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WWW.ACPOHE.CSP.ORG.UKTWITTER: @ACPOHE
Supporting Employees with Long-Term Conditions in the
Workplace
PROFESSOR KAREN WALKER-BONEDIRECTOR, MRC VERSUS ARTHRITIS CENTREFOR MUSCULOSKELETAL HEALTH AND WORK
Supporting employees with long-term conditions in the workplace: Setting the scene
Plan
• A (real life) case history
• Work is important for health
• Disability for work in the UK
• What do the patients tell us?
• Disclosure and the legalities
Plan
• A (real life) case history
• Work is important for health
• Disability for work in the UK
• What do the patients tell us?
• Disclosure and the legalities
My patient’s story
• 51 year old female, highly qualified employee in Local Authority role
• Team leader: 8 people
• Worked in this job for 18 years full-time
• Commutes by car (30-40 minutes each way)
• Married, 1 daughter
Clinical and educational history
• Presented with JIA aged 14 years
• Disease stabilised well on methotrexate in childhood and adolescence
• Left school with A-Levels and went on to University to do a degree
• Completed training as social worker
Progression
• Arthritis remained very stable (was able to stop methotrexate and conceive her daughter)
• 13 years ago, then aged 37, disease “flared up”
• Commenced on anti-TNF therapy with adalimumab and, in combination with methotrexate, arthritis controlled
• Stable from then until last year
Current picture
• 16 months ago, now aged 49, asked to switch adalimumab to biosimilar with £3,000 per annum cost saving to NHS
• Around same time, daughter (aged 15) taken ill and diagnosed with acute leukaemia
• After switching, she experienced an acute flare of arthritis: severe pain, stiffness, fatigue and immobility
• Needed to take 15 weeks off work to recover
• Returned 4 days/week after phased return
• Ongoing problems with arthritis
Work situation
• Asked for light-weight laptop, car parking nearer to offices, voice activated software, working from home one day/week
• Needed to keep team leadership active therefore needing conference software
How did the employer respond?
• Written letter of warning: starting disciplinary procedures – too much sickness absence
• Previously supportive line manager seeming hostile and distant
• Relationships in office “strained”
• Arthritis failing to stabilise despite new medications
Impression
• Highly skilled employee with vast experience doing an “important” role – part of her identity
• Inflammatory arthritis has been easy to control for many years
• Under stress from her daughter’s illness aggravated by events at work
• Rheumatologically, now challenging to manage the disease
• Angry, emotional, desperate
• Feeling “abandoned” by colleagues and employer – affecting self-esteem and health
Plan
• A (real life) case history
• Work is important for health
• Disability for work in the UK
• What do the patients tell us?
• Disclosure and the legalities
Work and health
• Work is central to human existence
• It is the motive force for all economies and provides structure and meaning to individuals and societies
• Good for health and well-being
• Good for financial health
• Good for families
• Socially inclusive and ‘a right’
Black C. Working for a Healthier tomorrow, 2008
The effects of unemployment on health
• Associated with poorer health and wellbeing
• Worse levels of pain
• Higher mortality : 5-10 years reduced life expectancy
• 2-3 fold higher risk of chronic disease
• 3-fold risk of psychiatric morbidity
• Higher medical consultation and hospital admission rates
Re-employment improves health outcomes
• Being back in (good) work improves health and wellbeing
• Facilitates independence
• Reduces need for healthcare intervention
• Work is part of recovery (hence phased return to work)
Plan
• A (real life) case history
• Work is important for health
• Disability for work in the UK
• What do the patients tell us?
• Disclosure and the legalities
Source: OECD (2014), Mental Health and Work: United Kingdom, Paris: OECD Publishing. Courtesy Shruti Singh
New UK disability claims are among the highest in the OECDNew claims per 1,000 of the working-age population (inflow rates),
latest year available
0
2
4
6
8
10
12
OECD
average
UK: Disability burden
Earlier intervention could
improve this
Proportion of people who will return to work in relation to duration of sickness absence
83.3
50
30
10
0
10
20
30
40
50
60
70
80
90
1.5 6 12 24
Duration sickness absence (months)
%
Plan
• A (real life) case history
• Work is important for health
• Disability for work in the UK
• What do the patients tell us?
• Disclosure and the legalities
Work Matters: RA and JIA
• >1200 RA and JIA patients
• 63.3% in paid employment
• 7.6% self-employed
• 17.3% out of workplace due to RA
• Most had disclosed (96%)
• 39% reported ‘no understanding’ from employer
• More likely coping at work if: understanding employer, reasonable adjustments in place and accessible and comfortable work environment
• Remaining at work giving financial security and sense of purpose
https://www.nras.org.uk/publications/work-matters
Work Matters: 5 main challenges
• Demanding role
• RA symptoms
• Lack of reasonable adjustments
• Commuting to/from work
• Lack of understanding employer or colleague(s) at work
Chronic pain patients
• Work is important to them
• Not enough support from healthcare professionals to enable them to work
• Work rather “ignored” in the consultation –focus on health outcomes (e.g. pain VAS)
Plan
• A (real life) case history
• Work is important for health
• Disability for work in the UK
• What do the patients tell us?
• Disclosure and the legalities
Disclosure and legalities
• Most people with a long-term condition would be eligible for protection under the Equality Act 2010 IF they declare their ‘disability’
• Still a difficult discussion for patients.. They are often frightened to disclose and may need support /resources to enable and empower them
• You can communicate with the employer but only do so THROUGH the patient (confidentiality) and leave to them to decide whether they share or not with employer
Equality Act
• Under the terms of the Equality Act someone is termed 'disabled' if they have a ‘physical or mental impairment’ which can have a ‘substantial and long-term adverse effect on that person’s ability to carry out normal day-to-day activities’. Normal day-to-day activities can include:
• walking or driving
• washing or getting dressed
• cooking or eating
• using public transport
• writing or typing
• carrying or moving things
What does the Act say?
• An employee with a disability is entitled to “reasonable adjustments” to enable them to participate in work to the same extent as workers without a disability
All healthcare professionals should…
• Always ASK their patients about work every time
• IF they are not working, do they want to?
• What are the barriers?
• Are they struggling at work?
AND: Ask questions to establish if:• Work is a likely cause of a health problem• Work has aggravated an existing health
problem• Their health problem has an effect on the
ability to do a job
Proportion of people who will return to work in relation to duration of sickness absence
83.3
50
30
10
0
10
20
30
40
50
60
70
80
90
1.5 6 12 24
Duration sickness absence (months)
%
Conclusion
• Work matters to everybody and facilitates health and wellbeing
• Part of our responsibility to enable patients to work if they wish (NOT force them if they don’t)
• Many services available to signpost people towards but region-specific
• You do NOT need to become expert but you do need to ASK about work and be prepared to do some supporting and sign-posting
• WORK is becoming a health outcome and physiotherapists can be on the vanguard
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/564038/work-and-health-green-paper-improving-lives.pdf
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