1. Enabling Life Potential through Vocational Rehabilitation “a process that enables people with functional, psychological, developmental, cognitive and emotional impairments or health conditions to overcome barriers to accessing, maintaining or returning to employment or other useful occupation."

2. Enabling Life Potential through Vocational Rehabilitation Worklessness and not disease is the biggest cause of health inequality, social exclusion, deprivation, and mortality

3. Enabling Life Potential through Vocational Rehabilitation All services should be aimed at maximising functional capacity of the working age population – physical, mental, social, spiritual It is not their diagnosis that is important – its what they can do! AHP’s crucial in delivering vocational rehabilitation services in Scotland

4. Enabling Life Potential through Vocational Rehabilitation - Healthy Working Lives Policy Review promote the health, safety and well-being of employees in the workplace; to help employees who become ill or injured to retain work; to provide access to services to enable movement towards work for those out of work as a result of illness or injury; to promote the benefits that work has for most people; to encourage all stakeholders, including employers, employees, healthcare professionals, employability advisers and trades unions, to recognise the benefits of work for health and their role in maximising the ability of working age people to retain or gain paid or unpaid employment. AHP’s critical to its success!

5. Enabling Life Potential through Vocational Rehabilitation - Healthy Working Lives Policy Review Redesigning the Client Pathways’.  Mapping current services and client pathways to work;  Recommend improvements in provision of, and links between, services that move people towards work;  Identify gaps in provision of relevant services and recommend how these can be addressed.

6. Enabling Life Potential through Vocational Rehabilitation Dame Carol Black - prevention of illness and promotion of health and well-being; early intervention for those who develop a health condition; and an improvement in the health of those out of work – so that everyone with the potential to work has the support they need to do so.

7. Enabling Life Potential through Vocational Rehabilitation  Only 3%-15% of companies in the UK have access to Occupational Health support services – inequalities in access  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 work rather than indicating what work tasks they can do

8. Enabling Life Potential through Vocational Rehabilitation 48% of work related problems in Scotland of MSK origin UK – 12.25 million work days lost due to MSK problems Costs £141 million just for GP consultations

9. Enabling Life Potential through Vocational Rehabilitation In Scotland there are over 275,000 Small & Medium sized Enterprises (SMEs) providing approximately 54% of all jobs. It is estimated that £10 billion is lost annually through working age ill health in terms of days lost and worklessness. It is known that 2.5%-3.5% of workers leave the workplace each year through ill health. Approximately 60,000 people make a new Employment Support Allowance claim each year in Scotland.

10. Developing a Vocational Rehabilitation Service for Small and Medium Enterprises in a Health Board area - launched 12 February 2008 Working Health Services Dundee Hotline 01382-825100

11. Working Health Services Dundee - Referral process Individual Hotline 01382-825100 - Telephone interview conducted Information passed to local Case Manager Case Manager assesses information and directs individual onto a pathway of care and eventual discharge Ergonomists Physiotherapist Occ Therapist Counsellor H&S Practitioners Occ Health Nurse/Adv Occ Health Physician Occ Hygienist Access to local services e.g Relate, Debt Counselling GP s Line Manager raise awareness

12. Enabling Life Potential through Vocational Rehabilitation Under the auspices of the NHS - free and confidential Case management model Multidisciplinary team Early intervention Easy to access service 01382-825100 Aimed at Small and Medium Enterprises Occupational Health support, Health and Safety, Health Promotion, support through the HWL Award programme

13. Enabling Life Potential through Vocational Rehabilitation A proposed new Fit for Work service, based on a case-managed, multidisciplinary approach, would provide treatment, advice and guidance for people in the early stages of sickness absence. Proposal for a Scottish Fit for Work National Service

14. Enabling Life Potential through Vocational Rehabilitation The pilot seeks to build upon the national Condition Management Programme structure whilst complimenting the strategic approach undertaken by the Scottish Centre for Healthy Working Lives. enhance it by providing an additional service aimed exclusively at providing personalised return to work support for sickness absentees. Incorporate the work of the 3 pilots.

15. Enabling Life Potential through Vocational Rehabilitation Add Vocational Rehabilitative Fit for Work Services to existing CMP teams Existing Vocational Rehabilitation pilots in East of Scotland continue, joined by CMP led FFWS providing full Scottish national coverage. Case Management CBT approach encompassing full bio- psychosocial model Focus on return to work tailored programmes to return sickness absentees.

16. Enabling Life Potential through Vocational Rehabilitation Scottish Centre for Healthy Working Lives (SCHWL) acting as hub and referral gateway. SCHWL expand support role via info/advice provision for both health professionals and “clients” SCHWL use network to roll out attendance management module to SMEs

17. Enabling Life Potential through Vocational Rehabilitation Pathway – GP onto orthopaedic waiting list. Many centres in Scotland patients screened by ESP’s within acute centres. National UK data identifies this pathway resulting in up to 70% not requiring surgical intervention. What does this mean for the patient? Sickness absence? Psychological problems? Reduction in functional capacity? No active management!

18. Enabling Life Potential through Vocational Rehabilitation  A Community Based Multi-professional Triage Team / Orthopaedic Assessment Service (OAS) – PT’s and GPwsi  A centralised referral management system – NHS 24 physiotherapy tele-health service?  All AHP musculoskeletal services to be delivered within a single system  All return clinic appointments following surgery seen by AHP MSK team

19. Community AHP MSK Services Integrated MSK Team Physiotherapy Podiatry OT Dietician Prosthetics Radiography Specialist nurse GPwsi Self Referral via NHS 24 Self management and advice through NHS 24 web base for rehabilitation GP Referral Walk in Self Referral Electronic Referral Vocational Rehabilitation Services & Chronic Pain Services Orthopaedic waiting list Rheumatology services Other acute services Electronic Referral GP Referral Electronic Referral NHS 24 – Enhancing the MSK pathway

20. Vocational Rehabilitation  join a collaboration to develop education and training relevant to this vocational rehabilitation agenda  Develop a vocational rehabilitation community of practice