an engaged workforce. If you have a well-engaged, healthy carer, the quality of care you are delivering as an organisation will be better. It is not just business as usual for the NHS. This has to become the usual business."

The Boorman review

The Guardian roundtable event followed the publication last November of the final report of the NHS health and wellbeing review. Led by occupational health expert Dr Steve Boorman, the review found that more than 45,000 NHS workers call in sick each day - one-and-a-half times the rate of absence seen in the private sector.

To reduce this figure, the final report made recommendations to improve staff health and wellbeing. It emphasised the business case for investing in occupational health services, highlighting how those NHS trusts that prioritised the health and wellbeing of their staff provided higher-quality care, had higher levels of patient satisfaction, lower staff turnover and lower rates of staff sick leave.

The report said if the best practice became standard throughout the health service, current rates of sick leave would fall by one-third, saving £555m a year.

nhshealthandwellbeing.org/index.html

This Guardian roundtable was in association with Benenden Healthcare

That loving feeling

Mon, 30 Nov 2009 09:49:00 GMT

Working in the public sector brings many benefits, but up until now it has never been known as a fertile breeding ground - but new research shows that its policy of more flexible working and less rigid career progression structure is ideal for parenthood

Working in the public sector has many advantages - but up until now it has not been widely known that it was the best place to have a baby.

New research by the Economic and Social Research Council at the University of Oxford examined patterns of employment and childbearing decisions for couples over a number of years, and found that the decision to have one or more children was intricately bound up with the working patterns of parents.

The relative security of employment in the public sector, together with a more 'family friendly' ethos in the private sector, both in the UK and Italy, is thought to foster fertility.

'The public sector tends to offer a guaranteed job to return to, a career progression more linked to seniority and more flexible hours and time off to care for sick children', Dr Tiziana Nazio, on of the report's authors explains.

'The results show that the decision to have a child is often far from straightforward, especially for women. There is a strong link between women's employment and fertility but not between men's work and fertility. 'Women's decisions about both work and having children seem to be linked to values, beliefs and other characteristics which are not measured in surveys, whereas men have children regardless of their orientation towards work,' she says.

"However, we did find a strong link between the pattern of men's careers and women's and it is also clear that children are more likely to be born in situations where it is easier for women to move in and out of the labour market, or to reduce their working hours for a period."

Contrary to expectations, the research revealed that temporary employment contracts, which are increasingly common for both men and women, do not put couples off parenthood. "Part-time employment, on the other hand, has a positive effect on childbirth, which may have been a key factor in sustaining British fertility,' says Nazio.

The study also reveals that the effect of redundancy on household working patterns is polarised. In some cases, where a man repeatedly loses his job, his wife quits hers as well. In other cases, the wife goes back to work to shield the family from falling into poverty.

"The behaviour is related to household type. Women with more qualifications may find it easier to find work, but those in low-paid jobs may be financially better off not working if their partner loses his job," says Nazio.

Sizing up the workplace

Fri, 30 Oct 2009 10:00:00 GMT

Outlawing workplace discrimination against aspects of personal appearance would mean employment tribunals
establishing the attractiveness of claimants

On 19 October 2009, the Size Acceptance Movement staged a demonstration in front of the mayor of London's office, calling for the introduction of legislation outlawing workplace discrimination against the overweight.

The mayor's office and the government are yet to comment on the demonstration but it raises some intriguing questions that are worthy of consideration.

Current legislation prohibits discrimination against employees or prospective employees on grounds of sex (including marital status, civil partnership and gender re-assignment), race (including colour, nationality and ethnic origin), disability, sexual orientation, religion or belief, and age.

However, it does not cover less favourable treatment or victimisation on grounds of weight (so-called 'size-ism') or other aspects of personal appearance (commonly known as 'look-ism').

In some circumstances, it may be possible for individuals to bring claims relating to issues of size-ism or look-ism using existing employment laws. For instance, there has recently been a well-publicised case involving a one-armed employee whose trendy retail employer took her off customer-facing duties, on the basis that her appearance might be off-putting to customers.

Equally, a female employee who considered herself to have been less favourably treated than a slimmer comparator might also be able to show that an overweight male employee would not have been treated in the same way, in which case she could bring a sex discrimination claim on this basis.

