WORKING HEALTH

SERVICES SCOTLAND

A NATIONAL FIT FOR WORK SERVICE

Cathy EvansSenior Case ManagerWorking Health Services Scotland

Working Health Services Scotland• 1 of 11 UK pilots – Funded by DWP/DoH led till March 2011

• Dedicated Case Management Service to SME employees absent or at risk of absence from work

• Provision of free rehabilitation services - Physiotherapy, Counselling

• Model engages a bio-psychosocial approach which deals with all life circumstances and not just disease/medical model

• Utilise existing services e.g. Voluntary Sector, Local Authority etc.

• Centralisation of data, creating a national database

• Available across all of Scotland via single Freephone number

• Target to support over 3,500 employees per annum

Aim of Service

To provide a proactive service which will

facilitate health improvement and support individuals to remain in or return

to work

Referral Criteria• Employed by a small to medium sized business (SME’s) less than 250

employees• Employer organisation has No access to occupational health services or

employee assistance programme (EAP)

• Client is absent or at risk of absence

Referral Source:

• Self• GP & Health Professionals• Partner Organisations –Job Centre Plus, Remploy, Social Work and

HousingAll referrals via freephone Advice line

0800 019 2211

All referrals – Self, GP, A&E, AHPs, JCP etc.

Scottish Centre for Healthy Working Lives

Freephone number 0800 019 2211

Advise, Signpost (NHS 24), Screen Out & Connect client to Local Working Health Service

14 Health Board Services

Central National Data Collation

National Overview

Why WHSS

• £10bn lost annually to ill health worklessness (Scotland)

• 17m working days lost in Scotland

• 3.3m due to work related ill health

• 99.9% of businesses are SME’s

• 64% of GPs did not recognise the benefit of being employed (DWP pensions survey 2007)

• Clients in receipt of health benefits for longer than 2yrs are more likely to retire or die on benefit than return to the workplace

Why WHSS

• Targeted at lowest paid within SMEs

• Particular focus on attempting to engage small and micro businesses – these are the most vulnerable to job loss and insolvency

• Model engages a holistic approach and can involve very complex scenarios, including engagement of client siblings, partners etc.

• Nature of service ensures that where clients are experiencing debt, housing, welfare issues etc., the Case Manager resolves via engagement of appropriate services (e.g. Local Authority, CAB, Victim Support, Drug and Alcohol agencies etc.)

• Model prevents on flow to JSA & ESA, reducing benefit dependency

Service Delivery

• Provision of a comprehensive Bio-psychosocial assessment with a focus on return to work

• Utilisation of pre-and post outcome measurement tools

• Identification of any health issues/barriers to work

• Development of an agreed care plan-tailor made to suit individual needs

• Prompt access to locally delivered treatments

• Case Manager supports individual throughout duration of programme - regular contact and reviews to monitor and encourage client progress

• Advice, support and mentoring –Assisting client to better understand and manage their health condition

• Occupational Health advice and support available

Case Management

• An accountable process where clients are managed through complex problems to maximum recovery.

• Key Principles• De-medicalise problems• Accept wider determinants of health• Re-Build Resilience

• Key Factors• People management skills• Non dependant relationships• Knowledge of local existing services• Rapid Access to therapies

Case Study

• 50 year old Man, self-employed as a catalogue distributor

• Presenting condition- Back pain due to trapped nerves

Assessment Identified

Anxiety and long term psychological issues resulting in previous gambling and alcohol addiction

Caring responsibilities for sister-in-law, causing stress at home

High pain levels, low mood, guilt and low self esteem

Financial difficulties due to inability to work contracted hours

Action Plan

• Referral to Physiotherapy for pain management

• Referral to North Lanarkshire Council for Alcohol to obtain long term counselling and support

• Identified carer’s support group in local area and referral completed

• Given information on CAB regarding benefit advice for low income support• Continue to support his attendance at Gambling and Alcoholics Anonymous

• Motivational support from Case Manager at regular review calls

• Utilisation of Self Help Materials- Self esteem

Intervention

• Client engaged in Physiotherapy, with significant improvement in pain levels and increased productivity at work

• CAB provided help and information

• Client attended counselling sessions

• Continued attendance with Alcoholics and Gambling Anonymous

• Continued support from Case Manager providing the client with motivational self-help materials and assessing improvement

Outcomes

•Client’s presenting condition of pain has been resolved through treatment

•Client continues to address long term psychological issues through counselling

•Client continues to access support through Gambling and Alcoholics Anonymous

•Sister-in-law now lives independently, which has improved relationship with Client and Partner

•Client has now been promoted to manager within the Company and now does less physical duties

Case Study Discussion

Outcomes

Pre and Post assessment tools used:-

• COPM

• EQ5D

• GHQ12

Customer satisfaction questionnaire

COPM % improvement % remained same % deteriorated

Performance 72% 26% 2%

Satisfaction 81% 16% 3%

EQ5D % improvement % remained same % deteriorated

Visual Analogue Scale (VAS)

86% 5% 9%

Self Care 17% 83% 0%

Mobility 25% 71% 4%

Usual Activity 45% 52% 3%

Pain 50% 47% 3%

Anxiety 45% 53% 2%

Pre and Post Measurement Outcomes

Destination Outcomes

• 68% of clients remained in or returned to work following completion of the programme

• 17% of clients destination unknown (due to unable to contact)• 10% of clients failed to return to work on completion of the

programme• 4% of clients failed to participate with the service following

enrolment stage.

• Of a sample of clients (60) who completed the programme:• 89% of clients said that the service had helped them stay at

work• 4% of clients said that the service did not help them remain at

work• 7% of clients didn’t know if the service had helped them remain

at work

How would you rate your overall impression of the service received through Case Management?

Poor 0.0% Good 10.5% Excellent 89.5%

How helpful was the support you received?

Poor 0.0% Good 13.2% Excellent 86.8%

How involved did you feel throughout the entire process?

Poor 0.0% Good 15.8% Excellent 84.2%

How would you rate the treatment you received?

Poor 0.0% Good 13.2% Excellent 86.8%

How would you rate the venue you were seen in?

Poor 13.9% Good 50% Excellent 36.1%

Client satisfaction Results

Client Satisfaction Results

I would recommend this service to othersAgree 100% Disagree 0.0%

I would use this service againAgree 100% Disagree 0.0%

This service has had a positive impact on my current work situationAgree 100% Disagree 0.0%

How would you rate the speed and delivery of the servicePoor 0.0% Good 18.4% Excellent 81.6%

Client Responses

• “Service was great, grateful for this service, did not know where I would be without it”

• “Service should be rolled out across the country. The NHS is slow and laborious, but found the quality of WHSS top class. Would recommend to anyone”

• “Really impressed with the speed of service, cutting out the middle man, not needing to go to the Doctor and be placed on their extensive waiting list, service was delivered quickly and efficiently”

• “I would have waited months to have counselling through my GP and this service has made a huge difference to my work and social life”

• “Everything perfect, never gave up on me, helped with all problems”

Making a Referral

Working Health Services Scotland Criteria

• Client must be working within an SME (less than 250 employees).• Employer organisation has no Occupational Health or EAP support.• Client is Absent or at risk of Absence.

• Referral Source:• Self• GP & Health Professionals• Health Partners (Social Work, Housing etc..)

• All referrals via freephone SCHWLS existing Advice line

0800 019 2211

THANK YOU

ANY QUESTIONS?