The Health and Work Service- Scotland, UK

Dr Alastair LeckieConsultant in Occupational Medicine

OHSASMedical advisor to Scottish Government

• Background• History of Scottish service• How service will be delivered in Scotland• Milestones• How you might contribute• Q&As

The Service will use a supportive, biopsychosocial approach with case management follow up to help ensure individuals return to work

as quickly as appropriate. Individualised Return to Work Plans (RtWPs) can be used to replace fit notes as evidence for sickness

absence for the duration specified in the plan.

7 day self-certification

period

4 weeks absence

GP fit note

Employee on sickness absence

Referral by GP

Return to Work Plan

Return to Work

6 weeks absence

Evidence of sickness absence

Employee journey

Case Management

HWSAssessment

Discharge Follow up

Referral by employer

Other evidence* Other evidence*

Employee goes on sickness absence

RtWP produced*

*the RTWP will be provided for the employee and shared with the GP and/or employer, with the employee’s consent.

The Health and Work Service will be delivered across Great Britain, with a unified

brand and scope

England & Wales- External procurement- Health Management Ltd

Scotland- Agency agreement with Scottish Government to

deliver on behalf of DWP

Overall- Same service & outputs across GB

Programme In Scotland• Programme Board • Implementation Group

– AdviceServices, Website & Advice Line – NHS24 & SCHWL

– Enrolment – NHS 24– Assessment & Return to Work Planning – Salus

• Medical Advisor• Stakeholders• Additional Advisors, e-health, marketing, Expert Panel

Glasgow Uni, finance, legal, project management etc

Management Group

Assessment Service

Regional Hub

NHS Boards

Case Managers Assessors

Regional Hub

NHS Boards

Case Managers Assessors

IT Quality Assurance

Enrolment Supervisor

Call Operators

Advice Services

Website

Health Information

Officers

Advice Line Manager

Call HandlersOccupational

Health Advisors

National Manager

(Contract Management/Whole

Service Overview/Quality Assurance)

Medical Advisor

- - - - - - - - -

DWP

A

SERVICE Health & Work Service

GP assessment, recommends

referral to H&WS (1)

GP checks eligibility & completes

information, including

consent and record is passed to

H&WS

HWS calls Individual &

checks consent,

eligibility and basic

demographics are completed

(2) (5,300)

Individual is transferred to

specialist advisor on tel (4)

**(9)

Eligible?

Return to referrer with response returned (3)

No

Yes

Individual is taken through

biopsychosocial assessment (5)

(47,700)

More intensive tel or face-to-face

assessment takes place (may not be

the same specialist as initial

assessment)

Further assessment required? (max. 3)

Discharged

Arrange time/date for assessment (6)

Individual attends GP for 2nd Fit Note

Employer checks eligibility & makes referral to H&WS after 4 weeks absence

(7)

HWS logs details

and date of receipt

Appt is made with specialist

advisor for face to face

assessment (4) **(9)

(1,908)

RTWP shared with

employer/GP (8)

Yes

Appt req?

Yes

Appt req?

Consent agreed to share with GP/employer

No

RTWP drafted/revised

RTWP shared with

employee (8)

Yes

Advice report provided for those who cannot have a RTWP agreed but still need support.

(10)

Max 3 – RTW not feasible at this

time

No

Yes No

Max 3

Face to face - appointment made within 2 days, First assessment within 5 working days

All telephone assessments within 2 working days

Follow up Questionnaire/

Tel call to check outcome for evaluation

CASE MANAGEMENT THROUGHOUT PROCESS

All RTWP shared within 2 working days of final assessment

WEBSITE

ADVICE LINE

Employee/employer /GP Calls Advice Line

Employee/employer/GP Visits Website

Employer Completes Electronic

referral

Key Issues/Milestones

• Go Live on 15th December 2014• Phased introduction with full service by March 2015• Estimated volumes running at estimated potential 50k

employees per annum• Clear criteria and service specification• Assessment & advice – not funded for intervention• Telephone based model• Scottish Service – expansion & redesign of WHSS• Performance managed by DWP to same standard as

England & Wales

  To April 2015 April 2015-16 April 2016-17

Assessment service Low High Low High Low High

Estimate Referral Range p.a. 2500 5000

10000 20000

30000 60000

Assumed invalid level of 8% 200 400 800 1600 2400 4800

Estimate cases/day 12 24 48 95 143 286

60% dealt with at initial assessment (p.a.) 1380 2760 5520 11040

16560 33120

Estimate assessments/day 7 13 26 53 79 158

No. of case managed/day 4 9 18 35 53 105

Face-to-face assessment/day 1 2 5 9 14 27

Call handlers @ 30 calls/day 1 1 2 3 5 10

Assessors @ 6 cases/day 1 2 4 9 13 26

Case managers @ 4 cases/day 1 2 4 9 13 26

How can you help?

• Questions now• Engage with your employers/OHDs• Work out how you are going to engage

with HWS• Identify any issues• Share issues today• Share solutions today!

Existing OH services

HWS Existing GP service

Referral routes Employer +/- self GP +/- employer None

ServicesEmployer driven/agreed

Sickness absence assessment

Sickness absence assessment

Point of involvement

Employer driven/agreed

@ 4-6 weeksGP/patient driven

agreed

Frequency of contact

Employer driven/agreed

Maximum of three times

GP/patient driven agreed

Workplace knowledge

Good

Employee information +/-

employer information

Employee information

Duration of involvement

Employer driven/agreed

3 months compulsory discharge

For ever

Quantity of involvement

Employer driven/agreed

1 per annum Unlimited

Interaction between HWS and OH

• Very similar to current fit notes• RtWP may suggest OH involvement• RtWP can be amended to include further

information from employer or their OHS• OHS may take over

Answers?

Employers• Input to service• Adjusting SA policies• Information gap• Practical issues re contacting service• RTWP input• Certification (legal standing)• What does employer get• Who is responsible for action on advice

Employers more

• Workplace knowledge• Signposting• Current OH provision• Tax relief• RTWP before assessment completed• Consent

OH

• Fit with existing OH provision • Conflict of advice• Disinvestment• Resourcing small number of OH

professionals• Who will deliver

Marketing communications

• Key messages• Detailed description of service• GP engagement • Employer engagement

Long term conditions

• F2f assessments• Support for mental health

2nd workshop

• Engagement1. Employers and HAWS

2. OH and HAWS

• Marketing/information