Health impact of shift working

The health impact of shift working is not well understood. We need more research and better risk assessment to protect workers.


The numbers of staff working shifts is increasing and there has been a marked increase in those working night shifts. While traditionally more men than women have worked shifts, that is changing with most of the new shift workers being women. Scotland has always had a higher proportion of shift workers than the rest of the UK and a range of UNISON’s public service workers are involved including the emergency services, hospitals, social care and in the energy sector.


I was in Stirling today, outlining the health implications to our police branch stewards and discussing how we can help members by designing work better to address these issues.


The research on this issue has identified a number of risk factors associated with shift workers. They are more likely to be obese, suffer from diabetes, smoke (particularly women) and eat less healthily. Interestingly, they are also more likely not to drink alcohol. While there is a statistical correlation between shift workers and these conditions, it is less clear what the causal link is. Shift workers are also more likely to be in lower income groups, who generally have poorer health.


Likely explanations focus on the disruption to circadian rhythms, the body’s internal clock. This can disrupt the workings of the hormone Melatonin, which can lead to poor sleep. We know that the lack of good quality sleep has been linked to obesity, depression, diabetes and heart disease.


A particularly worrying study showed that women working on night shifts for more than 30 years are twice at risk of breast cancer. This is thought to be linked to less Melatonin, which has cancer protective qualities and increased Oestrogen that has the opposite effect.


Another issue is a 40% increase in the risk of cardiovascular disorders. The causal reasons are unclear, but again the disruption to the circadian rhythm, damage to family and social life, stress and poor diet are obvious contributing factors.

So what can be done to limit the risks?


One health site gives the unhelpful advice of ‘get another job’! Although impractical and drastic, it may well be good advice for the over 40’s and those who have worked on shifts for many years. Some behavioural solutions help, such as establishing a stable sleep environment and schedule. Eating small health snacks on shift rather than a large meal, together with exercise and limiting stimulants like caffeine and energy drinks.


We should also be revisiting risk assessments with employers. This involves evaluating shift schedule design - avoiding split shifts, excessive 12 hour shifts and rotating shifts forward. There should be at least 48 hours between shift changes to allow the body to adjust. Occupational health should identify and treat workers who have sleep disorders and ensure more regular health checks from age 40 and those who have worked shifts for more than ten years.


Finally, we need more research to understand the causal links between shift work and ill health. In the meantime there needs to be better awareness of the risks and the actions workers and employers can take to minimise the risks.

Raising the standard of residential care

We need to put dignity and respect at the heart of the residential care system. That means better care for residents and supporting the workers who care for them.

I was in the Scottish Parliament today promoting UNISON's new Residential Care Charter. It follows on from our Ethical Care Charter, which has raised standards of care for people living in their own homes. UNISON’s residential care charter calls for:

• Time to care – to allow staff to properly care for the vulnerable people they look after
• Proper training and support for staff
• Decent pay for quality work
• Adopt measures to protect and support residents, including adequate staff ratios and thorough risk assessments

This summer the Scottish Government published new Health and Social Care Standards, which will be implemented April 2018. They set out what we should expect when using health, social care or social work services in Scotland. The Standards are underpinned by five principles: dignity and respect, compassion, be included, responsive care, and support and wellbeing. The principles themselves are not standards or outcomes but rather reflect the way that everyone should expect to be treated.

Now standards in glossy documents are fine, but what matters is how they are implemented. One of the standards states; "I experience consistency in who provides my care and support and in how it is provided"

According to the Care Inspectorate, almost half of care settings in Scotland are facing difficulty in recruiting the right staff. 59% of care homes for older people reported having one or more staff vacancies. Many more are suffering from high staff turnover. Inspectors regularly identify that stable and consistent staff teams are an important component of high quality social care which supports people well.

Even the private sector employers organisation, Scottish Care, has recognised the need to address workforce issues, they said:

“Social care in Scotland faces a fundamental crisis. The Care Inspectorate report together with our own work at Scottish Care states quite clearly that we are at the point of services becoming unsustainable and unable to deliver given the current recruitment and workforce crisis. The entire fabric of social care will begin to disintegrate without serious intervention and this will have a profound effect on the sustainability of wider health and social care supports."

