1. Fit for Work Dr Paul Williams – Chief Medical Officer Maximus
Chris Rhodes- Chief Nursing Officer
8th October 2015

2. Introduction

3. What was the driver for creating Fit for Work?
More than 900,000 absences of four weeks or more each year in the UK
Much reduced chance of no return to work after 4 weeks without intervention and 600,000 people fall into our benefits system each year
For most people, their work is a key determinant of self-worth, family esteem, identity and standing within the community, besides, of course, material progress and a means of social participation and fulfilment (Dame Carol Black, 2008)
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4. Fit for Work aims to ensure some form of OH intervention is available to all – currently OH services are available to around 30% of the UK population
Part of the aim is to support employees back into work without always requiring 100% fitness to achieve this
All assessments use a bio psycho social approach to ensure that these factors and behaviours are considered and the approach is Case Management
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5. What Fit for Work cannot do
No health surveillance/ statutory medicals
Assessment of fitness for employment
Short term absence referral support
Case Management after the 3 month point of an absence
Health promotion activity
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6. What if the employee already has access to OH?

7. The initial referral to Fit for Work will always proceed
Our aim is very much to complement existing OH services and not replace
If it is established that there is access to OH services – the Case Manager will suggest the employer refers on for any further action
With the employee consent, Fit for Work may contact OH services directly
With consent, a copy of the report can be shared with the OH provider, or the employee can forward directly to OH services
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8. Scope

9. Service Scope: what the DWP has asked for
An Advice Service – phone line and website – open to all, for general queries about matters affecting work and health
A voluntary Return to Work Service for employees who are off work due to sickness
GPs can make referrals at any stage, at the GP’s discretion, when the absence is likely to last for 4 weeks or more (but ideally certify for 1-2 weeks)
Employers can make referrals after 4 weeks of sickness absence
Not for the self-employed, and no self-referrals
The output of the service is a Return to Work Plan agreed with the employee, which functions as evidence of fitness for work

10. Advice Line – range of questions?

11. Application of safety guidance and Regulations within SME’s
Range of queries
SSP queries
Fit Note queries
Application of safety guidance and Regulations within SME’s
Support for SME’s with policy development for attendance management
Alcohol / substance misuse issues with staff
Advice following receipt of a fit note with ‘stress’
Occasional curved balls….
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12. The team and assessments
Key facts

13. Assessment Additional questionnaires
General
Health
Social
Psychological
PSEQ
(pain)
Audit
(alcohol)
Where the Case Manager has identified obstacles that they believe need to be better understood e.g. ones in diagram above
They have the option to use further specialised industry standard assessments (evidenced based questionnaires) to assist in their management of the case and assisting the employee with their overcoming these and RTW - PLAN – DO - ACT
EQ-5D
(functional issues)
PHQ-9
(depression)
Suicidal ideation

14. Predominantly telephone assessments – but face to face can be arranged with partner services
Current headquarters in Sheffield with satellite office in Cardiff. Further centres may open next year and home based staff likely to come on board early next year
All Case Managers must be a registered health professional with a minimum 2 years post registration experience and every team has specific OH expertise
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15. Some examples….

16. Presentation title

17. No apparent social issues and GP unable to support further
Case study
Alice, 20 years old – absent for 2 months with a fit note for borderline ‘POTS’ (Postural tachycardia syndrome)
History of GP support for previous low mood and mood gradually declining during absence
Employer unwilling to allow back into the workplace as there is an ongoing risk of collapse
No further medical management required and discharged with no planned follow up from the Cardiologist
No apparent social issues and GP unable to support further
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18. Employer engagement key to success
Supported with risk assessment to look at danger within the workplace
Postural condition so risk of collapse minimal
Risk of harm in the event of collapse not life threatening
Successfully back at work with minimal adjustments (cessation of lone working/physical exertion)
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19. Julie – 53 yr old Care Worker in Rhyl
2 week initial GP certificate – ‘muscle pain’
Had been medically managed for leg pains for some months
Pain at work not a significant issue – but poor sleep, fatigue and difficulty in resting at work made 12 hour shifts a problem
Despite unlikely EA application – plan suggested employer could consider max 8 hour shifts
Employer very willing to accommodate long term and offered alternative shift pattern to support busiest shift times
Very simple issue/solution
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20. What have we learned in the last 12 months?

21. People off work are generally busy people
Simple employer engagement is incredibly powerful
Being busy is good
Undoing a medical model of assessment takes time and patience
Good motivational interviewing is priceless
To love audit
Success at Fit for work isn’t particularly sexy – its about large volumes of simple assessments, advice and support to return to work
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22. Fit for Work Any questions?
Thank you for your time.

23. Trent Occupational Medicine Symposium 8th October 2015