Workplace Vocational Rehabilitation in Scotland Kathleen Houston Development Manager Vocational Reha

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Workplace Vocational Rehabilitation in
ScotlandKathleen HoustonDevelopment Manager
Vocational RehabilitationThe Scottish Centre for
Healthy Working Lives Vocational Rehabilitation
Association 2 July 2009
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Structure of presentation

• 1. Scottish Centre for Healthy Working Lives
• 2. The case for workplace vocational
  rehabilitation services
• 3. Development of Working Health Services
• 4. Wider Scottish Activities
• 5. Black Report Working for a Healthier
  Tomorrow
• How the recommendations are being addressed

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Section 1

• The Scottish Centre
• for
• Healthy Working Lives

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Improving Health in Scotland The Challenge (2003)
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Workplace
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Partnerships
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Structure of NHS HS - Directorates
Chief Executive

• Chief Executive's Office
• Human Resources
• Corporate Communication
• Partnership Management Programme

• International Development
• Organisational Development

SCHWL
Public Health Science
Programme Design and Delivery
Resource Management
Equalities and Planning

• Policy Evaluation and Appraisal
• Professional Support
• Evidence for Action
• Public Health Observatory

• Better Health
• Healthy Behaviours
• Healthy Living
• Healthy Sectors
• Health and Wellbeing
• Learning and Workforce Development
• Marketing

• Finance
• IT
• Resources

• Development and Planning
• Equalities Support

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Location - Princes Gate, Castle Street,
Hamilton
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Primary aims of the SCHWL

• To improve the health of working age people,
• To reduce inequalities
• To improve business and economic performance in
  Scotland
• To maximise the positive outcomes arising from
  the relationship between health and work

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Activities of the SCHWL
Learning and Development
Healthy Working Lives Award Programme
Delivery and development of Workplace Services
Provide training for staff Provide external
training

• National Advice line 0800192211
• Health Promotion
• Occ Health and Safety
• Vocational Rehab.
• Employability

• Bronze
• Silver
• Gold
• Mental Health Commendation Award

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• Scottish Centre for Healthy Working Lives
• Regions
• and
• Health Boards
• 3 Regional Co-ordinators
• 85 HWL Advisers
• Health and Safety
• Health Promotion
• Occupational Health Nurse/Advisors

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Section 2

• Why do we need workplace vocational
  rehabilitation services?

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Agendas

• 2000 Securing Health Together
• 2002 Pathways to Work Helping People into
  Employment
• 2004 Building Capacity for Work
• 2004 - Healthy Working Lives A Plan for Action
• 2005 Scottish Centre for Healthy working Lives
  Business Plan
• 2005 - Delivery for Health
• 2006 - Workforce Plus An Employability Framework
  for Scotland
• 2006 A New Deal for Welfare empowering People
  to Work
• 2006 - Keep Well ( Prevention 2010)
• 2007 A Delivery Framework for Adult
  Rehabilitation in Scotland

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Spectrum of employment - Scotland
Working age Total 4.19m (June 2007) M 16-65
yrs 1.91m F 16-60 yrs 2.19m

• Pathways
• Work focused interviews
• Access to NHS Rehab
• Assistance with employment
• Return to work credit

SMEs very little occ. health support available
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WHY contd GDP Scotland May 2009 (Insider May
2009)
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Availability of VR services

• Only 3-15 of companies in the UK have access to
  Occupational Health support services
  inequalities in access
• Mostly large companies or specialist operations
  e.g. lead, asbestos monitoring of employees
• Access to general services which are too
  downstream from the workplace - delayed
  loosing valuable time
• SME Sector (where the majority of people work)
  few have access to any kind of Occupational
  Health Support
• Poor links between employers and primary care
• Sick-notes state what an employee cannot do i.e.
  not work rather than indicating what work tasks
  they can do

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Why do we need VR services?

• Sickness absence costs the economy over 13.4
  billion a year (CBI 2007)
• over 175 million working days lost each year
• Public sector absence average of 9 days per
  employee (private sector 6.3 days) (CBI 2007)
  
• If public sector absences were reduced to
  private sector levels, absence would fall by 15.8
  million days, saving the taxpayer more than 1bn
  per year
• Costs of working age ill-health for UK
  Government and society are well in excess of 100
  billion per year

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Contd.

• Musculo-skeletal disorders
• - affect more than one million people in the UK
• - cost society 7.4 billion a year
• - acounts for up to a third of all GP
  consultations
• - 9.5 million lost working days. (Work
  Foundation)
• Common mental health problems
• - cause lower productivity at work
• - cost in excess of 15 billion a
  year
• (Sainsbury Centre for Mental Health).
• 271,400 people on Incapacity Benefit in Scotland
  (2.4 million in UK)
• the majority have been there for 5 years or
  more
• - proportionally much higher than other EU
  countries

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Section 3

• Development of
• Working Health Services

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Working Health Services Dundee multi-sites
Photo faraday st
Faraday Street Project Offices

• Service launched
• 12-13 February 2008

Ninewells Hospital
Kings Cross Hospital
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Working Health ServicesNHS Tayside, Lothian and
Borders

• Launch of WHS Lothian
• 10 March 2009

Launch of WHS Borders 3 July 2009
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Why was Dundee chosen?

