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Fit For Work EuropeThe Work Foundation

Fit EU Blog

Discourse on work and wellbeing in the EU

Archive for July, 2013

NICE to examine employers’ role in improving the health of employees – but what about the other parts of the puzzle?

Tuesday, July 16th, 2013

Fit for Work UK coalition chair, Professor Stephen Bevan, welcomes new NICE guidance for employers on helping people with long-term conditions to continue working, but warns that to make an impact, healthcare practitioners will need to be much more involved in their patients’ work outcomes.

The National Institute for Health and Clinical Excellence (NICE) has today finished its consultation on the draft scope of new public health guidance on “workplace policy and management practices to improve the health of employees”. This guidance, aimed at line managers and HR professionals in all sectors of business, will give advice on promoting employee wellbeing, including managing sickness absence and return to work.

This is a vital area for NICE to be looking at. As Fit for Work coalition member Steve Boorman blogged in June, at a recent think tank event on employers and health, an overwhelming number of speakers pointed to competence and capability of management and leadership as a key factor of people remaining in work. It is encouraging that this guidance is being developed and it comes soon after the announcement that the government has finally asked NICE to go beyond this traditional healthcare system perspective to take more of a societal perspective, as I blogged last month.

While employers have a key role in helping people with long-term conditions like musculoskeletal disorders (MSDs), better support from line management is only one part of addressing this issue.  It is absolutely vital to build better integration between health and work and to involve healthcare practitioners in the employment outcomes of their patients.

The Department for Work and Pensions took an important step in this direction last week, announcing a two year pilot scheme that will give people on Employment and Support Allowance (ESA) – the main benefit for people with long-term conditions or who are disabled – regular appointments with healthcare professionals with the aim of removing barriers to work.

However, the same links are not being made by the Department of Health and NHS England.  For example, although employment is a measured outcome in the National Outcomes Framework, it is not part of the Clinical Commissioning Groups Outcome Indicator Set (CCG OIS).  Healthcare practitioners are currently not being supported and incentivised to treat health as a clinical outcome.

Helping people with long-term conditions to return to or remain in work is an important issue; the impact of long-term conditions on work and productivity is only going to grow.  Just MSDs cause 7.5 million days lost due to work-related ill health each year[i], while up to 40% of people with rheumatoid arthritis leave work within five years of diagnosis[ii]. Rheumatoid arthritis alone costs the economy £1.8 billion a year in sick leave and work related disability[iii].

This is an area that no one stakeholder can tackle alone. We hope that the current Health Select Committee Inquiry on the Management of Long Term Conditions will prompt action from NHS England to join employers and the DWP in addressing this issue.

___________________________________

[i] Stress, depression or anxiety and musculoskeletal disorders accounted for the majority of days lost due to work-related ill health, 10.4 and 7.5 million days respectively http://www.hse.gov.uk/statistics/dayslost.htm

[ii] The Work Foundation: Management of Long Term Conditions- The Work Foundation’s submission to the Health Committee, March 2013 Available at: http://www.theworkfoundation.com/Assets/Docs/Reports/The%20Work%20Foundation%20LTC%20submission%20final.pdf

[iii]  “We estimate that the Rheumatoid arthritis costs the NHS around £560 million a year in healthcare costs with the majority of this in the acute sector. The additional cost to the economy of sick leave and work-related disability is £1.8 billion a year”. National Audit Office, Services for people with rheumatoid arthritis, July 2009  http://www.nao.org.uk/wp-content/uploads/2009/07/0809823.pdf

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What impact will the NICE quality standard on Rheumatoid Arthritis have on workers with the disease?

Monday, July 1st, 2013

Earlier last week the National Institute for Health and Care Excellence (NICE) published a quality standard on rheumatoid arthritis. Jamie Hewitt, government affairs manager at the National Rheumatoid Arthritis Society (NRAS), looks at the quality standard and its implications for work.

Rheumatoid arthritis (RA) is a chronic disease that occurs when the immune system attacks the body instead of defending it, causing inflammation that often results in serious damage to bones, joints and tendons, and can also affect internal organs like the heart, eyes and lungs. Currently the disease affects an estimated 690,000 people across the UK.

To date, outcomes for RA patients in the English NHS have been very mixed, resulting in very negative impacts on people’s ability to work in the long term. Although the disease can strike at any age from the age of 16 upwards, three quarters of people with RA are first diagnosed when of working age – with the largest cohort being over 40 years old – at the height of their wage earning potential.

Indeed the National Audit Office has calculated that sickness absence and worklessness caused by the disease amounting to an estimated £1.8 billion per year. Additional NRAS research has also found that almost a third of people with RA have given up work as a result of their disease, with well over a quarter doing so within one year of diagnosis, and over half doing so within six years.

Ensuring people are able to stay in work is therefore absolutely vital – but not just in pure economic terms –the psychological impact on patients is also important. For instance, an NRAS survey of members with the disease found that 88 per cent of respondents said that having a job helped them cope with the disease with incidences of depression are significantly higher among non-workers than workers.

So how does the new NICE quality standard on RA help? Put simply, it contains seven quality statements that, if implemented, should deliver high quality care to people with RA who show early signs and symptoms of the disease. We hope they will improve clinical outcomes for patients and enable them to stay in work, or make a swift return to work.

The new document places particular emphasis on early diagnosis and treatment. It recommends that people with suspected persistent synovitis be referred to a rheumatology service within three working days of presentation, be assessed by a rheumatology services within three weeks of referral, and offered disease modifying anti rheumatic drugs within six weeks of referral.

These statements reinforce the mantra of treating patients within the 12 week ‘window of opportunity’ from symptom onset as identified in existing NICE guidelines on RA. The existing guidelines point out compelling evidence that patients who are given treatment within 12 weeks of experiencing symptoms stand a much better chance of recovery. In practice, this means that patients can have a much better quality of life, including the ability to hold down employment and be free from the effects of substantial, irreversible joint damage.

By setting out the maximum time that should elapse between each stage of the referral process we hope that patients and healthcare professionals will be better able to identify delays, and put in processes to reduce and eliminate unnecessary delays. Properly implemented, the new NICE quality standard could lead to significant improvements in work outcomes for these patients.

However, a word of caution. Although we strongly welcome the introduction of the NICE quality standard, it is not a silver bullet. Earlier last week, to coincide with the launch of the first ever national RA Awareness Week, NRAS published a report about public awareness of the disease called ‘Breaking Down Barriers’. The report notes the significant challenges to improving clinical outcomes (and associated work outcomes) posed by the patient themselves. Poor public awareness of the disease symptoms means that half of all patients delay seeing their GP for around 12 weeks. A fifth delay seeing their GP for a year or more. At a stroke, the 12 week ‘window of opportunity’ can quite literally go straight out of the window.

The job is not yet finished. Yes, effective systems need to be put in place which incentivise speedy referral, diagnosis and access to appropriate, effective treatments. But at the same time this must be aligned with greater public awareness of the disease in the first place. Only through a combination of the two are we likely to see dramatic improvements in work outcomes for RA patients.

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