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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

[1] https://www.england.nhs.uk/2014/04/simon-stevens-speech/
[2] http://www.theworkfoundation.com/DownloadPublication/Report/370_REPORT%20-%20Self-management%20of%20chronic%20musculoskeletal%20disorders%2009%202014%20(1).pdf

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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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The power of the personal account. How qualitative research offers important insights into the self-management of musculoskeletal conditions in the context of work. Part 1

Tuesday, September 9th, 2014

Work itself should be considered as a form of self-management. This is the central finding of the study that The Work Foundation and Fit for Work UK launched on Friday, 5 September  entitled “Self management of chronic musculoskeletal conditions and employment”. Individuals whom we interviewed for the report found that partaking in work was an important way in which they managed several (often psychological) aspects of living with an MSD. However, the onus for managing one’s condition at work weighed far too heavily on the individual, and participants often described foregoing their home lives, social lives, and compromising their physical health to stay in work. Work as self-management was often being undermined as individuals struggled to self-manage in the context of work.

Other stakeholders have a far greater role to play in supporting self-management, and notable among those are the government, healthcare professionals, and employers. It was only through conducting an interview based study, and talking directly to individuals, that this tension between wanting to continue to work, yet often struggling to manage one’s condition successfully, could be revealed to the researchers.

Interview studies of course have their limitations. They are designed to provide depth rather than breadth meaning that statistical representativeness is foregone. The researchers are also far more ‘present’ in that they conduct and then analyse the interviews themselves meaning it is even more important that they are aware of how they may bias the results. However, this research demonstrates the power of speaking directly to individuals with lived experience of the phenomena being studied. There were some specific, very striking findings, which would be unlikely to have arisen if individuals living with chronic MSDs had not been interviewed.

Take the implications of the invisible nature of the condition, for example. Due to MSDs often not having easily visible external symptoms, individuals described how this meant others found it harder to understand their condition, and that they often were not offered support when they needed it. Some participants even described feigning alternative, more understandable, symptoms when in fact they felt unwell because of their MSD, in order to communicate to others that they were unwell.

People wouldn’t know [I had arthritis].  Sometimes that can go against me, because it’s a bit like you’re trying to do something and then you know that you’re struggling to do something.  And people go.. they don’t accept it.”

Participant 13

Sometimes I would.. if I’m not well, if things are a bit on top of me, in front of my colleagues I will say to them I have a headache, rather than go about the arthritis thing.”

Participant 10

These findings regarding the invisibility of the condition led the report to make several recommendations, including the need to employers and line managers to be more proactive in providing support, as sometimes individuals would be unwilling to come forward and identify their MSD as being the source of their problems. In my next blog, I’m going to explore the report further by discussing a subsequent set of findings related to the self-management of chronic conditions in the context of work – the crucial, yet often overlooked, relationship between workers and line-managers.

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People with chronic MSDs compromising their health to keep their jobs, new report reveals

Friday, September 5th, 2014

The government, the NHS, and employers are failing to provide the necessary support for people with chronic MSDs (musculoskeletal disorders)* to stay in work. This is according to a new report released today (Friday 5th September) by Lancaster University’s Work Foundation and the Fit for Work UK Coalition. The findings also indicate that some patients are putting their health at risk to hold on to their jobs.

Update: Commenting on the report, Sue Browning, deputy chief executive of the CSP, said: “Physiotherapists are experts at keeping people healthy in work, or facilitating a return after sickness absence, and it is very important that employers provide staff with fast access to occupational health services (…) The NHS should also make self-referral to physiotherapy available across the country”. Read the full statement of Sue Browning on the Chartered Society of Physiotherapy website.

Professor Stephen Bevan, director of the Centre for Workforce Effectiveness at The Work Foundation and founding president of Fit for Work UK, said: “Workers with MSDs often find themselves fighting a lonely battle to remain in work. The government, employers and clinicians should make it a priority to support them to remain in employment after diagnosis”.

Currently, Britain is losing 30.5 million working days a year to MSDs, which are the leading cause of sickness absence, according to the Office for National Statistics (ONS)**. Today’s paper shows that employers, in particular small organisations, have little knowledge about government schemes such as “Access to Work” and are insufficiently prepared to manage chronic conditions in the workplace. Many workers admit to being reluctant to ask for help from their line managers for fear of stigma, negative judgement and job loss. Others said they had to involve their union to get the necessary support or move into self-employment.

The interviews conducted for the report released today highlight that, unless action is taken, individuals’ health conditions and quality of life will continue to be damaged by work, with some leaving the labour market prematurely. The consequence of the status quo is an increase in productivity loss, sickness absence and, ultimately, the welfare bill.

One employee interviewed in the report said: “Last year, the team were very understaffed some individuals went off sick. I think the pressure to try and do other people’s jobs as well as your own just got too much for me. It was a very stressful time to me and that made my illness a lot worse”. Another explained: “It’s a bit rule by fear in this department these days. They’ll try and get rid of you if you’ve been off too long with your health”.

Kate Summers, research officer at The Work Foundation, commented: “Individuals with chronic MSDs will go to great lengths to remain in work. They will give up aspects of their family and social life, and they will even take roles below their skill set. This is because work can bring many benefits – be they financial, psychological or social. These benefits are undermined if individuals are working in a environment that is not good for their health”.

