Further details about the government's new Health and Work Service (HWS) have been published along with a substantial report examining the potential value of using telephone services to provide health and return to work support.
It is believed that a telephone-based model is the Department for Work and Pensions' (DWP) preferred choice to act as the initial gateway to the HWS.
The 140 page report published by the DWP confirmed that the HWS would be formed by two key elements - advice and assessment - with the assessment part working to:
- Identify all the obstacles preventing a return to work, and any measures, steps or interventions that would facilitate a return to work;
- Obstacles can be health-related, work-related, or non-health/ non-work-related;
- Recommendations for these will be included within a ‘Return To Work Plan' that will be shared with the employee, employer and GP for consideration;
- An Occupational Health (OH) professional will use a biopyschosocial approach to identify all the issues preventing a return to work and offer managed self-help and specialist advice; a further (face to face) assessment if needed;
- Case management.
Its authors concluded: "Telephonic contact is an attractive approach for the HWS with the potential to provide targeted delivery but there are still questions over its safety, effectiveness, acceptability and relative costs that this research explores. In particular, the findings of the research can inform the design approach to occupational health assessment and support in the planned new HWS."
Writing in the summary conclusion they added: "Telephonic approaches using assessment and triage, along with coordination of the key players, can be effective at reducing the number of sickness episodes, the number of days lost and the overall cost of a case/claim.
"Unnecessary healthcare can be reduced, without compromising client satisfaction. The important caveat is that this applies when services are well designed and implemented, and are staffed by professionals who have appropriate training and support.
"Central to enhancing return-to-work outcomes is that work is seen as a health outcome, and that work participation is the principal focus for the service: every client is asked about their work to identify obstacles to early return; they are helped to devise a practical and feasible return-to-work plan; there is coordinated action with the workplace.
"The assembled evidence indicates that when all these components are put together in an efficient manner, with appropriately skilled staff, the service will facilitate timely return to work and demonstrate cost-benefits and cost-effectiveness."
Several issues were highlighted that could prove to be strengths or weaknesses of a telephone assessment service.
The report noted that telephone approaches were unsuitable for clients with communication problems or complex pre-existing medical conditions in addition to the current common health problem, but that this could be remedied by using a face-to-face approach.
It also served to quell fears that serious medical conditions may be overlooked, but the authors emphasised that the process was not intended to replace clinical examination and be diagnostic.
"There is robust evidence that telephonic approaches (if suitably conducted) are generally accepted by service users, and are associated with high levels of satisfaction that equal or exceed those for face-to-face approaches. In addition, telephonic approaches are generally acceptable to health professionals," it said.
The authors also highlighted that a telephone approach could be used to speed up the "window of opportunity" for the intervention process.
"The evidence actually favours interventions that start sooner than the beginning of the vocational rehabilitation window. In the early days and weeks of absence a ‘light touch' intervention may be all that is required, with the intervention being escalated if return to work is delayed. Telephonic case management is suitable to guide this sort of stepped intervention," they added.
And they noted the main aspects of telephone services that had been shown to be effective for helping return to work were:
- Ensuring return to work is asked about in every case;
- Promoting self-management approaches as soon as appropriate;
- Demedicalising common health problems wherever possible;
- Having a monitoring process to avoid serial ineffective treatment;
- Integrating line managers into the return-to work-plan;
- Facilitating early referrals into the service.
