With 2.8 million people now out of work due to long-term sickness, an occupational health physician has developed a care pathway that brings together health and work support. Ashleigh Webber reports.
As economic inactivity continues to rise, helping people with long-term health conditions, injuries or disabilities back into the workplace has crept up the political agenda, recently culminating in the launch of the Department for Work and Pensions’ Back to Work scheme.
Often, people who have fallen out of employment have done so through no fault of their own. They want to be back at work; employers want to access their talents; and health professionals want the best outcomes for their patients. Yet, it is often reported that the right support simply isn’t there for a person who feels unable to work because of their illness or injury.
Long-term sickness and disability
Sickest areas of the UK are getting sicker
A new care pathway being piloted by several NHS integrated care systems, devised by an occupational health physician, is seeking to make the route back into work much easier for all involved.
The care pathway is thought to be the first process for referring patients from primary care to an occupational health assessment with a specialist clinician, such as an occupational therapist, psychologist, physiotherapist, OH physician or OH nurse.
Patients are also given access to the Department for Work and Pensions’ work coaches, who help to set goals for getting back to work and provide employment advice.
Not only could this help patients return to work sooner, it also broadens access to OH advice and increases awareness of OH services among employers. The government has previously estimated that only 45% of workers in Great Britain have access to OH.
Lack of ‘joined-up thinking’
Dr Shriti Pattani, a consultant occupational health physician at London North West University Hospitals NHS Trust and national clinical expert for occupational health and wellbeing for NHS England, devised the care pathway after seeing first-hand the lack of joined-up thinking among health services, employment services and employers when she became Public Health England’s health and work champion.
“At Jobcentre Plus there were lots of facilities to support our patients in primary care that I as a GP, but also as an occupational health physician, didn’t know existed. How did I not know with my leg in both camps? If that’s the case, then how can we expect our GPs to know what’s available out there?” she tells OHW+.
She encountered patients she felt would benefit from access to a work coach or a disability employment adviser, but she could not refer people to them. Although patients could be advised to go to Jobcentre Plus, Dr Pattani knew some would be unlikely to seek this support off their own backs.
People shouldn’t feel like they are going to a Jobcentre to be penalised – it should be about going to their local surgery and getting the support they need.”
She says: “I started thinking about how we could take people with the skills and knowledge to the place where they’re needed – to the patient themselves. People shouldn’t feel like they are going to a Jobcentre to be penalised – it should be about going to their local surgery and getting the support they need.
“At the same time, I also discovered there was good work going on at PHE, the Department for Work and Pensions, the Department of Health and Social Care, charities and so on, and I was speaking with different people and organisations all trying to achieve the same thing but not integrating.”
Using her influence in the occupational health community as a past president of SOM, as well as her role in PHE and the NHS, Dr Pattani began having conversations about how these different groups who had the same aim could be working together.
In 2022 a triage and referral process was set up, and 18 months later the care pathway is operating across 17 integrated care services in England.
Appetite among employers and patients
“There’s definitely an appetite for this; we know the country needs it and patients really appreciate it,” she says.
“Employers are giving us positive feedback – many say that they didn’t even know occupational health existed and could give them the support they needed – and GPs are telling us that it is helping with their immense workload, taking away some of the burden of fit notes.”
Patients are getting immense value from the service, with many thankful to speak to somebody who understands how their health condition or disability affects their ability to work.
“It’s been useful for them to hear that it’s completely normal for their confidence to have taken a hit, or that its normal to have experienced depression and anxiety and that any change to their day-to-day is going to cause more anxiety,” says Dr Pattani. “We’ve had feedback like ‘you’re the only person who’s really understood’.”
Dr Shriti Pattani has been nominated for an OBE for servces to occupational health.
One particular success story involved a patient who had the desire to return to work but felt they needed to lose weight. Their work coach was able to refer them to a local service that supported weight management and exercise, as well as find voluntary work opportunities to help build up their CV.
In some GP surgeries, reception staff can book appointments with work coaches rather than a GP if a patient requires job-related support rather than strictly health-related advice.
The pressure on GPs has also been alleviated slightly, with some reporting that the number of prescriptions they are issuing to some individuals has reduced.
We’ve had feedback like ‘you’re the only person who’s really understood’.”
Supporting vulnerable people
“There a lot of people who don’t feel they can work anymore because they’ve been off for so long,” says Dr Pattani.
“The service is also picking up a lot of vulnerable people – those on zero-hours contracts, or pregnant workers who haven’t had any advice and are doing manual handling work, for example.”
Awareness of occupational health services and legal responsibilities around employee medicals has also increased among employers.
She says: “We picked up somebody who has a condition caused by their work, and we went back to the employer to offer advice. [The employer] didn’t realise that a questionnaire every year could pick up people who might be developing this problem much earlier, which could help them to prevent employees from becoming disabled because of their job.
“Now that employer has retrained that person to do another job, keeping them in employment, and introduced simple measures to pick up anybody who might be at risk earlier on.”
Dr Pattani, who recently received an OBE for her services to occupational health, is optimistic about the future of the service and hopes its reach will soon be expanded into NHS musculoskeletal hubs, and mental health hubs further down the line.
“Early findings show the service is really well received, and we hope it will be taken up by more integrated care services,” she says.
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