Alternatively, an employer who (consciously or subconsciously) treats a younger employee who falls short of its employee image expectations less favourably than it treats fuller-figured or aesthetically-challenged older employees could face an age discrimination claim. Nevertheless, an employer engaging in size-ist or look-ist practices is generally unlikely to be found guilty of unlawful discrimination under the current statutory regime.

Despite SAM's efforts to highlight the issue, it is probable that this will remain the case for the foreseeable future, for a number of reasons.

Firstly, the government has recently proposed major new anti-discrimination legislation in the form of the equality bill, which is likely to come into law during the course of 2010. This will replace current legislation with a single Act dealing with all types of unlawful discrimination, as well as introducing measures to address the gender pay gap.

If there had been any appetite to extend the remit of discrimination legislation to cover size-ism and look-ism, this would presumably have been done during the preparatory stages of this bill, before it was introduced to parliament.

Secondly, even if the government did have a desire to introduce legislation to prevent less favourable treatment on grounds of weight or appearance (or, perhaps more probably, was required to do so by the European Union), drafting such legislation would be problematic.

Defining the point at which an overweight person becomes entitled to employment protection would be extremely subjective and, even if an objective measure (such as Body Mass Index) was used, this could produce some fairly arbitrary results. For example, BMI does not take body type into account and the scores of short and/or muscular individuals tend to be disproportionately high.

Defining the remit of the legislation would be even more of a minefield if it was extended to cover look-ism. It is difficult to see any objective standards that might be used to assess personal appearance and, in the absence of such guidelines, employment tribunals would be required to make a finding as to whether a claimant was sufficiently unattractive to benefit from statutory protection. It is not a prospect one would expect them to relish.

Finally, public policy considerations would also neeed to be taken into account and there would clearly be some conflict between the introduction of such measures and the National Health Service's 'fight against obesity'. Current disability legislation specifically excludes alcoholism and drug addiction from the definition of a disability to ensure that those who might be seen as contributing to their condition are not provided with greater protection than others.

It is not impossible to see similar approach being taken so that the overweight are not 'rewarded' to the detriment of their thinner and (it would be argued) healthier colleagues.

Although SAM's protests are unlikely to result in any change in the law or widen the potential liabilities faced by employers, they nevertheless raise some thought-provoking issues. Unlawful or not, there is no doubt that size-ism and look-ism go on in workplaces across the country, with the result that many decisions relating to the recruitment and promotion of staff are being taken on grounds other than merit.

Although research has suggested links between employees' weight and productivity/absenteeism levels, these only become statistically significant in the case of clinical obesity. It therefore appears that many employers are losing out on talented and hard-working individuals as a result of lazy sterotyping, which, in today's competitive marketplace, seems unfortunate and surprising.

James Williams is a partner at Archon Solicitors LLP

Prevention is better than cure

Wed, 28 Oct 2009 10:41:35 GMT

Working together to prevent social harm is a good thing but it's more difficult to justify spending in areas where policy evidence is weak

An inspirational project aimed at stripping away the bureaucracy preventing collaboration between public bodies and designed to prevent social harm rather than dealing with its aftermath was outlined in a speech given by Jason Lowther, director of policy and delivery at Birmingham city council, to the Society of Information Technology Management's annual conference in Edinburgh.

Like most other areas, Birmingham has had a Local Strategic Partnership (LSP) for some time, Lowther said, but also like most areas, "it used to be talking shop, which existed because it had to, to access Neighbourhood Renewal funding."

Accordingly, the policy behind the LSP had been all but meaningless. "With our first LSP strategy, a consultant wrote it, so it was a lovely strategy, but it just sat on a shelf. The next time we thought: let's take it more seriously, draw up a local area agreement and consult people on what we are aiming for together as partners in Birmingham."

What emerged was a strong commitment to collaboration among all local partners, who finally saw the value of working together, including working towards joint commissioning of services and joint appointments, Lowther said. "We were late to it, but we are catching up."

Together the partners sketched out a series of principles "to get more for less", which included 'co-production' – helping communities to help themselves; personalisation of services, as far as possible; and prevention – "shifting the model away from where most money is spend on problems once they have happened to solving problems, thus preventing much larger expenditure in months to come."

The initiative has led to Birmingham being selected for the new 'Total Place' experiment which is piloting both a collaborative and preventative approach between public agencies in 13 locations in England.

In Birmingham, project themes include early intervention for children with behavioural difficulties; learning disabilities; mental health; reducing impact of drug and alcohol misuse; and combating gangs.

