Writing Fit

We continue to take the ‘Fit for Work’ messages to National Governments wherever we can. Already, since the launch of the Irish report, we have briefed two prominent Irish Government Ministers. We have, among other things, called for a National Clinical Director for MSDs together with the formulation of a National Service Framework on MSDs in order to cement the clinical and labour market priority which Ireland should be given to MSDs in Ireland.

Last week I was a ‘witness’ – together with John Church, CEO of Arthritis Ireland - at a session of the Oireachtas Committee on Enterprise, Trade and Employment in the Irish Parliament – the rough equivalent of a Select Committee here in the UK. I presented the Irish ‘Fit for Work’ report and John and I were questioned for an hour by several Deputies and Senators, who were very interested in the implications of our research for Irish labour market policy.

Earlier in the day Jim Higgins MEP hosted a lunch session in conjunction with Arthritis Ireland for TDs and other opinion-leaders which also focused on the findings and implications of the Irish ‘Fit for Work’ report. Chaired by John Church, the audience heard presentations from Mr Higgins who focused on the growing awareness of the MSD issue in Brussels and Geraldine McCarthy, and eminent Rheumatologist. I also presented the main Fit for Work report findings and talked the audience through our main recommendations. A good debate followed which, among other things, covered the wider labour market status of people with disabilities, the potential for a UK-style ‘Fit Note’ in Ireland and the impact of Health Technology Assessment on access to drug therapies for Rheumatoid Arthritis.

There is a real sense of momentum in Ireland and clear evidence that many of the ‘Fit for Work’ messages are having an impact on the way policy-makers are thinking.

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!

Luminaries of work and wellbeing demand action. Read Steve Bevan’s latest blog post here.

This week The Work Foundation hosted a ‘Health at Work’ Reception to celebrate the high profile and progress which the issue has achieved among employers and policy-makers in recent years. But, with thoughtful speeches from Dame Carol Black, national director for Health and Work and Lord Freud, shadow minister for Welfare Reform, the audience was reminded that profile and momentum means little without implementation and real change in UK workplaces.

Dame Carol highlighted the impressive growth in awareness about workplace health which she had witnessed during her time as national director - indeed, she was generous enough to acknowledge the part which The Work Foundation has played in this. However, she called on the audience to play their part in making 2010 a ‘Year of Action’. Among other things she highlighted the progress being made by the government’s ‘Fit for Work’ pilots and the support being given to small businesses with workplace health problems. However, she warned that without the resolve of employers and GPs to embrace the principles of early intervention, job retention and rehabilitation, progress towards improving labour market opportunities for those with long-term and chronic conditions would be slow.

Lord Freud, echoing the sentiment of Dame Carol’s plea for action, focused on some of the mechanisms which might improve implementation. First he argued for support for those out of work to be driven by ‘outcome-based commissioning’ – a form of payment by results which would encourage sustainable employment for those with chronic illness or disability. Second, he argued that Good Work was an important way of ensuring that jobs were sustainable and of sufficient quality to engage people in meaningful activity, prevent a return to benefits dependency and, crucially, to improve their wellbeing.

The evening, sponsored by the healthcare company Abbott, also marked the launch of our latest piece of research, ‘Spondyloarthropathy and Work: A review of UK evidence’. The report looks at the effects of a range of conditions, including ankylosing spondylitis, psoriatic arthritis and Crohn’s disease, on a person’s ability to work, and examines what more needs to be done to best support the ‘work ability’ of people living with these conditions.

The audience was something of a ‘Who’s Who’ of luminaries from the world of work and wellbeing, including Dr Steve Boorman (Royal Mail), Professor Sayeed Khan (EEF), Dr Bob Grove (Sainsbury Centre for Mental Health) and Dr Paul Litchfield (BT). Many other friends of The Work Foundation were present and joined us in expecting 2010 to be a milestone year in ensuring that the health of the UK workforce becomes a major priority for the government, clinicians and employers.

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

This week I will be in Israel, having meetings and conducting interviews with national experts and public policy officials. Among those I’ll be meeting will be Prof. Tishler, Chair of the Israeli Rheumatology Physicians Union, Ron Wisinger- of the Israel Institute for Occupational Safety and Hygiene, Nachum Izkovich, CEO of the Ministry of Social Affairs, Vered Swid, Chief Advisor to the Prime Minister on Social and Welfare Affairs and Elliot Rosenberg, Head of the Department of Occupational Health in the Ministry of Health. I’ll also be catching up with my old friends Michael Yakuel and Ofra Balaban of Inbar – the Patient’s organisation.

As we finalise the Israeli Fit for Work? report, this visit will allow me to add to our understanding of the labour market status of people with MSDs and the support available to them as they try to live fulfilling working lives. I’m expecting to learn a lot.

Last week I attended two important events which focused on inflammatory conditions. The first was on Monday in London and was a conference organised by the National Audit Office (NAO) – an independent organisation which reports to the British Parliament on the effectiveness with which public money is being spent.

Earlier this year the NAO produced an influential report examining the quality of services for people with Rheumatoid Arthritis (RA). I was a member of the Advisory Group for the project, along with other friends of the Fit for Work? project such as Professor Paul Emery and Neil Betteridge of EULAR, and Ailsa Bosworth of the National Rheumatoid Arthritis Society (NRAS). Dame Carol Black, National Director for Health and Work, and herself a Rheumatologist, presented persuasively on the need to keep ‘work’ at the centre of the debate. I spoke on a panel discussion during the conference and emphasised the need to optimise early diagnosis and treatment – not just for clinical reasons – but to give people with Rheumatoid Arthritis the best chance of staying in and returning to work.

The second event was in Madrid on Wednesday evening and it focused on recent research (called Salud y Trabajo) conducted on the impact of inflammatory conditions on work disability in Spain conducted by TAISS and led by Pablo Lazaro. The event also featured two short films, made by independent film-makers, which told the compelling stories of two people recently diagnosed with Rheumatoid Arthritis and Ankylosing Spondylitis respectively. One of the aims of the event was to inform members of the audience about the impact of these conditions on both everyday functioning and on personal relationships. I hope to make these films available on the Fit for Work? website very soon.

Today I attended the first full meeting of the RMSD Interest Group in the European Parliament in Brussels. This group, initiated by EULAR, and chaired by Mrs Edite Estrela MEP (Portugal) was launched on World Arthritis Day in October this year. One of its aims is to raise the profile of Rheumatic conditions and MSDs in the Parliament and in the Commission and to help position EULAR as the authoritative source of clinical and patient voice.

The Group has a number of MEPs as members, including Jim Higgins (Ireland), Antoniya Parvanova (Bulgaria) and Marije Cornelissen (Netherlands). Senior figures from EULAR and EULAR-PARE represented included Professor Paul Emery, Professor Josef Smolen and Neil Betteridge.

The Group was addressed by Dr Gigorij Kogan, Scientific Officer from DG Research and a specialist in chronic disease. He described some of the research into rheumatic diseases and MSDs which the EU had funded during recent years and explained how research priorities were decided. The Group discussed whether rheumatic and musculoskeletal diseases were receiving enough priority given their prevalence and their economic and social impact.

The next meeting of the Group will be in March 2010 when the topic for discussion will be ‘Work’. The Fit for Work programme has been asked to provide input to this meeting and we will be working with EULAR to ensure that the content is both informative and provocative!