Writing Fit

You can download a copy of the Lithuanian report by clicking here.

Today was a busy day for those of us keen to spread the word about MSDs at work. In London the Work Charter was launched by the Arthritis and Musculoskeletal Alliance. The Work Foundation is happy to support it as it strongly echoes messages from our own Fit for Work? Research which has looked at the factors which help or hinder full participation at work among the 6.5 million UK citizens who have MSDs. There was good coverage of the report on the BBC website.

Meanwhile, in Brussels, I was presenting the results of our EU research to a ‘special interest group’ of MEPs in the European Parliament. Also presenting was Mr. Armindo Silva Head of Unit Social Protection and Inclusion Policies, Employment and Social Affairs Directorate. He explained how the new Directive of MSDs was being drafted and consulted on. I presented some of the key findings of the Fit for Work Europe report, highlighting in particular the need to focus on early intervention. Several MEPs spoke in favour of our findings on the links between MSDs and Mental Health and expressed interest in hearing more on this topic. Finally, Mr Marios Kouloumas, Chairman of Eular-PARE – speaking on behalf of people with Rheumatic diseases – explained the importance of taking into account the patient perspective in policy-making, emphasizing that Rheumatic and inflammatory conditions are not caused by work, but can make staying at work difficult if insufficient support is available. This was a very important point because the forthcoming MSD Directive only covers MSDs which are caused by work and not, by definition, Rheumatic conditions. I find this troubling, and it remains to be seen how this serious omission is dealt with by the European Commission.

I recently spotted coverage of this research, published in The Lancet. It suggests that ‘talking therapies’ such as Cognitive Behavioural Therapy (CBT), especially in group settings, can have a positive impact on recovery from chronic low back pain.

This chimes with the findings of our Fit for Work research which has sought to emphasise the importance of understanding the mental health issues frequently faced by people with MSDs. We found that, for some people, being diagnosed with a chronic condition can increase the risk of depression and anxiety. As a result, people at work might fear disclosing their condition to their employer. In addition, there is evidence that poor mental health can be a bigger barrier to rapid and successful return to work than the physical symptoms of an MSD.

At the launch of our European report in September 2009, Professor Jover from Spain presented data which illustrated that an early intervention for MSDs patients which included a CBT component made a significant difference to return to work rates and yielded a notable economic return. In the autumn of 2010 The Work Foundation will be publishing the results of a further study which is examining the links between chronic conditions and mental health in more detail. Watch this space!

Occupational Health [at Work] has published an article detailing the key findings of the Fit for Work initiative. You can download the article here.

The guidance issued by NICE on mental health in the workplace is very timely and helpful. Among other things, the material highlights the significant cost to business of condtions such as depression and anxiety, and advocates early intervention as a crucial step towards keeping people in work.

One area is, perhaps, under-emphasised and that is the relationship between mental health and chronic musculoskeletal pain CMP). Over 100m people in Europe have CMP, with over 40 percent of these remaining undiagnosed. A significant number of people with MSDs also develop mental health problems - indeed this can inhibit return to work long after physical pain has abated.

So, care of people with both MSDs and Mental Health must be better integrated. I’ll be making t is a point I’ll be making on Friday (6th Nov) at the 9th International Conference on Integrated Care in Vienna

On Tuesday, Dame Carol Black and I participated in a Roundtable event in the House of Commons - the seat of the British Government.  This was a well attended, lively event and I was given the opportunity to make the following speech about the Fit for Work programme:

“For last 18 months The Work Foundation has been conducting research across 23 countries examining the impact of MSDs – including Inflammatory Diseases – on labour market participation. Rheumatoid Arthritis (RA) was one of the conditions we examined in detail because we know that levels of work disability and withdrawal from the labour market are high among people with RA – up to 40% within 5 years of diagnosis.

We’ve been looking at the direct and indirect costs of sickness absence from work and of permanent work incapacity attributable to RA. We have also looked at the interventions which Governments, clinicians and employers can take which can keep people with RA attached to the labour market and help them lead fulfilling working lives and make their contribution to a productive economy.

We launched our report in Brussels two weeks ago and we are trying to influence both National Governments and the European Commission to support steps which maximise the Labour Market participation of people with RA. We are doing some of this Advocacy work in collaboration with EULAR.

A key issue (one of many) is that current employment legislation in EU does not recognise MSDs which are not caused by work. Manual handling (CLBP) and Display screen equipment (WRULDs) are in scope – but the duty of care to support those with pre-existing conditions – such as RA – where poor working conditions can make these conditions worse, is currently out of scope.

Good Work is good for health: this includes control over tasks, control over pace & time; manageable physical work demands & an ergonomically suitable working environment; flexibility of working time.

We must reverse the focus of policy & practice from Incapacity to Capacity – the UK ‘fit note’ idea is intended to reinforce this message.

People with MSDs – including RA – can also experience periods of depression or anxiety which can complicate the process of returning to work. Policy-makers, clinicians & employers need to build this into the way they manage job retention & return to work (RTW).

Up to 30% of people with RA avoid disclosing their condition to their employer or colleagues – part of the self-stigma experienced by many.

Early Interventions can be critical, for example:

• Accurate & early diagnosis
• Early access to treatments and therapies – especially if early symptoms can be arrested and remission achieved
• NAO data shows that early treatment brings economic & productivity benefits
• TWF shows that early intervention can prolong careers and delay premature withdrawal from the labour market and that there is an economic ‘premium’ to early intervention.

There is considerable political focus on incapacity in the UK at the moment, especially as we are seeking to reduce public expenditure. However, as long as the debate has a punitive tone and is dominated by speeches and newspaper articles which focus on getting the feckless & ‘workshy’ off benefits and back into work, we are going to struggle to address the far more serious issue of how we avoid people with long-term and chronic health conditions becoming detached from the labour market until way after this recession is over.

During the Fit for Work study I’ve met hundreds of people with RA and other inflammatory conditions. None have been feckless or ‘workshy’. Most have been energetic, passionate, proud, determined, analytical, resourceful and dignified. I have been privileged & humbled to work with them & I am all too aware of the talent that goes to waste if people like this are lost to the world of work.”

Minister Milquet, Ladies and Gentlemen; Distinguished Members of the European Parliament; Mrs Parvanova, Mrs. de la Mata, Mr Hutton, Distinguished       Guests, welcome to this reception, which marks the launch of the Fit for Work pan-European report – a remarkable analysis of the social and economic impact of musculoskeletal disorders (or MSD’s) in Europe.
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SHOW YOUR SUPPORT!

Read or download our call to action and pledge to get Europe Fit for Work!
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Policymakers, employers, health professionals, and patients must act collectively to ensure
continued active participation in work and society and a high quality of (working) life. These are
the preconditions for both physical and mental health, fulfilment, prosperity and social cohesion.

Read and download the call to action below:

[18.30 Tom Ling]  An excellent final session that demonstrated, once and for all, the case for action on MSDs at a European and National level.  Now our task is to work together to find those concrete actions that will move this debate along and change the way we keep people Fit for Work!
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