Minimising Longterm Sickness Absence and Healthrelated Incapacity for Work: evidence from DWPfunded

1
Minimising Long-term Sickness Absence and
Healthrelated Incapacity for Work evidence
from DWP-funded researchor Why were doing
what were doing!

• Dr Bill Gunnyeon
• Chief Medical Adviser
• Department for Work and Pensions
• 4 December 2008

2
Context

• Working for a Healthier Tomorrow
• March 2008
• Improving Health and Work Changing Lives
• November 2008

3
Is work good for your health and well-being?

• Worklessness is associated with poorer physical
  and mental health
• Work can reverse the adverse health effects of
  unemployment
• Work is generally good for physical and mental
  health and well-being
• Work can be therapeutic
• The beneficial effects of work outweigh the risks
• The beneficial effects of work are greater than
  the harmful effects of long term unemployment or
  prolonged sickness absence
• Waddell and Burton 2006

4
What Works at Work evidence review

• Interventions with employee-employer partnership
  and/or consultation yield the best results
• Communication, co-operation and common agreed
  goals between stakeholders can reduce sickness
  absence rates
• Employees attitudes and beliefs are important
  considerations (in addition to their health)
• Interventions should address both
  individual-level and organisational-level factors
• Hill, Lucy, Tyers and James 2007

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Vocational Rehabilitation What Works for Whom
and When

• VR is whatever helps someone with a health
  problem to stay at, return to and remain in work
  it is an idea and an approach as much as an
  intervention or a service
• Effective vocational rehabilitation requires both
  work-focussed healthcare and workplaces that are
  accommodating
• There is a strong scientific evidence base for
  many aspects of VR
• There is a good business case for VR and good
  evidence on its cost benefits
• Most people with common health problems can be
  helped to return to work by following a few basic
  principles of healthcare and workplace management
• Waddell, Burton and Kendall 2008

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Job Retention and Rehabilitation Pilot (JRRP)

• Randomised controlled trial which tested
  interventions designed to increase return to work
  rates of those off work for six weeks or more
• Pilot ran for two years
• Over 2,800 people divided into four groups, each
  of which received one of the following
  interventions
• workplace-based
• health
• combination of the above
• nothing (control group)

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JRRP outcomes

• Overall effect on return to work no effect from
  having an intervention compared to the control
  group
• But people suffering from mental ill-health had
  worse return to work rates than those in the
  control group
• Statistically insignificant impact on
  self-reported health by groups that received
  interventions
• DWP Research Report 2006 (no. 342)

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JRRP possible reasons for outcomes

• Poor communication and engagement between clients
  and advisors
• Clients reasons for return or non-return to work
  not discussed with advisors
• Interventions not always appropriate to clients
  perceived needs
• Barriers from employers and GPs
• DWP Research Report 2006 (no. 342)

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JRRP possible reasons for mental ill health
outcomes

• Specific JRRP return to work definition
  inappropriate for clients with mental ill health
• Clients more likely to be encouraged to make a
  complete recovery before return to work
• Inappropriate focus on returning clients to same
  employer
• Clients sometimes became overly dependent on
  their advisors and GPs
• DWP Working Paper 2008 (no. 45)

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Mental health and employment

• 5.5 million people of working age experience
  mental health problems but only 1.3 million are
  being treated
• GPs fail to detect about 50 of people with a
  mental health problem and undertreat anxiety and
  depression
• Sickness absence due to mental health problems
  account for 25 of short absence (lt 7 days) but
  47 of longer absences
• 85 of employers who do employ people with a
  mental health problem do not regret doing so
• Royal College of Psychiatrists Report March 2008

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Mental health and employment

• Key findings
• Most people who had returned to work associated
  this with significant improvements in their
  mental health
• People were reluctant to tell employer about
  their mental health condition
• Those who did reported positive and constructive
  response more than negative ones
• Some people left their jobs rather than going off
  sick
• DWP Research Report July 2008 (513)

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Routes on to Incapacity Benefit

• Key findings one year after claiming IB
• 24 were on a waiting list for medical treatment
  or psychological services
• 38 were receiving medical treatment or
  psychological services
• Of those who had returned to work
• 73 said their GP had been helpful in getting
  them back to work
• 72 said that getting healthcare had been
  important
• 92 said family and friends had been helpful
• 55 of those who had returned to work were doing
  a different job
• Those who were in work prior to claim were more
  likely to have returned to work
• DWP Research Report July 2008 (516)

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Pathways to Work

• Designed to encourage incapacity benefits
  claimants to move back to work
• Began in 2003 in selected areas now rolled out
  across the country
• New claimants must attend Work Focussed
  Interviews
• Choices package of support for claimants
• Return to Work Credit
• In work support

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Pathways to Work outcomes

• Increased probability (by 7.4) of being employed
  18 months after initial IB claim
• Reduced probability (1.5) of claiming IB 18
  months after initial claim
• 6.3 reduction 5 months after claim
• Some evidence on improvement in reported health
• Benefits of Pathways assessed as exceeding costs
  to both society as a whole and to the government
• DWP Research Reports 2007 (435), 2008 (498)

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Work and Health

• Those who are in excellent health earn 4-7 more
  than those whose health is average
• Those whose health is poor earn 7-15 less than
  those with average health
• Probability of being in work declines as health
  status worsens
• Those with excellent health are 17 more likely
  to be in employment compared with those whose
  health is average
• Those with poor health are 34 less likely to be
  employed compared to those whose health is
  average
• HSE Research Report RR639

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Conclusion

• Work is important to individuals and their
  families
• Work and health are closely linked
• We need to take an holistic approach which
  includes
• Improving work and workplaces
• Improving general health
• Better support to help people remain in or
  quickly return to work
• Better communication between individuals,
  employers and healthcare providers
• A broader focus for occupational health
• There is much evidence to support this but there
  are significant gaps which we need to address