The healthmatters blog; commentary, observation and review
Positive results for personalised care from Maternity Survey 2017, but further improvements needed to continuity of care
More than 18,000 women have responded to the Maternity Survey 2017, which is the biggest source of data on people’s experiences of maternity care in England. The results come at an interesting time; in 2015 NHS England announced a major review of national maternity services. As part of this review, the Better Births report (2016) outlined seven priority areas where improvements are needed.
Personalised care was one of these priority areas – and the survey shows mixed experiences of this at different stages of pregnancy. There was room for improvement in the information given to help mothers decide where to have their babies: although 59% said they “definitely” received enough information, this leaves two in five who would have liked more. Almost one in six (15%) said they were not offered any choices about where to have their baby – and whilst this is an improvement from a figure of 18% in 2013, it still leaves too many women without a say in a life changing decision.
Care during the labour and the birth, however, generally included good communication. Nearly nine in ten (89%) said that they were “always” spoken to in a way they could understand, and three-quarters (77%) said they were ‘always’ given enough time to ask questions or discuss their pregnancy. This has increased since 2013 (74%) and 2015 (75%).
Overall, most respondents felt involved in decisions throughout their pregnancy. Most women (77%) were ‘always’ involved in decisions about their antenatal care and 80% were ‘always’ involved in decisions about their care during labour and birth.
Continuity of care is another priority area identified in Better Births. The survey asked women whether they saw the same midwife throughout their pregnancy as one means of measuring continuity of care.
Most people did not see the same midwife at each appointment – but many said that they did not mind this. While over 60% of respondents (61%) did not see the same midwife for all of their antenatal check-ups, half (56%) of these women didn’t mind this. Also, 72% did not see the same midwife for all of their postnatal appointments but 65% of these women didn’t mind this. That many respondents did not mind seeing different midwives suggests that having appointments with different professionals still resulted in generally good experiences. However, it was striking that women who saw the same midwife for all of their antenatal care and the same midwife for all of their postnatal care reported receiving more compassionate care than average.
Chris Graham, CEO of Picker, concluded: “Better Births (2016) has a welcome focus on personalisation and continuity of care. These are two elements that are really important to people who use health services. The Maternity Survey 2017 shows some strong progress against both of these areas, alongside encouraging results on other subjects that are a high priorities for families such as clear communications (particularly in relation to during labour and birth) and involvement in decision making.
The results highlight that people who are able to see the same midwife across their care are likely to have better experiences of compassionate care – which emphasises the value of good relationships with trusted professionals. However, reported shortfalls in the number of midwives nationally mean that it is challenging to provide this level of personal continuity in all cases. The challenge for providers is to ensure that the same standard of personalised support can be provided by well coordinated teams who are able to collectively deliver continuity of care. The detailed survey results provide valuable local information about where this is going well, and we encourage all trusts to review their own findings and work with patients and families to deliver the best possible services.”
Markus Jakobsson, Chief Scientist at Agari, comments: “The theft of 30,000 medical records from a database in Florida is only the latest in a long line of incidents showing how vulnerable the healthcare sector is to deceptive emails.
Our research has found that the healthcare sector is targeted by more deceptive email than any other, with 92 per cent of all email domains carrying fraudulent emails. While email security training should be encouraged, with so many malicious emails using deceptive identities, organisations should not be relying on their staff to successfully sort the fakes from legitimate messages.
Instead, healthcare organisations need to work to prevent malicious emails from reaching their employees’ inboxes in the first place. One of the most effective ways of preventing email spoofing is the free-to-use Domain-based Message Authentication, Report & Conformance (DMARC) email authentication standard.
However, after examining 5,000 NHS email domains, we found just 1 per cent were currently using DMARC, and only five per cent of UK healthcare organisations had any DMARC policy in place.
Until DMARC is adopted as standard, cyber criminals will have free reign to impersonate domains and use trusted identities to target both employees and patients themselves. I implore all organisations to take this first step in protecting their private medical data from falling into criminal hands.”
New research shows just 5% of adults have the skills and confidence to provide first aid in emergency situations
Three UK charities call on the government to make first aid a compulsory part of the school curriculum
Three of the UK’s largest charities are seeking public support for first aid to become a compulsory part of the school curriculum, following new research which shows more than nine in ten adults (95%) would not be able to save lives in first aid emergencies. (1)
The British Red Cross, St John Ambulance and the British Heart Foundation – who together form the Every Child A Lifesaver Coalition – are calling on people throughout England to take part in the Government’s call for evidence on Personal, Social, Health and Economic (PSHE) education , and join their push for first aid skills to be taught in all schools.
