The Fit for Work Team is a not for profit, social enterprise which provides holistic, vocational rehabilitation and employment support to enable people to stay in or return to work and provides workplace health programmes.
We used an evidence-based approach which mapped our service provision to identified needs and commissioning priorities; services based on implementing NICE guidance including PH19 and relevant workplace guidance.
This, combined with evaluating the impact of our services on a range of measures including overall health status and financial savings using the NICE costings report, enabled us to make a successful business case for funding and to demonstrate our impact on the health of our clients.
Aims and objectives
The aim of adopting a NICE and evidence based approach was to demonstrate how our work contributed to improving the health as well as addressing the health needs of the working age population. This was achieved firstly by helping people stay in or return to work by supporting them to overcome bio-psychosocial health obstacles and, secondly, by targeting workplaces as a key setting for health promotion.
- To implement our commitment to adopting a best practice, evidence based approach in practice
- To highlight the link between our programmes and services and addressing the health needs and priorities of the local population
- To be able to demonstrate how delivering services and programmes which implement NICE Guidance and evidence based practice had impacted on the health of our clients and local services
- To bridge the divisions between welfare systems and health by demonstrating the links between work and health
- To use this approach to build our business case to potential commissioners/funders
Reasons for implementing your project
As part of national efforts to reduce the levels and impact of sickness absence, The Fit For Work Team working in Leicester, Leicestershire and Rutland, was one of a number of national DWP funded pilots to test a bio-psychosocial approach to providing early intervention support to help people on, or at risk of long term sick leave. We provided holistic vocational rehabilitation to help people to stay in or return to work and thus avoid moving onto benefits. Work is a key determinant of Health and those who are workless have a 20% increase in mortality, 2 to 3 times the risk of poor general health, mental health problems or injury than those in work. In addition, given the proportion of the population who are in work, the workplace is a key setting for prevention programmes and health improvement with the potential to target those less likely to access healthy lifestyle support, particularly if focussed on SMEs.
As funding for the pilots ended we needed to make the health and business case to potential commissioners to enable us to secure funding to continue delivering Fit for Work and to develop workplace health programmes to support prevention and health improvement. The pilots' success led to plans to develop and commission a national service but it was clear that this would mean a significant gap in service provision and the loss of the local capacity and capability in VCS and public services. Despite the fact that measuring households on benefits is part of the way that health inequalities is defined, and the services implemented NICE guidance, e.g. PH19, work was not recognised as a health outcome.
CCGs, whilst supportive, responded with the view that 'reducing the flow of people onto benefits' by funding a Fit for Work Service was not part of their commissioning remit or addressing their priorities. We were able to build a business case by mapping how our services addressed health priorities identified in local JSNA and health and wellbeing strategies. We presented our data on the impact of the FFW pilot using a range of key health and cost benefit measures. This included improvements in health status as an outcome of our service for 73% (EQ5Dscores) of clients as well as return to work rates. Our results also made it clear that holistic Case Management was key to our outcomes. The majority of clients quoted this personal support and non-medical intervention as the most important factor in their return to work supporting the holistic approach.
How did you implement the project
Our workplace health programme supports increased access to health improvement and prevention through the workplace. A pilot was commissioned by Leicestershire County Council (Public Health) to work with small and medium enterprises (SMEs) in the County to increase access to health promotion interventions and support behaviour change in a group identified as more vulnerable.
An evidence-based Workplace Needs Assessment tool enables employers to identify the health priorities of their work force. Support is then provided to access and implement evidence based, NICE-recommended health promotion interventions that are low cost or free including smoking cessation, physical activity and mental health promotion.
Our Fit for Work Service implements PH19 and follows the pathway this outlines. The multi-disciplinary team receives clinical leadership from a GP with occupational health expertise and is supported by an occupational health nurse. The delivery model uses case managers who are expert/specialist trained Information, Advice and Guidance (IAG) professionals. The Case Manager carries out a detailed assessment identifying the mental, physical and social barriers the client is experiencing. They provide interventions directly and also co-ordinate interventions from a network of providers. In support of delivering an evidence based approach, these interventions address the social /human issues (non-medical) as well as the medical barriers preventing a return to work. The case managers work with clients and integrate health and social care, and public, private, and third sector interventions to maximum effect.
Creating better links between and within the health sector and between health and the employment support/vocational rehabilitation sector is at the heart of the service. We used a variety of indicators to illustrate the impact of our service on outcomes and related health services and cost benefits.
In its first 6 months of full operation the workplace health pilot service impacted upon the health and wellbeing of approx. 750 Leicestershire based employees across 16 SMEs covering a variety of sectors including manufacturing, haulage, and IT. Early reporting highlighted increased staff engagement and participation in health promotion activity. Engaged employees have been identified as 43% more productive. The pilot enabled successful workplace smoking cessation clinics (saving in excess of £50,000 through reduced staff ill health costs). It enrolled employees onto lifestyle modification and behaviour change programmes, developed and mentored workplace champions and delivered a number of healthy eating and mental health interventions. SME engagement is based on demonstrating business as well as health impacts and promoting evidence based interventions.
For the Fit for Work Service we had collected data on the number of clients seen and on their outcomes in terms of return to work. We had also looked at changes in their reported health status at entry and discharge using EQ5D - 73% of clients reported improvement.
Calculating the financial benefits and cost savings is complex and national data is often limited but our data provided an insight: The pilot had issued 2,288 fit notes (on average 4 per client) preventing the associated appointments and workload for GPs. It is estimated that this is equivalent to savings of £70,928 (based on 10 minutes total GP time per fit note - Unit costs of health and social care (2011)). As 60% of client referrals relate to mental health, a similar saving to that of IAPT might be expected i.e. 3.2 fewer GP consultations, 1.5 fewer inpatient bed nights, 0.7 fewer outpatient procedures. Moreover, clients referred into the Fit For Work service receive an intervention at a point where they may not be eligible for IAPT referral and evidence suggests that, if they are not supported, their condition may deteriorate to a level where more expensive IAPT services are required. DWP estimated individual healthcare cost savings of around £1,200 and benefits savings of £8,500 per annum per person who returns to work. (DWP, 2011).
Using Long Term Sickness Absence and Incapacity for Work Costing Report, NICE Guidance 2009 estimates that Leicestershire has 4,953 long term sickness absence per year, with sick day costs of £9,693,732, taking away the cost of FFWS support provides a net saving of £6,549,005.
Key learning points
- Review local needs assessment and health strategies and outcomes - map how your proposals/service addresses these.
- Don't overlook related strategies or reports such as economic plans and profiles or NHS services priorities.
- Outline how your service or intervention addresses/implements NICE guidance/best practice recommendations in the issues or areas you are targeting.
- Identify how you will measure and demonstrate the impact and outcomes of your service /intervention from the beginning, both qualitatively and quantitatively. Collecting the overall health status of your clients before and after using EQ5D can provide evidence on the impact of your service