In Scotland, a residential care worker earns at least the Scottish Living wage of £8.45 an hour. This is significant progress, but workers can earn more stacking shelves in a supermarket. Our own surveys show that younger workers in particular are choosing less demanding jobs than care, which offer more money.

We are only going to change this dynamic if we value those who work in the sector. Yes, care jobs can be satisfying and worthwhile, but that doesn't pay the bills. Care with dignity should not be at the cost of a stretched and dedicated workforce.

Scottish Care has also highlighted a nursing shortage of 28% average vacancies in nursing homes, forcing providers to pay as much as £1000 for one agency nurse to do a night-shift.

Some providers are exiting the sector. Bield Housing and Care are closing 12 care homes in Edinburgh, Falkirk, Glasgow, Borders, South Lanarkshire and West Lothian by summer 2018. Some 160 elderly people, with dependent needs  including 24 hour personal care and feeding assistance, will be evicted from the place they have called home for decades. Many are over 90 years old.

While the Care Inspectorate does some monitoring of residential care homes, their resources are limited. Councils who contract the services do very little monitoring. Earlier this year UNISON asked councils, under freedom of information, for their monitoring policies. Overall, the responses indicate that contract monitoring is limited to returns from the contractor and review meetings with them. There is very little monitoring of the actual service delivery.

Anyone who listened to the voices of care workers in parliament today will understand that the standard of care needs to improve. 

Better care comes at a price, and so we need to have a debate in Scotland about how care should be funded. That includes difficult discussions about inheritance and contribution, directly or through taxation. It is crystal clear that we cannot go on in the same old way. UNISON's Residential Care Charter can raise standards, and help recruit and retain care workers. Older people in Scotland  deserve better.

Welcome energy decisions, but we must be bolder

There is no shortage of activity on energy policy and we haven’t even heard the outcome of the Scottish Government’s energy strategy consultation.

Let’s start with fracking. The Scottish Government has announced that the existing moratorium would continue ‘indefinitely’, which is an effective ban given their planning powers. This follows a similar ban on underground coal gasification. It will be the subject of a vote in the Scottish Parliament, but that should be a formality, as only the Tories support fracking. 

Claudia Beamish MSP still has her members bill which would put in place a stronger legislative ban. The problem with using planning powers is that the moratorium could be overturned very easily, unlike legislation. I suspect the government has decided to go down the moratorium route to avoid compensation claims from INEOS, who now have drilling licences that they can’t use. However, as the minister said, fracking, “cannot and will not take place in Scotland” - and that is the practical effect.

The overwhelming majority of people in Scotland will welcome this decision. A staggering 99% of the 60,000 respondents to the consultation supported a ban. Apart from INEOS, we had a grand rant from Jim Sillars, who claimed that people didn’t know about the consultation. Well, 60,000 respondents would indicate that claim is mince, not to mention the noise campaign groups having been making on the issue. Jim also expects trade unions to put pressure on the government to rethink the ban at the STUC. I wouldn’t hold your breath on that Jim, most unions are opposed to fracking. 

And you won’t win us over with nonsense claims about how fracking will end fuel poverty. Scotland’s geology means so little fracked gas could be extracted that its use would be for industrial, not domestic heating. Even if it could be extracted in any quantity, the cost would be prohibitive. That is why the investment is drying up for drilling in England and the companies are going to the UK Government with their begging bowl.

The next big announcement by the FM was the establishment of a state owned national energy company. Details on this are a bit scarce, but the announcement points, at least initially, to a retail operation. This is not exactly an original idea, with operations like Robin Hood Energy in Nottingham, Our Power Energy run by housing associations and the People’s Energy Company based in Musselburgh. 

A national energy company is something UNISON supported in its response to the energy strategy consultation. However, we envisaged a more radical option that involves generation and transmission as well as retail. We also support a big role for municipal energy - generating electricity, managing distribution grids, running energy efficiency schemes as well as retail sales. This is very common across Europe and seriously challenges the ownership model in Scotland, something the Scottish Government has been unwilling to do. The big energy companies’ reaction to the announcement last week, indicates that some modest retail competition doesn’t worry them very much. 

