As the UK's largest employer, the NHS should be doing much more to look after the health and welfare of its employees. Jeremy Davies reports

The need for the NHS to act as a trailblazer of good employment practice looks set to be a key message running through the 'welfare and healthcare' strand of this year's Health Hotel party conference fringe events.

Rabbi Baroness Neuberger, who speaks on health in the House of Lords for the Liberal Democrats, argues it is 'almost unbelievable' how poorly the NHS engages with the needs of its own employees suffering from mental illness.

'Of all organisations, you'd think the NHS would be sympathetic, but people working for it still don't feel able to tell their employer, even though disability discrimination legislation makes clear that people with mental illness must be treated fairly,' she says.

'There are a few isolated pockets of good practice but what's really needed is some inspiring leadership and a recognition that dealing better with employees' mental health problems is a key way of retaining talent in your organisation.'

Sainsbury Centre for Mental Health chief executive Angela Greatley cites South West London and St George's Mental Health trust as one of the few trusts to act as an exemplary employer in terms of mental health.

'Around 15 per cent of the workforce there would say they have experienced mental health problems themselves, and that's got to bring something extra to their work,' she says. 'Allowing jobs to accommodate people experiencing mental illness has got to become mainstream, not just something that affects two or three posts. We've got to start seeing mental illness as something no less normal than a broken leg. These are citizens entitled to the same rights and opportunities as everyone else.'

Rethink, the UK's largest severe mental illness charity, will also be contributing to the Health Hotel debate. Director of public affairs Paul Corry says the NHS should begin by surveying its workforce for prevalence of mental illness and respond to employees' needs more sensitively.

'Often all it takes is quite minor adjustments to help people cope better or return to work - like availability of flexible working options, the ability to take time off at short notice and other agreed ways, written into contracts, in which jobs might be adapted,' he says.

The feelgood factor

This is not just about altruism, adds Mr Corry. 'There is growing evidence that when in work, people with mental illness are more motivated and productive than the general workforce - so the NHS might find it could really benefit from looking towards excluded groups like people with mental illness, especially in a tightening labour market.'

Conservative MP for East Worthing and Shoreham Tim Loughton says private sector employers such as Marks & Spencer and British Telecom - who have invested heavily in occupational health - have a lot to teach the NHS.

But he stresses that, on a wider level, governments need to invest more heavily in mental health services: 'Since Labour came to power funding for mental health has fallen as a proportion of spending from 14 per cent of the overall NHS cake to around 11.5 per cent. Granted, the cake is now bigger, but we still need to see mental health funding getting back to at least its previous level, if not more.'

Backing calls from Labour peer Lord Layard for an extra 10,000 therapists across the NHS, Mr Loughton claims that a four-month course of cognitive behavioural therapy costs about£3,000 - roughly the same as four months' worth of incapacity benefit - and could help around half of people with depression or other mental illnesses get back into work.

It is not just people suffering from mental illness who need additional help to return to employment. The 'could work, can't work' fringe meetings, organised by the Stroke Association and the Chartered Society of Physiotherapy, will focus on how the government's plans to reform the incapacity benefits system will depend on improved diagnosis and access to timely treatment.

The Welfare Reform Bill, published in July, introduced a greater focus on early intervention, with increased support to employers and employees in managing health in the workplace; improved absence and return-to-work management; and increased support to health professionals 'to enable them to provide holistic treatment plans that recognise the benefits of work with respect to rehabilitation and long-term health'.

The Stroke Association cites stroke - Britain's third biggest killer - as a classic example of a condition whose victims could benefit from such an approach but which is currently under-prioritised and under-resourced.

For example, the association says while the best-quality treatment would involve professionals giving patients a brain scan within three hours of the onset of symptoms, at the moment less than half of stroke patients get a scan within 48 hours.

Road to rehabilitation

And even if a stroke patient does get appropriate and timely treatment, rehabilitation is often inadequate. Many stroke survivors need access to physiotherapy, occupational therapy and speech therapy as well as counselling and support. All too often waiting lists are many months long - a situation liable to worsen as cash-strapped trusts slash services, says Chartered Society of Physiotherapy head of public affairs Gary Robjent.

'It's easy to freeze junior jobs and that's exactly what trusts have been doing, meaning 93 per cent of this year's physiotherapy graduates don't have jobs to go to,' he says. 'Physios are ideally placed to take forward the cohesion of acute, community and social care that is supposedly on the government's agenda, but the rhetoric is a long way from matching the reality of what's happening on the ground.'

The need to plug such gaps in service provision is only going to become more pressing in future, as the 'demographic timebomb: can we afford not to care?' fringe meetings at both the Liberal Democrat and Labour conferences will discuss.

According to the King's Fund, which will host these sessions jointly with Help the Aged, the number of people aged 85 and over in Englandwill increase by two-thirds over the next 20 years, while even optimistic predictions forecast that the number of older people with high levels of need will rise by 54 per cent by 2026.

One contributor to the debate will be Sir Derek Wanless, whose 2002 inquiry into NHS spending helped persuade the government to set about bringing UK health funding into line with other European countries and who produced a similar review of social care for older people in England for the King's Fund in March this year.

His social care report concludes that just to keep pace with population changes caused by increasing numbers of older people would require total spending (public and private) on social care for older people to increase from the 2002 level of£10.1bn (1.1 per cent of GDP) to£24bn (1.5 per cent of GDP) by 2026.

Sir Derek found 'very serious shortcomings' in social care provision and funding arrangements. He recommends that to enable more people to receive care fairly and cost-effectively there should be more ambition in social care outcomes. He also says the current means-tested funding system should be replaced with a partnership model, whereby everyone in need would be entitled to an agreed level of free care, after which individuals' contributions would be matched by the state up to a defined limit. People on low incomes would be eligible for benefits to fund contributions.

Sir Derek believes this would be cost-effective and provide more community-based care, including better access for those with moderate needs, better support for carers, and improved services for people with dementia.

All of which should be music to the ears of Carers UK chief executive Imelda Redmond, who will also speak in this strand, focusing on the need for greater recognition and support for people with caring responsibilities.

'There are currently around six million carers doing the vast majority of the caring work done in this country with no recognition or reward - and mainly taking on these responsibilities when their careers would otherwise be peaking,' she says.

'There could be more like 9 million in 30 years', as more and more people survive longer with serious conditions.'

Ms Redmond says, first, the social care agenda throws down all sorts of challenges for the recasting of NHS services into a more community-focused model. Second, carers themselves tend to be among the most 'expensive' citizens, health-wise. Third, as the UK's biggest employer, the NHS could - just as with staff suffering mental health problems - do much more to support its own workers who have caring responsibilities.