NHS Health Scotland
Outcome Indicators

2.6 Develop understanding of customer, and develop tailored engagement strategies.

Activities to develop an understanding of existing and potential customers of the health, work and wellbeing agenda should be targeted at all workplaces and will contribute to greater engagement in the field.


Policy Note



Developing an understanding of workplaces in Scotland and their motivations and drivers for (potentially) engaging with the health, work and wellbeing agenda will enable the design and development of tailored messages to engage them, and ultimately to more workplaces being engaged and committed to prioritising health and wellbeing.

A key element of increasing engagement will be to determine whether there is clear evidence for the ‘business case’ for health, work and wellbeing (defined as a direct financial return and impacts on bottom-line benefits).

Evidence suggests there has been a lack of any well developed business case in the UK for why employers should invest in the health and well-being initiatives, and a lack of action has resulted from the limited access to information for both employers and employees on the effectiveness and cost effectiveness of these types of schemes.[1] There is some review level evidence from the United States that wellness programmes generated savings through reductions in health care costs and absenteeism [2] (although these may not all be directly applicable in the UK due to differences in health care and insurance systems and costs to employers).

Despite limited highly processed evidence there is an increasing body of case studies that might be considered as important emerging evidence in this field, and provide increased motivation for organisations to invest in worker’s health and wellbeing. For instance, case studies have shown a range of perceived benefits to businesses including intermediate (non-financial) benefits (e.g. reduced sickness absence, accidents and injuries, staff turnover and also increased employee satisfaction, productivity, employee health and welfare), as well as related bottom-line benefits (financial) (e.g. reduced recruitment costs, legal costs, healthcare costs, management time and increased revenue from improved productivity).[3] However, caution should be used when interpreting this evidence around the business case and its wider applicability.

Several sources also provide estimated costs of ill health and disability in the workplace that might be considered as emerging ‘evidence’ to support a so-called business case for investing in health and wellbeing in the workplace.[1, 3-6] Although there is some weak evidence that (some aspects of) vocational rehabilitation for musculoskeletal disorders can be cost-effective, it is argued that there is a good business case for employers to take a proactive approach to supporting health at work and, informed by reviews of evidence, authors report strong scientific evidence and considerable UK business experience that sickness absence and disability management is cost-effective, and may reduce sickness absence by 20-60%.4

Evidence on the cost effectiveness for managing long-term sickness absence is generally sparse.[7] NICE public health guidance 19 Managing long-term sickness absence and incapacity for work found that where evidence was available it showed that effective interventions would reduce employers’ costs in the long run.[7] However, the guidance also states that “in times of severe or very severe economic downturn, these interventions will become less cost effective” and that “the probability of a return to work for those receiving incapacity benefits would decrease when there is high unemployment”, highlighting the importance of external factors in achieving the outcomes in the outcomes framework.


Scottish policy note:

The Scottish Centre for Healthy Working Lives (the Centre) are to work with Scottish Enterprise, Highlands & Islands Enterprise and local government Business Gateways to promote the importance of workplace health and wellbeing to business success as part of advice given to clients; and to promote services of the Centre to clients as part of their business support.


  1. Black, Dame Carol (2008). Dame Carol Black’s Review of the health of Britain’s working age population, Working for a Healthier tomorrow. Presented to the Secretary of State for Health and the Secretary of State for Work and Pensions.

  2. Baicker K, Cutler D, Song Z (2010). Workplace Wellness Programs Can Generate Savings. Health Affairs, 29(2): 304-311.

  3. PricewaterhouseCoopers (2008).  Building the case for wellness.

  4. Waddell G, Burton AK, Kendall N (2008). Vocational Rehabilitation: What works, for whom, and when? A report for the Vocational Rehabilitation Task Group. The Stationary Office: London.

  5. Sainsbury Centre for Mental Health (2007). Mental Health at Work: Developing the business case. Policy Paper 8.

  6. Boorman S (2009). NHS Health and Well-being. Final Report. London: Department of Health.

  7. .NICE (2009). NICE public health guidance 19 Managing long-term sickness absence and incapacity for work. NICE: London.