The UK Government’s stop-start efforts to introduce a price cap on energy bills, has once more run into trouble. The minister claimed the cap would be in place this winter, a suggestion that was promptly contradicted by Ofgem. The legislation could take a year and then many months more for Ofgem to implement it. Shambles doesn’t even begin to describe this. 

All the usual suspects have been dragged out to tell us how wonderful the market is - all we need to do is get into switching supplier. Meanwhile, in the real-world consumers are increasingly supporting real public ownership options as set out the Labour manifesto. The TUC joined that call at its recent Congress, unanimously backing a motion that supports returning the energy sector to public ownership and democratic control. The motion also called for a mass programme of energy conservation and efficiency, a just transition strategy and investigating the long-term risks to pension funds from investment in fossil fuels.

The last few weeks have seen some important energy policy decisions that could help reshape our energy strategy. However, that will only happen if we are bolder and resist tinkering around the edges.

Improving the governance of public bodies

Scotland's public services are administered by some 200 public bodies. Most of these are run by boards that make the key decisions on the majority of public spending in our country. This means we should pay close attention to the governance of public boards.

In 2010 Audit Scotland published a report on the role of boards that made a number of recommendations. Holyrood's Public Audit Committee has recently conducted an inquiry into the same issue and have published their findings in a letter to the Cabinet Secretary.

Some of the key points they make include:

• Encouraging board members to provide an effective challenge to board chairs and chief executives, preventing ‘group think’ on our boards. As the recent SPA issue has highlighted, corporate responsibility should not be a means of silencing ‘difficult’ voices;
• The committee questions whether the involvement of a senior independent director on a board, as is the case in some parts of the private sector, could be a useful, additional check and balance on the performance of the board chair/ chief executive. Board's also need to establish a fully effective and transparent means of assessing the performance of all board members;
• It is essential that the public appointments process attracts the best possible candidates, who should not be discouraged by the complex process. The current system may reward those who are most adept at repeating public sector jargon;
• New legislation should give greater consideration to governance arrangements. Some of the problems have stemmed from poor initial decisions on governance arrangements;
• There is considerable variance in the governance arrangements across boards and not always a clear rationale for such differences; 
• Boards also take differing approaches to transparency such as holding meetings in public or private. The committee's view is that boards should be as transparent as possible and should meet in public unless there are justifiable reasons for meeting in private.

I contributed to an informal evidence session during the inquiry and the recommendations are very welcome. The membership of boards has become very 'samey', with the usual suspects dominating appointments. I have heard more than one board Chair use the phrase 'a safe pair of hands'. This isn't likely to to provide the sort of challenge the Committee is referring to. 

Workforce representation can provide a real challenge. The Fair Work Convention report recommended there should be a worker representative on every Scottish public body. Some have non-executive directors with a workforce interest. While these appointments offer an expertise that might otherwise be ignored, they are not a substitute for an employee director. However, such directors need to be supported and accountable, otherwise they can become isolated and less effective.

There is a tendency to use the shambles that is the SPA to highlight all that is wrong with public boards. The treatment of Moi Ali was both shocking and a 'good' example of the issues highlighted by the committee. However, we should remember that the structure of governance between Police Scotland and the SPA underpins many of the problems. There was a clear failure to recognise the governance problems this would cause when the legislation was going through parliament.

While the SPA is the most well known example, it isn't the only one. I can think of a number of NDPB boards that provide very weak governance. FE colleges are one as the severance packages row has illustrated. Food Standards Scotland is another, with the food industry having too great an influence. Most boards could do better on transparency.

In fairness it has to be said many of these governance failures are not unique to public boards. There has been a failure of governance in private and voluntary sector boards on pay and workforce issues. In addition, you can only appoint from applicants and many people of working age simply do not have the time to participate. On my way to giving evidence to the committee I bumped into an ex-steward who is now a senior manager in a private company that makes a big play of corporate governance. He told me that serving on public and voluntary sector boards used to be encouraged - now it is barely tolerated.

The Audit Committee recognises that some progress has been made in recent years, particularly over gender balance. Government now needs to focus on strengthening other aspects of governance. This report is a good starting point.

