Keeping people healthy at work
– the UK Government’s strategy
Professor Dame Carol Black
UK National Director for Health and Work
21 October 2009
The UK Welfare System and Work
• The Government wants as many people as possible to
share in the rewards of work, because paid work is the
best route to independence, health and well-being for
most people.
• The United Kingdom has a comprehensive, regulated,
state-administered cash-benefit social security
system, which covers the entire population.
• Alongside the benefit system, are tailored training
and support programmes managed through
government agencies.
The UK Healthcare System
• The UK National Health Service (funded from general
taxation, covering the entire population, and free at
the point of delivery) is divided into primary and
secondary care.
• Primary care is controlled by regional Strategic
Health Authorities through the Primary Care Trusts (a
Trust being a local board of unpaid appointees).
• Primary Care is the first point of contact for the
public, and includes family doctor (GP) practices,
pharmacists, opticians and dentists.
• Secondary care is hospital care.
Why people are off work
• Two-thirds of sickness absence
and long-term incapacity is due
to mild and treatable
conditions:
• Depression, anxiety, stressrelated mental health
problems
• Musculoskeletal conditions
• Cardio-respiratory
conditions
• Inappropriate “medicalisation”
• Poor retention in the workplace
of those with disabilities or
chronic disease
Contact with the
workplace is often lost
Misconceptions: the need to change attitudes



Compelling evidence shows that
work is generally good for both
physical and mental health and
well-being. Beneficial effects of
work outweigh the risks1
Nevertheless the fallacy persists
that individuals should only be at
work if 100% fit. Many individuals
wrongly believe that work is
harmful to health1.
Employees think that OH is of
benefit mainly to employers
• In some countries these
misconceptions underpin procedures
for certification of sickness absence2
• Also, vocational rehabilitation,
occupational health service, and
employer flexibility are frequently
inadequate.
• It is vital that employers, healthcare
professionals and the public
understand better the positive links
between work and health2
1. Waddell and Burton, September 2006
2. Working for a Healthier Tomorrow, Dame Carol Black, 2008
The UK system in 2007
•
A system of sickness certification that labels you as sick
•
No Occupational Health services in Primary Care
•
No pathways of rapid intervention to keep you in work or return you to it
•
Poorly-informed healthcare professionals with little understanding of work
as a (medical and social) determinant of health
•
Little interest from local Primary Care Trusts
•
Rehabilitation to work not critical to assessment of the performance of
PCTs
•
Poor retention in work of those with disabilities or chronic disease
The UK ‘Sick Note’
• At present, a family doctor
(General Practitioner (GP))
assesses a person’s health and
ability to work.
• The ‘sick note’ form requires the
doctor to state whether or not the
patient can work, and how long
they should refrain from work if
sick.
• Partial ability to work is not
overtly considered.
• Return to functional capacity and
work is NOT part of the
consultation
Occupational Health in the UK
“ Occupational Health services reflect the historical view of
‘industrial medicine’ as a benefit to employers which should
be financed by them. There is no OH provision in the
National Health Service.
The challenge for a new paradigm of OH is to examine the
care pathways for working people and find new ways to
support them before, during and after illness at work.
A new model has to be put in place to reflect the current
profile of employment in Britain.
It requires new partnerships and new ways of working across
traditional boundaries. Occupational Health must make a
greater contribution to the health of the national economy “
Lane Lecture, University of Manchester, Nov.2007
Working for a healthier tomorrow, 2008
- a new vision for health and work
Working for a
Healthier
Tomorrow
“At the heart of this Review is a recognition of, and a
concern to remedy, the human, social and economic
costs of impaired health and well-being in relation to
working life in Britain. The aim is not to offer a utopian
solution for improved health in working life, but rather to
identify the factors that stand in the way of good health
and to elicit interventions, including changes in
attitudes, behaviours and practices – as well as
services – that can help overcome them.”
Prevent illness, promote health, intervene early,
improve the health of the workless.
What is needed in the UK?
Recommendations to Government
• Education and Training of Health Professionals and
Managers (in business and the NHS)
• Change of attitude in the population
• An electronic ‘Fit Note’
• An early-intervention holistic service based in
primary care
• Support for employers in health and work
• Collaboration and co-operation between all sectors
Response of UK Government
- relevant to Primary Care
• Introducing an electronic ‘Fit Note’ (April 2010)
• Piloting a ‘Fit for Work’ early-intervention service (January 2010)
• Regional Co-ordinators situated in regional Public Health offices
• Education and training programmes for GPs, with further
extension to nurses and other health professionals
• Revitalised and re-orientated Occupational Health services,
available to all not just the few.
• A help-line for advice to small and medium-sized companies on
health and work
• Social marketing campaign
Proposed new UK model
• Poor contact with employers
• No early intervention
Fit for Work Service Pilots
FFWS concept
FFWS Pilots: range of models
Of:
• Employees off sick from work
• But also of:
• Presentees
• Unemployed – few, with specific,
unmet needs
From:
•General practice
•Employers
•Self referral
•But also from:
•Other healthcare professionals
•Job Centre Plus
•Voluntary sector agencies
Fit for Work Service Pilots
FFWS concept
FFWS Pilots: range of models
Fit for Work Service ‘hub’
B
E
S
P
O
K
E
S
E
R
V
I
C
E
S
MSK physio,
OT (NHS)
bio-
Psychological
therapies (NHS)
-psycho-
Advice: e’ment,
debt, housing
Conciliation
Self care support
-social
FFWS Pilots: range of models
Fit for Work Service ‘hub’
Based in primary care or in the
broader community
Case management:
• OTs, physios, psychological
therapists, employment advisors,
OH advisors
• Co-ordination: client, employer,
GP
• Timely access to FFWS ‘spoke’
services
Additional hub services:
• Physio, psychological therapy
• Specialist employer liaison team
(complex cases)
• OH physician, OH nurse
FFWS concept
The National Education Programme
- for GPs, starting April 2010
•
•
To change their behaviour when
managing health and work
problems
To increase confidence in their
everyday practice
Current:
• An interactive facilitated
3-hour session, developed
through a stakeholder
group.
Shift to:
Work is a ‘risk’ and
Work is generally good
(potentially) harmful to physical for physical and mental
and mental health.
health
therefore
and
Sickness absence/certification
‘protects’ the worker/patient
from work
Recognise the risks and
harm of long term
worklessness
Wales: Occupational Health Task
and Finish Group
The Minister accepted its conclusions and three key recommendations:
•
Changes to the current risk- and evidence-based legislation for
occupational health are not an effective way of improving health and
reducing ill health;
•
The integrated approach to Occupational Health, outlined in the Welsh
Assembly Government’s response to Dame Carol Black’s report, should be
further developed; and
•
A national occupational health service, provided by the NHS, and
made viable by contributions from employers, should be established.
Professor Mansel Aylward has been asked to convene a second Task and
Finish Group to take forward the recommendations, and in particular to
develop a costed delivery model for the national occupational health
service. This second Group will meet on a bi-monthly basis to take
this work forward.
Working Together We Will make a Difference
“By working together, our
efforts will help us to combat
social exclusion, eradicate
child poverty, support our
ageing population, and build a
workforce for tomorrow. By
improving health and work we
will make a real difference to
people’s lives.”