1. “Fit for Work Ireland” The Institute of Physical Therapy & Applied Science Croke Park April 2014 John Church – CEO, Arthritis Ireland

2. Arthritis Can Strike at any Age

4. Arthritis is a serious chronic disease..... Arthritis is a cause worth contributing to..... Arthritis Ireland is the solution..... Arthritis – The Challenge

5. Arthritis Ireland Working on a Cure Advocacy & Awareness Community

6. Arthritis Self-Management Courses Since 2006.... people courses

7. Moving is the Best Medicine Water Exercise Programme Community Exercise Programme

8. Moving is the Best Medicine

11. Fit for Work Ireland - Background 2009 Research carried out by The Work Foundation Fit for Work Europe, 24 countries Focus on Musculoskeletal Diseases (MSDs) only Report findings launched at Dublin Castle April 2011 Arthritis Ireland formed Coalition of key stakeholders Supported by Abbvie and Irish Life Corporate

12. Fit For Work Ireland Coalition Physician and Allied Health Groups Employers and Trade Unions Private Health and Life Insurers Patient Organisations Policy Makers The Fit for Work Coalition is supported by an on-going grant from AbbVie and Irish Life Corporate

13. Key highlights from the Fit For Work Report MSD’s are the most commonly reported cause of work related ill health in Ireland – costing the economy €750 million a year – 7m lost working days per annum MSD’s account for twice the number of days lost than through stress 25% of people with RA stop work within 5 years Full time employment amongst people with RA is very low at 22% Ireland has a low ratio of rheumatologists per head of population in Europe – 1 per 134k versus 1 per 80k optimum (W.H.O.) MSD’s will increase in Ireland- By 2030 greater than 60% will be over the age of 50

14. MSDs a Significant Issue at Work Social Welfare payments significantly increased since 1992 – 100k to c. 300k (number of claims) – €500m to €3.5b (expenditure on claims) – 1/3 rd of all Illness Benefit payments migrate to Long term Disability Benefit payments (€640m in total paid in 2009) MSDs account for 31% of all claims (49% EU average) – 7m lost working days per annum – €275m (2009 data) – 22 weeks V 11 weeks average duration of payment 4 weeks absence the key factor – C. 10% of workforce out absent for more than 28 days – 57% of all claims > 28 days – but 96% of total value

15. Fit for Work Ireland – Focus Areas Fit for Work Coalition focussed on two key work streams – Sickness certification guidelines – Case Management Early Intervention Sickness certification guidelines – GP guidelines prepared and submitted to the ICGP QIP committee – Proposed new Sickness Certificate Case Management Intervention – Potential savings of €178m in full year implementation at costs of €12m – 15:1 return on investment

16. Fit for Work – The Bigger Picture The potential annual savings arising from a coherent programme are of the order of €280m – over a quarter of a billion Euro. That estimate is in the same ball park as the estimated yield this year from the Local Property Tax. It does not include the benefits – personal, economic, social and fiscal, arising from improved competitiveness through the participation of skilled people in the work force and their better physical and mental health and well being...... Dr Don Thornhill, Chairman of National Competitiveness Council

17. Case Management Intervention Model Basic Absence Management Intervention after 4 weeks absence – OH Nurse Specialist contacts employee – 10% reduction in absence expected – €89m savings at a cost of €3m Enhanced Case Manager Intervention with MSD service – Above plus appropriate intervention such as Physio/OT/EAP – 20% reduction of absence expected – €178m savings at a cost of €12m Proposal for DSP to implement a pilot in a region covering c. 10,000 cases – 3 nurses and 3 administrators at a cost of €375k – Control and test location – External agency to manage pilot

18. Case Management Model ( Intervention at 4 weeks ) Employer/ DSP Basic Absence Mgmt Case management required ? Return to Work Enhanced Case Management Physio/OT/EAP OHS to employer CMS OHP Employer HR H&S Treating doctors Outcomes Fit RTW now Target date set Review Yes No Savings 10% reduction or €89m20% reduction or €178m > 4 weeks

19. Early Intervention – Case Studies DAA active injury and absence management programme 1.25% reduction in overall absence 2.62% reduction in LT absence Department of Education introduction of national OHS 1.17% reduction in overall absence 2.>70,000 days pa 3.12 fold return on investment based on teacher substitute savings alone Royal Mail 1.Absenteeism reduced from 7% to 4.5% over 3 years with savings of over €270m

20. MSDs – The Window of Opportunity 11.9% of all adults 18+ were clinically diagnosed with an MSD, in next 10 years this will rise to 12.6% (Institute of Public Health) MSD’s will increase in Ireland- By 2030 greater than 60% will be over the age of 50 Currently no national policy on intervention or integration between health services, employer and employee What if we could reduce the duration of illness payments on MSDs from 22 weeks to average of 11 weeks??

21. Early Intervention is Key Better health outcomes for employee Earlier return to work Substantial cost savings

22. Mini Marathon

23. Thank You John Church – CEO, Arthritis Ireland