We continue our series on professions allied to occupational health by looking at how physiotherapists will play a key role in the new Health and Work Service. Chartered physiotherapist Joshua Catlett explains where physiotherapists fit into a multidisciplinary team.
Physiotherapists are established as one of the key types of professionals working alongside occupational health (OH) doctors and nurses to cut down on sickness absence rates. The two professional groups have collaborated on a pilot where the work of physiotherapists was included in assessments under the Safe Effective Quality Occupational Health Service (SEQOHS) accreditation scheme. The outcomes from the pilot will help inform the revision of the standards, which are currently under review.
Employers that contract physiotherapists to provide OH services are seeing good returns because people are able to stay in work through a combination of preventive measures and fast, effective treatment.
These physiotherapists work with employers to provide safe, effective work environments and offer advice and treatment to employees who begin to develop a problem that could result in sick leave. In many cases, this early intervention prevents any absence from being necessary.
If someone does go on sick leave, they are seen as soon as possible before their condition worsens, to ensure that symptoms are treated and any underlying behavioural or environmental factors, such as poor posture or a poorly designed work station, are dealt with to facilitate a swift return to work.
Physiotherapy and the Health and Work Service
This is good for the individual, saves money for the employer and boosts the economy overall by keeping a taxpayer in work.
This “triple win” was cited in early February 2014, when the Government made the latest announcement on its new Health and Work Service (HWS). The service will offer an assessment to anyone who has been off sick for more than four weeks to help identify ways to get them back to work.
Clearly, physiotherapists will play a big part in this service, fulfilling two roles. First, they will use their expertise in movement and function to assess a person’s condition, identify the causes of the problem and then suggest the steps that could help them return to work. These steps might include changes to working practices and patterns, alterations to the work environment or seeing a health professional for treatment.
This is where the second role comes in: providing treatment at the earliest opportunity to prevent problems from becoming long-term, chronic conditions.
Physiotherapists use body posture as a tool that can be adapted to meet job demands with minimum stress on the musculoskeletal system. They give expert advice to maintain fitness and flexibility, and to develop a reserve of strength to meet demands of an individual’s job.
They also identify how habitual patterns of movement and working predispose musculoskeletal problems, and work with individuals and groups to improve musculoskeletal health, prevent injuries and improve efficiency.
Up to 30% of sickness absence is because of a musculoskeletal condition and, in many cases, early access to a physiotherapist could have dealt with the immediate problem and corrected any other factors to avoid a recurrence.
Evidence of improvement
Pilot schemes of the HWS have already shown promising results; for some people, physiotherapists have been able to support an earlier return to work than might otherwise have been possible.
In April 2013, the BBC reported on a scheme running in Leicestershire that helped a warehouse worker who had developed a shoulder injury. His GP referred him to the scheme, which in turn arranged for him to receive physiotherapy immediately, rather than wait on an NHS list for several weeks.
By providing this fast access to physiotherapy and then arranging a phased return to work, the employee was able to get back to his job much quicker than his GP had initially anticipated.
As noted at the time by Dame Carol Black, whose report on sickness absence led to the creation of the pilot schemes, too many people fall out of work when their condition could have been managed: “It wastes human life. It ruins people’s sense of self-worth, dignity. It’s bad for families, bad for the economy, and bad for the community.”
Benefitting both the public and private sectors
Much of the coverage around that service has focused on help for the private sector, but OH physiotherapy is also helping public bodies make critical savings during this time of austerity.
In 2012, Staffordshire County Council contracted a private OH physiotherapy company to reduce its sickness absences. The rapid-access physiotherapy service begins with a telephone triage to allow contact with the employee within 24 hours of first being off work.
During the call the nature of the problem is established, with self-management advice and exercises discussed. If necessary, a face-to-face physiotherapy appointment can be arranged at a convenient time and location for the employee.
Since the start of this rapid-access physiotherapy programme, the council has reported an 8% drop in staff absence, amounting to 9,000 fewer sick days per year, a 12% reduction in musculoskeletal absences and a 300% return on investment.
A dedicated physiotherapy service is now in place for staff with conditions such as pain and stiffness in joints, muscles, nerves and soft tissues. It offers rapid treatment to help staff to return to work quickly.
Rolling out good practice
In the NHS, although more work still needs to be done, there are signs that it is getting a grip on high levels of sickness absence. Perhaps ironically, the health service historically has not done a great job of looking after the wellbeing of its own employees.
The Boorman Review, published in 2009, said that the NHS could save £555 million per year by providing fast access to services such as physiotherapy to help keep staff fit for work. The review also highlighted that improved staff health ensured better treatment for patients, because sickness absences had led to cancelled appointments and longer waiting times.
Yet even last year, an audit conducted by the Chartered Society of Physiotherapy found that about 40% of health trusts in England still did not have a health and wellbeing strategy in place for its staff – despite this being a key recommendation from Boorman.
At a time when the NHS is tasked with saving £20 billion by 2015, it is remarkable that this simple way to reduce costs is being overlooked.
Services that work
There are, of course, pockets of excellence. Fast Physio is a dedicated, inhouse service that provides rapid access for employees at East Lancashire Hospitals NHS Trust. Urgent referrals are seen for an assessment, management and advice within three working days, and routine assessments within 10 days.
Employees also get telephone and email advice to enable them to self-manage their injury more effectively, and there are recommendations for workplace adjustments where appropriate. Advice and support is provided for both managers and employees during an individual’s return to work.
After the service had been running for 18 months, there had been a 32% reduction in days lost to musculoskeletal-related sickness.
Physiotherapists have been demonstrating their effectiveness and return on investment across all sectors for a number of years in OH.
When PricewaterhouseCoopers analysed the impact of health and wellbeing initiatives at 55 organisations, ranging in size from 70 to 100,000-plus employees, it found consistent evidence of reduced absence and increased productivity.
In one case, an employer experienced a return of £34 for every £1 spent on providing in-house and discounted physiotherapy for staff.
SEQOHS is an accreditation scheme for clinical occupational health services, through which the performance of services is assessed against as rigorous set of standards owned by the Faculty of Occupational Medicine. As part of a review of the standards SEQOHS is working in partnership with the professional network, the Association of Chartered Physiotherapists in Occupational Health and Ergonomics (ACPOHE), on a pilot involving a small group of occupational physiotherapy service providers. The pilot will enable these services to run through the SEQOHS accreditation pathway. The services will not be formally assessed for accreditation, however the learning and outcomes from the pilot will help to inform the revision of the SEQOHS standards, in support of widening its reach to embrace the non-traditional services within the evolving market place.
OH physiotherapists now work in a diverse range of settings across all sectors. Whatever type of workplace they are in, however, the evidence shows the employer will see an average return of £3 for every £1 invested in the service. As the economy continues to struggle back to life, the importance of that statistic speaks for itself.