For each theme, the team will visit sites that are known to be innovating by collaborative working across agencies. They will also look at savings, since the project as a whole is "unashamedly about saving money, as well as improving services."

The key will be to put the citizen at the centre, Lowther said. "At the moment, if you are vulnerable young person, you will have masses of reviews by housing, social services, mental health etc, none of them talking to each other."

He illustrated the human failings of such a system with the poignant tale of a young man known to his family, 'Matt' (not his real name), who after a traumatic childhood had been adopted and had had behavioural problems at home and at school which had led to his exclusion; return to foster care; and drift into petty crime.

A huge amount of money had been spend by many public agencies on Matt, said Lowther, but at no time had any of them spoken to each other and worked out how to prevent further harm together, saving a fortune in the process.

"It doesn't have to be like that – we could do common reviews."

As part of Total Place, Birmingham had carried out an exercise mapping total public expenditure on the area, he said, and where it was spent, and it had come out as £7.2 billion a year, excluding pensions. "My first thought was, Gosh, that's a lot of money," Lowther said. "My second was, are we confident that this is being spent in the best possible way? I am pretty sure it is not."

Very little of that money is currently spent on prevention, for example, he said. "In the health service, less than 2% is spent on preventing ill-health. And far more is spent on employment benefits than on regeneration and job creation."

There may be some good reasons for this, Lowther admitted. Often, there was a lack of evidence as to which preventative measures actually work, for example: "policy evidence is strong in health, but weak in social care."

There are also problems with a mismatch of where savings accrue, he said. "For example, parenting classes have been shown to work, and for every £1 spent by council, £4 comes back to public sector. But only £1 of this comes back to the council itself, so we spend £1 to save £1 – that's OK, but not exciting. And the other partners get £3 back, for no action. So we are starting to have conversations about how we can get more payback."

Furthermore some major barriers to progress can only be addressed nationally, by ministers, Lowther said. One big stumbling block is the existence of short-term financial horizons, which make expenditure now impossible if savings are only accrued in several years' time. "So we need to talk to the Treasury about looking longer – can we look over a 3 or 5 year period, or 10 or 15 year periods?"

Conflicting performance management and regulatory or audit expectations on different public sector partners was another barrier at national level, he said. "Unless we have a single performance management structure for public services, it will not work: we will not be thinking about collaboration, we will be thinking about whether we will be sacked or not."

This is an edited version of a speech by Jason Lowther given at the Society of Information Technology Management's annual conference in Edinburgh. Dan Jellinek is editor of e-government bulletin

Putting its Trust in staff

Tue, 01 Sep 2009 13:53:11 GMT

Staff wellbeing and engagement underpins major change at Mersey Care NHS Trust

Mersey Care NHS Trust is currently going through a major change process. We are bidding to attain Foundation Trust Equivalent Status (FTe), a new standard of excellence for NHS organisations, particularly
trusts that provide secure mental health services.

If successful, we will receive the green light to work in a similar way to Foundation Hospital Trusts, but will remain under the control of central government. Also, we will be empowered to deliver high quality services to local people who will have greater influence over the health services we provide.

We have had to restructure the organisation; we have appointed a new chair and made significant changes to the way we operate. A tough new financial plan has been created to deliver greater efficiencies and increase productivity.

We recognise these targets will have a major impact on staff and want to ensure that their wellbeing and health are important. To achieve sustainable change, it was crucial to engage all employees so they would respond more positively to the planned changes.

The new leadership roles require people with sophisticated leadership skills

Part of the restructure was the establishment of new clinical business units which are jointly run by a new team of clinicians and managerial staff from within the trust. These units have their own financial and productivity targets and are tasked with reducing absence rates and ensuring employee engagement and well-being are high. The new leadership roles require people with sophisticated leadership skills, commercial know-how and the ability to engage their teams to deliver the new targets.

We appointed Robertson Cooper Limited, a leading business psychology company to help us implement the change process because they offered us a unique way of integrating employee engagement and wellbeing with leadership development.

The company used ASSET, its employee engagement and wellbeing survey with all our staff to assess the impact of the changes. In the past, we used an annual employee survey to assess a sample of our workforce. However, ASSET was given to all staff at every level in Mersey Care and it incorporated a focused set of questions to assess the impact of the changes on employee engagement, wellbeing, motivation and commitment. ASSET helped us get a grip on what matters to employees in terms of feeling good about coming to work.

