Professor Mansel Aylward talks to Angela Faherty about his achievements in medicine and the Government's initiative to get people back to work
Professor Mansel Aylward has had a remarkable career. A specialist in rheumatology and rehabilitation, therapeutics and clinical pharma-cology, Aylward began his career working as a surgeon, physician and general practitioner (GP).
However, it was his desire to gain a greater understanding into the psychosocial factors affecting the way certain people respond to illness that led him to his current role as chief medical adviser, medical director and chief scientist at the Department for Work and Pensions (DWP).
"My initial plan was to go into surgery, but after two or three years I realised I did not want to be a surgeon as it was too far removed from patient contact. I realised I would rather interact with patients and understand why they are ill and what can be done about it," he says.
It was while working as a GP in his hometown of Merthyr Tydfil in Wales, that Aylward further developed his interest in trying to understand why some people have great difficulty in responding to treatment and overcoming illness. Convinced that psychosocial factors played a part in the way people respond to their condition, Aylward embarked on a study to find out more about the causes of post-menopausal depression in women.
"I did some work which looked at why some women at the time of the menopause were more sad than simply just being unhappy," he says.
"It suggested the imbalance of certain chemicals at the time of the menopause related to changes in hormone levels and that these could be corrected by hormone replacement therapy (HRT)."
While the use of HRT in post-menopausal women is now common, in the early 1970s, Aylward says there was a general reluctance by the medical and allied professions to accept that some women during the menopause required treatment with hormone replacement.
The negative response to his work did not deter him however, and Aylward went on to open the first free HRT clinic to women in Great Britain. This success led to the establishment of SIMBEC Research, a medical research company which Aylward headed up for 10 years.
"I established SIMBEC to get money to conduct the research and develop the ideas I had. But I ended up being a businessman and lost touch with my medical background and I regretted that. So I sold the business and returned to medicine," he says.
Aylward feels it is in his current role for the DWP that he can influence the greatest change. He played a key role in the development and evaluation of the medical assessment for incapacity, and more recently, has played a major role in the Government initiative, Pathways to Work.
"What I find most interesting about the medical civil service," he says, "is that if you do the right thing, you can change the lives of hundreds of thousands of people in your career by the advice you give and the changes you make to policies in health and social service.
"If I was working as a GP – while that is something to be admired – I would only be able to help a fraction of that amount."
Aylward explains that one of the key issues for Government is Social Security expenditure. Around £36bn is paid out each year to people receiving benefits for illness and disability, and unless something is done to address the rising number of claimants, the situation may get out of hand.
"When you think the evidence strongly suggests that if one intervenes early and finds out the issues that are present in some of these people that go on to long-term incapacity, then you may be able to do something about it.
"This is where the way people think and what they believe in comes in to play. The fears they may have about their condition and the lack of confidence they develop quickly when they are out of the workplace all play a part. If we can engage with them quickly, all the evidence shows you are on to a winner," he says.
It is this line of thinking that has set the foundations for the Pathways to Work initiative, which focuses primarily on the need for early intervention and rehabilitation. The Pathways project is being piloted in seven locations across the UK, and Aylward is confident it will succeed.
"I have always felt rehabilitation is a solution and it has been neglected for many years. Traditionally, when one thinks of it, it is usually associated with drugs, alcohol, and reforming prisoners, but the rehabilitation we are talking about is getting people to restore their function or use their function in a different way," he says.
Recently, rehabilitation has also become the key focus for many insurers and employers keen to lower the cost of sickness absence in the workplace. The rising cost of sickness absence and escalating employers' liability premiums has led to an increased awareness of the need for greater health and safety initiatives in the workplace.
This increased awareness has led to greater interaction between the public and private sectors, and Aylward is keen to further develop the relationship that has developed in recent years.
"Working with the insurance industry is important for the Government because we share common concerns. The number of people receiving benefits, whether State or through insurance, is rising and we can learn a tremendous amount from each other, particularly in the way we assess people with disabilities, the way we intervene, and at what time and the benefits of this," he says.
Aylward says the Government's relationship with insurers has developed dramatically over the past six years and is confident this will improve, but it will not be without its challenges.
"The way forward is to work together, in fact, there is no other way to do it. We have to work and learn from each other.
"There is a difficulty in that if you look at the health of the nation, there is no real change in the overall health of people. Yet, the number of people coming onto benefits has increased dramatically since 1995 and as we are confronted by this, we need to have a common and evidence-based approach. We need to work together," he says.
Looking to the future, Aylward is headed for pastures new. He plans to resign from his current position at the DWP towards the end of next year and take up a five-year role as joint chair at the School of Psychology, Cardiff University and The School of Medicine, University of Wales College of Medicine, where he will continue to research bio-psycho-social issues.
After being made a Companion of the Bath in the Queen's Birthday Honours List in 2002, Aylward feels he has earned recognition for his hard work, but has no intention of stopping. "I should have retired last November, but to be honest I don't think I'll ever retire. I'll always be doing something," he says.
