Health,Disease and Unemployment: the Bermuda Triangle of Society

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Health,Disease and Unemployment: the Bermuda Triangle of Society Jonathan Shapiro Health, disease Emma Hill and unemployment: Julia Manning The Bermuda Triangle of Society Supported by a grant from Health, disease and unemployment: The Bermuda Triangle of Society Jonathan Shapiro Emma Hill Julia Manning Supported by a grant from Contents 01 About this Publication 3 02 Executive Summary 4 03 Background and Context 6 Medical view 10 Good work versus bad work 12 Occupational health and vocational rehabilitation 13 Summary of Programmes designed to assist in reducing unemployment 14 Broader costs 15 04 Methodology 16 05 Why a Bermuda Triangle? 18 06 Themes 20 Generic Points 20 British attitudes to work 20 Illness and unemployment are not separate issues 21 Other themes 22 Prevention is better than cure, even with long term ill health 22 Occupational Health: whose services are they anyway? 23 Where welfare is concerned, small is beautiful 24 General practice: tinker, tailor, provider, landlord, case manager, or none of the above? 25 The flexible workplace: oxymoron or aspiration 26 Incentivising the return to work 26 07 Summary of key messages 28 The British andWork 28 Prevention is better than cure, even with long term ill health 29 Occupational health: it is broke, so let’s fix it 29 Where welfare is concerned, small is beautiful 30 The role of general practice 30 The flexible workplace: oxymoron or aspiration 30 Incentivising the return to work 31 08 Conclusions 32 09 Footnotes 34 10 Appendices 35 Appendix 1 –Work Outcomes Interview Schedule 35 Appendix 2 – Interviewees 35 11 Bibliography 38 Health, disease and unemployment: The Bermuda Triangle of society 01 About this Publication The measure of successful NHS treatment is increasingly not a case of whether a process target has been met, but whether that treatment was a success. In other words, what was the final ‘outcome’? Did the patient get better and stay well? Added to this is the crucial question for the working age population – how quickly did they get back to work? This project looked at whether being at work is or could be considered a clinical ‘outcome’ of successful health treatment. Can keeping people in work or returning them to work find its place as an indicator of a successful health intervention on which professionals or institutions can be measured? We make fourteen recommendations and observations that we believe will be of value to policy makers. The overall challenge is increasing the visibility to frontline professionals and employers of those trapped in the ‘Bermuda Triangle’ of illness, wanting to work and unemployment - rescuing or preventing them from getting lost there in the first place. We are indebted to Abbott Healthcare who enabled this research to be undertaken, and to all our sponsors for their unrestricted funding on which we depend. As well as driving our on-going work of involving frontline professionals in policy ideas and development, sponsorship enables us to communicate with and involve officials and policymakers in the work that we do. Involvement in the work of 2020health.org is never conditional on being a sponsor. Julia Manning Chief Executive June 2010 www.2020health.org 2020health.org Disclaimer 83 Victoria Street London SW1H 0HW The views expressed in this document are those of the T 020 3170 7702 E [email protected] authors alone. All facts have been checked for accuracy as far as possible. Sponsored by Abbott. The views Published by 2020health.org expressed in this document do not necessarily reflect © 2010 2020health.org those of Abbott. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means without the prior written permission of the publisher. 3 Health, disease and unemployment: The Bermuda Triangle of society The recommendations and observations that came out 02 of the interviews, discussions and analysis were: 01 The first aim of any policy change should ensure Executive that it is in the interests of the individual, the employer, and society at large to align the Summary incentives and close the loop between health, illness, and unemployment. 02 Raising the perception of control is key to Recent reports have made a huge improving productivity, and all the work on contribution to raising the profile of the leadership, engagement, and so on is actually relationship between health and work. They trying to do this. An overt focus on improving this culture would reap rapid and sustainable benefits. have highlighted how important it is that we have a healthy workforce, that health and 03 Getting patients back to productive and wellbeing are intrinsically connected and sustainable work should become a key that intervening early in illness is a key factor objective and outcome indicator for all health to recovery and the return to work, whether services, particularly the NHS. All forms of clinical education need to include this aim from in the same or a different role. their outset, and throughout both undergraduate and continuing training. With the increased calls for the NHS to be held accountable for health ‘outcomes’, the 04 An important aspect of this emphasis must be the aim of this study was to establish whether inclusion in the diagnostic process of the social and psychological aspects of an illness as well as its being at work is or could be considered physical manifestations, and treatment should a clinical ‘outcome’ of successful health be aimed at ameliorating patients’ ability treatment. Could keeping people in work or to return to work as part of returning them returning them to work find its place as an to better health. indicator of a successful health intervention 05 One essential in this regard would be the on which professionals or institutions could strengthening of direct links between the be judged? This report describes how we NHS and the Department of Work and identified the recommendations previously Pensions (DWP) , not damaging the formal links made with a view to delivering improved and relationships that have been established health and wellbeing in the workforce. We between the departments by outsourcing the joint working. then used these recommendations as a basis for interviewing experts in the field as to 06 There needs to be an acceptance on the part of the their awareness of and /or agreement with employer and of wider society that it is normal them. Their responses prompted two for the work environment and job roles to particular themes that were then taken to change as people’s careers progress , even if that entails physical change (seating, instrumentation, the front line, to test them with people etc), and changes to the terms as well as the working in health, welfare and back-to-work conditions of employment. programmes. These were: 07 OH services should be made more widely 01 ‘Occupational health medicine is available, less focused on the needs of the irrelevant to the link between health employer, and more widely based than on Occupational Health (OH)doctors alone. and work.’ This has only been partly addressed by the DH’s advice lines for small and mid-sized 02 ‘How may a return to work be enterprises (SMEs). incentivised, to the benefit of the individual, their employer, and the state?’ 4 08 Clearly, whilst there is an economy of scale in This list reflects both that significant progress has already providing services that help people back to work, been made in the understanding of the relationship the clear message from this work is that any between work and health, but also that there are benefits of size are more than offset by their noteworthy challenges ahead in changing the culture. disbenefits in terms of intimidation and lack There was universal agreement that being able to work of involvement. should be considered a health ‘outcome’. The challenge is increasing the visibility to frontline 09 There was consensus concerning the use of GP professionals and employers of those trapped in facilities as a venue for the work and advice the ‘Bermuda Triangle’ of illness, wanting to work required to help the workless get back to work. and unemployment, and rescuing them from there Their local nature and size and relative informality – or preventing them from getting lost there in the are helpful, and they could be populated by staff first place. from private and/or voluntary organisations. The idea of linking the tasks associated with the return to work to specific health care issues at a single venue was also appealing. 10 However, predicting the absence of sickness or a reduction in turnover require a leap of faith, and such faith is often the missing ingredient in introducing some of these changes. This may be one area where legislation concerning the employee benefits mentioned above may be appropriate. 11 It should be possible to introduce some kind of tapering scale as health and workfullness improve, by which welfare payments reduce as ‘real’ income grows without any step changes being triggered in a way that avoids the classic benefits trap. 12 What is required is genuine early intervention, preferably in time to preempt the whole workless phase, particularly when predictable health issues are causing the problem. There needs to be increased awareness of how important appropriate prescribing is in helping people return to work as quickly as possible. 13 It may be that medical support for such interventions could be an extension of the ‘fit note’ idea, using the GP’s imprimatur to validate such discussions, and preempt any punitive reaction by less enlightened employers. 14 With the rising awareness of and interest in work related stress, it may be that increasing the profile of the Health and Safety Executive (HSE) in this area could bring sufficient pressure to bear on employers on its prevention and more effective treatment of stress.
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