NHS must focus on helping people return to work

Helping to support people with long-term conditions and get them back into the workforce is an important part of providing care, but is an area that is sadly lacking in the current health service, says the Royal College of General Practitioner’s Dr John Chisholm.

For individuals with long-term conditions, holding down a fulfilling job at a time of economic instability can be a constant concern. Musculoskeletal disorders (MSDs) and mental health conditions are the leading causes of long-term sickness absence.

MSDs can have a devastating affect on the quality of life of both people and their households. They also cost the UK economy billions of pounds a year in terms of: direct healthcare costs; the indirect costs of lost working time and productivity; and social support for individuals and their families.

This is the subject of new report Taking the strain: The impact of musculoskeletal disorders on work and home life, launched by Fit for Work UK – a coalition of organisations campaigning for better support for people with long-term conditions.

The report draws on a survey of more than 800 people living with MSDs recruited from patient organisations, and makes a series of recommendations for policymakers and anyone working in the healthcare profession.

Perhaps most worrying for GPs is the report’s finding of a lack of visible clinical support for those with MSDs to assist them in staying in work. Only half of respondents reported discussing condition management in the workplace with a healthcare professional, revealing a lack of prioritisation around keeping the individual in employment as an outcome on the part of some clinicians.

Waiting for diagnosis

Early identification and treatment of MSDs is key to supporting return to work. However, the survey found that among those responding it took an average of 4.22 years to diagnose an MSD, and that following diagnosis one in 10 respondents had to wait more than a year to receive treatment.

quotemarksWork, providing it is ‘good work’, has a beneficial effect on health outcomes and social integration, as well as on the financial wellbeing of patients and their families.”

The report discovered a heightened risk of job loss, early retirement and financial hardship among people with MSDs. As the condition progresses, the ability to maintain performance at work usually diminishes, and a number of survey participants said they felt that their condition had prevented them from reaching their full potential at work.

As we know from previous research, work – providing it is “good work” – has a beneficial effect on health outcomes and social integration, as well as on the financial wellbeing of patients and their families.

It is important that GPs are aware of their role in supporting patients with these conditions who may be at risk of being trapped in low-quality jobs ill-suited to their level of skill.

The NHS needs to gear up better to support return to work and job retention. For the ambition in the NHS Outcomes Framework of “employment of people with long-term conditions” to become reality, we need to mainstream employment through all relevant health policy frameworks and collect data on employment outcomes. The goal of encouraging a return to work needs to run through National Institute for Health and Clinical Excellence (NICE) guidance and quality standards, and to be incentivised through the Commissioning Outcomes Framework. The NHS must also implement the recommendations of the 2009 Boorman review and improve the health of its staff.

Cost-effective intervention

There is now a huge body of evidence available on cost-effective interventions that can help people with MSDs retain their jobs and be productive.

Many of these are cost neutral, involving changes in behaviour and approach. Even where investment is needed, returns accrue through a reduction in welfare spend. Now we need the political, managerial and clinical will to make work a clinical outcome and support our patients.

If you agree, or want to find out more, please sign up for news on the Fit for Work UK website.

Dr John Chisholm is a council member and health and work lead for the Royal College of General Practitioners

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