Research, commissioned by the British Red Cross, asked more than 2,000 UK adults about their knowledge, confidence and willingness to intervene in three potentially life-threatening first aid emergencies – helping someone who is bleeding heavily, is unresponsive and breathing, or is unresponsive and not breathing.
The findings show the vital need to provide first aid lessons in schools to address the public’s lack of knowledge and confidence to step in during a first aid emergency. The research shows:
- Only 1 in 20 (5%) people would feel knowledgeable, confident and willing to act in those three scenarios – 95% of people would not.
- Seven in ten adults (71%) lack the knowledge and confidence to act if someone collapsed and was unresponsive and breathing.
- Nearly seven in ten (69%) people polled lack the knowledge and confidence to act if someone was bleeding heavily.
- In addition to these scenarios, eight in ten adults (81%) also said they lack the knowledge and confidence to act if a baby was choking. (1)
Further research by the British Heart Foundation showed that 60% of adults would be worried about knowing what to do if they witnessed someone having a cardiac arrest and only 20% of respondents were able to correctly identify the signs of a cardiac arrest (2).
Meanwhile, a survey by St John Ambulance shows that 80% of people feel that first aid lessons should be compulsory in all schools. (3)
But by making it compulsory for every child to receive just one hour of first aid education a year as part of PSHE, hundreds of thousands of young people could be empowered with the skills to save a life. Take part in the call for evidence by visiting www.redcross.org.uk/
Joe Mulligan, Head of First Aid Education at the British Red Cross, said: “When an emergency strikes, giving first aid could save someone’s life. We all hope that someone would be able to help us in an emergency, but our research shows that few people feel they have the skills and confidence to act in some serious situations.
“By taking part in the government’s call for evidence and making first aid a mandatory part of PSHE on the national curriculum, you could help us empower future generations with the simple but vital skills to save someone’s life in an emergency.”
The Every Child a Lifesaver Coalition is asking teachers, parents, young people, and anyone who feels passionately about getting first aid taught in schools, to take part in the call for evidence.
Carl Makins, Head of Training at St John Ambulance, said: “Children attend school for more than 1,000 hours a year; we’re asking for just one hour of that curriculum for them to learn first aid skills that will last a lifetime and might one day enable them to be the difference between a life lost and a life saved.’
Simon Gillespie, Chief Executive at the British Heart Foundation, said: “CPR really is the difference between life and death for thousands of people every year in the UK who suffer a cardiac arrest. Every second counts, so it is vital that school children across the UK are equipped with this simple, life-saving skill. It takes less than an hour to learn CPR, so dedicating just one PSHE lesson per year could create a generation of lifesavers.”
The government’s call for evidence Changes to the teaching of Sex and Relationship Education and PSHE closes on Monday 12th February 2018.
Take part in the call for evidence by visiting www.redcross.org.uk/
In recent years, there has been an increasing use of the ‘tech’ suffix in all manner of industries. Even the passing observer will probably have noted that in the worlds of finance, marketing, property and health, tech start-ups are launching in their droves to help remould the way each sector operates.
Financial technology – FinTech – undoubtedly paved the way; in the aftermath of the 2008 global economic crisis, new online platforms and apps emerged at pace to challenge traditional practices, not to mention the incumbent banks that held a monopoly over the sector. Today, ten years on, consumers and businesses alike use all manner of new digital solutions to complete important transactions and manage their finances.
The same trend has since spread across many other industries. And promisingly, the healthcare sector has started to follow suit. In fact, as we enter 2018 it appears that HealthTech is finally in a position where it can begin having a significant, meaningful impact on people’s day-to-day lives.
On the one hand, new tools are empowering the individual to take better care of their own health. On the other, technological innovations are also enabling healthcare providers – both in the public and private sectors – to offer better, cheaper, efficient and personalised services.
From fitness apps and wearable devices through to online marketplaces and medical diagnosis tools, HealthTech covers a broad range of digital solutions and there are too many examples of brilliant new pieces of technology to name. But importantly, these solutions are not just ways of ridding us of cumbersome, out-dated processes and lengthy paper trails; they also deliver products and services that hitherto have simply not been possible or financially viable. The result is that in the home, on the go or in a hospital, we now have access to superior tools for improving our mental and physical health.
