1. Welcome to the webinar. The webinar will start shortly. If you have any difficulties in dialling into the webinar please call the events team on 0844 800 9753

2. NHS Employers Implementing Rapid Access webinar Chaired by Jennifer Gardner, Programme Lead, Health and Well-being, NHS Employers

3. NHS Employers conference 27 th September 2012 Ruth ten Hove, Professional Adviser, CSP

4.  Describe the benefits of rapid access to physiotherapy, to prevent short term injury becoming a long term problem  Outline the care physiotherapists can offer to help people return to the workplace or support them to remain at work  Identify the cost savings and benefits to employers of an easily accessible physiotherapy service

5.  Problems affecting the muscles, tendons, ligaments, nerves or other soft tissues and joints. Symptoms usually result in pain and loss or restriction of movement.  Alternatively, there may be a more gradual onset of symptoms, with initial tingling, then slight swelling or soreness which may persist and gradually worsen

6.  Up to 60% of people on long term sick cite Musculoskeletal Disorders (MSD) as the reason  22% of people on Incapacity Benefit have an MSD  MSDs are the most common reason for repeat consultations with the GP – up to 12% of primary care consultations  Low back pain is the number one cause of long term illness amongst manual workers

7. Likelihood of Return to Work (RTW)  6 months 50% chance of RTW  12 months 30% chance of RTW  24 months 10% chance of RTW  Once on Incapacity Benefit (IB) for 6 – 12 months 90% remain on for at least 5 years  People on IB for more than two years are more likely to die on benefits than return to work

8. “12 more sessions of this and your back will be fine Mr Smith!”

9. www.tsoshop.co.uk/flags Kendall Burton Main Watson 2009

10. Soft tissue Injury Attempt to self manage Presents in GP surgery first time Paper referral to physiotherapy Presents in GP surgery second time Referral received in physio dept and processed Physio waiting list Physio assessment Needs further investigation? Orthopaedic specialist

11.  Prevention of illness and promotion of health and wellbeing;  Early intervention for those who develop a health condition;  An improvement in the health of those who are out of work, so that everyone with the potential to work has the support they need to do so..  Dame Carol Black’s Review of the health of Britain’s working age population, Working for a healthier tomorrow, was published in March 2008

12.  A system of access that allows patients to refer themselves directly to a physiotherapist without having to see anyone else first, or without being prompted by another healthcare professional.  (Department of Health 2006)

13.  present sooner  high levels of patient satisfaction  wait less  more autonomous  off work less  more complete Rx  same outcomes   Holdsworth LK, Webster VS, McFadyen AK. Are Patients who Refer Themselves to Physiotherapy Different from those Referred by GPs?: Results of a National Trial Physiotherapy 92 PP 26-33 March 2006  Self Referral pilots to musculoskeltal physiotherapy and the implications for improving access to other AHP services. DH Report 2008

14.  no floodgates  fewer Do Not Attends  less prescribing, investigations and secondary referral  time savings for GPs and patients  Cost effective

15.  people who self-refer to physiotherapy take fewer days off work (on average 4 versus 7) and are 50% less likely to be off work for more than one month when compared with people referred via the more conventional route  Ref: Self referral pilots to musculoskeletal physiotherapy and the implications for improving access to other AHP services, DH 2008

16.  Stop people going off work in the first place  Get people back to work on full normal duties  If alternative or modified duties are required to facilitate return to work, ensure they are specific, time limited and transitional  Deliver a cost effective service

17. “In depth consultation in a relaxed and unhurried way. Constructive advice for self-help and management for living with arthritis.” “This service should continue to be offered for all patients.” “Self referral is a good idea. I hope it continues.” “I was hoping for some massage rather than exercises to do.” “Cost effective in terms of my time and commitments.” “I was very pleased at the speed my self referral was dealt with.” “Most appreciative of ‘personal exercise programme’ given to me and explained.”

