The BBC reported this week that the new Health and Work Service (HWS) being developed by the DWP will cover England, Scotland and Wales and will involve non-compulsory health assessments and treatment plans (BBC News on 9 February 2014). Owain Thomas today (11 February 2014) from Workplace Savings and Benefits reports however that, “Employer participation in the new Health and Work Service (HWS) could become mandatory if its initial voluntary structure is not a success, the government has admitted.” He goes onto quote Minister for welfare reform Lord Freud saying, “It is strictly a voluntary service, it is not a mandatory service as it could have been and it may become (as the OECD recommended), but we want to see how it works first on a voluntary basis.”
“It is in the end a voluntary service and we are hoping that it can remain a voluntary service. That is one factor that we will monitor very closely.”
A mandatory service would indeed create an entirely feel to employers, employees and GP’s and may alter referral, assessment and intervention processes and arguably require a complete redesign. Are we heading for a UK version of Workers Comp?
We have been aware of such a recommended service since the Black and Frost report (Health at work – an independent review of sickness absence) on 21 November 2011 and that it may become a reality following the Government’s response (response to the sickness absence review’s recommendations on 17 January 2013) just a year ago. Since then we at Obair have been following developments and in our different voluntary roles with professional organisations (College of Occupational Therapists Specialist Section – Work and Case Management Society UK) and engaging with our colleagues where we can regarding the design and delivery of such a service. At present we understand that the HWS will support people who have been on sick leave for more than four weeks, back into work. Referrals will be made by the GP (who is the gate keeper to claiming statutory sick pay) and or the employer but the uptake of the referral by the employee will be optional at this stage.
The GP is primarily duty-bound to protect the health of the individual and there is a big question as to whether GP’s will initiate a referral to HWS. The Work Foundation discussed this in October 2013 looking at the motivation of GP’s and their conclusion was “If GP’s do not see return to work as in their patients’ best interests or important for their wellbeing then they are unlikely to motivate them to take up an offer of the HWS or any other type of vocational support. The success of the WHS depends heavily on the patient’s motivation to take up an offer to attend but also on the GPs motivation to refer their patients into the service.”
Following referral, it is envisaged that the employee would undergo an assessment by an occupational health advisor who could come from any of the following professional healthcare groups Occupational Therapists, Occupational Health Nurses and Physicians and Physiotherapists. Taking a case management approach, the specialist will undertake an assessment either via the telephone or face to face and then be guided as to appropriate next steps. We have no details of how screening will be operationalised or how people will be chosen to have more or less intensive interventions but the use of tele-assessments is something the DWP have recently published evidence on in their report “Telephonic support to facilitate return to work: what works, how, and when?” Their results indicate robust evidence supporting telephonic triaging, case management and some return to work interventions (including monitoring) and adequate evidence supporting telephonic-based signposting and self-management techniques.
The Work Foundation and Macmillan held an event to look at the HWS and long term conditions and specifically to:
- To identify the factors that affect people’s ability to work with certain long – term conditions, and also identify the similarities across conditions.
- To discuss certain aspects of the Service and how these should be taken forward for people with long – term conditions. This included aspects such as: the quality of the advice, the timing of the referral, case management, and how the Service can best work alongside the NHS.
- By the end of the session, to achieve a shared understanding of how the Service needs to work for people with long-term health conditions.
Following the event a report was produced that is helpful in considering important aspects about the new HWS in relation to long-term conditions, which echoes our own concerns here at Obair. These concerns for us are not just related to long-term conditions but resonate with most conditions and would be pertinent for a voluntary or mandatory service. Our broad recommendations would include:
- Having an individualised approach by assessors at HWS
- Ensuring robust assessments, triangulating data from multiple sources
- Ensuring evidence-based work assessment procedures
- Focusing on the function of the employee matched to the intrinsic demands of the job
- Ensuring timeliness and flexibility of referral to HWS
- Ensuring availability of specialist assessment and intervention and the capability to refer on to other specialists as required
- To work integrally with the employer
- To work alongside existing healthcare providers in primary, secondary, private and third sectors
- Having the capacity to follow employees up post assessment for an extended period if required to optimise safe and sustainable return to work
Once we know more information regarding the details of how the HWS will be operationalised, which service providers will be prime deliverers and any further information, we will blog about this again. Your comments are most welcome.