Devil’s advocate: Fast-track treatments are not the answer to getting medical professionals back to work

Fast-tracking treatment is all the rage. It is the latest magic bullet in the OH armoury.

Influential agencies such as the Health and Safety Executive, the National Audit Office and Auditor General of Wales have all offered fast-track schemes as examples of good practice.

Prominent in this debate is whether the NHS should fast-track care for nurses. Supporters argue that the absence of nurses has an adverse impact on those in their care (or rather not then in their care). Is this persuasive? If so, then an even stronger case must be made for nurse managers, as they have responsibility for even more patients, and stronger still for the most senior managers of healthcare organisations.

I like this argument. As a healthcare manager, I wonder whether I should have an entourage of carers keeping me in peak physical condition in the best interests of those with a current illness? And what about those in other carer roles – doctors, other health professionals, and not least family members.

Isn’t it about time we stopped wasting resources caring for sick people, and invested all our efforts in maintaining the wellbeing of those who are in excellent health?

Red herring

This brings us to the nub of the problem. Research has repeatedly demonstrated the majority of sick leave has nothing whatsoever to do with illness – it is due to socio-cultural factors. How can there be a rationale for fast-tracking care if absence is not usually due to illness? At the most, this serves only to reduce absence that is wholly attributable to waiting lists, and the full benefit of this will only materialise if the absentee then resumes work at the pace they would otherwise have done. The evidence for this is scant.

While interventions in healthcare have been accelerated, there is little evidence that patients’ expectations of resuming normal activities are also being accelerated. Day case surgery has not brought with it day case resumption of work. Changing patients’ behaviour is notoriously difficult, as the whole ‘smoking kills’ saga beautifully illustrates. It is much easier to provide care one day sooner in the hope this will reduce absence, and much more difficult to change the patient’s expectation of the recuperative period.

Evidence on the typical recovery period for interventions is beginning to emerge. Doctors seem reluctant to encourage patients to resume work without evidence while at the same time issuing certificates that withdraw the patient from the proven health benefits of returning to work. A cultural shift is needed where workers expect to work unless there is evidence that they cannot, or that to do so would be significantly more harmful than not.

This cultural shift is some distance away. This week, yet another patient of mine was too ill to attend an appointment. I struggle to understand how he could have been too ill to attend a medical appointment in a general hospital. What management response is commensurate with this behaviour?

Accountability

The tax paying public shouldn’t have to endure even longer waits as they see clinicians fast-tracked. They should, however, expect knowledgeable clinicians to fast-track themselves back to work, and they should expect managers to make sure that when clinicians don’t attend appointments, they are fast-tracked into their office to explain themselves.

Dr Richard Preece is a consultant occupational physician

References
http://findarticles.com/p/articles/mi_qn4156/is_20041128/ai_n12592364
http://society.guardian.co.uk/NHSstaff/story/0,,1514994,00.html
http://www.healthcarecommission.org.uk/_db/_documents/04018124.pdf
http://www.hse.gov.uk/pubns/misc743.pdf
http://www.nao.org.uk/conferences/a_safer_place_to_work/saferprog.htm
http://www.wales.nhs.uk/documents/agw2004_1.pdf
http://www.sehd.scot.nhs.uk/publications/DC20040420OHSSIG.pdf

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