Transcript Rapid access webinar presentations

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NHS Employers
Implementing Rapid
Access webinar
Chaired by
Jennifer Gardner,
Programme Lead,
Health and Well-being,
NHS Employers
NHS Employers conference
27th September 2012
Ruth ten Hove,
Professional Adviser, CSP

Describe the benefits of rapid access to
physiotherapy, to prevent short term injury
becoming a long term problem
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Outline the care physiotherapists can offer to
help people return to the workplace or support
them to remain at work

Identify the cost savings and benefits to
employers of an easily accessible physiotherapy
service
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Problems affecting the muscles, tendons,
ligaments, nerves or other soft tissues and
joints. Symptoms usually result in pain and loss
or restriction of movement.
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Alternatively, there may be a more gradual onset
of symptoms, with initial tingling, then slight
swelling or soreness which may persist and
gradually worsen
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Up to 60% of people on long term sick cite
Musculoskeletal Disorders (MSD) as the reason
22% of people on Incapacity Benefit have an
MSD
MSDs are the most common reason for repeat
consultations with the GP – up to 12% of
primary care consultations
Low back pain is the number one cause of long
term illness amongst manual workers
Likelihood of Return to Work (RTW)
 6 months 50% chance of RTW
 12 months 30% chance of RTW
 24 months 10% chance of RTW

Once on Incapacity Benefit (IB) for 6 – 12 months
90% remain on for at least 5 years

People on IB for more than two years are more
likely to die on benefits than return to work
“12 more sessions
of this and your
back will be fine Mr
Smith!”
www.tsoshop.co.uk/flags
Kendall Burton Main Watson 2009
Soft tissue
Injury
Presents in GP
surgery first time
Referral received in
physio dept and
processed
Orthopaedic
specialist
Attempt to self
manage
Presents in GP
surgery second
time
Paper referral to
physiotherapy
Physio waiting
list
Physio
assessment
Needs further
investigation?
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Prevention of illness and promotion of health
and wellbeing;
Early intervention for those who develop a
health condition;
An improvement in the health of those who are
out of work, so that everyone with the potential
to work has the support they need to do so..
Dame Carol Black’s Review of the health of Britain’s working age population, Working
for a healthier tomorrow, was published in March 2008
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A system of access that allows patients to refer
themselves directly to a physiotherapist without
having to see anyone else first, or without being
prompted by another healthcare professional.

