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Supporting Employees with Long-Term Conditions in the

Workplace

PROFESSOR KAREN WALKER-BONEDIRECTOR, MRC VERSUS ARTHRITIS CENTREFOR MUSCULOSKELETAL HEALTH AND WORK

Supporting employees with long-term conditions in the workplace: Setting the scene

Plan

• A (real life) case history

• Work is important for health

• Disability for work in the UK

• What do the patients tell us?

• Disclosure and the legalities

Plan

• A (real life) case history

• Work is important for health

• Disability for work in the UK

• What do the patients tell us?

• Disclosure and the legalities

My patient’s story

• 51 year old female, highly qualified employee in Local Authority role

• Team leader: 8 people

• Worked in this job for 18 years full-time

• Commutes by car (30-40 minutes each way)

• Married, 1 daughter

Clinical and educational history

• Presented with JIA aged 14 years

• Disease stabilised well on methotrexate in childhood and adolescence

• Left school with A-Levels and went on to University to do a degree

• Completed training as social worker

Progression

• Arthritis remained very stable (was able to stop methotrexate and conceive her daughter)

• 13 years ago, then aged 37, disease “flared up”

• Commenced on anti-TNF therapy with adalimumab and, in combination with methotrexate, arthritis controlled

• Stable from then until last year

Current picture

• 16 months ago, now aged 49, asked to switch adalimumab to biosimilar with £3,000 per annum cost saving to NHS

• Around same time, daughter (aged 15) taken ill and diagnosed with acute leukaemia

• After switching, she experienced an acute flare of arthritis: severe pain, stiffness, fatigue and immobility

• Needed to take 15 weeks off work to recover

• Returned 4 days/week after phased return

• Ongoing problems with arthritis

Work situation

• Asked for light-weight laptop, car parking nearer to offices, voice activated software, working from home one day/week

• Needed to keep team leadership active therefore needing conference software

How did the employer respond?

• Written letter of warning: starting disciplinary procedures – too much sickness absence

• Previously supportive line manager seeming hostile and distant

• Relationships in office “strained”

• Arthritis failing to stabilise despite new medications

Impression

• Highly skilled employee with vast experience doing an “important” role – part of her identity

• Inflammatory arthritis has been easy to control for many years

• Under stress from her daughter’s illness aggravated by events at work

• Rheumatologically, now challenging to manage the disease

• Angry, emotional, desperate

• Feeling “abandoned” by colleagues and employer – affecting self-esteem and health

Plan

• A (real life) case history

• Work is important for health

• Disability for work in the UK

• What do the patients tell us?

• Disclosure and the legalities

Work and health

• Work is central to human existence

• It is the motive force for all economies and provides structure and meaning to individuals and societies

• Good for health and well-being

• Good for financial health

• Good for families

• Socially inclusive and ‘a right’

Black C. Working for a Healthier tomorrow, 2008

Being out of work is bad for health

The effects of unemployment on health

• Associated with poorer health and wellbeing

• Worse levels of pain

• Higher mortality : 5-10 years reduced life expectancy

• 2-3 fold higher risk of chronic disease

• 3-fold risk of psychiatric morbidity

• Higher medical consultation and hospital admission rates

Unemployment

Mental illness

Worklessness

High personal debt

Suicide x2Self harm x10

Re-employment improves health outcomes

• Being back in (good) work improves health and wellbeing

• Facilitates independence

• Reduces need for healthcare intervention

• Work is part of recovery (hence phased return to work)

NB: Good work is good for us..

Plan

• A (real life) case history

• Work is important for health

• Disability for work in the UK

• What do the patients tell us?

• Disclosure and the legalities

Source: OECD (2014), Mental Health and Work: United Kingdom, Paris: OECD Publishing. Courtesy Shruti Singh

New UK disability claims are among the highest in the OECDNew claims per 1,000 of the working-age population (inflow rates),

latest year available

0

2

4

6

8

10

12

OECD

average

UK: Disability burden

Earlier intervention could

improve this

Causes of disability for work

Proportion of people who will return to work in relation to duration of sickness absence

83.3

50

30

10

0

10

20

30

40

50

60

70

80

90

1.5 6 12 24

Duration sickness absence (months)

%

Plan

• A (real life) case history

• Work is important for health

• Disability for work in the UK

• What do the patients tell us?

