Working with Health Professionals to Reshape Health Services Anna Tebay Work for Health Programme Lead - GMPHN 1

GMPHN – Who We Are GMPHN is a collaborative organisation that works on behalf of the 10 Greater Manchester Directors of Public Health to ensure that public health has a strong and credible voice with national, local and regional partners We work with local partners to help reduce the impact of ill health on individuals and to support the Greater Manchester economy 2

Work for Health Programme Aim To reshape Health Services to integrate work as part of a patients treatment plan Outcomes Focus on speeding up recovery time and helping patients better manage their health conditions (mental and physical) Helping people stay in work 3

Definitions ‘Work’ is paid or unpaid activity undertaken in a meaningful and structured way to deliver benefits to others The definition includes caring, volunteering, self employment, fostering, mentoring and wider civic engagement Long term health conditions that this project has focused on include: MSK conditions such as back & neck pain, mild strokes, asthma, COPD, diabetes, heart disease, depression, bipolar and anxiety

What We Know Good work is good for health and wellbeing Being unemployed for more than 12 months significantly reduces life expectancy equivalent to smoking two packets of cigarettes a day (Francis 2010) Individuals will often have a combination of physical and mental health conditions – and the reasons for being out of work will change (Black and Frost 2011) When an individual is unwell they make an early judgement on whether they will be returning to work, influenced by family, friends and health professionals

3 Pathfinder Sites Bolton (Farnworth), Oldham (Stanley Road), Wigan (Worsley Mesnes) 6

Insight Interviews To find out why work was not routinely included as part of a treatment plan Participants recruited from local healthcare and community settings Group and individual interviews 12 focus groups; 7 individuals Interviews transcribed Thematic analysis conducted 7

Why isn’t Work routinely included as part of a patient’s Treatment Plan? Health professionals have mixed views as to whether patients should be 100% fit before returning to work Inconsistent practice across Greater Manchester Perception that patients with the mildest health conditions are the most likely to want to work Attitudes and perceptions present the greatest barrier 8 Key Finding: Health professionals are nervous about having the conversation of work and health

Perceived Barriers: Talking Work & Health Health Professionals: Assumption that the conversation was taking place with other health professionals Perception that people would rather be on benefits than work and therefore don’t want to discuss work and health Perception that patients don’t want to return to work until 100% fit Perception that work discussions will be viewed as ‘pushing’ people back to work before they are ready Nervous about how this could damage relationships 9

Health Professionals: Health professionals are uneasy about how patients will receive non medical treatment and advice about work Unsure of how to start the conversation about work and health Uncertain of what to discuss Discussions of work and health usually take place with those perceived as the most motivated to work rather than those that would benefit the most 10

Perceived Barriers: Talking Work & Health Individuals: Individuals perceive health professionals as not having the time or desire to discuss anything non medical Work not seen as something that health professionals would provide advice on Thought that health professionals would be more likely to discuss work and work adaptations for physical health conditions than they would for mental health 11

Testing Perceptions No examples of negative experiences as a result of raising the conversation of work and health When individuals brought up the conversation, health professionals were receptive and engaging Individuals were ill prepared for the conversation and left having wished they had asked more questions In the main, health professionals didn’t feel that work and health conversations would impact on appointment times 12

Key Finding: Both the individual and the health professional wait for a cue from the other before raising the conversation of work and health The patient was ill prepared for the conversation Conversations were not maximised to full advantage Allied health professionals were under utilised in supporting people to stay in or return to work 13

Cultural Attitudes Cultural shift is needed to normalise working with health conditions Treatment needs to consider the whole person, this includes work 14 Key Finding: Society focuses on what an illness may prevent people from doing, rather than crediting what we can do Most of the barriers that we identified are around having the conversation of work and health The second phase of the work for health programme focuses on mechanisms to alleviate these barriers

A Suite of Evidence Based Tools Developed with and for health professionals Roll out across Greater Manchester

Work for Health Training Conference events to obtain ‘buy-in’ GP peer led discussions Allied Health Professionals (AHP) Psychological Practitioners Core training programmes Joining up practice GP’s and AHP’s Public Health colleagues 16

Work for Health Conversation Guide Developed by Salford University Assess values and beliefs the patient holds about work Gears the conversation as a solution focused approach after identifying concerns 17

18 More than a quarter of the 28 million workers in this country are managing a long term health condition or impairment For too long we have assumed that people with health conditions should be protected from work. The reality is that work can be good for health, aid recovery and support people to manage their conditions better

Commissioning Framework A health systems approach that focuses on promoting and integrating good clinical practices which will help individuals remain in or return to employment during periods of physical or mental ill health This framework seeks to address the identified gap between evidence, guidelines and health care practice Aims to create dialogue between commissioners to reinforce that mental and physical health often can not be disaggregated 19

Summary Work for Health principles will be embedded within practice as a sustained approach All aspects of roll out will be monitored and evaluated Learning will be shared with other regions for best practice and utilisation 20

Questions? Anna Tebay – Work for Health Programme Lead, GMPHN