WORKING HEALTH

SERVICES SCOTLAND

A NATIONAL FIT FOR WORK SERVICE

Cathy EvansSenior Case ManagerWorking Health Services Scotland

Working Health Services Scotland

• Dedicated Case Management Service dedicated to employees of SMEs who are 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• Client is absent or at risk of absence

Referral Source:

• Self• GP & Health Professionals• Employers-with employee consent• 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, Employers 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

Contact Targets

• Assessment completed within 5 working days of making referral

• Intervention appointment arranged within 10 working days of referral

• Length of engagement in service is between 2-12 weeks

• 3 and 6 month follow up to assess sustainability of good health

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 relationships

• Client has now been promoted to manager within the company

Case Study• 46 Year old lady- Hospice care worker• Presenting Condition- Stress/Anxiety

Assessment Identified Long term problems with Anxiety Financial difficulties Relationship disharmony Work related concerns Increased alcohol intake

Action Plan

• Referral to counselling• Given information on CAB regarding benefit advice for low

income support• Motivational support from Case Manager at regular review calls • Utilisation of Self Help Materials- Self esteem, sleep, building

and improving relationships, relaxation CD, mood and alcohol diary

• Increase physical activity• Details of local support group

Intervention

• Client engaged with counselling services- marked improvement in levels of stress/anxiety.

• CAB provided help and information • Attendance at Local leisure centre• Continued Attendance at Al Anon meetings• Continued support from Case Manager providing the

client with motivational self-help materials and assessing improvement

Outcomes

• Levels of Stress/Anxiety greatly reduced

HADS Pre A=18 D=12 Post A=8 D=6• Continued use of self help materials• Reduced alcohol Intake with improvements in relationship with

husband• Increased physical and social activity• Work concerns discussed with manager and client reassured

her fears are unfounded• Client enjoying attending work and enjoying the personal

satisfaction of providing vital caring services.

Outcomes

Pre and Post assessment tools used:-

• COPM

• EQ5D

• EQ5D/HADS

Customer satisfaction questionnaire

WHSS Service: Performance Measures

EQ5D Deterioration Same Improvement McNemarMobility 28 ( 3%) 619 (64%) 323 (33%) p<0.001Self Care 24 ( 2%) 711 (75%) 232 (24%) p<0.001Usual Activity 23 ( 2%) 357 (37%) 589 (61%) p<0.001Pain 15 ( 2%) 378 (39%) 577 (59%) p<0.001Anxiety 23 ( 2%) 586 (61%) 359 (37%) p<0.001

VAS 94 ( 10%) 81 ( 8%) 786 (82%)

COPM"Clinically Significant" Deterioration Same

"Clinically Significant" Improvement

Performance 9 ( 1%) 244 (27%) 645 (72%)Satisfaction 5 ( 1%) 174 (19%) 719 (80%)

GHQ12 Pre (mean) Post (mean) Paired t-testLikert 16.9 8 p<0.001

Deterioration Same Improvement McNemarBimodal 6 ( 1%) 218 (44%) 273 (55%) p<0.001

Completion Outcomes• Following programme completion, 55% of clients reported that they were not taking any medication, 22%

remained on same medication, 5% had some additional, 16% had some reduction and 2% had some reduction and some additional.

• Following completion of the programme, 82% of clients reported that their health issue had been resolved either partially or fully, 13% of clients felt their health issue had not been resolved and 5% were unknown.

• On completion of the programme 85% of clients reported that Working Health Services (WHS) had helped them to remain at/in work, 5% reported that it hadn’t helped them and 10% was unknown.

• 96% of Clients reported that they will still be able to do their job in the 6 months time

• 762 were in work (presentees) on entry and remained in work on completion of programme

• 183 were off sick (absentees) on entry and returned to work on completion of the programme

• 44 were in work on entry but were off sick on completion of the programme

• 30 were off sick on entry and remained off sick on completion of the programme

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

Case Management?

Poor 0% Good 14% Excellent 86%

How helpful was the support you received?

Poor 0% Good 11% Excellent 89%

How involved did you feel throughout the entire process?

Poor 1% Good 17% Excellent 83%

How would you rate the treatment you received?

Poor 1% Good 17% Excellent 83%

How would you rate the venue you were seen in?

Poor 4% Good 39% Excellent 57%

Client satisfaction Results

Client Satisfaction Results

I would recommend this service to othersAgree 99% Disagree 1%

I would use this service againAgree 99% Disagree 1%

This service has had a positive impact on my current work situationAgree 98% Disagree 2%

How would you rate the speed and delivery of the servicePoor 1% Good 11% Excellent 88%

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”

THANK YOU

ANY QUESTIONS?