Separating new tech from hot air
However, as with any new technological trend, there are bumps in the road that must be navigated. One such issue is the habit of businesses jumping on the tech bandwagon; out of their desire to be seen as cutting edge and ‘on trend’, some companies will adopt the tech suffix even though, when you review the way they actually manage and deliver their services or products, there is little evidence of any proprietary technology involved.
While not a fatal concern, falsely labelling businesses as being a FinTech, PropTech or HealthTech firm threatens to undermine the truly innovative start-ups operating in these respective industries. It also has the potential to confuse consumers and deter investors, who may develop an erroneous impression of what these terms really mean, in turn prohibiting mass uptake on the new solutions.
As the HealthTech market matures, people will naturally cultivate a greater understanding of the term and what it encompasses. What’s more, over time the companies not offering a unique or well-built tech proposition will likely fade away, leaving a more concentrated collection of talented businesses that will be charged with driving the industry forward.
Start-ups seeking support
Another obstacle standing before the UK’s HealthTech sector is its need for support from multiple external bodies. In order for the current crop of HealthTech start-ups to transition into high-growth SMEs and potentially become multi-national enterprises in the years ahead, they will require help – help from the Government and help from investors.
Positively, amidst tightening budgets for the UK’s public healthcare services, the Government has placed an increasing emphasis on the adoption of new digital solutions. For one, it has already implemented its Five Year Forward View, which makes an explicit commitment to creating the conditions necessary for proven innovations to be adopted faster and more systematically through the NHS.
This intent is already having an impact; the Clinical Entrepreneurs Programme run by NHS England recently selected 138 entrepreneurs to design and deliver new technological solutions and innovations. Furthermore, with the Conservative Party looking for ways to lessen the burden on the NHS by providing better preventative and out-of-hospital care, this same willingness to embrace new tech could extend beyond hospitals’ walls and into the broader healthcare and wellbeing space.
The Government does not have to look far. High-growth start-ups are driving innovation across the industry. For example, to improve the accessibility and management of healthcare services, new platforms in the HealthTech space are now offering an online marketplace for people to source healthcare solutions, supported by integrated payment systems to take the pain out of previously disjointed processes. It’s simple and cost-efficient solutions such as these that will drastically improve the UK’s existing healthcare services.
Indeed, alongside the support from Westminster, the HealthTech industry also has reason for optimism as a result of the backing it has, and continues to receive, from investors. As seen with FinTech and, more recently, PropTech, investors are hungry to identify and put money behind promising, innovative new start-ups. Consequently, the UK’s digital health market is expected to grow by nearly £1 billion in 2018 to reach a total of £2.9 billion.
Healthcare prepares to jump into the digital age
There are evidently many reasons for optimism in the HealthTech space. With public and private sector support and a plethora of stimulating talent emerging all the time, 2018 stands to be a breakthrough year as businesses and the wider public begin to embrace new technologies that will make their lives easier and, of course, healthier.
The market still has some distance to travel until it reaches maturity, but the trail blazed by FinTech pioneers over the last decade has already helped to alter people’s mind-sets by opening them up to using tech-based platforms for vital tasks. In the next 12 months and beyond, it will be exciting to see how readily people shift from traditional practices to instead using newer methods for bettering their health or those of others. Yet even if the process takes time, there is no longer any question that the healthcare sector is on the cusp of an irreversible move into the digital age.
Rohit Patni, CEO and co-founder, WeMa
Manufacturing in the medical devices sector is attracting close scrutiny by regulators as they seek to tighten up oversight to ensure the highest standards of public safety and to promote fair market access for all companies. Fundamental changes are being introduced under the new EU Medical Device Regulation (MDR) which will involve medtech firms adhering to stringent new standards across many critical processes. These include the reclassification of devices including legacy products, the reprocessing of single use devices, clinical evaluation and evidence standards, mandatory product liability insurance, labelling and the supply chain, and technical documentation.
At Maetrics we firmly believe that manufacturers who achieve MDR compliance as quickly as possible – rather than waiting until the 2020 deadline draws closer – will reap substantial commercial advantages over their less proactive competitors.
