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Posts Tagged ‘Dame Carol Black’

Getting Britain’s workforce working: the crucial role of rheumatologists

Friday, April 15th, 2016

As Simon Stevens put it in his very first speech in his NHS England post:

“If like me you believe in a tax-funded NHS, you’ll want the Health Service to play its part in growing our nation’s economy, precisely so we can sustain public health services for generations to come.” [1]

No single specialty is in a position to make a bigger contribution to this agenda than rheumatology. Musculoskeletal disorders (MSDs) represent the single biggest cause of sickness absence in the UK, accounting for more than 30 million sick days taken in 2013. [2]

We know that much sickness absence due to MSDs is avoidable.  Provided with appropriate advice and support, many people could return to work.  Giving such support will however require a change in the mindset of healthcare professionals in two important ways.

Firstly, the misguided belief that work is somehow incompatible with long-term conditions needs to be fundamentally challenged. There is a growing evidence of the therapeutic benefits of work in general and for those with MSDs. In many cases, staying active and remaining in work not only bring physical benefits but can also make a world of difference to individuals’ self-confidence, self-esteem and mental wellbeing.

Secondly, work needs to become a clinical outcome for patients of working age.  Rheumatologists endeavor to return patients to functional capacity – for many this can and should include work. Rheumatologists need to ensure that work-related issues feature throughout the clinical episode. Patient surveys tell us that the issue of work comes up in conversations with healthcare professionals all too seldom. This has to change.

The management of MSDs can be a complex and expensive endeavour. If we want investment to be made in new diagnostics, treatments and workforce, we in the rheumatology community must also find ways to demonstrate return on that investment.

The inclusion of work in consultations does not cost much. Yet if implemented at scale, this small adjustment in the way that rheumatologists approach their conversations with their patients could make an enormous difference, not only to the health of the British workforce but to the British economy as a whole.

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


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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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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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