The report makes four recommendations:
1. The government should increase participation to initiatives like “Access to Work” and should provide extra assistance for employees working in small and medium enterprises;
2. The government should also ensure that work is viewed as a “clinical outcome” by clinicians and invest in more “specialist nurse” roles;
3. Employers should consider all necessary workplace adjustments and offer career development opportunities for people with chronic MSDs;
4. Clinicians should view it as part of their role to ask patients about their work lives.

The authors of the paper also added that they welcome the government’s new Health and Work Service in England and Wales, but that it needs to focus on sustained return to work outcomes.

The report is being previewed on Friday at the conference “Self care & resilience: How we can care?” organised by the College of Medicine at the King’s College, in London

– ENDS –


Notes to the Editors:

1. Kate Summers, research officer, is available for interviews, briefings and written comment.
3. The paper is part of a national campaign led by Fit for Work UK, informing the public debate on dealing with the growing burden of MSDs and calling for coordinated action across all main political parties in the UK.
4. *Musculoskeletal disorders (MSDs) cover around 200 disorders that affect the joints, bones, muscles and connective tissues. MSDs include back pain, arthritis, osteoarthritis, ankylosing spondylitis, injuries caused by trauma, such as fractures, and other conditions that are the result of genetic or developmental abnormalities, as well as bone and soft tissue cancer.
5. ** The “Sickness Absence in the Labour Market” report.
6. The Fit for Work UK Coalition is an active partnership of healthcare professionals, policymakers, employers and advocacy groups founded in 2007. It supports people with long-term conditions, particularly musculoskeletal conditions. Their members are: AbbVie, the Arthritis and Musculoskeletal Alliance (ARMA), BT Group, Capita, the Chartered Society of Physiotherapy (CSP), National Ankylosing Spondylitis Society (NASS), National Rheumatoid Arthritis Society (NRAS), The Work Foundation, and the Royal College of General Practitioners (RCGP).
7. Lancaster University’s Work Foundation transforms people’s experience of work and the labour market through high quality applied research that empowers individuals and influences public policies and organisational practices. The Work Foundation is part of Lancaster University – an alliance that enables both organisations to further enhance their impact.

Media enquiries:

Ioana Piscociu, ipiscociu@theworkfoundation.com, 020 7976 3526, for urgent out-of-hours enquiries: 0755 178 14 06.

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Taking the strain: Measuring the impact of musculoskeletal disorders

Wednesday, December 12th, 2012

Earlier this year the Office of National Statistics (ONS) confirmed that musculoskeletal disorders (MSDs) remain the single most important cause of absence from work among UK workers. Looking at the human stories behind these statistics is very important and our new Fit for Work report, ‘Taking the strain: the impact of musculoskeletal disorders on work and home life‘, draws on a survey of 809 people living with MSDs in the UK. It finds them eager to work, but largely unsupported by public services.

Representing the government at the report’s launch was James Wolfe from the Department for Work and Pensions, alongside three members of the Fit for Work UK coalition: Phil Gray, from the Chartered Society of Physiotherapy; Clare Jacklin, from the National Rheumatoid Arthritis Society; and Dr John Chisholm, from the Royal College of General Practitioners.

With contributions from an engaged and expert audience, we debated the problem of people with MSDs dropping out of the workforce prematurely, and considered what government could do to stem this loss. In these tough economic times and with restrained public spending, ensuring public services help keep people in work was felt to be common sense. Many agreed the NHS needed to be further incentivised to support return to work, for example by allowing NICE to consider work outcomes and incentivising commissioners to prioritise job retention and return to work through the new Commissioning Outcomes Framework.

Meanwhile, many in the audience regretted the delay in the government’s response to Dame Carol Black and David Frost’s Sickness Absence Review. There were hopes this would soon be addressed, and that a positive announcement on an Independent Assessment Service, as recommended by the review, would be forthcoming. The mood of stakeholders at the launch was one of determination, but also of frustration. There is now a huge body of evidence on cost-effective interventions that can help people with long-term conditions to retain their jobs and be productive at work. All that seems to be missing is the political will to coordinate action across government and to effect change. This is what the Fit for Work UK coalition will be tackling in the coming months, so watch this space!

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EVENT: Musculoskeletal disorders – The true extent of the societal burden

Friday, November 16th, 2012

Monday, 10 December 2012

The Work Foundation, 21 Palmer Street, London, SW1H 0AD

Speakers include:

James Wolfe, Deputy Director for Health, Work and Wellbeing, Department for Work and Pensions
Phil Gray, Chief Executive, Chartered Society of Physiotherapy
Clare Jacklin, Director of External Affairs, National Rheumatoid Arthritis Society
Dr John Chisholm, RCGP Council Member and Health and Work Lead
Stephen Bevan, Director, Centre for Workforce Effectiveness, The Work Foundation

The context:

With the Government’s response to the Sickness Absence Review expected shortly, and debate on where employment features in the proposed Commissioning Outcomes Framework, this event will address the impact of musculoskeletal disorders and the implications for long-term health care and welfare spending.

Our new report includes new patient survey data and is part of a major study conducted by The Work Foundation across over 30 European countries. This report looks at the impact that MSDs have on the lives of UK workers, the adequacy of the treatment and support they receive, and the human and financial costs of these conditions.

Questions to be addressed:

What is the wider impact of MSDs on the households?

What are the implications of chronic disease for job quality, skills development and social mobility?

What can employers, policymakers and the NHS do to join up in tackling the devastating impact of MSDs in the UK?

This initiative is supported by a grant from the healthcare company Abbott

To book a place at this event, contact Alice Holland on 0207 976 3513 or aholland@theworkfoundation.com and include your name, job title, organisation, email address and phone number.

 

 

 

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