Helping people who suffer from debilitating illnesses get back into work remains a mammoth task for any government, particularly one that is committed to cutting the country’s welfare bill. Abbott, the global healthcare company, came together with Total Politics to discuss how the NHS, supported by government and employers can ease the process.

The government’s ambitious Work Programme is currently being rolled out, and aims to “support a wide variety of customers back into sustained employment” with a major reform of the entire welfare system. Inevitably, there is pressure to reduce the number of people on Employment and Support Allowance (ESA), and the panel agreed that any solutions would require smart government.

While the panel also agreed that ESA can play an important role in supporting those already suffering from long-term illnesses, few felt that enough attention had been paid in recent years to tackling the root causes.

Phil Gray of the Chartered Society of Physiotherapy noted that the largest single reason for people being off work sick is that they are suffering from musculoskeletal disorders (MSDs). He felt that there was a distinct lack of joined-up thinking between the NHS and the Department for Work and Pensions (DWP) in providing ongoing support for these kinds of conditions. “The reality with those schemes is that the NHS won’t implement them,” he said.

Andrew Attfield, associate director for health and employment at Barts and the London NHS Trust, put this incoherence down to what he sees as the relative “short-termism” of the NHS in not focusing on early intervention. He believed that there was insufficient focus on the kind of on-the-job support that would help people regain their footing, and that all too often MSDs were seen as a lower priority.

In fact, MSDs have been estimated to cost the UK economy approximately £7bn a year. A National Audit Office report gauged that there are 26,000 new rheumatoid arthritis (RA) cases diagnosed a year. The DWP has put the cost of out-of-work benefits to those with RA alone at £122m for the year 2007-08, demonstrating that there is significant scope for a reduction in costs if this is tackled. As Ros Meek, director of the Arthritis and Musculoskeletal Alliance, pointed out, MSDs are currently the fourth-largest spending area in the NHS, but there are no targets for improving services.

Baroness Finlay noted the dearth of attention paid to the economic impact of MSDs, particularly within the health service. “We have been living in a target-driven NHS,” she said. Dr John Chisholm, member of the Councils of the Royal College of General Practitioners and a vice-president of the British Medial Association, supported this view, claiming: “The service is not just there to meet demand for early intervention. There is also a lack of access to occupational health advice.” Dr Chisholm also pointed out the need to improve the ‘return to work’ dialogue between employers, employees and GPs. The need for speedier referrals for patients from initial contact with GPs to seeing a specialist was vital, he said.

The ‘fit note’ or the Statement of Fitness for Work, an innovation suggested in Dame Carol Black’s ‘Working For a Healthier Tomorrow’ review of 2008, was also discussed. According to Dr Chisholm and others, it has been welcomed by GPs and employers, and there are hopes that if it can replace the conventional ‘sick note’, it can reinforce a positive and proactive attitude to helping people with long-term conditions like RA back to work.

It was also suggested that the National Institute for Health and Clinical Excellence (NICE) could keep health and work issues in mind when developing quality standards – something that is not formalised at the moment.

Minimal access to occupational health services, the panel felt, was a big concern. Without support and flexibility from employers, sufferers of MSDs who attempted to return to work could find their jobs hived off to those considered more able, in spite of their experience. It was agreed that the government needs to do more to support employers in holding onto staff, something which would have the added bonus of reducing the ESA bill.

The panel agreed on the seriousness of the challenge facing the government. “We’ve created a huge social problem that we can’t buy off,” remarked Lord Boswell. “We need to get all the components to fit together.” Attfield was optimistic: “Who pays for all of this is politics, but it can be done. But if you don’t have employers, the DWP and the NHS having a debate on this, you’ll get nowhere.”