the case for supporting people with long term conditions in the workplace dr bill gunnyeon chief...
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The case for supporting people with long term conditions in the workplace
Dr Bill Gunnyeon
Chief Medical Adviser
Department for Work and Pensions
Employment and Health Statistics
4 quarter average to June 2011
27.5 million employed/ self employed
730,000 off sick
26% with a health condition
or disability
30% with a health condition or disability
8.9 million inactive
50% with a health condition
or disability
2.4 million unemployed
Labour Force Survey; men and women, 16-64 ,GB
ME/CFS and the benefit system
Incidence in general population 0.1 - 0.2%
Proportion of ESA claims 0.4%
Significantly greater chance of being
allowed ESA
Why support people to stay in work?
Evidence Individual
Financial Status and self esteem Social contact Family impact Avoiding negative mindset
Employer Reducing absence and turnover Reputation Employee commitment Equality Act compliance
State Reduced flow from work to benefits Improved health outcomes Changing demographics
Lifestyle related conditions
Is work good for your health and well-being?Waddell and Burton 2006
Work is generally good for physical and mental health and well-being
Worklessness is associated with poorer physical and mental health
Work can reverse the adverse health effects of unemployment
Work can be therapeutic
The beneficial effects of work outweigh the risks
The beneficial effects of work are greater than the harmful effects of long term unemployment or prolonged sickness absence
“Vocational Rehabilitation – What Works for Whom and When” Waddell, Burton and Kendall 2008
VR is whatever helps someone with a health problem to stay at, return to and remain in work; it is an idea and an approach as much as an intervention or a service
Effective vocational rehabilitation requires both work-focussed healthcare and workplaces that are accommodating
There is a strong scientific evidence base for many aspects of VR
There is a good business case for VR and good evidence on its cost benefits
Most people with common health problems can be helped to return to work by following a few basic principles of healthcare and workplace management
Why support people to stay in work?
Evidence Individual
Financial Status and self esteem Social contact Family impact Avoiding negative mindset
Employer Reducing absence and turnover Reputation Employee commitment Equality Act compliance
State Reduced flow from work to benefits Improved health outcomes Changing demographics
Lifestyle related conditions
Demographic changes present an increasing challenge
46%
47%
48%
49%
50%
51%
52%
53%
2008 2013 2018 2023 2028 2033
years
Pe
rce
nta
ge
Wkng Age under 40
Wkng Age over 40
2.5
2.6
2.7
2.8
2.9
3
3.1
3.2
3.3
2008 2013 2018 2023 2028 2033
years
Old Age Support Ratio
An ageing workforce
With more chronic or progressive diseases
Having to support more people ofpension age
00.20.40.60.8
11.21.4
2006 2033
years
m
Coronary heart disease diabetes
Why support people to stay in work?
Evidence Individual
Financial Status and self esteem Social contact Family impact Avoiding negative mindset
Employer Reducing absence and turnover Reputation Employee commitment Equality Act compliance
State Reduced flow from work to benefits Improved health outcomes Changing demographics
Lifestyle related conditions
Chronic ill health
Healt
hy W
eig
ht,
Healt
hy L
ives
Healt
hy W
eig
ht,
Healt
hy L
ives
Obesity levels are too high, with significant impact on individuals, the health service and society as a whole
By 2050, if trends continue, 60% of men and 50% of women could be clinically obese (UK Foresight report)
HEALTH IMPACT
• 58% type 2 diabetes
• 21% of heart disease
• 10% of non-smoking related cancers
• 9,000 premature deaths a year in England
• Can reduce life expectancy and quality of life
COST
• National Health Service - £4.2bn
• Wider economy - £15.8bn
• Foresight estimates by 2050 costs to economy of £50bn
Overweight & obesity forecast trend 2007-2050
Government initiatives
GP education
Fit Note
Fit for Work pilots
OH advice services for SMEs
Sickness Absence Review
Improvements to WCA
Work Programme
Universal Credit
GPs’ attitudes towards patients’ health and work
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
GPs have a responsibilityto society to facilitate return
to work
Staying in/returning to workindicator of success
Helping people stayin/return to work is
important part of role
Worklessness isdetrimental to health
Work is beneficial forhealth
Somewhat/completely agree Somewhat/completely disagree
99% of GPs agree that “work is generally beneficial for people’s health”
99%
96%
88%
77%
66%
Source: GP Attitudes to Health and Work Survey
GPs’ attitudes towards patients’ health and work
7% 5% 6%10%
13% 12%
54%48%
42%
60%
36%
26%
0%
10%
20%
30%
40%
50%
60%
70%
Improved quality ofdiscussions with
patients aboutreturn to work
Improved advice Igive to patients
about their fitnessfor work
Increasedfrequency with
which I recommendreturn to work asaid to recovery
Helped my patientsmake a phasedreturn to work
Increased length ofmy consultations
Made no changesto my practice
Completely Agree Somewhat Agree Somewhat Disagree Completely Disagree
GP responses to the statement: The Fit Note has….
Source: GP Attitudes to Health and Work Survey
Sickness Absence and Rehabilitation Survey 2011 - EEF
20% indicated Fit Note had already reduced sickness absence
28% agreed Fit Note had improved quality of return to work discussions between line manager and employee
Proportion of companies contracted by GPs to ask about availability of adjustments doubled after Fit Note introduction
Reduction in proportion of employers identifying GPs as a barrier to rehabilitation from 39% in 2006 to 26% in 2010
Measures used in the last 12 months by employers to help keep employees with health problems in work or
facilitate their return to work
Source: Health and well-being at work: A survey of employers
Percentage of employers citing each
67
3
4
5
9
11
17
18
22
25
28
29
No measures provided
Job coach/ personal assistant
Building modifications
Other specialised equipment
Access to OH services
Different chairs/desks
Phased return to work
Extra breaks
Different duties
Reducing employee workload
Meetings with employees to discus extra help
Allowing reduced or different hours
Attitudes of working age adults to health and work
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Paid work isgenerally good for
physical health
Paid work isgenerally good for
mental health
Go to work with acold
Go to work if hadlong term backpain and back
was sore
Go to work if hadlong term
depression andwere feeling down
Per
cen
tag
e w
ho
ag
ree
84%
58%62%
91%83%
Government initiatives
GP education
Fit Note
Fit for Work pilots
OH advice services for SMEs
Sickness Absence Review
Improvements to WCA
Work Programme
Universal Credit
Summary
Chronic health conditions are an increasing challenge
The evidence for supporting people with chronic conditions to work for as long as possible is clear
Achieving this requires partnership between healthcare professionals, employers and individuals
Perceptions and behaviour are changing
But there is much still to do