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Archive for January, 2013

Is the government’s response to the sickness absence review good enough?

Wednesday, January 23rd, 2013

Dr John Chisholm CBE is a member of the Fit for Work UK Coalition, representing the Royal College of General Practitioners.  He is also a member of the Council for Work and Health and the National Stakeholder Council for Health, Work and Wellbeing.  This commentary is written in a personal capacity.

Most GPs will have welcomed the government’s response last week to the Sickness Absence Review by Dame Carol Black and David Frost (published in November 2011). In particular, the way sickness absence is managed in the future will radically change when the independent, state-funded Health and Work Assessment and Advisory Service is rolled out in 2014. Most GPs are only too aware that the longer someone is off sick or out of work, the harder it is to get back to work. The new service can help assess individuals earlier, offer advice to employees, employers and GPs, as well as ensure each case is managed, followed up and includes appropriate interventions where necessary.

The government’s response is a significant step forward, yet it remains somewhat vague about the funding and delivery of the necessary interventions. GPs are often frustrated by delays in access to NHS services – including physiotherapy and cognitive behavioural therapy – that may result in unnecessarily prolonged sickness absence and long-term worklessness. It is therefore essential to introduce mechanisms to achieve early intervention, including obligations on employers to implement the service’s recommendations on workplace adjustments whenever possible.

It is also not clear how GPs will refer patients to the new service. The report implies that the fit note itself will trigger referrals, but also assumes that eligibility to be seen will be restricted to employees without access to occupational health services at work. At a time of rising GP workload, GPs will want the referral system to be simple and streamlined, without requirements for detailed referral letters or questioning of patients about their employers’ occupational health arrangements.

In addition, there are potential problems with using a large number of occupational health professionals in the new service at a time when they are already in short supply and when many are heading towards the end of their careers, So it is important that the new service can find the workforce it needs without detriment to other occupational health provision. In parallel with this, the quality and standards of the service must be monitored to ensure it is delivering the necessary benefits.

One of the key points of the report is the importance of data in monitoring progress. Analysis of information available from the roll-out of electronic fit notes and from the new Assessment and Advisory Service will help, as will monitoring progress on the Health, Work and Wellbeing initiative. This uses such indicators as reducing the proportion of people out of work due to ill-health and improving access to appropriate and timely health service support. However, more data could be collected on longitudinal employment outcomes through the mechanisms already in place to collect patient data, as staying in or returning to work is an important indicator of clinical success. Such attitudinal change and data collection can be incentivised through the Commissioning Outcomes Framework.

The government response will undoubtedly have a major impact on how sickness absence is managed in Great Britain, in particular through the introduction of the new Assessment and Advisory Service next year. However, there are still some issues to be resolved in respect of referrals, interventions, workforce, quality monitoring and data collection. GPs and other stakeholders will be keen to work with the Department for Work and Pensions to ensure the new processes not only lead to cultural change but produce benefits for employers, taxpayers, the economy, health care professionals and most importantly for the future of those employees and patients at risk of long-term worklessness.

 

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Government response to Sickness Absence Review welcomed but flawed

Thursday, January 17th, 2013

The government has today published its response to Health at work – an independent review of sickness absence. Responding, Professor Stephen Bevan of The Work Foundation and the campaigning coalition, Fit For Work UK, said:

“We welcome the government’s response to the Sickness Absence Review, as the declining health of the UK’s ageing workforce is likely to be a threat to productivity and economic growth for at least the next thirty years. The Fit for Work Coalition has a special interest in the thousands of UK workers who have musculoskeletal health problems, which cost the economy at least £7 billion each year and cause at least £10 million lost working days each year.

“The proposal to introduce a health and work assessment advisory service to support workers, GPs and employers after the fourth week of sickness absence is especially welcome. Our research shows that early intervention is the best way of helping people to stay in, or return to work. However, we are disappointed that the response fails to align incentives in the healthcare and welfare systems. Specifically, GPs in the new Clinical Commissioning Group (CCGs) are not being incentivised to consider work as a clinical outcome.

“Also, employment is not included in the Commissioning Outcomes Framework (COF), which will guide the way they treat and refer their patients. Up to 30 per cent of GP consultations relate to musculoskeletal conditions. We are concerned that if GPs have no incentive to consider how staying in work can benefit their patients, the aspiration of the government to reduce sickness absence and increase productivity may be at risk.”

Ends

Notes to editors

1. Professor Stephen Bevan and senior researcher, Ksenia Zheltoukhova are available for interviews, briefings and written comment.

2. Fit for Work UK is a campaigning coalition established in 2011 with the aim to shift the treatment and care of musculoskeletal disorders (MSDs) from being disabling conditions to manageable conditions.

3. Taking the strain: The impact of musculoskeletal disorders on work and home life, published in December 2012 by Fit For Work UK, is available for download

4. The international Fit for Work Patient Survey 2012 is available at www.fitforworkeurope.eu

5. The Work Foundation aims to be the leading independent, international authority on work and its future. The Work Foundation is part of Lancaster University – an alliance that enables both organisations to further enhance their impact.

6. Fit for Work Europe is a unique multi-stakeholder coalition that strives to better align the work and health agendas in the EU and to shift the perception of musculoskeletal disorders (MSDs) from being disabling conditions to manageable conditions, ensuring that more European citizens stay or return to work, while helping to improve the sustainability of Europe’s health and welfare systems. Fit for Work is a partnership of organisations and individuals, and enjoys the patronage of The Work Foundation, the UN’s Bone and Joint Decade, the European League Against Rheumatism (EULAR) and RAND Europe. The Fit for Work Europe Coalition is supported by an ongoing grant from Abbott – a founding partner – and a supporting grant from GE Healthcare.

Media enquiries:

Tom Phillips 020 7976 3554

tphillips@theworkfoundation.com

Anna Kharbanda 020 7976 3646

akharbanda@theworkfoundation.com

For urgent out-of-hours media enquiries: Nasreen Memon 07825 527 036

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