Why is this? Firstly, the requirements encompass the most wide-ranging set of changes to the regulatory landscape since CE Marking was introduced in 1993. Preparatory work, such as obtaining buy-in from the various stakeholders within the organisation and adapting the necessary business processes, will be an in-depth and lengthy process and can not possibly be achieved properly in a last-minute compliance rush. Secondly, the industry is already questioning whether there is sufficient capacity in terms of suitably qualified in-house consultants to guide compliance preparations, and likewise, enough Notified Bodies (NBs) to conduct the audits and certifications within the required timeframes. It has been reported recently that NBs have begun turning down new clients for CE Marking, which indicates the pressure they are already under even before the MDR floodgates are fully open.
In part, outsource providers can plug the in-house gap by providing expert support but it should be emphasised that this resource is also limited and is likely to be seized upon by the compliance first-movers. Even if they have the time to wait for in-house professionals or outsource providers to finish contracts and become available, medtech firms that delay their compliance plans will still find themselves at a severe disadvantage – not least because over-demand tends to push up costs. At the time of writing it is difficult to imagine how the dual challenge of the in-house skills shortage and regulatory under-capacity can be solved in time for the entire medtech industry to achieve compliance by the deadline, even if it is two and a half years away.
Our best estimates put MDR compliance under-capacity in the region of 20% of total market value. The consequences of this are significant. Non-compliant manufacturers whose products are uncertified will simply be unable to service the market and their compliant competitors will step in to pick up the business. It has been acknowledged by large operators in Europe that this loss of market share may never be recovered.
We have formulated a financial model to put figures on the scale of this opportunity – the MDR Market Opportunity Value model (MOV) – and it reveals that $16.5 billion in potential revenues is the prize on offer to fully MDR-compliant manufacturers. If we look at this from the non-compliance perspective, it is also the value of the possible revenue penalty for those that find themselves excluded from the market.
It is clear that medtech firms need to take action sooner rather than later to reap full advantage of the MDR compliance opportunity. What measures can be taken in-house? First and foremost, they must book their certification work in with NBs (as soon as the NBs become MDR-compliant themselves). They should create a comprehensive, practical MDR compliance strategy which involves appointing team members from across the business to take ownership of assessing each necessary process. We would recommend that firms scan their product portfolios for any unnecessary products that could be eliminated before the auditing begins.
In many cases, medtech firms will choose to partner with compliance outsourcing specialists who can provide expert guidance throughout this process, from planning through to implementation and certification. This is especially likely to be the case given the unprecedented extent and complexity of the changes set out by the MDR and the scale of the Market Opportunity Value achievable by compliance pioneers.
By Peter Rose, Managing Director Europe, Maetrics
See full details of Maetrics’ Market Opportunity Value model here
The healthcare sector has long been one of the favourite targets for cyber criminals thanks to the large amounts of private data held by organisations. Patient records are a useful source of personally identifiable information (PII), such as names, addresses and birth dates, which can be used to launch more effective targeted cyber-attacks on individuals.
Deceptive emails are the weapon of choice for criminals angling for this data, with attackers most often impersonating a trusted contact to trick the victim into sharing confidential information. The most recent example of this highly successful tactic came in early January, when a healthcare organisation in Florida had more than 30,000 patient records stolen when a fraudster tricked an employee out of their database password. Our research has found that the healthcare sector is targeted by more deceptive email than any other sector, with 92 percent of all email domains used by healthcare organisations carrying fraudulent emails.
Why deceptive emails slip past defences
While the deceptive email strategy has been around for years, the threat has become more visible in recent months as attackers have both refined their targeting and increased the number of attempts. One of the reasons these deceptive emails have continued to be so effective is that they are designed to evade the email security systems most organisations have in place, and few of these solutions have adapted to catch them.
Traditional email solutions work by signature-based detection, looking for malicious attachments or blacklisted keywords that indicate a suspicious email. This does not work for these attacks, nor does the traditional anti-spam approach of looking for anomalous spikes in volume from a given sender, or spikes of a particular email subject line. A well-crafted deceptive email will contain nothing to alert a standard email scan, and will be effectively indistinguishable from a legitimate message. After fooling the machine, fraudsters have a number of tricks for deceiving the human eye as well, such as setting the display name to match that of a trusted contact.
