The International Convention Centre (ICC) in Birmingham is one of those in the middle-of-nowhere, vast complexes. However, the sense of desolation as I made my way from the railway station that delivers you into the heart of the complex through endless empty pavilions and past a man-made lake edged with daffodils, themselves struggling to be cheerful, was mitigated by the realisation that Crufts opened in the very same complex as the Health and Wellbeing at Work conference. Crufts, the most famous dog show in the world, the show that inspired the film ‘Best in Show’, was on my bucket list. And that is despite the fact I am a cat person. Crufts was opening the day I was leaving the ICC, and in the meantime I could watch it being set up. Tick.

I was at the conference to co-chair a session on future directions in return to work (RTW) with that honorary Australian, Dame Carol Black.

Three academics presented: Professor Mark Gabbay, University of Liverpool; Professor Alex Collie, Monash University; and Dr Agnieszka (Iggy) Kosny, Institute of Work and Health, Canada. They were joined on a panel by Dr Paul Litchfield, BT Group; Monica Garcia, Swiss Re; Professor Debbie Cohen, Cardiff University; Mark Amour, Association of Chartered Physiotherapists in Occupational and Ergonomics; and Hugh Robertson, Trades Union Centre, to discuss this issue.

This discussion was held in the context of a government focus on “what it will take to transform employment prospects of people with disabilities and long term conditions” as Gina Radford, the Deputy Chief Medical Officer, speaking on behalf of the Department of Work and Pensions and the Department of Health, had said earlier in the day.

 

The ‘Fit Note’ needs clarity: Panel

 

Consultation on a Work Health and Disability Green Paper had just closed; but according to Radford the Fit Note was already under review.

I thought the attitudes expressed during the panel discussion could be grouped into three:

[ordered_list]

1. The Fit Note needs better support to be properly implemented and achieve its potential – in the UK context this means embedding OHS expertise into primary care. After Carol Black’s review in the late 90s, OHS units were set up to provide advice on RTW to employers and general practitioners (GPs). These have been used by employers but not doctors. Alex Collie was concerned enough about the negative view of the Fit Note to write a thoughtful piece on LinkedIn after participating on the panel, essentially saying don’t throw the baby out with the bath water. Or to use epidemiology-speak, the certification of capacity is necessary but not sufficient for RTW.
2. Roles of key players in the RTW system require clarification and better coordination – RTW requires medical, employment and insurance decisions, one person cannot make all of these, and currently inputs are not well co-ordinated.
3. The RTW system needs to be reviewed (back to basics). This is a more disruptive view, which recognizes that there are huge changes underway in health care and work and that we need to be designing RTW for future systems, not current.

[/ordered_list]

As well as providing better support for the Fit Note, ideas for improvement were generated during the discussion.

 

Evidence base confirms need for broadened focus

 

Those ideas included:

[unordered_list style=’circle’]

• Clarify roles of primary health care providers and rehabilitation providers (funded by employers, insurers and others).
• Develop a shared understanding of work as a health outcome (health benefits of good work) across all stakeholders in the community including workers and their families, via a public health type campaign;
• Eliminate certification for sickness absence. This would become a matter between employers and workers with health care providers giving advice as needed. There are examples of this in practice already; and
• Provide programs to workers via third parties to support self-management of their recovery. There are examples of this in practice already. More complex cases will require case managers, but there are many ways such services could be provided.

[/unordered_list]

 

In short it seems to me that we are realising an intervention that focuses on one actor alone in the system, the GP, has not worked very well. In reality we have acknowledged this in practice for a long time.

The evidence base for this was confirmed recently in a comprehensive international systematic evidence review on interventions for RTW for musculoskeletal disorders and mental health conditions undertaken jointly by the Institute of Work and Health in Canada and the Institute for Safety, Compensation and Recovery Research here. This review found there was strong evidence of effectiveness for interventions that operated across multiple domains.

Traditionally this would have meant improving co-ordination of health care providers, employers and workers compensation insurers, but in recent conversations there is growing realisation of the alignment between workers’ compensation, life insurance, superannuation and disability support.

 

NHS CEO: Public sector will lead by example

 

The potential to forge new partnerships with the aim of improving work participation of people with health conditions and disability no matter what the cause is starting to excite exploration. This is clearly the approach being taken in the UK, where the management of work-related conditions is not separated from healthcare as it is here.

Simon Stephens, the brilliant National Health Service CEO, spoke at the Health and Wellbeing at Work conference. He acknowledged that those of us who have been working in this field for a long time had been professionally marginalised, but said that now employers and workers needed our skills to improve work participation by people with health conditions.

His interest lies in the expectation by government that the public sector will lead by example in achieving this.

 

Collaborative partnership between govt, regulator, researchers and insurers

 

At a workshop in early April held by SuperFriend, insurers and employers, with a few others, came together to discuss what support the insurance industry could best offer employers.

The portrayal of the current relationship between insurers and employers was dire, especially by small to medium employers.

On the other hand the potential for insurers, employers, health care providers and superannuation funds to come together in innovative partnerships to provide work-place based support at a time of need rather than crisis, to prevent claims and a damaging long duration off work, was tantalising.

The Collaborative Partnership for Work Participation (the Partnership), something I am heavily involved with, is now underway. Chaired by Comcare CEO Jennifer Taylor, its core membership comprises the Insurance Council of Australia, EML insurance, Department of Employment, Department of Social Services, the Australian Council of Trade Unions and the Australasian Faculty of Occupational and Environmental Medicine.

Other organisations are participating in its projects, the first of which is research to explore the movement of people across the sectors in the system: workers’ compensation, life insurance, superannuation, health care and disability support; to describe the system as a whole, especially the interfaces between sectors, with the view to identifying areas for improvement.

Meanwhile Safe Work Australia (SWA) has a project focussing on developing a national approach to the provision of support to GPs for RTW.

The Partnership and (SWA) will collaborate to ensure that the national approach can be used cross-sectorally. That is, start to acknowledge and address the current problem that GPs face in having different advice and tools from workers’ compensation, life insurance, medical retirement and disability support.

There is a lot going on in this area internationally.

Whilst there will be variations driven by differences in systems between nations, there is much to be had from communication and possibly collaboration in this improvement effort. Australia can and should aim for a RTW system that is best in show.

 

 

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First published in Thomson Reuters Inside OHS, 26/04/2017

Inside OHS Editor: Stephanie D’Souza; (02) 8587 7684; Stephanie.D’Souza@thomsonreuters.com