Health Works Supporting Health In Working Age

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Health WorksSupporting Health In Working Age
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Setting the SceneRoddy DuncanScottish
Government
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Approx 2.5 million people in Scotland of working
agegt70 in employmentCost of ill-health
approx. 10 billion p.a. to economyApprox
250,000 on incapacity benefit/ESA1 in 6 working
people have poor mental health
Some Numbers
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Meets important biopsychosocial needsSound
evidence baseMost people capable of undertaking
some type of workMost people with health
conditions want to workPoor work/working
conditions can affect healthPoor health can
limit ability to work
Work1 is good for health
1. By work we mean, more generally, any activity
that give purpose to life. This could be paid
work, volunteering or caring duties, for example.
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Health Works a patient centred approach to
healthcareNeeds a change in culture work
outcomes for patientsEfficient and effective
opportunity to avoid over-medicalisation
biopsychosocial approachImportance of working
in partnership focus on successful outcomes for
patients
Quality Strategy
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For Patients faster, direct access to
treatment positive advice and support faster,
fuller recovery keep job and earnings sustained
independence.For Health Boards efficient use
of resources reduced waiting times reduced
prescription costs reduced inappropriate
diagnostics reduced repeat visits.For Scotland
reduced sickness absence improved
productivity reduced demand on public services
increased workforce participation increase in
people managing own health.
Benefits
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Some examples of activity in Scotland that is
translating the ambitions of Health Works into
practical examples of patient-centred, effective
and innovative healthcare services.
Putting it into practice
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The National Musculoskeletal (MSK) ProgrammeDr
Sarah L Mitchell
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National MSK Re-design Part of Health Works
Focus on local services redesigning their MSK
pathway around patientsFocus on employment, the
Scottish OfferFocus on developing a national
point of access to local MSK services Focus on
developing interdisciplinary teams delivering
MSK
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Why are we re-designing our MSK services?People
in Scotland with MSK conditionscurrently
experience..Variable access to MSK services
Variable managementVariable measurement of
outcomesNo formal assistance with helping
people back to work or into workAnd
sometimeslong waits for these variable
serviceswe could do so much better.
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Impact of MSK conditions MSK most commonly
reported type of work related illness and take up
more than 30 of all GP consultations.Prescripti
on costs for MSK Result in loss of 12.5 million
working days lostLow back pain is the most
common musculoskeletal problem affecting an
estimated 18 million people, with associated
costs of 7bn p.a. to the economy due to working
days lost.
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What are we proposing?

• A National MSK Triage and Referral Management
  Service for NHS Scotland delivered within NHS 24
• Local referral management hubs within boards
• Direct referral into WHSS for those working in
  SMEs
• Development of Interdisciplinary pathways using
  evidencebased outcome measures
• Development of algorithms within pathway to
  ensure correct service provision
• Early identification of employability issues,
  anxiety depression scores

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Evidence states thatApprox 30 people only
need advice and informationNHS 24 non clinician
pathways are safeSTaRT Tool - KeeleFree up
frontline resources
Rationale of Approach
Using a central referral system will... Provide
fast access to information and consistent
national approach
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Advice and Information ResourcesPatients need
information to support self management Need for
national resources that provide high quality,
consistent informationNHS inform can fulfil
that roleScottish Backs, neck, knee, shoulder
sites, VideoPhysio, PhysioTools, Back in Control
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.is a national service helping you to find
amongst other information how to access public
services and search for local information and
advice.Access to Scottish Backs and NHS inform
via digital TVText NHS 24 to 61061http//looki
nglocal.gov.uk/digitv/cds/nhsscotland/Netgem/home.
html
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MSK Service re-design New process
GP directed to Self Referral number
GP referral through SCI Gateway (est. 30,000
patients
Emergency Numbers
HUB (based at Referral Management Centre - TBC)
Central Referral Management System (NHS24)
Call handler takes call (8x Band 3)
Review previous 24 hour referrals into SCI
Gateway.
Self Referral (est. 15,000 patients)
MSK Triage Form filled in by call handler (WTE x3
on hand for support)
Patient entered into SCI Gateway (by Joint,
Medium/High)
Patient allocated appointment slot (Band 2)
TRAK automated letter sent to patient (and
communication sent to CRMS)
First Contact AHP telephone consultation and EQ5D
WHSS (est. 5) (exit from system)
Low routed self-management (exit from system)
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MSK Service re-design New process
Available Services
First Contact Physio assessment (EQ5D and outcome
measures)
HUB
AE
Mental Health
Leisure
First Contact Podiatry assessment (EQ5D and
outcome measures)
TRAK automated letter sent to patient (and
communication sent to CRMS)
Older People Services
Vocational Services
Self Management and exit from system
Employability Services
Rheumatology
First Contact OT assessment (EQ5D and outcome
measures)
Community Pharmacy
2nd AHP Appointment (intervention)
Pain Services
Ortho
First Contact AHP telephone consultation and EQ5D
Dietics
TRAK / CES Info. dump
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Key Performance indicators to include      
         