• City of Discovery
• Famous for Jute, Jam and Journalism
• Discussion with Management of NHS HS -already
  several health initiatives where linkages are
  possible e.g. OHSXtra, Keep Well
• Willingness on part of NHS Tayside and Health
  Board Managers to take project on board
• Evidence of good city-wide partnerships between
  NHS, Enterprise and DWP
• Good mix of industries
• Good size of population
• Geographical location away from central belt

Royal Research Ship Discovery built in Dundee
and Capt R F Scott sailed on his first voyage to
Antarctica in 1901
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Dundee profile

• Working age popn. (16-64 yrs) resident in the
  City 92,745
• Working age popn. (16-64 yrs) resident within 30
  mins
• from the City 193,232
• Economically active in the City 64,300
• No. of jobs in Dundee 84,068
• (largest sectors Wholesale and
  Retail)
• Approx number of workplaces in Dundee 4,000

River Tay Rail Bridge
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Structure of Working Health Services Dundee team

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Use of IT Web database

• Linked into NHS Tayside IT systems secure
• Allows client notes to be accessed and updated
  from several sites in the area
• Reduces risk of paper records being lost in
  transit
• No filing required saves time
• Use of consistent validated tools GHQ12, EQ5D and
  COPM
• Records can be accessed in real time
• Data entered is used for statistical analysis

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How the referral mechanism operates
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Gender (N397)
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Home base (N397)
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Depravation categories (N169)
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Salary (N397)
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How client heard of service (N397)

•  

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Primary Presenting Issue (N 397)
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Other measures pre-intervention

• Medication for the condition (N397)
• 76 Yes
• Absent at pre-intervention (N397)
• 29 Yes

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Other measures post intervention (a)

• Medication for the condition (N172)
• None 40
• Reduction 7
• Same 42
• Some reduction some additional 4
• Additional 7
• Absent at post-intervention (N183)
• 8 Yes

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Client view of health issue resolution (N182)
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Other measures post intervention (b)

• Think programme helped RTW or stay in work
  (N182)
• 86 Yes

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Summary of Interim Report

• Clients broadly representative of Dundee City
  population
• Main reasons for referral MSD
• Outcome measures indicate improvements in health
  and return to work / work retention
• Clients perceive programmes benefit

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Components of a workplace vocational
rehabilitation model

• Team structure
• - Multi agency
• - Multi-disciplinary
• - Core team of experts
• - Co-location of team
• Service delivery
• - Early intervention
• - Easy to access service
• - Aimed at Small and Medium Enterprises
• - Occupational Health support, Health and
  Safety, Health Promotion, support through the HWL
  Award programme local Health Board and voluntary
  sector projects
• Model of delivery
• - Case manager approach
• Use of IT
• - Web database
• Clinical governance
• - Professional standards
• - VRA standards

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• Working Health Services
• Dundee - 01382-825100
• Lothian - 0131-537-9579
• Borders 01896-825983

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Section 4

• Wider Scottish picture

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Scottish picture

• Appointment of Rehabilitation Co-ordinators in
• 14 Health Boards
• (Co-ordinated, integrated and fit for
  purpose A Delivery Framework for Adult
  Rehabilitation in Scotland, Feb 2007)
• Brings together strands of Care of the
  elderly, Long Term Conditions and Workplace

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EducationIntroduction and sponsorship of the
NIDMAR course (National Institute of Disability
Management and Research

• Modules
• A - Effective disability management programmes
• B - Return to work co-ordination
• E - Job analysis
• F - The role of assessment
• G - Communications and interviewing skills
• M - Problem solving in groups

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Linking with NHS24

• Current
• Pilot areas for self referral to physiotherapy
• ( In Scotland Physiotherapists treat a total
  of 271,000 patients including 64,000 back pain
  patients
• Holdsworth 2007 potential cost efficiencies up
  to 2m)
• Future
• Pilot areas for accessing Dietetic services
• NHS Lothian and NHS Highland
• (linked to obesity agenda)

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Web site development self management and

• Working Backs Scotland currently under review
  launch Back Care Week in autumn
• Upper Limb and Neck - new website under
  development
• Potential links with existing knee website NHS
  Lothian

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Meeting the Black Report Recommendations
Section 5
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Meeting the Black Report Recommendations

• Chapter 3 -The role of the workplace in health
  and well-being
• Health and Wellbeing consultancy service to
  provide employers with advice and support
• SCHWL - free and confidential advice line and
  visits to workplaces
• Easier ways for smaller employers to establish
  health and wellbeing initiatives
• Links to the HWL Award programme

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Meeting the Black Report Recommendations contd.

• Chapter 4 Changing perceptions of fitness for
  work
• Fit for Work service case management,
  multidisciplinary approach for people in the
  early stages of sickness absence
• Working Health Services Dundee, Lothian and
  Borders

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Meeting the Black Report Recommendations contd.

• Chapter 7 - Developing professional expertise for
  working age health
• OH and VR in mainstream healthcare
• Working Health Services Dundee, Lothian and
  Borders
• Clear standards of practise
• Adhere to the Vocational Rehabilitation
  Association Standards
• Clear standards of accreditation
• Introduction of the NIDMAR course in Scotland
• Systematic gathering and analysis of data at
  national, regional and local levels
• Use of web database and validated tools

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• Questions?