Fit for Work Dr Paul Williams – Chief Medical Officer Maximus Chris Rhodes- Chief Nursing Officer 8th October 2015

Introduction

What was the driver for creating Fit for Work? More than 900,000 absences of four weeks or more each year in the UK Much reduced chance of no return to work after 4 weeks without intervention and 600,000 people fall into our benefits system each year For most people, their work is a key determinant of self-worth, family esteem, identity and standing within the community, besides, of course, material progress and a means of social participation and fulfilment (Dame Carol Black, 2008) Presentation title

Fit for Work aims to ensure some form of OH intervention is available to all – currently OH services are available to around 30% of the UK population Part of the aim is to support employees back into work without always requiring 100% fitness to achieve this All assessments use a bio psycho social approach to ensure that these factors and behaviours are considered and the approach is Case Management Presentation title

What Fit for Work cannot do No health surveillance/ statutory medicals Assessment of fitness for employment Short term absence referral support Case Management after the 3 month point of an absence Health promotion activity Presentation title

What if the employee already has access to OH?

The initial referral to Fit for Work will always proceed Our aim is very much to complement existing OH services and not replace If it is established that there is access to OH services – the Case Manager will suggest the employer refers on for any further action With the employee consent, Fit for Work may contact OH services directly With consent, a copy of the report can be shared with the OH provider, or the employee can forward directly to OH services Presentation title

Scope

Service Scope: what the DWP has asked for An Advice Service – phone line and website – open to all, for general queries about matters affecting work and health A voluntary Return to Work Service for employees who are off work due to sickness GPs can make referrals at any stage, at the GP’s discretion, when the absence is likely to last for 4 weeks or more (but ideally certify for 1-2 weeks) Employers can make referrals after 4 weeks of sickness absence Not for the self-employed, and no self-referrals The output of the service is a Return to Work Plan agreed with the employee, which functions as evidence of fitness for work

Advice Line – range of questions?

Application of safety guidance and Regulations within SME’s Range of queries SSP queries Fit Note queries Application of safety guidance and Regulations within SME’s Support for SME’s with policy development for attendance management Alcohol / substance misuse issues with staff Advice following receipt of a fit note with ‘stress’ Occasional curved balls…. Presentation title

The team and assessments Key facts

Assessment Additional questionnaires General Health Social Psychological PSEQ (pain) Audit (alcohol) Where the Case Manager has identified obstacles that they believe need to be better understood e.g. ones in diagram above They have the option to use further specialised industry standard assessments (evidenced based questionnaires) to assist in their management of the case and assisting the employee with their overcoming these and RTW - PLAN – DO - ACT EQ-5D (functional issues) PHQ-9 (depression) Suicidal ideation

Predominantly telephone assessments – but face to face can be arranged with partner services Current headquarters in Sheffield with satellite office in Cardiff. Further centres may open next year and home based staff likely to come on board early next year All Case Managers must be a registered health professional with a minimum 2 years post registration experience and every team has specific OH expertise Presentation title

Some examples….

Presentation title

No apparent social issues and GP unable to support further Case study Alice, 20 years old – absent for 2 months with a fit note for borderline ‘POTS’ (Postural tachycardia syndrome) History of GP support for previous low mood and mood gradually declining during absence Employer unwilling to allow back into the workplace as there is an ongoing risk of collapse No further medical management required and discharged with no planned follow up from the Cardiologist No apparent social issues and GP unable to support further Presentation title

Employer engagement key to success Supported with risk assessment to look at danger within the workplace Postural condition so risk of collapse minimal Risk of harm in the event of collapse not life threatening Successfully back at work with minimal adjustments (cessation of lone working/physical exertion) Presentation title

Julie – 53 yr old Care Worker in Rhyl 2 week initial GP certificate – ‘muscle pain’ Had been medically managed for leg pains for some months Pain at work not a significant issue – but poor sleep, fatigue and difficulty in resting at work made 12 hour shifts a problem Despite unlikely EA application – plan suggested employer could consider max 8 hour shifts Employer very willing to accommodate long term and offered alternative shift pattern to support busiest shift times Very simple issue/solution Presentation title

What have we learned in the last 12 months?

People off work are generally busy people Simple employer engagement is incredibly powerful Being busy is good Undoing a medical model of assessment takes time and patience Good motivational interviewing is priceless To love audit Success at Fit for work isn’t particularly sexy – its about large volumes of simple assessments, advice and support to return to work Presentation title

Fit for Work Any questions? Thank you for your time.

Trent Occupational Medicine Symposium 8th October 2015