Work and Health Policy Hacks
Last month I presented to a UK based audience of health and social security policy stakeholders ahead of the release of funding to tackle the gap in the occupational health landscape. With elections on the horizon in the UK and the US, work and health is firmly on the policy agenda. Prof Kim Burton and I caught up on the policy knowledge legacy gap, and the cornerstones of evidence-based work and health services.
Status quo
Work and health (or lack thereof) are independently huge issues facing incoming political administrations in both the UK and the US. While there are barriers to tackling these related issues synergistically, sorting out the confluence of work and health is increasingly necessary to find affordable and sustainable solutions. This may well include developing innovative business/ healthcare relationships, perhaps crossing between the private and public sectors.
Organisational memory is very short
There are several examples of policy workups and pilot schemes in both the US and the UK that contain knowledge and evidence that can be leveraged. Starting from scratch is unnecessary and costly in an environment where progress and follow through has been limited in recent decades. Instead, previous projects should be used as building blocks. For example, Prof Kim Burton and colleagues’ community focussed Health and Work Service concept, developed for the US Federal Government, was a springboard for the Retain initiative, currently being piloted in five states in the US. Many successful programmes are built on the same principles of early intervention in a potentially long term sickness absence journey by coordinating a biopsychosocial approach.
What are the components of an effective service?
1- Managing expectations
Signposting to a ‘may be fit for work’ conversation involves groundwork being laid far before a service user enters a consultation room. The public and media dialogue around work and health must shift towards the potential benefits of working through a period of ill health- ‘working while recovering’.
2- Timely interventions
The earlier the intervention the better. Once someone is off for four weeks, there is already a 20% chance they will never return to work.
3- Data gathering
A clear identification of needs can inform triage of services. Thorough data gathering involves understanding a service user’s health, function and psychosocial context.
4- Triage —> tiered approach according to needs
This involves an individualised assessment to identify the key obstacles to working, followed by signposting and referring out to health services (medical/ physiotherapy/ psychological therapy) and psychosocial support and planning for return to work. The most expensive expertise may only need to be called upon in particularly complex cases.
5- Shared decision making
Person-centred care tailored to each service user’s psychosocial context, together with agreement on actions needed is essential for success.
6- Resource knowledge
Interagency collaboration between health and work services with timely and place-based support are fundamental for efficient running of services.
7- Feedback loop
This is important from an individual as well as systems learning perspective.
Lara’s take
Addressing work and health together is no longer a luxury, it is fundamental to efficient policy in a climate where governments are struggling to find funds. With elections looming in the UK and the US, incoming political administrations need to implement solutions that address labour supply and government revenues, improve the health- particularly the mental health- of their populations, and reduce spend on healthcare and social security. Work and health policy reform should be top of mind as a route forward. In a landscape where working with corporate stakeholders and businesses is essential it is even more important to keep pace. Starting from first principles is unnecessary and will slow down innovation and collaboration.
Kim’s take
We know much of what needs to be done: it’s just the doing that’s the obstacle!