Opinion: Work, health and rheumatology
Head of Policy - John Hopgood, discusses the latest policy developments around employment and health within rheumatology
Last December, the government published a long awaited paper on work, health and disability. Improving Lives was the result of years of pressure from the charity sector – BSR collaborated with Versus Arthritis, NASS, ARMA, NRAS and many other organisations and individuals through the Fit for Work coalition on the issue – but, almost a year on, what impact have the new policies had?
The short answer is little, if any. As yet, the government have done scant work towards implementing any of their proposals.
Within rheumatology, this is significant. More than 30 million working days are lost each year in the UK due to musculoskeletal conditions. Four out of five people who are living with a musculoskeletal condition report that it has limited the number of hours they can work. Last month, new research from Versus Arthritis showed that a quarter of people living with arthritis didn’t receive any support from their employer to allow them to continue in work.
This week, we published a new rheumatology fact sheet on work and health. Our members are seeing an ever-growing number of patients, and find themselves under greater pressure to help people manage their conditions in a way that ensures continuation in employment is a focus. In spite of this, however, there remains limited awareness among decision-makers of the positive impact that the rheumatology multi-disciplinary team can have on the workforce. This needs to change, and BSR aims to make sure that all our members are properly supported in – and recognised for – the role they play.
There are other considerations that come into play beyond health professionals. A recent paper based on data from the BSR Biologics Register in Axial Spondyloarthritis demonstrated that patients undergoing biological therapy showed significantly better improvements in productivity and activity impairment compared to those patients who were on non-biological therapies. However, even with the improvements observed with biological therapy, there is still a substantial impact on work. It seems likely that pharmacological intervention alone is not enough to improve work participation; members of the MDT will need more guidance on how to address this particular need.
What, then, can be done? At the heart of our new fact sheet are four key recommendations that we believe will better support our members in the aim of seeking to promote employment as an outcome of patient care.
Firstly, we need to ensure that all medical undergraduate and postgraduate degrees incorporate the topic of work and health. This training should be coupled with opportunities for continuing professional development in this area. We know that many healthcare professionals currently receive no formal training in this – half of patients have never had a conversation with their doctor about managing their condition in the workplace. This is an easy thing to rectify if the government are serious about giving clinicians the means to support their patients when it comes to employment.
Secondly, a guide needs to be created for health professionals that outlines what responsibilities they have to their patient’s employer and, in particular, what an employer is required to provide their employee. As Versus Arthritis’ research demonstrates, too many employers are still failing to make reasonable allowances for employees with musculoskeletal conditions. It’s vital that clinicians feel empowered to assert the rights of their patients in the workplace.
Thirdly, we need to ensure that secondary care input in sought when creating employment support pathways. Return to Work plans are central to government proposals, but unless healthcare specialists are able to help shape those plans, their impact will be significantly diminished.
Finally, a system needs to be put in place that makes it easier for healthcare professionals to signpost their patients to appropriate local services that might help support their return to work. Even with the best training available, our members can’t be expected to provide all the support that any individual might need. Every clinician should be confident directing patients towards the best place for further support.
Those recommendations are just the starting point, of course. But given that the impacts of rheumatoid arthritis alone costs the UK economy in the region of £4billion per year, it is clear that the government needs to start taking action urgently – and BSR is committed to working with our colleagues at other charities to make sure they do.