Funding, not more quangos will improve care integration

The implementation of health and care integration won’t be achieved on the cheap. While there should be long-term savings and better care from a shift to community services, it will take time to realise that ambition.

The Scottish Parliament’s Health and Sport Committee has been holding an inquiry into the budget for next year. We don’t have much idea how big the pot will be until the UK Autumn Budget and the Scottish Government decides on its own tax policies. However, that still allows some scope for an examination of the principles that underpin the budget.

The Integrated Joint Boards (IJB) are now responsible for some £8.3bn of expenditure – a substantial part of the Scottish budget and supplemented by local taxation. In evidence to the committee the IJB finance officers highlighted that resources are not keeping up with demands. They said:

“There is emerging evidence which indicates that the current level of resources is less than that required to meet current cost and demand pressures. In practical terms this means that the required shift in the balance of care will take longer to achieve. A number of Integration Authorities have modelled the level of additional resources required to meet cost and demand pressures, with estimates between 3% (for 2018/19) and 14% (over two years) of existing budget.”

The clear message to the committee was that increased demand, largely due to demographic change, means that they don’t even receive a standstill budget. Transformational change comes with a much bigger price tag.

Measures to reduce unplanned admissions to hospitals and cut delayed discharges can be successful. A number of IJB performance reports demonstrate progress. Not least in Glasgow, which claims continuing decreases in delayed discharges with acute bed days lost falling from 38,152 (13/14) to 15,557 (16/17). However, the picture continues to vary across the country. As I said while giving oral evidence to the committee; unplanned admissions will continue until a full social care service is in place – hospitals don’t turn patients away.

I did notice a definite pitch from IJB directors and finance leads for direct funding and greater control. We should remember that IJBs don’t employ staff and get their budgets from health boards and councils. Their complaint is that funding ‘doesn’t lose its identity’ in this system and they have matrix performance monitoring. Concerns over double counting of health and care funding are valid, as are the constraints of ring-fencing.

It was entirely predictable when you create a system that co-ordinates services that sooner or later the leaders want to create an empire that they have more control over. This leads to a demand for stand-alone bodies – in effect a whole new set of local quangos. 

This demand should be resisted. The change that is required in care cannot be achieved by IJBs in isolation. One of the points I picked up from trade union colleagues in Norway was that separating the management of acute and community services made it that much more difficult to achieve resource transfers. The same applies to councils, who run range of other services that impact on health; like housing, planning, libraries and leisure services. You don’t join up services by fragmenting them even more.

From a staff perspective, such direct control would involve a massive transfer of health and care workers to new organisations. A move that will be resisted by all the trade unions for good reason. Such a transfer would take many years and the harmonisation negotiations would be a complete nightmare. It would require a massive funding pot and divert staff and management effort for years.

It is clear that transformational change in the health and care system requires a significant increase in funding. While there are still some organisational and cultural barriers to integration, more local quangos are not the solution.

Why John McDonnell's PFI pledge is welcome and affordable

John McDonnell caused a stir yesterday with his pledge to bring Private Finance Initiative (PFI) contracts back in house. Commentators who bandy about huge sums of money to pay for this commitment are missing the point.

The shadow chancellor said in his conference speech that Labour had already pledged not to sign any new PFI deals. He then added: “We will go further. I can tell you today, it’s what you’ve been calling for. We’ll bring existing PFI contracts back in-house.”

Unsurprisingly, this was immediately welcomed by UNISON, who campaigned against PFI from the outset, whichever government (Tory, Labour and SNP) used the scheme. Dave Prentis tweeted, “At long last! Our party sees sense on PFI”.

Let’s start by understanding what a PFI scheme is. Instead of borrowing in the normal way, public bodies contract with a consortium of private companies known as a Special Purpose Vehicle, to design, build and operate a public asset - typically schools, hospitals, roads and waste treatment works. The Tories invented the idea, Labour developed it and the SNP use it in Scotland to this day – albeit renamed as NPD or Hubcos. Instead of meeting the borrowing and running costs directly, public bodies pay an annual fee to the contractors.