After the ASSET results had been evaluated, Robertson Cooper devised a development centre programme based on an adapted version of the NHS Leadership Qualities Framework (LQF) that made it easier for leaders to apply to wider organisational development.

At the development centres, 51 managers and senior clinicians who were considering applying for the new leadership positions in the clinical business units were put through rigorous assessments to assess their leadership potential and skills required for the new roles.

The tests included psychometric assessments and realistic scenario-based exercises involving professional actors, where candidates role-played the challenges that would typically confront a leader of a clinical business unit. The development centres played an important role in creating the right climate in which to select the best people for the new roles, improve wellbeing and engagement and to educate new leaders on how to address staff priorities and become more effective leaders.

The board saw great value in this approach and 83% of the senior managers and clinicians who completed the evaluation agreed that the content of the development centres met their expectations. We have now appointed new leaders in all of the business units. In addition, the results from the ASSET survey are being used to build action plans with leaders as they settle into new roles over the next 12 months. We have already reduced employee absence rates across the trust and continue to develop our approach to staff wellbeing and engagement.

Our goal is to achieve sustainable change at Mersey Care. In turn, this will enable us to deliver excellent health services to patients in Merseyside – and that, ultimately, is our mission.

Kim Crowe is executive director, Mersey Care Trust

Birmingham's home comforts

Thu, 27 Aug 2009 11:28:00 GMT

A concerted effort by the city council to deliver a 'three-star improvement plan' for better housing services has won it accolades from the Audit Commission, customer satisfaction and a proud workforce

At a time when local government faces an uncertain financial future and mounting public debt, there is enormous pressure on councils to cut budgets and yet deliver improved levels of public service.

In the area of housing, Birmingham city council has had to face an enormous challenge given the huge size of our customer base and the size of the organisation - the credit crunch means we have more people needing social housing while there is a national shortage of housing stock and less available resource to deliver the services our customers desperately need.

Sales of council land are finite and yielding less revenue, so we need to be inventive to find ways to improve service delivery at the same time as cutting costs.

As part of the council's overall determination to transform our services through the business transformation programme, our aim since 2006 has been to deliver a more efficient and customer focused housing service that meets the three-star criteria set out by the Audit Commission and delivers real improvements for our customers where it really affects them – in their homes.

Whatever the size of an organisation, there is one crucial element that any change and improvement programme needs to consider – how to involve your staff and enthuse them from the very start to share the journey and have a personal investment in the success of the transformation.

Key lines of enquiry

We chose to empower every division in the housing service through our housing transformation programme to draw up and take ownership of a 'three-star improvement plan' to show what changes were needed and how they would make them, benchmarked against both the Audit Commission's key lines of enquiry document and other best practice three-star organisations.

These individual plans were then overseen by a senior management team which would both mentor and challenge, with monthly updates for each plan presented by the relevant manager.

So instead of imposing a corporate vision from above, the individual divisions, who of course had the most direct experience of their specialist areas, were encouraged to think for themselves moderated and guided by senior management.

Some of the key innovations that have come out of this work include:

• The value for money matrix tool, which that helps to calculate whether a service is providing value for money. The process involves asking customers for feedback, investigating costs and comparing them with the costs and customer satisfaction from other local authorities and housing providers. This has proved very successful and has been cited as a good example of current best practice by the Audit Commission in its strategic housing inspection in January

• The roadmap tool monitors the progress of our housing transformation projects to provide clarity across the breadth of our transformation work. We knew that having a number of projects running concurrently needed an understanding of the interdependence between them. At any one time we can see the progress that has been made and the effect each project will have on another project. We continue to monitor the cashable and non-cashable benefits through our existing performance management framework

Partnerships are another key tool. The city housing partnership, set up with housing associations, private sector and the Homes and Communities Agency, has been very valuable and a landlords' forum has been set up to work in partnership with private landlords to help them provide good quality homes and services to some of Birmingham most vulnerable residents.

By working in partnership we have been able to license many of the city's houses in multiple occupation with approved private landlords working to best practice. Our award-winning home options service, run in partnership with neighbourhood offices and specialist agencies such as St Basils, has enabled us to take a more proactive approach to tackling homelessness in the city.

