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Archive for the ‘FfW UK Coalition’ Category

Informal Carers: The forgotten employees

Monday, November 21st, 2016

Providing unpaid care for disabled, sick or elderly relatives and loved ones is often a physically and emotionally challenging task for the individual. Informal carers not only reduce the burden on the social care system and therefore the economy, but they often do so with very little support (financial or otherwise) for themselves. This group are also often excluded from the job market, with over a million UK residents providing 50 or more hours of care a week, more than full-time working hours. For those who have fewer hours of caring responsibilities, a lack of flexibility in the workplace may also make continuing work impossible. A survey by Carers UK (in 2011) found 44% of carers reporting that they had been pushed into debt as a result of the extra costs of caring or of giving up work or reducing working hours to provide care.

This is not a small problem – the 2011 Census identified that 10 per cent (5.8 million) of UK residents had a caring role, with over a third (37 per cent, 2.1 million) giving 20 or more hours care a week. It is estimated that £5 billion is lost to the economy through people dropping out the workforce to care for others. And the cohort of carers is likely to grow given the impact of the ageing population in the UK, and predicted growth in people with co-morbid chronic conditions. Gaps in employment will also impact on individual’s pension provisions and savings. Unsurprisingly, the biggest losers in term of the labour market are women, with more carers of working age being women then men, peaking in caring responsibility in the 45-59 age group.

This is a challenge that both employers and policymakers have to take seriously if they do not wish to continue to lose a significant proportion of the workforce. Efforts need to be made to make sure that people with caring responsibilities are supported to remain in their jobs by employers offering flexibility where it’s needed and where they are able – i.e. in terms of flexible hours and permitting emergency leave (annual leave at short notice) when emergencies arise. Jobs need to be designed in ways that consider this likely future. Managers need to encourage employee to tell them of such issues and their needs so they can be worked through together.

For those who have little choice but to leave the labour market, due to their employer or the extent of their caring responsibilities, it’s important to make sure that those who want to return, are able to. The Carers UK survey found that 56% of respondents who gave up work to care had spent over 5 years out of work as a result. In times of economic instability, re-entering the workforce after an extended absence can be very difficult – and support and guidance will be needed. A number of local programs exist in the UK which focus on supporting carers to stay in, though more often to get back to, work including finding the right jobs that offer the flexibility needed. These need to be evaluated and best practice information shared nationally to ensure that more people are helped by programs that work.

In the meantime, guidance needs to be available to provide carers with information on how to get back into the labour market. For example, showing carers how they can positively account for their time out of formal work to employers – looking at what has been achieved rather than what hasn’t and identifying transferable skills and relevant responsibilities. Opportunities for training to upskill, particularly in respect to new technologies, need to be available and accessible. Perhaps the biggest barrier to getting back into work after a long absence is confidence – but with the right supports in place, and a more positive attitude among employers about employing people with gaps in their work history through taking the time out to care for a loved one, these obstacles can be avoided.

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Improvements in patient care must be based on evidence and not media grabbing knee-jerk proposals

Saturday, September 17th, 2016

Why would an individual go into the nursing profession today, in 2013? Perhaps because of a frozen salary? A reduced pension? Or the constant barrage of criticism and name-calling? No. In reality, the overwhelming majority of our student nurses chose nursing because they want to care for people when they are most vulnerable. The government however, is labouring under the illusion that our would-be nurses have an ulterior motive, and are entering nursing with no real desire to deliver the fundamentals of nursing.

The government’s latest proposal is to make future nurses work as a health care assistant (HCA) for up to a year, before being allowed to start their training. It’s a solution to a problem that does not exist. The evidence shows that not only are there no major shortcomings in the way we train nurses, but that graduate nurses actually drive up standards. The RCN is currently holding its annual Congress and Lord Willis, chair of the independent commission on nursing education, has addressed delegates this week. He strongly rebutted the government’s proposal and told the hall “improvements in patient care must be based on evidence not media grabbing knee-jerk proposals – many of which [Robert] Francis did not propose and which have little evidence to support their introduction”.

The reality, which one would have expected the government to know, is that student nurses currently spend half of their degree on clinical placements. They spend this time walking the wards, and learning about care in our communities. They are shown the importance of fundamental care and are regularly inspired by the compassion of their mentors.

Nurse education is fit for purpose; it does not need interventions from Whitehall that show no understanding of the way the system works, nor the evidence at hand.

Nurses do not need to be told that they enter the profession for the wrong reason. Instead, they need adequately staffed wards, they need decent budgets and they need the freedom to get on with the job. Our Congress has sent a powerful message this week; the government would do well to listen.

