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Healthy HR – Cut to the bone

A group of experts, supported by the independent think-thank The Work Foundation, claim to have found a solution to reduce Musculoskeletal Disorders by 39 percent. Ioana Piscociu, Project Manager of Fit for Work Europe, within The Work Foundation, explains.

Musculoskeletal disorders (MSDs) are cutting productivity rates to the bone in the UK. Employers lost an alarming 30.6 million working days to MSDs in 2013, the Office for National Statistics (ONS) reports. The over all picture of absenteeism in the UK, to illness is staggering. Last year’s productivity loss is comparable with roughly 14,230 years of business days, (as reported by the ONS), but what is not widely known is the loss could be much higher, as highlighted in the autumn of 2013, Employee Outlook well-being survey, run by the Chartered Institute of Personnel and Development. Weighted to represent the UK workforce, it indicated that 67 percent of employees admitted that they “have gone into work in the past 12 months when they were genuinely ill, rather than take the day off”. Put simply, presenteeism, or being at work while unwell, adds to an already alarming productivity loss, as employees’ productivity is compromised.

Contrary to popular belief, MSDs are more harmful to British employees, their employers and the whole UK economy, than stress. MSDs cover 200 conditions, causing pain and functional impairment to the people living with them, and include widely-known conditions such as; back pain and arthritis, injuries caused by trauma, such as fractures, and other conditions that are the result of genetic or developmental abnormalities, as well as bone and soft tissue cancer. A major research project conducted by The Work Foundation – Fit for Work looks at the impact of MSDs globally, across more than 40 countries. Fit for Work has found that more than a half (55  percent ) of all work-related illness in the UK are caused by MSDs in contrast with stress, which causes only 30 percent  of work related illness. To make matters worse, three out of ten working age individuals living with an MSD also have depression.

Far from being a problem unique to Britain, MSDs are hitting workforces around the world, which are in pain, off sick and at risk of becoming disabled. In its 2010 issue, the Global Burden of Disease study found that MSDs are the leading reason for sickness absence or disability among European workers, while worldwide, MSDs come second only to mental and behavioural disorders. Chronic conditions don’t only affect the lives of workers with the disease, but also their families, health care and social systems, employers and the wider economy. The European Commission estimated that every year, MSDs diminish the EU economy by €240 billion (£200bn), which is almost two percent of the GDP. At organisational level, costs are yet to be precisely determined, but one does not need a sophisticated formula to realise the severe impact that sickness absence, presenteeism and, sometimes, the replacement of skilled employees, can have on productivity and profits.

Figures aside, what can be done? Although their causes are hard to grasp, there is growing evidence that MSDs can be manageable conditions, thus preventing unnecessary costs. Generally speaking, encouraging employees to have happy, healthy lifestyles may keep the doctor away. High intakes of alcohol, smoking, unbalanced diets, or lack of physical activity, can all contribute to a previously healthy individual developing an illness. The European Agency for Safety and Health at Work warns that a mixture of genetic, environmental and behavioural factors may lead to the development of an MSD and the emergence of co-morbid conditions, such as cardiovascular diseases and obesity. Spending more and more hours at the office, bent over to check our iPads or smartphones on the train, or simply working from home, from our beds, or with the laptop on our knees and curled spines, can affect our bones and joints. Jobs that require the carrying or moving of heavy loads, and performing repetitive movements with our hands or arms can also, in time, cause an MSD. Hence, it might not come as a surprise that in excess of 40 million workers in Europe are living with an MSD caused by their work. To further compound the risk of work related MSDs, we are living longer, and the retirement age is increasing. It is likely that in the near future, we will be working at the age of 70 years, whilst living with one of several chronic conditions. In fact, forecasts tell us that by 2030 half of the workforces of some EU countries, including the UK, will have an MSD.

Are employers ready to manage it? A report from the Fit for Work Europe Coalition, written by The Work Foundation and launched in the European Parliament, found that the UK is indeed lagging behind countries such as; Poland, France, Romania, and Germany when it comes to managing sickness absence related to MSDs. Not only does the report confirm the shocking ONS figures, but it also says that the solution has been found and tested in a two-year pilot in Spain. If the results of the pilot were replicated in the UK, the innovative care model, which the authors call “Early Intervention”, could bring an extra 60,000 employees to work each day.

The new care model was founded by Dr. Juan Angel Jover, head of the Rheumatology Service Hospital Clinico San Carlos from Madrid, Spain, and is now supported by the Fit for Work Coalition. Moreover, the early intervention shares some of the principles of the

newly-inaugurated Health and Work Service, developed by the DWP. Both programmes are aimed at tackling sickness absence and facilitating appropriate management of chronic conditions. In contrast, employees enrolled in the early intervention model are assessed and diagnosed by rheumatologists, or other specialists, within the first five days of sick leave. Depending on the severity of their condition, some of them can remain in work, whilst carrying out a schedule of physical activity and medication. Altogether, the Spanish care model assessed 13,000 workers with MSDs throughout a period of two years; Dr. Jover also established a control group of patients in order to compare the old way of managing MSDs with the innovative model. According to analysis conducted by the Annals of Internal Medicine (2005), the results of the early intervention programme sound promising, both for employees and employers. Sickness absence and permanent job loss related to MSDs were reduced by 39 percent and 50 percent  respectively. The cost-benefit analysis also shows that almost £10 was recouped for every £1 invested in the programme.

Following the success of the pilot, 25 early intervention programmes have opened across Spain. Some are completely funded by the government, whilst others rely on public-private partnerships. Countries like; Portugal, Latvia and Lithuania are now refining and implementing their own approaches, whilst in the UK the programme will be tested in Leeds. Dr. Jover and the Fit for Work Coalition claim that the programme can be established within the workplace with some adjustments to facilitate the early referral to specialist care, which is key to early intervention. Whilst the private sector understands the importance of keeping its employees healthy, it has been rather reluctant to invest in health programmes like the early intervention model. Investment in health interventions in the workplace are often perceived as expensive. Some large employers would cover a private health insurance for their employees, or offer access to an occupational health physician. Nonetheless, just a few companies manage to keep track of the real reasons why their employees take sick leaves, and even fewer with the treatment and care received by the workers diagnosed with an MSD. The Fit for Work Europe Coalition explains that employers could only lose more money in the long run, if they continue to ignore the problem. Given the clear-cut return on investment generated by the early intervention model, the Coalition is hoping to convince more and more companies to take to the programme sooner rather than later.


Fit for Work Europe is a multi-stakeholder Coalition, driving policy and practice change across the work and health agendas. We aim to deliver more investment in sustainable healthcare by promoting and implementing early intervention practices. Research shows this approach is the most effective way of ensuring people with MSDs (musculoskeletal disorders) can enter and remain in work across the EU and globally.Fit for Work Europe a project led by The Work Foundation and managed by four Co-presidents, each bringing a different perspective to the four workstreams, research, clinical work, policy and health economics – of the coalition:Prof Stephen Bevan, Founding President of Fit for Work Europe and Director of the Centre for Workforce Effectiveness at the Work Foundation
Prof Paul Emery, Former President of EULAR, University of Leeds; Prof Dame Carol Black, Principal of Newnham College Cambridge, Expert Adviser on Health and Work to the Department of Health, England and Dr Antonyia Parvanova, Member of the European Parliament

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