'Ending Rough Sleeping Champion'

By making the best use of support that is available through other third sector agencies, this has culminated in our national recognition as an 'Ending Rough Sleeping Champion'. Since 1998 our pioneering work to tackle rough sleeping has reduced rough sleepers from 56 to four. Our success has been the result of strong partnerships with a range of statutory and voluntary organisations.

Customer interaction is also important. The tenants' performance monitoring group is a group of tenants who review our performance each month against our key performance indicators. They have the ability to issue 'improvement notices' if they are not satisfied with our performance.

There is also a task and finish group that monitors our progress against our action plan to deliver the promise in our housing agenda of better housing services for residents and tenants. This group is informed by an advisory panel of residents and tenants.

We promised our customers back in 2006 that we would work to deliver them a three-star service. By 2010 our decent homes programme to bring all council homes up to the decent homes standard will be complete; we have already reached over 90 per cent in 2009. And it's not just our customers who are happy: the Audit Commission inspectors commented on how proud the staff are of the service they provide and the organisation for which they work.

There has been a real culture change in the directorate. The business transformation programme has reinforced our feeling of self-belief. It's a complete change to how staff felt five years ago when we were a 'no star' directorate. There's a definite can-do attitude and the achievements staff have made over the last four years has given them a thirst for improvements that deliver better services for our customers.

Councillor John Lines is cabinet member for housing and Elaine Elkington, is acting strategic director for housing and constituencies at Birmingham city council

Could have been a contender

Thu, 13 Aug 2009 10:17:51 GMT

With the Olympics coming to London in 2012, the government hoped it would inspire citizens to take up more sport and a healthier lifestyle. New sports facilities were planned, particularly in London, but the recession seems to have knocked the wind out of its plans

Government ambitions to get two million more adults to take regular exercise could be thwarted as the recession undermines plans to build new facilities according to new research from a leading London-based property consultant.

The government had high hopes that we Britons would be swept to new levels of physical fitness, either shamed into action or sucked along in the slipstream as the UK's Olympic contenders prepared for 2012.

It was to be rather like the Wimbledon-effect, only better: everybody and their aunt dusts off a tennis racket for two weeks every summer, but this was supposed to last for years.

A host of new sports facilities were to provide the cornerstone of the fitness regime for the new cohort of healthy sub-Olympians. And with London as host city that was where, quite apart from the official Olympic facilities, the densest rash of new sports halls and swimming pools was expected to materialise.

The great national fitness plan may be going awry however. After an initial enthusiastic flurry there has been a rather "disappointing absence" of an Olympic effect in the provision of new sports facilities in London according to new research from property consultant Drivers Jonas.

The firm says the number of new and refurbished sports centres completed in the capital has slowed over the last two years.

The survey of all 33 London boroughs revealed that 61 new or refurbished facilities were completed in the two years to the end of 2008. It took only 18 months to achieve that total in the period covered by the previous Drivers Jonas survey.

The number of projects in the pipeline has also shrunk from 36 to 21. New schemes coming through hit a low around the end of 2008 and it is hard to see a reversal of the trend in the lead up to 2012 according the report states.

The recession has taken its toll, according to the firm. Some projects are funded through "planning gain" whereby, under the so-called Section 106 agreement, in order to get planning consent a developer promises to provide public facilities as part of a bigger scheme. As it is a by-product, a sports facility can become a casualty if the commercial element of the project is shelved.

However, 43 per cent of the total completed were publicly funded. Of these facilities, 30 per cent are gyms, 16 per cent are sports halls, 14 per cent are swimming pools and 4 per cent are synthetic pitches while running tracks and squash courts each represent 2 per cent. The largest proportion of the facilities is dance halls – 32 per cent – so perhaps a Celebrity-Come-Dancing-effect is in play too?

The new facilities are not evenly spread, nor are they all on the eastern side of the capital where the Olympics will have their centre of gravity. Hounslow, Lewisham and Ealing have provided the most new facilities although Hackney, in the east, has seen the biggest public sector provision.

Boroughs in which no new facilities have opened in the last two years include Brent, Kensington & Chelsea, Merton, Newham and Redbridge. However, Drivers Jonas points out that raising the level of participation in sport is more than a matter of building new facilities.

The firm's survey points out that Sutton, Kingston and Enfield are ranked highly in terms of residents' satisfaction with their facilities but these boroughs rank rather less well in terms of actual participation.

"Build it and they will come"? Well maybe.