Health and work support pilot: final evaluation

Appendix 1: Client case studies

David's Story

• David lives in Dundee. He has experienced health problems since his early 20s, but in recent years his condition has deteriorated and he has taken time out from work.
• Due to improved medication, he resumed working, but was having problems with his employer, who was not accommodating his physical health needs.
• David was referred for an Occupational Health assessment. He valued having somebody independent involved. David felt he "had a choice" in what was required, and was pleased when the suggestions were accepted by his employer.
• While David did feel the service was very busy, in January 2020 he said HWS had helped him greatly. He felt "much more secure" in his role at work, and better able to manage his physical health needs.
• David said "It's just changed my life…before I was dreading work, now I enjoy it – it has changed dramatically. Without it I would have had to stop working."
• David spoke to us again in May 2020. He was feeling a lot better, and was still employed, but on furlough and shielding due to the pandemic. David was unsure about his next steps, and was not sure if he would return to work – but he said this was due to COVID-19.
• David's support from HSW had come to a close by May 2020. He knew which services were still available to him, and who to contact if he needed further support.
• David said "I know if I have problems I just phone cline and nurses, I know they are there if I need. I got a phone call from Dundee City Council to see if I needed any support"
• In August and November 2020, David was back in work, continuing his employment. His employer had made changes to support him, and this meant he was able to stay in work. David though HWS had given his employer skills which could be applied to other members of staff. HWS has changed how he feels about going into work.
• David said "This has made a big difference to how I feel at work…the pain isn't so bad when I come home, it's just given me the ability to do it. It's good going into work now."

Kerry's Story

• Kerry lives in Dundee. She has been in employment for around 10 years, and has experienced depression for a long period of time. Her stress and anxiety was worsening when she decided to speak to someone about her mental health. She self-referred to HWS after hearing about it through her boss.
• Kerry found the initial assessment straightforward and was pleased that there was a short waiting time between her meeting with the case manager and her first appointment. Kerry got mental health support from HWS, helping her to develop strategies to deal with stressful situations.
• By January 2020, Kerry's support from HWS had concluded. She said the support had "definitely" helped her in her daily life and that she felt better able to manage stress and anxiety. She had embedded weekly yoga and meditation into her routine.
• Kerry said "HWS kind of taught me when I need to know the signs of when I am getting stressed and ways of dealing with it and made it easier".
• Kerry's work was disrupted by COVID-19, with periods of furlough. She said she coped with it quite well: "I surprised myself…I have go on with it and survived".
• By May 2020, Kerry said her health had never been better, and she thought the pilot had contributed to the improvement. She reflected that the best element of the support she received was the one-to-one relationship.
• Kerry said "I'm pretty sure it has contributed to how I feel, I feel that if I hadn't had it I wouldn't have coped as well".
• In November 2020, Kerry was still employed. A year on from HWS, she still thought HWS had a positive effect on her life. However, Kerry was finding her personal circumstances so stressful that the strategies she had learned through HWS were having a more limited effect.
• Kerry said "My circumstances are so stressful now that it can't have as much of an effect…HWS has had an effect, but maybe not as much as I would have liked".

Craig's Story

• Craig lives and works in Dundee. He has worked for over 20 years in security. Around 4 years ago he started experience back pain, which increased in severity until Craig could "hardly work" and had to take some time off. His GP referred him to HWS.
• Craig thought he probably wouldn't have heard about the service were it not for his GP. He was called the day after his referral and seen within 6 weeks for physiotherapy.
• Craig found the physiotherapy the most helpful element of the support, and felt the support had helped him sustain his employment. When he was discharged, he had a check in with his case manager, who made him feel that "if needed, the door was open for more support".
• Craig said "I work long days…often walking around, driving or sitting so it's a lot of movement and strain…so it really helped…I managed to go back to work".
• Craig had been able to continue working through the pandemic. He even felt more secure in his role as a result of HWS when we spoke to him in May 2020. He said HWS "made me feel a bit better about everything".
• A year on from HWS support, Craig was continuing to follow his physiotherapy exercises, and was in work.
• Craig said "The advice I was given through HWSP was great: to do my physio, to take care of my back more, has really helped, much more careful about the way I sit and the way I lift things".
• Craig said he would definitely recommend HWS to anyone else experiencing similar problems with the balance between their health and work.
• Craig said "I am at work on moment, so that shows the HWSP support helped. I try my best to stick to advice I was given, walking and exercising".

