SALUS

RETURN TO WORK

SERVICES

Nancy WatsonSenior Case ManagerSalus – NHS Lanarkshire

Salus – Return to Work Model• Population based approach aimed at supporting both Workless and

those Absent from Work to return to the Workplace/Labour market.

• Three Tier Service Model • Bio Psychosocial principles,• De-medicalising conditions• Promoting Education & Self Management

• Most of the Issues do not require Medical Solution• Most of the solution is waiting to be accessed

Services Provided• Voc Rehab to Workless populations

• Case Management (LA’s, Scot Gov, PCT, Private Sector..)

• Voc Rehab to populations at risk of Job Loss• Fit for Work (SME based)

• Specific Population Work• MCN Stroke• Physiotherapy – Pain Management• Keep Well – Screening Programme• EASY – NHS Lanarkshire absence management

• All Externally funded (zero core funding)

• Approx 7,000 individuals per annum.

Case Management Content All programmes contain these elements:

The Bio-Psychosocial Approach• Telephone case management• Initial holistic assessment including clinical risk assessment• Pre & Post quantifiable measures• Connection and supervision through multiple agencies where

appropriate• Cognitive/educational modules on understanding and managing

conditions• Co-ordinated Care • Constant Communication throughout• Outcome driven (Job, return to Work, Health Improvement goal)

Role of Case Manager

Co-ordinate

Mentor

Communicate Mediate

Motivate

Refer/Signpost

Identify

Case Manager

Core Elements Presenting Conditions• Managing Depression• Managing Anxiety• Managing Aspiration• Pain Management• Managing Fatigue• Managing Addiction• Confidence Building• Coping Strategies• Health Promotion• Managing social/family

circumstances• Linking to employability

Services

• Mental Health 46%• Musculoskeletal 28%• Other 12%• Alcohol/Drugs 11%• Stroke 3%

PerformanceMental Health (N=3,446)

7.24

11.5

9.0

4.9

0.0

2.0

4.0

6.0

8.0

10.0

12.0

Pre Post

Average Score

Sca

le P

oin

t

Anxiety

Depression

ANXIETY LEVELS FELL ON AVERAGE 37%

DEPRESSION LEVELS FELL ON AVERAGE 46%

Performance - Function

3.5%7.7%

17.9%

89.9% 89.3%

79.6% 78.0%

4.1%

8.7% 12.8%6.5%

2.0%0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

EuroQol VAS(n=199)

VDPQ (n=195) COPM perform(n=196)

COPM satisf(n=196)

% c

lien

ts clients decreased%

clients no change %

clients increased%

Customer Satisfaction• 92.3% of clients stated that case management had a positive impact on their current

work situation• 99.6% of clients would recommend the service to others• 100% of clients rated their experience of case management as Excellent (78.3%) or

good (21.7%)

• Delighted with the help I got. I wouldn’t be where I am today – back at work and feeling much better.

• Really excellent service that definitely helped me a great deal. Thanks for all your help.

• Case Manager was helpful in supporting me, made me realise I have a future.• Happy with all the help I received. It has made a real difference to me. Thanks you so

much.• Really enjoyed the experience, you have given me information, and made me think

about my future. Your service is very worthwhile.

Thank You

Any Questions?

Reducing Sickness Absence Its EASY

Moyra Anderson

Absence Management Co-ordinator

Evidence Based Interventions that Reduce Sickness Absence

• Early Intervention• Musculoskeletal• Mental health• OP/OHA/Other

• Case Managed approach

• Maintaining contact with employee / workplace

• Postal intervention- advice

• Health Promotion activities

• Phased return to work

• Work modification

Our Role

• Friendly

• Non judgemental

• People need support

• Continuous improvement

• Evidence based

• Proportionate

EASY Results

• For each SA event reported to EASY

1. Consent – a) participation b) data

2. Who – sex, age, job family

3. Where – Division, Clinical Division, Directorate, Ward

4. Cause of Absence – “Swiss” categories (http://www.iom-world.org/sicknessabsence/saclassn.htm)

5. When - First day of Absence, Date return to work

Mental Health

• 3056 SA reports in 2010

• 156 are due to Mental Health problems (5%)

• 103 of these stress related (66%)

• 11 work related (11%)

EASY Results

NHS Lanarkshire: Sickness Absence Rates before and after the introduction of EASY (SWISS)

3%

4%

5%

6%

7%

May June July Aug Sep Oct Nov Dec Jan Feb Mar Apr

HEAT Target

Pre-EASY 2007-2008

Post-EASY 2008-2009

Post-EASY 2009-2010

Post-EASY 2010-2011

Post-EASY 2011-2012

EASY Results

Half Lives: All causes

5

10

28

0

5

10

15

20

25

30

EASY Results

Half Lives by EASY Quarter: All causes

75 4 4 5 5 5 5 5

35

118

10 11 108 8 7

71

43

21

29 30

2119

21

15

0

10

20

30

40

50

60

70

80

90

100

Apr to June2008 (79)

July to Sept2008 (631)

Oct to Dec 2008(2432)

Jan to Mar 2009(2474)

Apr to June2009 (2286)

July to Sept2009 (2521)

Oct to Dec 2009(3456)

Jan to Mar 2010(2956)

Apr to June2010 (2033)

Quarter

Da

ys

Ab

se

nc

e

Total 50%

Total 75%

Total 87.5%

Secondary Compliance

NHSL: All Causes: Half Lives by Secondary Compliance: First Day of Absence Monday to Friday

45

65

79

1415

16

22

35

31

0

5

10

15

20

25

30

35

40

0 (N = 11914) 1 (N = 1695) 2 (N = 412) 3 (N = 435)

Secondary Compliance

Da

ys A

bse

nce

50%

75%

87.5%

Feedback

• Staff

• 89% satisfied with the help received from EASY• 82% satisfied with waiting time for support services• 84% rated NHSL as an employer positively• 88% rated EASY Service positively

• Manager

• 87% felt EASY was helpful in returning their staff to work more quickly• 94% felt involved during their staff members absence• 89% rated the EASY Service positively

Conclusion

• Evidence based service model with support from Day 1 of absence

• Sickness absence reduced by over 30%

• Cost savings on bank staff

• £ 7 million directed towards productivity, rather than statutory sick pay

• Provides a snap shot of current health – related issues e.g. mental health

• Know why people are absent

• Led to strategic development of supportive services e.g. SPS, ECS