Fit for Work

Dr Paul Williams – Chief Medical Officer MaximusChris Rhodes- Chief Nursing Officer8th October 2015

Introduction

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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)

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• 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

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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

What if the employee already has access to OH?

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• 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

Scope

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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?

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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….

The team and assessmentsKey facts

AssessmentAdditional questionnaires

Assessment

General

Health

Social

PsychologicalPHQ-9

(depression)

PSEQ

(pain)

Suicidal ideation

Audit

(alcohol)

EQ-5D(functional issues)

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• 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

Some examples….

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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

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• 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)

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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

What have we learned in the last 12 months?

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• 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

Fit for WorkAny questions?

Thank you for your time.

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Trent Occupational Medicine Symposium

8th October 2015