Viewpoint: NHS must better support return to work and job retention

For people with long-term conditions, holding down a fulfilling job at a time of economic instability can be a constant worry. Musculoskeletal disorders (MSDs) and mental health conditions are the leading causes of sickness absence.

Dr John Chisholm: 'We know that early identification and treatment of MSDs is key to supporting return to work.'
Dr John Chisholm: 'We know that early identification and treatment of MSDs is key to supporting return to work.'

MSDs can have a devastating impact on the quality of life of both individuals and their households, and cost the UK economy billions of pounds in terms of direct health care costs and the indirect costs of lost working time and productivity and social support for individuals and their families. 

This is the subject of a new report, Taking the strain: The impact of musculoskeletal disorders on work and home life, launched by Fit for Work UK – a coalition of organisations campaigning for better support for people with long-term conditions.  The report draws on a survey of more than 800 people living with MSDs recruited from patient organisations, and makes a series of recommendations for policy-makers and healthcare professionals.

Perhaps most worrying for GPs is the report’s finding of a lack of visible clinical support for individuals with MSDs to help them stay in work.  Only half of respondents reported discussing managing their condition in the workplace with a healthcare professional, revealing a lack of prioritisation of work as an outcome on the part of some clinicians. 

We know that early identification and treatment of MSDs is key to supporting return to work.  However, the survey found that amongst those responding it took an average of 4.22 years to diagnose a MSD, and that following diagnosis, one in 10 respondents had to wait more than a year to receive treatment. 

GP patient advocates

The report found heightened risk of job loss among people with MSDs, early retirement and financial hardship.  As the condition progresses, the ability to maintain performance at work understandably diminishes, and a number of the survey participants revealed they felt that their condition had prevented them from reaching their full potential at work.  As we know from previous research, work, providing it is ‘good work’, has a beneficial effect upon health outcomes and social integration, and on the financial wellbeing of patients and their families.

As patient advocates, GPs need to be mindful of their role in supporting patients with long-term conditions who may be at risk of being trapped in low quality jobs ill-suited to their level of skills. 

Across the board the NHS needs to gear up better to support return to work and job retention. For the ambition in the NHS Outcomes Framework of ‘employment of people with long-term conditions’ to become reality, we need to mainstream employment through all relevant health policy frameworks and collect data on employment outcomes.  ‘Work’ needs to run through NICE guidance and quality standards, and to be incentivised through the Commissioning Outcomes Framework. We also need to get our own house in order in the NHS by implementing the recommendations of the Boorman review to improve the health of our own staff.

There is now a huge body of evidence on cost-effective interventions that can help people with long-term conditions to retain their jobs and be productive at work.  Many of these are cost-neutral, involving changes in behaviour and approach, and even where investment is needed, returns accrue in reduced welfare spending.  All we need now is the political, managerial and clinical will to make work a clinical outcome and support our patients to remain in or return to work.  If you agree, or want to find out more, please sign up for news on the Fit For Work UK Coalition website.

* Dr John Chisholm is a Council member of the RCGP and health and work lead.

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