“Fit for Work Ireland”

The Institute of Physical Therapy & Applied Science

Croke Park April 2014

John Church – CEO, Arthritis Ireland

Arthritis Can Strike at any Age

Arthritis Can Strike at any Age

• Arthritis is a serious chronic disease .....

• Arthritis is a cause worth contributing to.....

• Arthritis Ireland is the solution.....

Arthritis – The Challenge

Arthritis Ireland

Working on a Cure

Advocacy & Awareness

Community

Arthritis Self-Management CoursesSince 2006....

people

courses

3,500 200

Moving is the Best Medicine

Water Exercise Programme Community Exercise Programme

22 groups

Moving is the Best Medicine

Fit for Work Ireland - Background

• 2009 Research carried out by The Work Foundation

• Fit for Work Europe, 24 countries

• Focus on Musculoskeletal Diseases (MSDs) only

• Report findings launched at Dublin Castle April 2011

• Arthritis Ireland formed Coalition of key stakeholders

• Supported by Abbvie and Irish Life Corporate

Fit For Work Ireland CoalitionPhysician and Allied

Health GroupsEmployers and Trade

UnionsPrivate Health and

Life InsurersPatient

Organisations

Policy Makers

The Fit for Work Coalition is supported by an on-going grant from AbbVie and Irish Life Corporate

Key highlights from the Fit For Work Report

• MSD’s are the most commonly reported cause of work related ill health in Ireland– costing the economy €750 million a year– 7m lost working days per annum

• MSD’s account for twice the number of days lost than through stress

• 25% of people with RA stop work within 5 years

• Full time employment amongst people with RA is very low at 22%

• Ireland has a low ratio of rheumatologists per head of population in Europe– 1 per 134k versus 1 per 80k optimum (W.H.O.)

• MSD’s will increase in Ireland- By 2030 greater than 60% will be over the age of 50

MSDs a Significant Issue at Work• Social Welfare payments significantly increased since 1992

– 100k to c. 300k (number of claims)– €500m to €3.5b (expenditure on claims)– 1/3rd of all Illness Benefit payments migrate to Long term Disability Benefit payments (€640m

in total paid in 2009)

• MSDs account for 31% of all claims (49% EU average)– 7m lost working days per annum– €275m (2009 data)– 22 weeks V 11 weeks average duration of payment

• 4 weeks absence the key factor– C. 10% of workforce out absent for more than 28 days– 57% of all claims > 28 days– but 96% of total value

Fit for Work Ireland – Focus Areas

• Fit for Work Coalition focussed on two key work streams– Sickness certification guidelines– Case Management Early Intervention

• Sickness certification guidelines– GP guidelines prepared and submitted to the ICGP QIP committee– Proposed new Sickness Certificate

• Case Management Intervention– Potential savings of €178m in full year implementation at costs of

€12m– 15:1 return on investment

Fit for Work – The Bigger Picture

The potential annual savings arising from a coherent programme are of the order of €280m – over a quarter of a billion Euro. That estimate is in the same ball park as the estimated yield this year from the Local Property Tax. It does not include the benefits – personal, economic, social and fiscal, arising from improved competitiveness through the participation of skilled people in the work force and their better physical and mental health and well being......

Dr Don Thornhill, Chairman of National Competitiveness Council

Case Management Intervention Model• Basic Absence Management Intervention after 4 weeks absence

– OH Nurse Specialist contacts employee

– 10% reduction in absence expected

– €89m savings at a cost of €3m

• Enhanced Case Manager Intervention with MSD service

– Above plus appropriate intervention such as Physio/OT/EAP

– 20% reduction of absence expected

– €178m savings at a cost of €12m

• Proposal for DSP to implement a pilot in a region covering c. 10,000 cases– 3 nurses and 3 administrators at a cost of €375k

– Control and test location

– External agency to manage pilot

Case Management Model(Intervention at 4 weeks)

Employer/ DSP

Basic Absence Mgmt

Case management

required ?

Return to Work

Enhanced Case Management

Physio/OT/EAP

OHS to employer

CMS OHP

Employer HR H&S

Treating doctors

Outcomes

Fit RTW now

Target date set

Review

Yes

No

Savings 10% reduction or €89m 20% reduction or €178m

> 4 weeks

Early Intervention – Case Studies

• DAA active injury and absence management programme1. 25% reduction in overall absence

2. 62% reduction in LT absence

• Department of Education introduction of national OHS1. 17% reduction in overall absence

2. >70,000 days pa

3. 12 fold return on investment based on teacher substitute savings alone

• Royal Mail 1. Absenteeism reduced from 7% to 4.5% over 3 years with savings of over €270m

MSDs – The Window of Opportunity

• 11.9% of all adults 18+ were clinically diagnosed with an MSD, in next 10 years this will rise to 12.6% (Institute of Public Health)

• MSD’s will increase in Ireland- By 2030 greater than 60% will be over the age of 50

• Currently no national policy on intervention or integration between health services, employer and employee

• What if we could reduce the duration of illness payments on MSDs from 22 weeks to average of 11 weeks??

Early Intervention is Key

• Better health outcomes for employee

• Earlier return to work

• Substantial cost savings

Mini Marathon

Thank You

John Church – CEO, Arthritis Ireland