(Department of Health 2006)
present sooner
 high levels of patient satisfaction
 wait less
 more autonomous
 off work less
 more complete Rx
 same outcomes
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Holdsworth LK, Webster VS, McFadyen AK. Are Patients who Refer Themselves to
Physiotherapy Different from those Referred by GPs?: Results of a National Trial Physiotherapy
92 PP 26-33 March 2006
Self Referral pilots to musculoskeltal physiotherapy and the implications for improving access to
other AHP services. DH Report 2008
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no floodgates
fewer Do Not Attends
less prescribing, investigations and secondary
referral
time savings for GPs and patients
Cost effective
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people who self-refer to physiotherapy take
fewer days off work (on average 4 versus 7) and
are 50% less likely to be off work for more than
one month when compared with people referred
via the more conventional route
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Ref: Self referral pilots to musculoskeletal physiotherapy and the implications for improving
access to other AHP services, DH 2008
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Stop people going off work in the first place
Get people back to work on full normal duties
If alternative or modified duties are required to
facilitate return to work, ensure they are specific,
time limited and transitional
Deliver a cost effective service
“Cost effective in
terms of my time and
commitments.”
“I was hoping for some
massage rather than
exercises to do.”
“Most appreciative of
‘personal exercise
programme’ given to
me and explained.”
“Self referral
is a good idea.
I hope it
continues.”
“This service
should continue
to be offered for
all patients.”
“I was very pleased
at the speed my self
referral was dealt
with.”
“In depth consultation in
a relaxed and unhurried
way. Constructive advice
for self-help and
management for living
with arthritis.”
Return2Health – A
multi-disciplinary
approach to health
and wellbeing
Occupational Health &
Wellbeing and HR teams,
University Hospital Southampton
NHS Foundation Trust
Overview
•
•
•
•
Background and design
R2H implementation
Evaluation
Conclusions
Organisational drivers
• Local strategy
– Staff experience
– Target absence rate
3.5% (from 4.4%)
• National steer
– Quality, Innovation
Productivity and
Prevention (QIPP)
Evidence base
• Sickness absence is associated with poor
health 1,2
• Case management intervention studies
– Improve subjective clinical outcomes3,4
– Few studies have control data5,6
1.
2.
3.
4.
5.
6.
Reinhardt Pedersen C, Madsen M.. 2002.J Epidemiol Comm Health 56, 861-7
Black C. 2008. www.dwp.gov.uk/docs/hwwb-working-for-a-healthier-tomorrow.pdf
Case management services: the current picture. Annual report April 2007-March 2008. SALUS and NHS Scotland.
Vocational Rehabilitation, what works for whom and when? Waddell G, Burton K, Kendal NAS. The Stationery Office
Taimela S, et al 2008a. Occup Environ Med 65: 236-241.
Taimela S, et al 2008 b Occup Environ Med 65: 242-248.
Not clear…..
• Whether they perform better than standard
care at reducing absence
• How cost effective?
Return2Health
• Multi-disciplinary “Fit for Work” service
• Entry point 4 weeks of absence
• Aim to reduce long term sickness absence
and adverse impact on health/wellness
• Timescale: funded by SUHT 2008
– Implemented during 2009
– Fully operational 2010
R2H components
Fast track
treatments
Human
Resources,
Career
Support
On-line
CBT
Pastoral
advice
Exercise &
activity
management
Core MDT
OH Physician,
CASE MANAGER,
Physiotherapist,
Sign-post
social
support
CLIENT
Line
Manager
So what’s new?
• Case manager approach - proactive
– Frequent contact
– Goal setting
– Enabling and empowering
• “Hands on” advice to managers
Motivational Interviewing
“A collaborative, person-centred form of
guiding to elicit and strengthen motivation
for change”
•Goal orientated
•Change talk
•Draw out rather than impose ideas
•Autonomy
•Collaboration
R2H Project management
• Steering group
– Multiple clinical disciplines and partnership
•
•
•
•
Psychiatry
Psychology
Chronic pain
OH, case managers
– HR
– Managers
– Union representatives
– Communications
Training and tools
• Training - bespoke
– Case management
– Motivational interviewing and CBT skills
• Tools
– New operational policy
– Generic examples of adjustments in practice
• Closely mirrors management structure
– Divisional links
Evaluation
• Controlled intervention study
• Comparisons
– Before-after intervention
– Between hospitals
(intervention – control)
Outcome measures
• Main outcome:
– Proportion of 4 week absences that continue
beyond 8 weeks in duration
• Secondary outcomes:
– Staff wellbeing and satisfaction
– Cost of agency staff
– Number of ill Health retirements
Data collection
• Electronic Staff Record (ESR)
– Absence start and finish date
– Cause
• Agency staff costs
• Reason for leaving
– Health
– Ill health retirement
• Staff surveys
Results
• Control hospital 4000 employees
• Intervention hospital 9000 employees
• 70-80 4 week absences per 1000 staff at
both hospitals
• 20% musculoskeletal, 10-15% mental ill
health
R2H referrals
number (%) referred within 6 wk of going absent
2008
2009
2010
Musculoskeletal
61 (40.7)
99 (48.8)
Mental illness
53 (41.7)
86 (58.9)
Other
118 (30.9)
125 (37.3)
Unknown
12 (27.3)
6 (27.3)
Total
244 (34.7)
316 (44.8)
Sickness absence
Before/after R2H
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
0
Q1 2008
Q2 2008
Q3 2008
Q4 2008
>8 weeks/>4 weeks
Q1 2009
Q2 2009
Q3 2009
Q4 2009
>12 weeks/>4 weeks
Q1 2010
Q2 2010
Q3 2010
>24 weeks/>4 weeks
Sickness absence - between hospitals
Control
hospital
Intervention Difference
hospital
intervention
- control
2008
8wk/4wk %
51.2
51.7
Mean days lost >4 wk
51.8
46.5
0.8
(-6.9 to 8.6)
2.6
(-2.6 to 7.9)
46.6
45.2
-4.9
(-12.5 to 2.7)
5.8
(0.5 to 11.1)
48.5
41.7
2009 (reduction from 2008)
8wk/4wk %
(95% CI)
Mean days lost >4 wk
(95% CI)
1.8
(-7.6 to 11.2)
2010 (reduction from 2008)
8wk/4wk %
(95% CI)
Mean days lost >4 wk
(95% CI)
10.7
(1.5 to 20.0)
Other outcomes
• NHS Staff Survey results improved in 2010
– High score for OH/R2H in UHSFT survey
• Agency staff costs: 27% reduction in
UHSFT (v 1% increase in control Trust)
• Ill health retirements: 26% greater
reduction at UHSFT v control Trust
Cost effectiveness
• Cost of intervention
– Sustainable £57k annually (1.5 w.t.e case
managers)
• Savings on absence (10% of 4-8wk episodes)
– average of 2 days per absence is saved
– 700 absences per year = 1400 person days
– Cost approx. £41 per day
• Appears cost effective
Conclusions
• R2H is
– Effective at reducing long term absence
– Appears cost effective
– Affordable, adaptable and deliverable under
“real life” conditions
• Excellent acceptability to staff
Please feel free to type your questions into
the question box provided on the right
hand side of your screen.
Many thanks.