According to a survey by the RCN, Almost 90 per cent of nursing staff said staffing levels were not always adequate to provide safe patient care, with almost a third saying they were rarely or never safe. More than 8,000 RCN members responded to the survey.

The Royal College of Nursing is a partner of The Work Foundation.

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People with chronic MSDs compromising their health to keep their jobs, new report reveals

Friday, September 5th, 2014

The government, the NHS, and employers are failing to provide the necessary support for people with chronic MSDs (musculoskeletal disorders)* to stay in work. This is according to a new report released today (Friday 5th September) by Lancaster University’s Work Foundation and the Fit for Work UK Coalition. The findings also indicate that some patients are putting their health at risk to hold on to their jobs.

Update: Commenting on the report, Sue Browning, deputy chief executive of the CSP, said: “Physiotherapists are experts at keeping people healthy in work, or facilitating a return after sickness absence, and it is very important that employers provide staff with fast access to occupational health services (…) The NHS should also make self-referral to physiotherapy available across the country”. Read the full statement of Sue Browning on the Chartered Society of Physiotherapy website.

Professor Stephen Bevan, director of the Centre for Workforce Effectiveness at The Work Foundation and founding president of Fit for Work UK, said: “Workers with MSDs often find themselves fighting a lonely battle to remain in work. The government, employers and clinicians should make it a priority to support them to remain in employment after diagnosis”.

Currently, Britain is losing 30.5 million working days a year to MSDs, which are the leading cause of sickness absence, according to the Office for National Statistics (ONS)**. Today’s paper shows that employers, in particular small organisations, have little knowledge about government schemes such as “Access to Work” and are insufficiently prepared to manage chronic conditions in the workplace. Many workers admit to being reluctant to ask for help from their line managers for fear of stigma, negative judgement and job loss. Others said they had to involve their union to get the necessary support or move into self-employment.

The interviews conducted for the report released today highlight that, unless action is taken, individuals’ health conditions and quality of life will continue to be damaged by work, with some leaving the labour market prematurely. The consequence of the status quo is an increase in productivity loss, sickness absence and, ultimately, the welfare bill.

One employee interviewed in the report said: “Last year, the team were very understaffed some individuals went off sick. I think the pressure to try and do other people’s jobs as well as your own just got too much for me. It was a very stressful time to me and that made my illness a lot worse”. Another explained: “It’s a bit rule by fear in this department these days. They’ll try and get rid of you if you’ve been off too long with your health”.

Kate Summers, research officer at The Work Foundation, commented: “Individuals with chronic MSDs will go to great lengths to remain in work. They will give up aspects of their family and social life, and they will even take roles below their skill set. This is because work can bring many benefits – be they financial, psychological or social. These benefits are undermined if individuals are working in a environment that is not good for their health”.

The report makes four recommendations: 1. The government should increase participation to initiatives like “Access to Work” and should provide extra assistance for employees working in small and medium enterprises; 2. The government should also ensure that work is viewed as a “clinical outcome” by clinicians and invest in more “specialist nurse” roles; 3. Employers should consider all necessary workplace adjustments and offer career development opportunities for people with chronic MSDs; 4. Clinicians should view it as part of their role to ask patients about their work lives.

The authors of the paper also added that they welcome the government’s new Health and Work Service in England and Wales, but that it needs to focus on sustained return to work outcomes.

The report is being previewed on Friday at the conference “Self care & resilience: How we can care?” organised by the College of Medicine at the King’s College, in London

– ENDS –

Notes to the Editors:

1. Kate Summers, research officer, is available for interviews, briefings and written comment. 3. The paper is part of a national campaign led by Fit for Work UK, informing the public debate on dealing with the growing burden of MSDs and calling for coordinated action across all main political parties in the UK. 4. *Musculoskeletal disorders (MSDs) cover around 200 disorders that affect the joints, bones, muscles and connective tissues. MSDs include back pain, arthritis, osteoarthritis, ankylosing spondylitis, injuries caused by trauma, such as fractures, and other conditions that are the result of genetic or developmental abnormalities, as well as bone and soft tissue cancer. 5. ** The “Sickness Absence in the Labour Market” report. 6. The Fit for Work UK Coalition is an active partnership of healthcare professionals, policymakers, employers and advocacy groups founded in 2007. It supports people with long-term conditions, particularly musculoskeletal conditions. Their members are: AbbVie, the Arthritis and Musculoskeletal Alliance (ARMA), BT Group, Capita, the Chartered Society of Physiotherapy (CSP), National Ankylosing Spondylitis Society (NASS), National Rheumatoid Arthritis Society (NRAS), The Work Foundation, and the Royal College of General Practitioners (RCGP). 7. Lancaster University’s Work Foundation transforms people’s experience of work and the labour market through high quality applied research that empowers individuals and influences public policies and organisational practices. The Work Foundation is part of Lancaster University – an alliance that enables both organisations to further enhance their impact.

