Work as a Health Outcome in the Devolved Nations:

How Scotland, Wales and Northern Ireland tackle sickness-related worklessness
by Mark Weston and Julia Manning published by 2020health December 2012

Executive Summary

The proportion of adults in Britain who are unable to work because of health problems has more than tripled since the 1970s, at an estimated annual cost to the economy of over £100 billion. While half of those in Scandinavia who suffer a major injury return to work, in Britain the proportion is just one in six. In England alone, 2.1 million people claim health-related benefits, a number that despite health improvements has barely shifted in the past decade.

Work is clearly needed to improve our record on reducing sickness-related worklessness, therefore. This report gathers lessons from Scotland, Wales and Northern Ireland and draws on them to make recommendations for policy-makers and practitioners in England, as well as identifying areas for improvement in the devolved nations themselves. Efforts in the latter are often more advanced than those in England, and each boasts innovative programs that provide useful lessons for the Health and Wellbeing Boards that will bear primary responsibility for redressing England’s deficit in this area.

Based on our review of the literature, in-depth telephone interviews with high-level stakeholders in the field, a field visit to Glasgow, and a London workshop with members of Health and Wellbeing Boards, we make the following recommendations for those wishing to reduce sickness-related worklessness in England and in the devolved nations:

1. The importance of leadership: The success of Wales and Scotland in this area has been founded on strong leadership from the centre. England’s Health and Wellbeing Boards should press the case for action to high levels of government as well as locally.
   
2. Clear national strategies: The governments of Scotland and Wales developed strategies that held the various stakeholders to account and defined clear timelines and responsibilities for action. These resulted in the establishment of effective national bodies to promote workplace health and return to work services, and in a flurry of local-level initiatives to see policies through. England and Northern Ireland currently lack such well-defined strategies.
   
3. Get your own house in order: The Northern Ireland Civil Service and RCN Wales have shown leadership in developing effective workplace health strategies. Sickness absence costs the NHS over £500 million each year (Black, 2008), and private sector firms are likely to look more favourably on efforts to reach them with work and health schemes if those delivering them look after their own staff well. Improving the health of those working for the NHS can have the added effect of persuading them of the importance of the work and health nexus.
   
4. Goal-directed joint working: Involving a range of stakeholders in the development of policies and the delivery of programmes is vital for effective implementation. Engaging the most relevant stakeholders for achieving particular objectives and securing their sign up to targets increases accountability and renders goals more likely to be met.
   
5. Consistent communications: The value of communicating consistently to all audiences was repeatedly highlighted by our interview respondents. Strong and clear messages can assist in the creation of a coherent “national brand” for health and work.
   
6. The value of hubs: Employers and health care practitioners are likely to benefit from one-stop shops that provide a single point of contact to which they can turn for assistance and information, and which can direct them to the relevant service.
   
7. The value of hubs for programme implementers: To avoid reinventing the wheel, those designing and delivering health and work programmes would benefit from a central hub – either national or UK-wide – where case studies and data on programme effectiveness are collated and disseminated.
   
8. Inclusion of cost-benefit analysis in evaluations: Evaluation of programmes in the devolved nations has been consistent and quite rigorous. However, few analyses have assessed the benefits of projects in comparison with their costs. Practitioners in all four home nations should endeavour to incorporate cost-benefit analysis into policy and programme evaluation.
   
9. Targeting of “other” health professionals: Allied Health Professionals, practice nurses, optometrists and even practice receptionists can transmit valuable messages to those with health conditions, and rather than expending all their time and effort trying to convince GPs, advocates of programmes should focus part of their communication campaigns on these non-GP audiences.
   
10. Take a long view: Prevention is vital to reducing sickness-related worklessness, and there is much that employers and health and social service providers can do to help stop people needing to take time off work. If a health problem develops, early intervention is needed to prevent it causing prolonged absence. Care and guidance should not stop when a client returns to work, moreover – the steps on the road back to employability should be valued and built into targets, and continued assistance in the period after re-employment reduces the risk of clients being placed in unsuitable jobs in order to meet targets, and helps with adjustments that lead to sustained employment.

Full text (PDF 31pp)

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