The Health and Work Service - Scotland, UK Dr Alastair Leckie Consultant in Occupational Medicine OHSAS Medical advisor to Scottish Government

Background History of Scottish service How service will be delivered in Scotland Milestones How you might contribute Q&As

The longer someone is off work on a period of sickness absence, the harder it is to get back to work and research suggests that long-term worklessness is damaging to health, social and financial wellbeing Government review found that in the UK, approximately 2% of total working time is lost due to sickness absence every year. This reduces economic output by £15 billion per year and costs: - employees £4 billion in lost earnings - employers £9 billion per year in sick pay and associated costs - the Government £2 billion in sick pay and foregone taxes The Government’s response to this review accepted a recommendation to introduce a state-funded health and work assessment and advisory service from 2014 [now the Health and Work Service ]. The Service has been designed to provide early intervention for sickness absence at the four week point, - the critical drop off point for returning to work.

HWS will provide support to GPs, Employees and Employers It has two component elements: *4 – 6 weeks of sickness absence has been identified as a critical point for not returning to work Health and Work Service Assessment Available to employees on, or expected to reach, 4 weeks* of sickness absence. Referral primarily through a GP, or through an employer, subject to employee’s consent. Provides an occupational health assessment identifying all obstacles preventing a return to work, culminating in a Return to Work Plan (RtWP). The RtWP will identify measures, steps or interventions that would facilitate a return to work and make appropriate recommendations, including information on how to access appropriate interventions. The plan will be shared with their GP and employer, subject to employee consent. Assessment will be delivered by telephone or face to face where appropriate Advice GPs, employees, employers and will be able to access health and work advice at any time. Provides Health and Work advice to help with current or anticipated sickness absence issues (regardless of length) This will be delivered via a website and telephone line.

The Service will use a supportive, biopsychosocial approach with case management follow up to help ensure individuals return to work as quickly as appropriate. Individualised Return to Work Plans (RtWPs) can be used to replace fit notes as evidence for sickness absence for the duration specified in the plan. 7 day self- certification period 4 weeks absence GP fit note Employee on sickness absence Referral by GP Return to Work Plan Return to Work 6 weeks absence Evidence of sickness absence Employee journey Case Management HWS Assessment DischargeFollow up Referral by employer Other evidence* Employee goes on sickness absence RtWP produced* *the RTWP will be provided for the employee and shared with the GP and/or employer, with the employee’s consent.

The Health and Work Service will be delivered across Great Britain, with a unified brand and scope England & Wales -External procurement -Health Management Ltd Scotland -Agency agreement with Scottish Government to deliver on behalf of DWP Overall -Same service & outputs across GB

Programme In Scotland Programme Board Implementation Group –AdviceServices, Website & Advice Line – NHS24 & SCHWL –Enrolment – NHS 24 –Assessment & Return to Work Planning – Salus Medical Advisor Stakeholders Additional Advisors, e-health, marketing, Expert Panel Glasgow Uni, finance, legal, project management etc

Management Group Assessment Service Regional Hub NHS Boards Case Managers Assessors Regional Hub NHS Boards Case Managers Assessors IT Quality Assurance Enrolment Supervisor Call Operators Advice Services Website Health Information Officers Advice Line Manager Call Handlers Occupational Health Advisors National Manager (Contract Management/Whole Service Overview/Quality Assurance) Medical Advisor DWP

Key Issues/Milestones Go Live on 15 th December 2014 Phased introduction with full service by March 2015 Estimated volumes running at estimated potential 50k employees per annum Clear criteria and service specification Assessment & advice – not funded for intervention Telephone based model Scottish Service – expansion & redesign of WHSS Performance managed by DWP to same standard as England & Wales

To April 2015April April Assessment service LowHighLowHighLowHigh Estimate Referral Range p.a Assumed invalid level of 8% Estimate cases/day % dealt with at initial assessment (p.a.) Estimate assessments/day No. of case managed/day Face-to-face assessment/day Call 30 calls/day cases/day Case 4 cases/day

How can you help? Questions now Engage with your employers/OHDs Work out how you are going to engage with HWS Identify any issues Share issues today Share solutions today!

Existing OH services HWS Existing GP service Referral routesEmployer +/- selfGP +/- employer None Services Employer driven/agreed Sickness absence assessment Point of involvement Employer 4-6 weeks GP/patient driven agreed Frequency of contact Employer driven/agreed Maximum of three times GP/patient driven agreed Workplace knowledge Good Employee information +/- employer information Employee information Duration of involvement Employer driven/agreed 3 months compulsory discharge For ever Quantity of involvement Employer driven/agreed 1 per annumUnlimited

Interaction between HWS and OH Very similar to current fit notes RtWP may suggest OH involvement RtWP can be amended to include further information from employer or their OHS OHS may take over

Engage with employer Branding and publicity to come Alert and explain to employer(s) Consider amending procedures Attend

Further input Health & Work Service Working with Employers and Occupational Health Workshop Wednesday 24th September 2014 The Lighthouse, 11 Mitchell Lane, Glasgow, G1 3NU 9 –

Answers?

Employers Input to service Adjusting SA policies Information gap Practical issues re contacting service RTWP input Certification (legal standing) What does employer get Who is responsible for action on advice

Employers more Workplace knowledge Signposting Current OH provision Tax relief RTWP before assessment completed Consent

OH Fit with existing OH provision Conflict of advice Disinvestment Resourcing small number of OH professionals Who will deliver

Marketing communications Key messages Detailed description of service GP engagement Employer engagement

Long term conditions F2f assessments Support for mental health

2nd workshop Engagement 1.Employers and HAWS 2.OH and HAWS Marketing/information