1. ‘Change the card, change the deck, change the game’ : approaches to case management Trent Occupational Medicine Group October 2014 Tricia O’Neill RGN, MSc, MBA (Dist.) Head of Occupational Health and Wellbeing

2. S ainsbury’s landscape 161k employees 1200 stores, 22 logistics centres, 3 support centres and 1 bank Presence in Asia Conservative cost of absence in the £m’s – including presenteesim & medical dismissal costs MSD’s, mental health and chronic conditions main reasons for absence 2

3. Def. of case management - a generic term, with no single definition collaborativeassesses, plans, implements, co- ordinates, monitors and evaluates healthemployment ……is a collaborative process which: assesses, plans, implements, co- ordinates, monitors and evaluates the options and services required to meet an individuals health ……… and employment needs… (CMSUK, 2014) Can be sector, condition or service specific Insurance – reduction or mitigation of claim costs Legal – defence/prosecution NHS – preventing hospital admission Rehabilitation eg life changing injuries In workplace terms, generally means a referral for occupational health opinion on fitness for work. – Managed by occupational health professionals who may/may not seek other medical/health professional opinions 3

4. Macro-environment factors shape OH services & case management –P –Political: BIK, UK benefits related to absence/capability –E –Economics : economic growth, consumer confidence –S –Societal: demographic change, diversity –T –Technological: innovation to drive down cost of service –E –Environmental: labour markets including OH –L –Legal: risk based compliance, employment law 4

5. Over past decade, so six trends have emerged 5 1.F2F  remote 2.Paper records  electronic 3.OHP’s  OH Managers/non-health manager 4.In-house  out-house 5.Medical labels  functional capability 6.“secret”  “full disclosure” of records

6. So, how does a large retailer like Sainsbury’s manage case management? 6

7. Our approach Occupational health team – Service hub in Manchester – 3 OHA’s, 3 admin (and 7 Safety Direct team) – 5 field based OH & Wellbeing partners Remote case management – c. 4000 referrals/pa Referral at week 6 of absence but maybe longer Average case duration c. < 75 days – Dependant on medical reports required – C. 60% return to substantive role +/- temp or permanent adjustments Support resources Contracted Occ Physician & access to a network of OP’s EAP Physiotherapy in logistic sites 7

8. We use a 7 R’s principles & approach Colleague in work Step 1 R eview & R ight messages Step 2 RTW Step 3 R ehabilitation Step 4 R easonable Adjustments Step 5 R e- deployment Step 6 R etraining Step 7 Step 7 R eaching an employment decision an employment decision

9. RR Step 1 : Review and Right messages Criteria : ALL absent colleagues We want you back Regular tel contact/weekly Monthly F2F, in-store/on site Use TLC approach to conversations Consider OH referral at week 6 Remind colleague of Validium EAP Key points Health@Work directory, OH referral – ‘how to call card’ Colleague leaflet - ‘What I need to know about my OH referral’ Validium EAP: 0800 027 77 77 Connect Resources

10. R Step 2 : RTW Criteria : ALL colleagues Fix date and time for 1:1 Complete RTW form Provide HWB advice/signpost Review RTW plan within the week Key points Health@Work directory RTW form Review notes Connect Resources

11. R Step 3 : Rehabilitation Criteria : only for colleagues who are returning after > 4 weeks absence, not always necessary and is discretionary Consider adjusting hours/days, shifts and tasks Time bound has review and end date, no more than 4-6 weeks Has the GP recommended any adjustments? Key points As before, and : Rehabilitation guidance notes Fit note guidance notes Access to work support Resources

12. R Step 4 : Reasonable Adjustments Criteria: For any colleague who has a condition that disadvantages them from meeting the requirements of their job due to symptoms and/or condition. Short term – define length and review date Long term – maybe necessary under the Equality Act, 2010, may need to consider contractual changes Trial of work option Key points As before, and: ‘Little book of diversity’ Reasonable Adjustment guidance Resources

13. R Step 5 : Re-deployment Criteria : when adjustments are exhausted, unsuccessful or substantive role no longer viable Map available roles against colleague capability Consider functional assessment vs. roles Don’t have to create a role Key points As before, and: Trial of work Access to work and Remploy Resources

14. R Step 6 : Re-training Criteria: Only when colleague has capability to work or reasonable adjustment are not sufficient and there are no suitable roles available Option to retain talent/skill in business A business decision not medical opinion Key points Internal move Access to work or Remploy Resources

15. R Step 7 : Reaching an employment decision Criteria : all previous considerations have been explored, have been unsuccessful (from a capability not a colleague perspective) and no suitable alternative roles available Criteria : In pension scheme All treatment options exhausted Clinical specialist report on record Colleague requests Key points – IHER Criteria : Medical condition known and can do some work but none available in JS that matches capability Unlikely to RTW in forseeable future, 3-6 months Colleague refuses adjustments, rehabilitation, redeployment or retraining Key points - capability Criteria: Not in Pension scheme GP report on record, treatment options exhausted Functional capability assessment supports contention not fit for any role Unlikely to RTW in forseeable future, 3-6 months Sufficient funds available Key points – Medical dismissal

16. In summary…… Success of case management depends upon: –The OH delivery model –Organisational model of people management, including robust policies –Supporting interventions available i.e physio, EAP –Specialist resource available with right skill set –Number of non clinical flags – yellow, blue, black (Kendall & Burton, 2009) –And ultimately employees desire to return to work However, case management is ‘horses for courses’ and ‘one size does not fit all’ 16

17. Thoughts, feedback, questions? 17

18. Contact: Tricia.O’Neill@sainsburys.co.uk 07788 353 835 18