While tricking a healthcare organisation into giving access to its database may be the ultimate win for a fraudster, many also attack individual patients by impersonating the organisation itself using the same tactics. Of the 875m emails appearing to come from monitored healthcare organisations over the last six months, we found 56 per cent were actually malicious emails spoofing the domain. Criminals generally use this approach to trick targets into giving up personal information which can be used to fuel more targeted social engineering attacks, or simply sold on to other criminal groups.
The difficulty in distinguishing a well-made fake from the real thing, combined with the steady number of deceptive emails reaching the inboxes of employees and patients alike, means that it is impossible to rely on individuals to successfully spot the difference. In other words, technology must address this threat.
Keeping patient data safe
Healthcare organisations need to work to prevent malicious emails from reaching their employees’ inboxes in the first place. One of the most effective ways of preventing email spoofing is the free-to-use Domain-based Message Authentication, Report & Conformance (DMARC) email authentication standard.
DMARC uses two email authentication techniques, Domain Keys Identified Message (DKIM) and Sender Policy Framework (SPF), to verify if a message genuinely has permission to use the email domain. Domain owners can apply policies to block emails that fail to pass outright, or quarantine them. Organisations using DMARC can also receive updates when emails using their domain fail to pass authentication, alerting them to ongoing attempts to impersonate them.
The NHS mandated the use of DMARC among other email security solutions in January 2017, with a review in July asserting that organisations needed to meet the secure standard as soon as possible. However, after examining 5,000 NHS email domains in November 2017, we found that just 1 per cent were currently using DMARC, and only five per cent of UK healthcare organisations had any DMARC policy in place.
However, although DMARC is a powerful tool for dealing with untargeted attacks such as large-scale phishing attacks, it only addresses around six per cent of targeted email attacks. Targeted email attacks are not only different from large-scale phishing attacks in terms of the impersonation technologies the criminals use, but also in terms of the content of the messages, and the goals of the attackers. Targeted attacks are most commonly aimed at key employees, with the goal of having them share massive amounts of sensitive data. By being more convincing, they are also associated with significantly higher success rates for the criminals. While the number of targeted attacks is much smaller, each one can have a huge impact as they are far more effective. Since email spoofing is commonly not the impersonation approach of choice, DMARC is also not the most suitable countermeasure. Instead, organisations will need to take on an email security solution that is capable of detecting signs of deception such as a mismatch between the sender name and the actual sender identity in order to address this threat.
Healthcare organisations must begin their email security journey now if they are to keep the private medical data they are entrusted with safe from criminals. While attackers are still able to freely impersonate healthcare domains with minimal effort, patients and employees alike are under threat from deceptive attacks that abuse their trust. This problem is urgent to address, as data that is leaked can never be unleaked, and healthcare providers have access to some of the most sensitive data there is.
By Markus Jakobsson, Chief Scientist at Agari
Today we share a new guide to help charities understand, measure, evaluate and analyse their wellbeing impact. Ingrid Abreu Scherer, Programme Manager at the Centre, explains why we need the guide, and how it can help you, even if you’re not a data scientist.
People are complicated, and measuring traditional outcomes can sometimes hide this complexity – and thereby hide the full impact of your activities.
At the Centre we study this complexity, and the different things that make up our wellbeing: the quality of our health, work, relationships; how happy, anxious or satisfied we feel; how confident, purposeful, or connected our lives are. It’s all interconnected, and changes many times over the course of our lives.
Wellbeing can be measured by looking at observable factors (like employment), as well as by looking at factors that are subjective to the person experiencing them, like how safe we feel.
Charities and social enterprises have an impact on wellbeing of the people and, in most cases, the communities they work with. Hopefully they improve wellbeing. But they may also make people’s wellbeing decrease, even while achieving their organisational mission.
For example – if a family is constantly being moved from one temporary housing to the next, they will at any point be considered to be ‘in housing’. However, the benefits of having a place to live may be undermined by the stress and uncertainty of constantly moving, by the inability of children to have stable schooling or friendships, and by the lack of connection to the local area. Just measuring a family’s housing situation is not going to give us a full picture of their wellbeing.
We know work is important for wellbeing, but if a new job leaves the newly-employed person feeling more isolated and unsafe, the unintended consequence is lower wellbeing. Having a job is good – but having a good quality job is better, as the graph below shows.
You probably already knew this. And if you work in a voluntary, community or charity organisation, you also probably design your services and approach around the complexities of people’s lives.
