Fit for Work

• More than 900,000 absences of four weeks or more each year in the UK

• Much reduced chance of no return to work after 4 weeks without intervention and 600,000 people fall into the benefits system each year

• For most people, their work is a key determinant of self-worth, family esteem, identity and standing within the community, besides, of course, material progress and a means of social participation and fulfilment (Dame Carol Black, 2008)

• Currently OH services are available to around 20% of the UK population

• Part of the aim is to support employees back into work without always requiring 100% fitness to achieve this

• All assessments use a bio psycho social approach to ensure that these factors and behaviours are considered

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Service Scope: what the DWP has asked for

• An Advice Service – phone line and website – open to all, for general queries about matters affecting work and health

• A voluntary Return to Work Service for employees who are off work due to sickness

• GPs can make referrals at any stage, at the GP’s discretion, when the absence is likely to last for 4 weeks or more (but ideally certify for 1-2 weeks)

• Employers can make referrals after 4 weeks of sickness absence

• Eligibility: Off work from paid employment, Living in England/Wales, have a fit note from GP, No previous referral in last 12 months.

• The output of the service is a Return to Work Plan agreed with the employee, which functions as evidence of fitness for work

• The assessment and RtWP development is carried out by a health professional

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Bob’ story• 28 years old and a Fitter– lived with his girlfriend who had spinal injuries after a car accident (Bob was driving). No previous mental health issues. Had agreed some emergency unpaid leave for one month with employer initially, but hadn’t returned to work when care arrangements were in place.

4 Employer presentation FfW v2 September 2015

• Assessment identified:

• Complete withdrawal of social contact other than immediate family for both

• Loss of confidence in ability to work and the development of some paranoia in relation to how people felt about him and accident causation

• Contact avoided with his line manager and any colleagues – and feeling increasingly embarrassed about absence and illness and unable to face the prospect of returning

• Worsening low mood (discussed with GP) – anti depressants prescribed but not taken

5 Employer presentation FfW v2 September 2015

• Plan

• CBT to challenge negative thoughts (EAP in place)

• A plan with clear timelines to meet colleagues and manager – and established there was no basis to the paranoia

• A plan for social activity with girlfriend (pub quiz, lunch out with friends, trips to the supermarket and walks outside)

• A plan to return to work 3 weeks later (after meeting with manager and some sessions of CBT) on a phased return

• Signposted to local support groups 6 Employer presentation FfW v2 September 2015

Stephen – 42 year old Support Worker

7 Employer presentation FfW v2 September 2015

• GP referred – absent from work for 7 months (4 months suspended on full pay and 3 months sick)

• Had highlighted concerns at work that included his manager and another colleague

• Manager had then issued ‘counter allegations’ and Stephen was suspended pending investigation

• The process took 4 months and as a result, Stephen was exonerated and his manager and the other employee were dismissed

• The impact on his own mental health was significant and Stephen had since developed low mood and sleep issues and GP had referred for Talking therapies (Mindfulness based CBT)

• The employer was keen for him to return and the teenager in his care and family had contacted him personally to say thank you and request his return.

• There was also a concurrent issue with TUPE arrangements which were complicating matters and his feelings about work

8 Employer presentation FfW v2 September 2015

Plan

• Agree to separate out concerns re TUPE as likely to be best resolved in employment rather than away from the workplace

• Continue mindfulness based CBT and assume positive impact on mood/sleep

• Contact with employer to relay the gravity of the impact on him and to ensure this was fully appreciated by the business

• Date agreed 3 weeks hence to return to work – phased and visit with line manager in one week

9 Employer presentation FfW v2 September 2015

The Referral Process

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Fit for WorkGP feedback

Dr Avi Prasad, Leicestershire GP and CCG co-chair:“As a GP, I want to see that my patients are fully looked after and supported. Patients who have been off for over four weeks will now have the opportunity to get an occupational health assessment by a health professional and the aim of Fit for Work will be not only to help get people back to work successfully but also to improve the overall health of the patient.”

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Dr. Mohammed Sohail Khan, GP in Yorkshire: “The fact that Fit for Work works directly with patients and their employers means that everyone - the patient, the employer, and me, the GP – is saved time; and the care the patient receives is more joined-up.”

Dr. Simon Dobson, GP in Wales: “The good thing about the service is that it means I can refer patients to people who are experts in occupational health, which isn’t something we are trained in as GPs. This helps patients get back to work quicker, and it also saves me so much time.

It also means that there is a better standard of care for the patient, because they are dealing with someone trained in occupational health, who can help them create a personalised plan to help them get back to work in a way that suits them. I’m hopeful that more GPs will start referring patients to Fit for Work – it means less time writing sick notes and more time focusing on patients’ health.”

Fit for WorkEmployer feedback

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Gemma Rylatt, manager at Humberston Park School:“Fit for Work helped make our employee’s return to work really simple – without them we would have had to go through a lengthy process, doing things like writing to her doctors. Fit for Work helped cut out that long-winded process and did all of the legwork for us, which was really helpful from a business perspective.”

Philip Horsfield, practice manager at Village Green Surgery: “I know that our employee felt very comfortable talking to the Fit for Work case manager. She just needed to build up her confidence again so that she could ease back into work.

“She returned on exactly the date agreed in her Return to Work Plan – the process was very quick and efficient. The experiences we’ve had with Fit for Work were great and I couldn’t be happier with how the service works.”

Fit for Work2016 and beyondWhat are the key challenges?•  Awareness – we want Fit for Work to

become the default response nationwide for people who hit four weeks sickness absence

• The biopsychosocial approach – how do the different aspects really work, especially the non-health and non-work aspects?

• Our approach to businesses – working in conjunction with OH services in larger businesses, while continuing to promote the service to SMEs with a lack of OH provision

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In the pipeline• Service improvement - As use of the

service increases, we will have more MI and satisfaction data to challenge processes and promote continuous improvement

• Service evaluation - We are starting longer-term evaluation, provided by the Institute for Employment Studies, that will allow us to learn and apply lessons about the way the service works

• Other services - There is potential to look at how wrap-around treatment and intervention services could complement Fit for Work (such as the Welsh Government-funded successor services to the Rhyl pilot).

Thank you!