Deborah's story

• Deborah lives in Dundee. She has worked for the same employer for over 40 years and does manual labour as part of her job. She took 5 months off work in early 2019 due to problems with her wrist. Deborah's manager suggested she get in touch with HWS.
• Deborah was pleased with the short wait time and felt the Case Manager understood what she was going through. However, she felt that she wasn't treated like an individual by her physiotherapist.
• Deborah said she felt she could have read the information about the recommended exercises online and felt her time had been wasted. Deborah did acknowledge that she did not do the exercises "religiously…just when I remembered and could fit it in".
• Deborah said "She (the case manager) explained everything…it was pleasant…she sympathised with me and was really understanding".
• Deborah was put on furlough in May 2019, which was a positive outcome for her as it reduced her anxiety about transmitting COIVD-19 to other vulnerable people she lives with.
• Having a case manager meant Deborah had someone to talk to, which she valued. She thought that physiotherapy had not had a limited impact. She said other factors caused her pain to improve.
• Deborah said "My pain got better because I am no longer working as much and not heaving as many heavy things rather than thanks to the exercises I think".
• By August, Deborah was back at work. She reflected that the support from HWS did help at the time, but wore off gradually. Other factors had also helped her maintain her improved physical health.
• Deborah said "I'm feeling good at the moment. I suppose HWS has made a long term difference…I've had an improvement in my frame of mind, but it's hard to say if this is because of HSW or support at work".

Ben's story

• Ben lives in Dundee. He came to HWS during a college course and was "in and out" of part time employment due to longstanding mental ill health. He was referred to HWS by his GP as situations with his employer were exacerbating his problems.
• Ben quickly got support with his mental health through HWS. This helped Ben to manage his feelings, improve coping mechanisms and to look at the root causes of his experiences. When asked if he felt he was treated with respect and dignity he said "yes – 100%".
• Ben said "HWS generally helped me to get into a better headspace…talking to professionals about it, gave me the tools I needed to really make a change".
• Ben said the support he received, once a month for 6 months, was really good, but he did with it had been more regular. Ben was so pleased with the support that he recommended HWS to another colleague."
• Ben continued with his college course online throughout the pandemic and said he felt he was handling lockdown well: "my mood hasn't deteriorated massively being isolated".
• By May 2020, Ben had reflected that HWS had made a "generally positive impact". He had been rejected from his first choice university, feeling his next steps were "a bit up in the air". He felt the support from HWS had helped him to cope with this challenge.
• Ben said "It would have definitely thrown me off more to get rejected beforehand, still annoyed me that I didn't get my first choice university but it didn't get under my skin as much as it would have before".
• In August 2020, Ben still felt that HWS had made a positive impact and was continuing to help him manage his mental health. Ben was employed as a waiter, on furlough but pleased to be in work and earning. He was also receiving further counselling and said he still put what he learned from HWS into practice.
• Ben said "Looking at how everything turned out with COVID it seems like I made the right choice [to delay going to university]."

Richard's Story

• Richard lives in Dundee and was working in a warehouse when he began experiencing muscular pain in his arm, which prevented him from working. He was referred to HWS by his GP and his case manager quickly organised physiotherapy.
• Richard appreciated the case manager approach and felt listened to. He said "It was so nice to come on the phone and explain what was going on from the very beginning…I felt that if I needed anyone to speak to I could".
• In January 2020, Richard was coming to the end of his physiotherapy. He had seen benefits from the treatment, with the pain "nowhere near as bad" and was continuing with exercises as part of a long-term recovery.
• Richard said "If I hadn't been through this process I would be in a worse place in life…my injury would be much worse"
• Richard acknowledged that the pandemic had taken its toll, but had also given him an opportunity to get bac in work in warehousing.
• By May 2020, Richard was happy to be back at work, where his job was less physical. He was seeing improvements in his arm as a result of continued physiotherapy exercises.
• Richard said "Things are looking positive…I am very happy to be back to work. I have regained that sense of purpose in my life, and my mental health is doing a lot better too – I just hope things keep going this way!"
• At the end of 2020, Richard felt HWS had made a profound impact on his work and life, and acknowledged that changing employer had also benefitted him. He said HWS "didn't feel like a service – the people I dealt with were so so genuine. I will always be thankful to them for that".
• Richard said "I could have been left with complete unemployment and no sense of hope without HWS. It was one of the most positive things at a really really bad time. I've got them to thank for being back in the workplace."

