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Archive for May, 2015

Joint Working

Friday, May 22nd, 2015

The health benefits of work have been well documented, and we know that many people with long-term conditions such as arthritis or who have a disability continue to work successfully.

Creative support measures can be instrumental in helping individuals with disabilities or long-term conditions remain in or return to the workplace. Reasonable adjustments such as flexible working, reduced hours, reallocating duties or location can improve the capacity of the employee to remain in the workplace, thus ensuring the employer retains their skilled member of staff.

In addition to these adjustments that can be agreed between employee and employer, the government’s Access to Work scheme has proved invaluable to many, providing funding for equipment, travel to work or for a support worker.

When employees find themselves off work due to a painful and debilitating musculoskeletal condition, they need timely diagnosis and support to help them return to work. For some the condition may be temporary, while others may find they have to adjust their lives to accommodate the onset of a disabling, long-term condition.

Chronic inflammatory arthritic conditions, such as Rheumatoid Arthritis, can be permanent and rely on a range of interventions from primary and secondary care to help the individual manage their condition in the workplace.  The prompt diagnosis of this type of arthritis can be crucial in preventing severe disability. It can cause irreversible joint damage, tendon rupture and loss of muscle. These gradually affect the range of movement of joints, which in turn has an impact on work and quality of life.

Arthritis Care’s Joint Working employability project in Scotland aims to support individuals to ‘Work Well With Arthritis’. In partnership with the Rheumatology Occupational health team within two NHS areas, the service offers a range of engagement options to suit the individual, including 1-1 meetings, email and / or telephone. Referrals are received from NHS staff, DWP, employers as well as self-referral.

The project aims to address the difficulties individuals face managing their condition in work and / or support their journey back into the workplace.

It is acknowledged that working with arthritis can be challenging, with fatigue, pain and stiffness cited as the main issues affecting people’s ability to work. Taking time off sick due to flares, problems with colleagues not understanding the condition, the need for specific adaptations and the effects of medication can leave individuals feeling anxious, isolated and overwhelmed.

Joint Working aims to help each service user find what works best for them, reassuring them of their rights within the workplace, providing information and referral pathways to a range of support and services such as Access to Work, self-management courses, workplace adjustments, training or disability benefits.

Unfortunately, some people may not be able to continue working, and so the service can provide information and support to help them make the right decision for them or look at other employment options.

In partnership with the NHS Healthy Working Lives service, Joint Working also aims to raise awareness among employers, providing free Arthritis Awareness training or information for staff.

Being diagnosed with a chronic long-term condition is not something most people plan for, and there is considerable work to be done to help support those people in the workplace who have found themselves in this situation.

While advances in medical care help people to remain well enough to work, there is a need to address the lack of coordinated support for people entering a new phase of their life with a chronic condition.

Working with arthritis is achievable, if individuals are given the right support at the right time in their lives.

Judi Rhys
Chief Executive
Arthritis Care

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Pain and work

Thursday, May 14th, 2015

It is estimated that by 2030, four out of ten working age people will have at least one chronic health condition, and some will have several. The most common symptom is pain with the mental and physical effects of pain. Further, in many individuals symptoms fluctuate, often unpredictably. This presents a challenge, to those who are affected, to their health professional advisers and especially to their employers.

I shall consider the effects of painful conditions on the lives of people of working age and ways in which those effects can be ameliorated.

First, the evidence is consistent and fairly strong that for most people, work – good work – is good for their physical health, their mental health and their overall wellbeing. And it is certainly true that good work can enable people to live lives that are fulfilling personally, socially and economically – helping to ensure their wellbeing.

This is no less the case for most people who are not wholly well or fit. Indeed, most people with long term health conditions, many of which are painful, do in fact work.

What are the effects of painful conditions on the lives of people of working age and how can those effects can be ameliorated and their wellbeing restored?

Except where there are obvious features such as deformity, altered posture or gait, or difficulty in movement or undertaking physical tasks the symptoms are subjective and their effects often difficult for employers and co-workers to fully understand.

Neither, of course, is pain solely a physical problem; always there are psychological and emotional elements. Anything one does might influence pain and the experience of that pain, and the consequences. Pain will trouble us to varying degrees depending on our mental state. Moreover, pain can influence that mental state.

The circumstances of working life and the personal and employment needs that must be met bring particular considerations into play.

Effective approaches to bring pain under control, make it tolerable, to enable the fullest possible working life depend on the attitudes and actions of many participants, first on skilled clinicians, in a range of specialties. But this aim cannot be achieved by clinicians alone. It requires close and sensitive collaboration with patients themselves. Without their keen, committed, informed participation the results will fall short. Often there must be acceptance of pain, importantly with the recognition that enhanced physical activity is not something to be endured but rather an essential part of coming to terms and rejecting unnecessary curtailment of activity that can still be rewarding and enjoyed.

The challenge is not just for any single part of our health and work system. If affected people are to have fulfilling working lives then facilitating entry to work, job retention and return to work after sickness absence must also be a concern of the welfare system and, crucially, of employing organisations.

There is compelling evidence that the conditions of work are themselves important and sometimes decisive factors in influencing both mental and physical health and overall wellbeing of working people. Further, there is a growing recognition among employers of the importance of employee health and wellbeing to the performance and reputation of their organisations, and a keen awareness of the costs when employee wellbeing is neglected.

However, for many the onus for self-managing a painful condition at work weighs too heavily, often at great cost to their personal lives at home, and their social lives. The effort to stay in work can compromise their physical health.

Recent research has revealed more fully the tension between wanting to continue to work, in the face of a struggle to manage the painful condition successfully. Being in work as a condition of effective self-management is often undermined as individuals seek to self-manage in that context. The report Self-management of chronic musculoskeletal disorders and employment captured the barriers that people with chronic musculoskeletal face in the workplace.

A central finding of the study was confirmation that work itself should be considered as a form of self-management. Individuals interviewed for the report found that partaking in work was an important way in which they managed several (often psychological) aspects of living with their painful condition.

Individuals also described how the invisible nature of pain meant that other people found it harder to understand their condition, and that they often were not offered support when they needed it. Some even described feigning alternative, more understandable, symptoms in order to communicate to others that they were unwell. Such experience raises the crucial, yet often overlooked relationships between employees and their line-managers, and also with their immediate colleagues.

Progress in these matters turns on such fundamental matters as workplace culture, senior leadership and line management skills. There is growing evidence of better understanding amongst employers, employees and health professionals of the benefits of good work on health. This heralds a wider culture change in attitudes to health and work. Among health professionals, for example, maintaining or returning to work is widely accepted as a desirable health outcome.

Dame Carol Black
Expert Advisor on Health and Work to the Department of Health & Principal of Newnham College Cambridge

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