Keeping people healthy at work – the UK Government’s strategy

Professor Dame Carol Black UK National Director for Health and Work 21 October 2009

The UK Welfare System and Work

• The Government wants as many people as possible to share in the rewards of work, because paid work is the best route to independence, health and well-being for most people. • The United Kingdom has a comprehensive, regulated, state-administered cash-benefit social security system, which covers the entire population.

• Alongside the benefit system, are tailored

training and support programmes

managed through government agencies.

The UK Healthcare System

• The UK National Health Service (funded from general taxation, covering the entire population, and free at the point of delivery) is divided into primary and secondary care.

•

Primary care

is controlled by regional Strategic Health Authorities through the Primary Care Trusts (a Trust being a local board of unpaid appointees).

• •

Primary Care

is the first point of contact for the public, and includes family doctor (GP) practices, pharmacists, opticians and dentists.

Secondary care

is hospital care.

Why people are off work

• Two-thirds of sickness absence and long-term incapacity is due to mild and treatable conditions: • Depression, anxiety, stress related mental health problems • Musculoskeletal conditions • Cardio-respiratory conditions • Inappropriate “medicalisation” • Poor retention in the workplace of those with disabilities or chronic disease Contact with the workplace is often lost

Misconceptions: the need to change attitudes

 Compelling evidence shows that work is generally good for both physical and mental health and well-being. Beneficial effects of work outweigh the risks 1  Nevertheless the fallacy persists that individuals should only be at work if 100% fit. Many individuals wrongly believe that work is harmful to health 1 .

 Employees think that OH is of benefit mainly to employers • In some countries these misconceptions underpin procedures for certification of sickness absence 2 • Also, vocational rehabilitation, occupational health service, and employer flexibility are frequently inadequate.

• It is vital that employers, healthcare professionals and the public understand better the positive links between work and health 2

1. Waddell and Burton, September 2006 2. Working for a Healthier Tomorrow, Dame Carol Black, 2008

The UK system in 2007

•

A system of sickness certification that labels you as sick

•

No Occupational Health services in Primary Care

•

No pathways of rapid intervention to keep you in work or return you to it

•

Poorly-informed healthcare professionals with little understanding of work as a (medical and social) determinant of health

•

Little interest from local Primary Care Trusts

•

Rehabilitation to work not critical to assessment of the performance of PCTs

•

Poor retention in work of those with disabilities or chronic disease

The UK ‘Sick Note’

• At present, a family doctor (General Practitioner (GP)) assesses a person’s health and ability to work.

• The ‘sick note’ form requires the doctor to state whether or not the patient can work, and how long they should refrain from work if sick. •

Partial ability

to work is not overtly considered. • Return to functional capacity and work is NOT part of the consultation

Occupational Health in the UK

“ Occupational Health services reflect the historical view of ‘industrial medicine’ as a benefit to employers which should be financed by them. There is no OH provision in the National Health Service.

The challenge for a new paradigm of OH is to examine the care pathways for working people and find new ways to support them before, during and after illness at work.

A new model has to be put in place to reflect the current profile of employment in Britain.

It requires new partnerships and new ways of working across traditional boundaries. Occupational Health must make a greater contribution to the health of the national economy “

Lane Lecture, University of Manchester, Nov.2007

Working for a healthier tomorrow, 2008 - a new vision for health and work

Working for a Healthier Tomorrow “At the heart of this Review is a recognition of, and a concern to remedy, the human, social and economic costs of impaired health and well-being in relation to working life in Britain. The aim is not to offer a utopian solution for improved health in working life, but rather to identify the factors that stand in the way of good health and to elicit interventions, including changes in attitudes, behaviours and practices – as well as services – that can help overcome them.”

Prevent illness, promote health, intervene early, improve the health of the workless.

What is needed in the UK? Recommendations to Government

• Education and Training of Health Professionals and Managers (in business and the NHS) • Change of attitude in the population • An electronic ‘Fit Note’ • An early-intervention holistic service based in primary care • Support for employers in health and work • Collaboration and co-operation between all sectors

Response of UK Government - relevant to Primary Care

•

Introducing an electronic ‘Fit Note’ (April 2010)

•

Piloting a ‘Fit for Work’ early-intervention service (January 2010)

•

Regional Co-ordinators situated in regional Public Health offices

•

Education and training programmes for GPs, with further extension to nurses and other health professionals

•

Revitalised and re-orientated Occupational Health services, available to all not just the few.

•

A help-line for advice to small and medium-sized companies on health and work

•

Social marketing campaign

Proposed new UK model

• Poor contact with employers • No early intervention

Fit for Work Service Pilots

FFWS concept FFWS Pilots: range of models

Of:

• Employees off sick from work • But also of: • Presentees • Unemployed – few, with specific, unmet needs

From:

•General practice •Employers •Self referral •But also from: •Other healthcare professionals •Job Centre Plus •Voluntary sector agencies

Fit for Work Service Pilots

FFWS concept FFWS Pilots: range of models Fit for Work Service ‘hub’ S E R V I C E S B E S P O K E

MSK physio, OT (NHS) Psychological therapies (NHS) Advice: e’ment, debt, housing Conciliation Self care support

bio -psycho -social

FFWS Pilots: range of models Fit for Work Service ‘hub’

Based in primary care or in the broader community Case management:

• OTs, physios, psychological therapists, employment advisors, OH advisors • Co-ordination: client, employer, GP • Timely access to FFWS ‘spoke’ services

Additional hub services:

• Physio, psychological therapy • Specialist employer liaison team (complex cases) • OH physician, OH nurse

FFWS concept

The National Education Programme - for GPs, starting April 2010

•

To change their behaviour when managing health and work problems

•

To increase confidence in their everyday practice

•

An interactive facilitated 3-hour session, developed through a stakeholder group. Current:

Work is a ‘ risk ’ and (potentially) harmful to physical and mental health.

Shift to:

Work is generally good for physical and mental health

therefore

Sickness absence/certification ‘ protects ’ the worker/patient from work

and

Recognise the risks and harm of long term worklessness

Wales: Occupational Health Task and Finish Group

The Minister accepted its conclusions and three key recommendations: • Changes to the current risk- and evidence-based legislation for occupational health are not an effective way of improving health and reducing ill health; • The integrated approach to Occupational Health, outlined in the Welsh Assembly Government’s response to Dame Carol Black’s report, should be further developed; and •

A national occupational health service, provided by the NHS, and made viable by contributions from employers, should be established.

Professor Mansel Aylward has been asked to convene a second Task and Finish Group to take forward the recommendations, and in particular to develop a costed delivery model for the national occupational health service. This second Group will meet on a bi-monthly basis to take this work forward.

Working Together We Will make a Difference

“By working together, our efforts will help us to combat social exclusion, eradicate child poverty, support our ageing population, and build a workforce for tomorrow. By improving health and work we will make a real difference to people’s lives.”