The scheme has been criticised on many grounds and in the early years the main driver was keeping capital projects off the public sector off the balance sheet. Particularly important in Scotland because of the block grant and led to the saying ‘it’s the only game in town’. 

The main problem with PFI is that the private sector can’t borrow as cheaply as the public sector, and of course take a profit. Government can now borrow very cheaply indeed and this had led to calls to refinance such projects. PFI schemes are notoriously secretive, but we know that they are paying interest rates of 7%+, at a time when public bodies could issue bonds at a little over 1%.

UNISON Scotland set out in our ‘Combating Austerity’ plan how this can be done and save millions of pounds of austerity cuts in the process. The Public Accounts Committee at Westminster, hardly a bastion of socialist economics, also highlighted how such refinancing had been achieved in England. Sadly, while some projects have been brought back in-house in Scotland, progress has been glacial, as our progress report this summer shows.

An important forerunner to any contract renegotiations should be stricter monitoring of contracts and restructuring the existing provisions. A number of public bodies in Scotland are beginning to take this seriously, but again more could be done. At UK level John McDonnell could help by committing to changing some of the Treasury rules that make refinancing more difficult than it might be.

That’s why the commitment from Scottish Labour leadership candidate Richard Leonard is so welcome. He said: “Scotland has a huge liability to PFI and the Scottish Government’s Non-Profit Distributing scheme. The Scottish Government could and should set up a debt disposal department dedicated to raising funds to buy out the total outstanding £28.8bn PFI and NPD debt on operational contracts. Doing this could save the public purse hundreds of millions of pounds. If I’m Labour leader I’ll be pressing them on this issue and as a Labour First Minister it will be a priority.”

McDonnell’s actual commitment is fairly modest and doesn’t commit Labour to a massive increase in public spending. That’s because the public sector is already paying over the top for these schemes, so bringing them in-house would actually be a saving to the public purse. As well as giving public bodies control over vital public assets.

Health & safety and the ageing workforce

With twice as many people working past the State Pension Age, we need to give proper attention to the health and safety implications of the changing workforce.

I have highlighted before our research into the ageing public sector workforce in Scotland. With the 50-60 age group expanding the fastest, around 40% of the workforce is likely to retire within ten years. This is reflected in the wider workforce, with one in three workers over the age of 50 by 2020.

Yesterday, I was speaking at the RoSPA conference in Glasgow on this issue.

I argued that we need to recognise that despite equality legislation, older workers face at best unconscious bias in the workplace, and at worst overt discrimination. This shows itself in attitudes towards training, development and promotion opportunities. The UK will have 7.5m job vacancies to be filled by 2022, and that's before the impact of Brexit. With one million 50-64 year olds unemployed, but wanting to work, we simply cannot allow their skills to be wasted.

As I said in a recent column in The Scotsman, we need to talk less about the demographic time bomb and more about the demographic dividend. We need to find ways of keeping older experienced staff and helping them to pass on their knowledge and skills.

That's not to say that we should ignore the health implications. Older workers are at risk of burnout, due to the physical and emotional demands of their jobs over a long period. We need to look at later life career changes, flexible working and develop a funded sabbatical policy.

Older workers have a lower incidence of short-term absence, but a higher risk of long-term illness. This needs to be reflected in sickness absence policies that have become increasing rigid in recent years. For example, workplace dementia will be a new condition for many employers to address. Some 3,200 workers under 65 have been diagnosed and this means that employers need a strategy that includes diagnosis, support and adaption. The Alzheimer's Society has a useful guide on this issue.

While there is no evidence that older workers are at greater risk in the workplace, there are some age related factors. Older workers are at marginally higher risk from slips and falls; physical strength and stamina declines with age; as does sight and hearing. However, I could produce a different list of risks with younger workers.

We therefore need to respond to the challenges and opportunities of an ageing workforce as we would for any other safety risk. By risk assessment and if necessary by redesigning jobs to reflect age factors. All the time remembering that older people are not a homogenous group, to be lumped together in a one size fits all response.

Overall, we need to change workplace culture to regard older workers as a positive gain to the workforce. This starts by raising awareness and developing a strategy. Such strategies need to recognise the health and safety implications - always remembering that work needs treatment too, not just the worker.