Governments’ silo-budgeting perpetuates disability unemployment.

What do you think:

  • Does Governmental silo-budgeting increase ill-health unemployment and reduce productivity and economic growth?
  • If the evidence shows that early health interventions make economic sense, why aren’t they happening?
  • Are employers and the health sector really ready to work alongside long-term sick/disabled people wanting to work?

I’ve been banging on for years that:

  • our health care systems can be disabling because of the delays in treatment,  the frequent consequence of additional conditions and  priorities being driven by single Government Departments;
  • That the resultant unemployment costs to both individuals and taxpayers need to drive pan-Government action rather than silo-working/budgets.

As you can imagine, I feel a bit smug that the recent Fit for Work report seems to agree and offers strong cost benefit evidence for early health interventions for working age people acquiring impairments.  While not an advocate of age lotteries in allocating care and being mindful of the pressures already faced by the NHS, there must still be opportunity for earlier, more effective and work-related health interventions that, in turn, reduce demands on the NHS, benefits system and other publicly-funded services.  I strongly commend the Executive Summary of the report.

Significant points for me were:

  • Chronic ill-health (including disability) is likely to increase amongst the working age population (longer working lives automatically increase propensity for disability);
  • The providers bearing the cost of earlier health interventions need to be “compensated” from the savings from social security benefits and more (even employers);
  • There is almost certainly a stronger role for health insurance providers to be more active: rewarding employers who deploy occupational and other health care to provide early interventions by reducing insurance premiums;
  • Micro, small and medium sized businesses may be less likely to have such medical insurance in place, some will offer low-level employment with higher health risks and may therefore employ more people  with no/low qualifications – data to check the levels of risk for such employees and so to target publicly-funded early interventions would be valuable;
  • There is now an incentive for employers who make early interventions and return to work through the government’s “fit for work” free occupational health scheme;
  • Simply including return-to-work as a goal for health care providers (improves long-term health, reduces future demand on health care, improves overall productivity and economy) could re-focus their services with substantial benefit for all;
  • For individuals, the message is “take Charge” of: your health, your treatment, your return to work and your workplace adjustments – easier said than done when social structures have tended to give the power and authority to the health and benefit sectors alongside employers.

The report reviewed seven other studies on musculoskeletal disorders (MSDs and concludes that with “reasonable degree of confidence that targeted, multidisciplinary, work-focused, consensual and early therapeutic interventions which are clinically-led but involve employers and individual workers can deliver superior and cost-effective return-to-work and related outcomes compared to ‘usual care’. More specifically, they have shown us that, in the right combination, such early interventions can:

  • Reduce sick leave and lost work productivity among workers with MSDs by more than 50 per cent. Even in studies using ‘friction cost’ approaches, the early intervention is more cost-effective than ‘usual care’;
  • Reduce healthcare costs by up to two-thirds;
  • Reduce disability benefits costs by up to 80 per cent;
  • Reduce the risk of permanent work disability and job loss by up to 50 percent;
  • Reduce the risk of developing a co-morbid mental illness
  • Deliver societal benefits by supporting people with work-limiting chronic conditions to optimise their functional capacity and remain active at work and maintain economic independence.

Penny Melville-Brown

Disability Dynamics ltd

Helping disabled people to work since 2000

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