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Karen Steadman
Senior Researcher
Karen Steadman

The Health and Work Service - health and work are just the start of it…

Authors: Karen Steadman Karen Steadman

17 October 2013

Earlier this week (15 October) I attended an event to inform us about the development of Department of Work and Pensions’ (DWP) proposed Health and Work Service (HWS). The HWS, due to come into effect towards the end of 2014, will be an independent service which provides help and advice to employees and employers in order to support the return to work of those off sick for four weeks or more. Referrals to the service can be made by GPs, as well as directly by employers and employees. My colleague Tyna Taskila has written a blog raising the question of GPs role in HWS.

This excellent event run by Macmillan and the DWP, hosted by The Work Foundation, focused on long-term conditions and the HWS. Representatives from a range of health charities, patient, and interest groups, all spoke knowledgably and passionately about how the service can best be developed to support people with long-term conditions who want to remain in work.

Health and work is a broad church, and in order to make the service valuable for users, a broad range of issues and factors will have to be considered when making assessments on individual cases and developing their return to work plans. Dr Bill Gunnyeon, Chief Medical Advisor at the DWP, is very much aware of this, highlighting, in his introduction, that the HWS is about more than just health problems, and more than just health at work problems, with a remit including factors ranging from job quality to personal debt.

What really got me thinking though was a question from Dr. Andrew Frank, Chair of the Vocational Rehabilitation Association, about the impact of social problems on people’s return to work ability and intention. This got me thinking about the social and personal factors that might need to be considered when developing the HWS, and the range of challenges and questions they pose.

The recent evaluation of the Fit Note program found that those living in socially deprived areas were among those most likely to have a long-term sickness episode over 12 weeks. It also identified that fit notes issued to patients in the most socially deprived areas were nearly five times more likely to be long-term than those issued in the least socially deprived areas.

The social determinants of health and the inequities they cause are well known – but the question remains whether there are implications here for the HWS? To what extent do socio-economic issues have to be considered in order to provide an effective and equitable service?

A very quick and completely unscientific web search threw up a couple of journal articles which indicated some association between salary and the likelihood of return to work – implying that those in lower paid jobs are less likely to remain in their job following a period of sickness absence. The possible reasons for this are multiple - lower salaries might be linked to less secure jobs, to a lower likelihood of in-work support, lower awareness from the employer of how to manage a return to work, or indeed, lower employer inclination to bother.

A possible factor worthy of consideration is the role of individual motivation in people’s return to work decisions. Might we conceive that those in lower salary, and perhaps lower quality jobs could be less motivated to take steps to retain those jobs after they have been disrupted by sickness absence? This brings me to another interesting area: the broader role of motivation and indeed self-confidence in individual return to work decisions.

In terms of mental health, and particularly severe mental health conditions such as schizophrenia, motivation to work is the greatest predictor of work. Discussions with my colleagues in the musculoskeletal field identified that this is an issue they saw too, with the experience of long-term conditions undermining an individual’s confidence in their work. It is easy to imagine a situation wherein having taken, and continuing to take, time off sick for a recurrent condition an individual might feel bad about the impact of this on their team and consider that the team might be better off without them. This is certainly worth considering within the HWS. Perhaps training in motivational interviewing will be a valuable attribute for those providing advice through the service, to attempt to mitigate the impact a health condition may have had on people’s motivation for and self-confidence to return to work?

The level of support in the workplace itself will also be a motivating (or demotivating) factor. The individual in the example above will doubtlessly be more positive about a return to work if their colleagues and employer are. So, to what extent will existing workplace relationships impact on the HWS? And then what about other factors in creating positive work environments? Is it the type of line manager, engagement, feeling valued and rewarded, communication, organisational trust? The list could go on and on.

Dr Gunnyeon remarked in his introduction that developing the HWS was the hardest thing his team had ever done - and I can certainly see why! But, though the issues are complex and the remit broad, I was certainly heartened by the level of support there is for the HWS, and the number of experts and advocates who are out there poised and willing to assist with its development. I, for one, look forward to seeing it progress over the next year.