• Disclosure and the legalities

Work Matters: RA and JIA

• >1200 RA and JIA patients

• 63.3% in paid employment

• 7.6% self-employed

• 17.3% out of workplace due to RA

• Most had disclosed (96%)

• 39% reported ‘no understanding’ from employer

• More likely coping at work if: understanding employer, reasonable adjustments in place and accessible and comfortable work environment

• Remaining at work giving financial security and sense of purpose

https://www.nras.org.uk/publications/work-matters

Work Matters: 5 main challenges

• Demanding role

• RA symptoms

• Lack of reasonable adjustments

• Commuting to/from work

• Lack of understanding employer or colleague(s) at work

Chronic pain patients

• Work is important to them

• Not enough support from healthcare professionals to enable them to work

• Work rather “ignored” in the consultation –focus on health outcomes (e.g. pain VAS)

Plan

• A (real life) case history

• Work is important for health

• Disability for work in the UK

• What do the patients tell us?

• Disclosure and the legalities

Disclosure and legalities

• Most people with a long-term condition would be eligible for protection under the Equality Act 2010 IF they declare their ‘disability’

• Still a difficult discussion for patients.. They are often frightened to disclose and may need support /resources to enable and empower them

• You can communicate with the employer but only do so THROUGH the patient (confidentiality) and leave to them to decide whether they share or not with employer

Equality Act

• Under the terms of the Equality Act someone is termed 'disabled' if they have a ‘physical or mental impairment’ which can have a ‘substantial and long-term adverse effect on that person’s ability to carry out normal day-to-day activities’. Normal day-to-day activities can include:

• walking or driving

• washing or getting dressed

• cooking or eating

• using public transport

• writing or typing

• carrying or moving things

What does the Act say?

• An employee with a disability is entitled to “reasonable adjustments” to enable them to participate in work to the same extent as workers without a disability

What are “reasonable adjustments..?”

All healthcare professionals should…

• Always ASK their patients about work every time

• IF they are not working, do they want to?

• What are the barriers?

• Are they struggling at work?

AND: Ask questions to establish if:• Work is a likely cause of a health problem• Work has aggravated an existing health

problem• Their health problem has an effect on the

ability to do a job

Proportion of people who will return to work in relation to duration of sickness absence

83.3

50

30

10

0

10

20

30

40

50

60

70

80

90

1.5 6 12 24

Duration sickness absence (months)

%

Conclusion

• Work matters to everybody and facilitates health and wellbeing

• Part of our responsibility to enable patients to work if they wish (NOT force them if they don’t)

• Many services available to signpost people towards but region-specific

• You do NOT need to become expert but you do need to ASK about work and be prepared to do some supporting and sign-posting

• WORK is becoming a health outcome and physiotherapists can be on the vanguard

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/564038/work-and-health-green-paper-improving-lives.pdf

• Prof Jo Adams

• Prof Nigel Arden

• Dr Serena Bartys

• Prof Steve Bevan

• Prof Cecile Boot

• Prof Marijn de Bruin

• Prof Anthony Bull

• Prof Kim Burton

• Prof Susan Cartwright

• Prof David Coggon

• Prof Cyrus Cooper

• Prof Philip Conaghan

• Ms Stefania D’Angelo

• Dr Linda Dean

• Mr Maciek Dobras

• Dr Steve Duffield

• Dr Jo Erwin

• Prof Nicola Fear

• Dr Ira Madan

• Dr Kathryn Martin

• Dr Jane Martindale

• Prof Alison McGregor

• Prof Sigurd Mikkelsen

• Prof Rob Moots

• Ms LaKrista Morton

• Dr Fehmidah Munir

• Ms Lisa Newington

• Dr Georgia Ntani

• Dr Enrica Papi

• Dr Vaughan Parsons

• Prof Katherine Payne

• Prof George Peat

• Dr Yeliz Prior

• Prof Lisa Roberts

• Ms Lisa Shipway

• Prof Nadine Foster

• Prof John Goodacre

• Dr Nicky Goodson

• Dr Richard Graveling

• Prof Alison Hammond

• Dr Clare Harris

• Dr Richard Heron

• Dr Paula Holland

• Dr Rosemary Hollick

• Prof Matthew Hotopf

• Dr Kassim Javaid

• Ms Cheryl Jones

• Dr Gareth Jones

• Dr Cathy Linaker

• Prof Ewan Macdonald

• Prof Gary Macfarlane

• Dr Jo Shim

• Dr Julia Smedley

• Dr Mike Smith

• Mr Martin Stevens

• Dr Holly Syddall

• Prof Allard van der Beek

• Dr Suzan Verstappen

• Dr Elaine Wainwright

• Mr David Warwick

• Dr Ross Wilkie

• Dr Daniel Whibley

• Prof Tony Woolf

• Dr Gwen Wynne-Jones

• Ms Elena Zaballa

Thank you

https://www.mrc.soton.ac.uk/cmhw/