referrals into secondary care referrals into secondary care referrals into secondary care referrals into secondary care referrals into secondary care referrals into secondary care referrals into secondary care    
GP MSK consultations GP MSK consultations GP MSK consultations GP MSK consultations GP MSK consultations        
Improved patient experience Improved patient experience Improved patient experience Improved patient experience Improved patient experience Improved patient experience
Physio (MSK) demand Physio (MSK) demand Physio (MSK) demand Physio (MSK) demand Physio (MSK) demand        
Mental Health referral Mental Health referral Mental Health referral Mental Health referral
referrals into employability services referrals into employability services referrals into employability services referrals into employability services referrals into employability services referrals into employability services referrals into employability services referrals into employability services  
Reduction in prescription charges Reduction in prescription charges Reduction in prescription charges Reduction in prescription charges Reduction in prescription charges Reduction in prescription charges Reduction in prescription charges
Reduction in investigations Reduction in investigations Reduction in investigations Reduction in investigations Reduction in investigations Reduction in investigations      
Functional improvement outcomes Functional improvement outcomes Functional improvement outcomes Functional improvement outcomes Functional improvement outcomes Functional improvement outcomes Functional improvement outcomes Functional improvement outcomes
DNA rate                
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Baseline Activity Carried out in NHS
Lanarkshire Measurement of outcomes on all
patients attending physiotherapy for 1 month
using EQ5DMeasurement of the HADS score on a
selection of patients attending
physiotherapy.Measurement of patient experience
  
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EQ5D Analysis JOINT
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EQ5D Analysis Employability Status
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EQ5D Analysis
Employed Population Hours Worked
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EQ5D Analysis Unemployed Anxiety/Depression
Scores
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EQ5D Analysis Low Back Pain
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Develop national Advice and Triage service during
2011Enhance current out of hours protocols
during 2011Systems piloted in Lanarkshire and
Lothian from autumn 2011System evaluation
Spring 2012Report consideration and national
roll outResource pack and support
When will all this happen?
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Equitable access for MSK patients to appropriate
management optionsConsistent, high quality
information and advice developed and adopted
across NHSScotlandEnhanced user experienceA
true health/employability pathway savings??
Proposed Major Deliverables of Pathway
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NHS Quality in ActionScotlands
Bio-Psychosocial ServiceNational Fit For Work
Service Mark KennedySalus Occupational Health
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• NHS Economic Growth
• Supporting Healthy Workforce
• Reducing Absence
• Ensuring those wishing to work are able to work
• Increasing Resilience

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Salus Bio-Psychosocial Model

• Case Management Service
• Supporting employability agencies across 40 of
  the UK
• Central to the National Fit for Work Programme
  Working Health Services Scotland (WHSS)
• Core of NHS Lanarkshires Attendance Management
  service