Media enquiries:

Ioana Piscociu, ipiscociu@theworkfoundation.com, 020 7976 3526, for urgent out-of-hours enquiries: 0755 178 14 06.

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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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Independent Advisory Service must have the right resources and incentives to be effective

Tuesday, April 16th, 2013

Last week (11 April) Professor Stephen Bevan, Fit for Work Europe founding president and a director at The Work Foundation, highlighted why the Government’s proposed Independent Advisory Service for  helping people with health problems return to work must do more for those with long term conditions.   In an interview with Radio 4’s In Business, Professor Bevan spoke of the need for a holistic service which uses the input of occupational clinicians. He argued that tailored support for individuals would help keep people in work long term and called for the service to take a different approach to the  Work Capability Assessments. He proposed that employers and employees work together to  find ways  for individuals to return to work.

Research by Fit for Work (FfW) UK has highlighted the immense difficulties people with musculoskeletal conditions (MSDs) face trying to remain  in work.  FfW UK’s recent study of 809 people diagnosed with a MSD (published in December 2012) found that three quarters of survey respondents who were retired said their condition had influenced their decision to leave the labour market. While the majority retired before reaching the age of fifty-five. The findings revealed further barriers to employment. Within three years of diagnosis, half of people with rheumatoid arthritis are registered as work disabled.  Inability to stay in work may have a further spill over effect into the wellbeing and financial stability of entire households which is especially worrying as , 57.4 % of respondents who were not in work had been primary income earners before leaving their job. It was also clear from the FfW findings that work needs to be introduced into the CCG (Clinical Commissioning Groups) Outcomes Indicator Set as an clinical outcome for people with MSDs as early as possible.

As  Professor Bevan says, “Returning to the workforce after an absence can be incredibly hard for people with long term conditions like musculoskeletal disorders, and it gets harder the longer one is not working.  The new Independent Advisory Service will make a difference to thousands of people every year if helps  people work with their employer to find ways to stay in their job. This will require a true partnership between the service, clinicians, employers and people using it and we urge the government to encourage this approach in its design of the service, for example, by ensuring all targets incentivise keeping people at  work for the long term.”

You can listen to the programme again at this link: http://www.bbc.co.uk/programmes/b01rr7zj

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Volcanic Ash!

Thursday, April 22nd, 2010

Wow! What a trip. Last Wednesday, I went to Stockholm to present the pan-European Fit for Work report at the 1st Baltic & North Sea Conference on Physical and Rehabilitation Medicine. I was scheduled to return Thursday afternoon, but needless to say the volcano disrupted my return travel plans.

I presented the findings to the conference attendees before I learned about the volcano. The presentation focused on interventions available to facilitate retention and return to work, such as early identification, multidisciplinary and cognitive behavioural team-based approaches, targeted and tailored interventions, work-style interventions and reintegration approaches. The biopsychosocial and International Classification of Functioning, Disability and Health models underlined many of the approaches used in these interventions.

Britt Arrelöv (Sweden) chaired a panel discussion around the topics I presented. On the panel were Andrew Frank (United Kingdom), Jan Ekholm (Sweden), and Christoph Gutenbrunner (Germany), and I. One of the key questions to the panel was the definition of early. Early varies by condition and type of intervention but is very important to consider. For instance, most cases of back pain resolve themselves within four to six weeks, so once the case goes beyond this time period, it is time to begin implementing interventions to facilitate recovery and reduce the likelihood of prolonged absence. However, for other conditions such as rheumatoid arthritis or ankylosing spondylitis, outcomes are often better the earlier individuals receive appropriate treatment.

Other points of discussion reflected on the role of rehabilitation medicine and the role of good work, as well as the importance of individual motivation and the psychosocial factors related to recovery. All in all, the discussion was very interesting and well received.

A few hours after the presentation, I learned about the volcanic eruption delaying my flight back to the UK. I thought I might be delayed for a day at the most, but seven days later I finally returned to the UK. We now know a variety of ways to travel from Stockholm to London ranging from driving, taking a train, riding a ferry to a combination of all three! Thankfully, I was able to board one of the first flights back into London and that Stockholm is a nice place to be stuck for an unexpected visit.

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