So why doesn’t the way we measure our impact, for the most part, take this complexity into account as well? Why do we still tend to focus on traditional outcomes, while so often missing out on evaluating vital wellbeing impacts?
We think there might be a number of reasons:
- There’s not been, until now, a clear and simple way to understand, measure and analyse the wellbeing data
- There’s a need to make a stronger case for valuing wellbeing impact
- Some wellbeing impacts – like confidence or sense of belonging – are often taken for granted by voluntary and community groups, and not worth measuring
- There’s a need for a reliable framework – based on evidence and robust methods – that the sector can use, and which is accepted by funders and commissioners
- Funders and commissioners are not always asking for wellbeing impacts to be measured
- Organisations may have been collecting the information in different ways, without knowing how to compare impact between projects – within the same rganization, within areas, or across sectors.
Whether you want to improve health, education or employment, measuring wellbeing can show you the wider impact you have on the people and communities you support.
How to Measure Wellbeing Impact will help you put together a simple questionnaire to measure the wellbeing of the people you work with – whether you write your own or use tried and tested questions.
It will help you understand how to compare your different projects, and see the impact you’re having overall. You can also find out how to compare your results against the national, regional or local averages to make the case for your service.
Ultimately, our hope is that measuring wellbeing will help you understand your projects better. By developing your own wellbeing survey, and linking your findings to data you already collect, you’ll understand your full impact on people’s wellbeing. You’ll also find out what works to improve wellbeing and why.
Beyond your organisation, wellbeing measures can help us create a bigger picture. If organisations use consistent measures and share their results with us, we can start to build a better, bigger picture of what works. And identify strengths, and where there’s room for improvement across the sector.
- Study shows employees lose an average of 30.4* working days each year due to sickness and underperformance in the office as a result of ill-health.
- Productivity loss due to physical and mental health issues is costing the UK economy an estimated £77.5 billion a year**.
Research from the 2017 Britain’s Healthiest Workplace survey (BHW)***, a study of almost 32,000 workers across all UK industries, has revealed that employees lose, on average, the equivalent of 30.4 days of productive time each year as they take time off sick and underperform in the office as a result of ill-health (otherwise known as presenteeism). This is equivalent to each worker losing six working weeks of productive time annually. Importantly, while some sectors performed better than others, the results demonstrated high levels of productivity loss across all sectors and organisational sizes.
When translated into monetary terms, the combined economic impact of this ill-health related absence and presenteeism is £77.5 billion a year for the UK economy. Worryingly, employee work impairment and the associated productivity loss appears to be on a worsening trend, up from 27.5 days and £73 billion respectively in 2016.
Britain’s Healthiest Workplace, which was developed by VitalityHealth and is delivered in partnership with the University of Cambridge, RAND Europe and Mercer, also points to a growing presenteeism problem, with time missed by the average employee through absence reducing since 2016 (3.3 days to 2.7 days), while increases in presenteeism (24.2 days to 27.7 days) have more than offset the observed reduction in absence. This increase in presenteeism demonstrates the importance of having a holistic understanding of employees’ physical and mental health, both in and out of the workplace.
Shaun Subel, Director of Corporate Wellbeing Strategy at VitalityHealth, said: “The Britain’s Healthiest Workplace results illustrate the significance of the productivity challenge facing the UK, but importantly also point to an exciting alternative in how employers can approach this problem.
“For too long, the link between employee lifestyle choices, their physical and mental health, and their work performance has been ignored. Our data demonstrates a clear relationship – employees who make healthier lifestyle choices benefit from an additional 25 days of productive time each year compared to the least healthy employees, and also exhibit higher levels of work engagement and lower levels of stress. As a result, effective workplace health and wellbeing solutions can deliver tangible improvements in employee engagement and productivity, and make a significant impact on an organisation’s bottom line.”
Chris Bailey, Partner at Mercer Marsh Benefits, said: “Some employers still doubt the impact of presenteeism, dismiss the data, and fail to take action. It’s key to understand that people are not machines – we are not 100% task focused and performing at our best all of the time.
“It is not a case of having a presenteeism problem or not. All organisations will see a reduction in how productive their people are when they are experiencing physical or mental health issues. The data shows that those organisations who understand this and take steps to maximise their employees’ productive time at work, for example through supporting an active workforce, promoting good nutrition and enabling positive mental health, enjoy a competitive advantage.”