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Principles of BPS Model

• Person Centric
• Engages patient ( family) in multiple ways
• Medical (conditions/disease)
• Attitudinal (behavioural, victim syndrome,
  addictions)
• Social (Relationships, housing, debt etc)
• Single Case Manager
• Assesses (validated clinical tools pre post
  intervention) and co-ordinates all aspects of
  care
• Single point of contact and solution focused
• Motivates/advocates and maintains direction
• Early Intervention

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• Telephone based
• Delivered by both clinicians and non clinicians
• Web based dataset (paperless)
• Has a framework of supportive agencies/interventio
  ns (physiotherapy, counselling, debt advisors,
  employment advisors etc..)
• Highly Efficient
• CM caseload 200-250 patients per annum
• 9 DNA
• Appointed within 2 days
• Longest wait for intervention 5 -7 days

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Working Health Services Scotland

• Scot Gov DWP funded
• Support to individuals employed within SMEs
• Eligible - Those sickness absent or at risk of
  sickness absence
• Central Hub supported by 14 regional Health Boards

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WHSS - Results
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28 of individuals were absent on engagement
62 at risk of absence 78 present with MSK
problem, 15 mental health, 2 Cardio-vascular
(5 other)
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Tackling Inequalities
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• From a sample of 450 records
• 98 of clients reported that the service has had
  a positive impact on their current work situation
• 99 of clients would recommend the service to
  others
• 100 of clients rated their experience of case
  management as excellent (86) or good (14)
• 100 of clients stated that the support they
  received was excellent (89) or good (11)

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NHS Lanarkshire Attendance Management

• Traditional model
• 1 week Self Certificate
• At 28 days of absence- long term refer to
  Occupational health
• Further 5-10 days to appoint
• Total approx 38 days absence circa 8 working
  weeks

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NHS Lanarkshire Attendance Management

• Salus NHSL Model
• Early intervention
• Absentee called at home on day 1,3 10
• Referred to Occupational Health at day 11
• Nurse led from day 11
• Case Manager appointed to complex cases
• Frequent case conferences with HR

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Quality Ambition

• Most appropriate treatments, interventions,
  support and services will be provided at the
  right time wasteful variation will be
  eradicated.
• Incorporates Innovation (tele web)
• Partnership (14 HBs and many public, private and
  3rd sector support agencies)
• Person Centric- patient at core of all decisions
• Measurable
• Inexpensive

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Vocational Rehabilitation is everybodys business
(DVD)Judy GibsonScottish Government
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• Wider Context and ConclusionsRoddy Duncan

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Christie Commission Efficiency and
Effectiveness customer-ledWelfare Reform
reduce barriers to work?Fit Note Encourage
doctors to discuss return to workEmployers
Create positive, supportive workplaces
Wider context
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Work is a key social determinant of
healthPeople do not need to be fully fit to
be in workReturn to work can be part of the
recovery processAll healthcare professionals
have a role to playNeed to learn from current
good/innovative practice
Conclusions
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Find out who your Boards lead for Health Works
is.Find out more about current health and work
initiatives.Discuss within your Board how you
can adopt and introduce patient-centred,
work-outcomes focussed, care pathways.Practitione
rs consider work status in routine
practiceSpeak to those who are already doing it
What you should do
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QA
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Links and further reading
Scottish Government Health and Work Web
Pages http//www.scotland.gov.uk/Topics/Health/wo
rkingage-1 UK Government Health Work and
Wellbeing Strategy http//www.dwp.gov.uk/health-wo
rk-and-well-being/ Scottish Centre for Healthy
Working Lives http//www.healthyworkinglives.com/
DWP Guidance on Fitnote http//dwp.gov.uk/healthc
are-professional/news/statement-of-fitness-for-wor
k.shtml Healthcare Professionals Consensus
Statement http//www.dwp.gov.uk/docs/hwwb-healthc
are-professionals-consensus-statement-04-03-2008.p
df
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Health Work Continuum
Out of work on benefits
In work
At risk of losing work
Safe Healthy
Ill/Injured
Incapacitated
Short-term absence
long-term absence





Cost to society