18. Return2Health – A multi-disciplinary approach to health and wellbeing Occupational Health & Wellbeing and HR teams, University Hospital Southampton NHS Foundation Trust

19. Overview Background and design R2H implementation Evaluation Conclusions

20. Organisational drivers Local strategy –Staff experience –Target absence rate 3.5% (from 4.4%) National steer –Quality, Innovation Productivity and Prevention (QIPP)

22. Evidence base Sickness absence is associated with poor health 1,2 Case management intervention studies –Improve subjective clinical outcomes 3,4 –Few studies have control data 5,6 1.Reinhardt Pedersen C, Madsen M.. 2002.J Epidemiol Comm Health 56, 861-7 2.Black C. 2008. www.dwp.gov.uk/docs/hwwb-working-for-a-healthier-tomorrow.pdfwww.dwp.gov.uk/docs/hwwb-working-for-a-healthier-tomorrow.pdf 3.Case management services: the current picture. Annual report April 2007-March 2008. SALUS and NHS Scotland. 4.Vocational Rehabilitation, what works for whom and when? Waddell G, Burton K, Kendal NAS. The Stationery Office 5.Taimela S, et al 2008a. Occup Environ Med 65: 236-241. 6.Taimela S, et al 2008 b Occup Environ Med 65: 242-248.

23. Not clear….. Whether they perform better than standard care at reducing absence How cost effective?

24. Return2Health Multi-disciplinary “Fit for Work” service Entry point 4 weeks of absence Aim to reduce long term sickness absence and adverse impact on health/wellness Timescale: funded by SUHT 2008 –Implemented during 2009 –Fully operational 2010

25. R2H components Core MDT OH Physician, CASE MANAGER, Physiotherapist, Human Resources, Career Support Line Manager Fast track treatments On-line CBT Pastoral advice Exercise & activity management Sign-post social support CLIENT

26. So what’s new? Case manager approach - proactive –Frequent contact –Goal setting –Enabling and empowering “Hands on” advice to managers

27. Motivational Interviewing “A collaborative, person-centred form of guiding to elicit and strengthen motivation for change” Goal orientated Change talk Draw out rather than impose ideas Autonomy Collaboration

28. R2H Project management Steering group –Multiple clinical disciplines and partnership Psychiatry Psychology Chronic pain OH, case managers –HR –Managers –Union representatives –Communications

29. Training and tools Training - bespoke –Case management –Motivational interviewing and CBT skills Tools –New operational policy –Generic examples of adjustments in practice Closely mirrors management structure –Divisional links

30. Evaluation Controlled intervention study Comparisons –Before-after intervention –Between hospitals (intervention – control)

31. Outcome measures Main outcome: –Proportion of 4 week absences that continue beyond 8 weeks in duration Secondary outcomes: –Staff wellbeing and satisfaction –Cost of agency staff –Number of ill Health retirements

32. Data collection Electronic Staff Record (ESR) –Absence start and finish date –Cause Agency staff costs Reason for leaving –Health –Ill health retirement Staff surveys

33. Results Control hospital 4000 employees Intervention hospital 9000 employees 70-80 4 week absences per 1000 staff at both hospitals 20% musculoskeletal, 10-15% mental ill health

34. R2H referrals number (%) referred within 6 wk of going absent 200820092010 Musculoskeletal61 (40.7)99 (48.8) Mental illness53 (41.7)86 (58.9) Other118 (30.9)125 (37.3) Unknown12 (27.3)6 (27.3) Total244 (34.7)316 (44.8)

35. Sickness absence Before/after R2H

36. Sickness absence - between hospitals Control hospital Intervention hospital Difference intervention - control 2008 8wk/4wk % 51.251.7 Mean days lost >4 wk51.846.5 2009 (reduction from 2008) 8wk/4wk % (95% CI) 0.8 (-6.9 to 8.6) 2.6 (-2.6 to 7.9) 1.8 (-7.6 to 11.2) Mean days lost >4 wk (95% CI) 46.645.2 2010 (reduction from 2008) 8wk/4wk % (95% CI) -4.9 (-12.5 to 2.7) 5.8 (0.5 to 11.1) 10.7 (1.5 to 20.0) Mean days lost >4 wk (95% CI) 48.541.7

37. Other outcomes NHS Staff Survey results improved in 2010 –High score for OH/R2H in UHSFT survey Agency staff costs: 27% reduction in UHSFT (v 1% increase in control Trust) Ill health retirements: 26% greater reduction at UHSFT v control Trust

38. Cost effectiveness Cost of intervention –Sustainable £57k annually (1.5 w.t.e case managers) Savings on absence (10% of 4-8wk episodes) –average of 2 days per absence is saved –700 absences per year = 1400 person days –Cost approx. £41 per day Appears cost effective

39. Conclusions R2H is –Effective at reducing long term absence –Appears cost effective –Affordable, adaptable and deliverable under “real life” conditions Excellent acceptability to staff

73. Please feel free to type your questions into the question box provided on the right hand side of your screen. Many thanks.