Paul's story

• Paul lives in Fife. He has been with the same employer for over a decade. During that time, he took two significant periods off work due to mental ill health, including work-related stress. When Paul's mental health and wellbeing started to decline again his mental health nurse referred him to HWS.
• Paul found the referral process "straightforward" and said "they called when they said they would, which doesn't usually happen". He also liked having one main person to speak to, who understood his situation. He thought HWS complemented other mental health services that he was accessing.
• Through HWS, Paul was supported to open up to his employer about his mental health, to set personal goals and to start an online course. Paul said that HWS helped him "100%...it helped me build my confidence up because my confidence had hit rock bottom".
• Paul said "Being a guy you don't tend to open up about things…I was worried about the stigma, but telling my employer about it [mental ill health] has rally changed things for the better"
• Due to COVID-19, Paul started working from home full time. While he was missing his colleagues, he managed the transition well.
• Paul thought his case manager was approachable and friendly, and liked that he didn't have to re-explain his situation each time they spoke.
• Paul said "The case manager got to know you…it wasn't just like with GPs for instance, where you go and see a different doctor each time, and then it's not so easy to explain [your situation] over and over again".
• A year on from HWS, Paul was still in work and was pleased to say he had "not been off sick once…Now I am better than I have been in years and years". He was feeling resilient. He attributed much of this to HWS which he said was a "fantastic service" which he had recommended to others.
• Paul said "I thought it would never get better…but HWS helped me to get perspective on things. There have been times where things have been challenging but I'm a lot more resilient now because of the support I received."

John's story

• John lives in Fife and works in agriculture. He developed a problem with his shoulder which started affecting his work. He was referred to HWS by his GP, and found it easy and straightforward to access the pilot's services.
• John had four sessions with a physiotherapist which he said "got it [the problem] sorted"
• In January 2020, after his support from HWS had ended, John said the support had helped him with his daily life. He was still getting some "trouble" with his shoulder, but not to the extent that he could not work.
• John said "Being a guy you don't tend to open up about things…I was worried about the stigma but telling my employer about it [mental ill health] has rally changed things for the better."
• John continued working through the pandemic. He found the experience "a bit isolating" but commented that he felt fortunate to have a stable job.
• By May 2020, John was continuing to work. He said he was "going about my job now not even thinking about my shoulder". He said he would definitely recommend HWS to others, as he flet he had received specialist, personalised support with short wait times.
• John said "The doctor just gives you painkillers and tells you to rest…I can do that on my own. Going and getting a physical examination made a big difference…I feel it's more worthwhile."
• In both August and November 2020, John reported no recurrence of the problems with his shoulder and was still in full-time employment. "HWS definitely meant I could keep working".
• John said "I had calls from the person helping me from HWS checking in, I didn't feel like a referral was made and then I was forgotten about."

Mark's story

• Mark lives in Fife and is a recent university graduate. He works in consultancy and had mentioned to a colleague that he was experiencing joint pain which was affecting his work. Mark first heard about HWS when he was receiving private physiotherapy.
• It was "really easy" for Mark to access physiotherapy through HWS, and he felt he had the right level of support and assessment from the case manager. He received four sessions of physiotherapy.
• Mark said "I felt like I didn't have to do much after the initial phone call, except book the appointments. It was all hunky dory. I even recommended HWS to a co-worker."
• The support helped Mark with his daily life. He felt he was treated with dignity and respect by both his case manager and the physiotherapist. He said the physiotherapy had worked. "it used to be quite sore sitting down so it could hurt…it's definitely helped in that aspect".
• Mark continued to work full times, including some essential office work, which meant he felt work had "not really changed for me" during the pandemic.
• In May 2020 Mark was feeling positive, and reflected that the pilot had had longer term benefits: "it helped at the time and now it is easier with my job know, I was sitting in the in the office and it was giving me bother, it's all fine now…it got me back on my feet".
• Mark said "I keep doing the stretches and working on it, the same stuff that the physiotherapist told me to do…I feel like I'm all good".
• By summer 2020, mark felt his physical health problems were broadly "resolved" and by the end of the year, Mark remained positive about the long term impact that HWS had made on his life.
• Mark said "It definitely helped. At the time I was really struggling with it and going to the gym wasn't helping at all. With the physio it got better and now I can do anything."

Peter's Story

• Peter lives in Fife. He has lost his job due to a mistake at work which cost his company money. The experience triggered problems with mental ill health, so Peter went to the GP who referred him to HWS. He was unable to access counselling through other channels because of a previous criminal offence.
• Peter accessed support quickly: "It was less than a month before I saw someone…it was quick, three weeks I think". Peter was supported with breathing techniques and other coping mechanisms to manage his mental health. He felt he was treated with respect and dignity.
• Peter said "It more or less opens your eyes when you read into it [mental health support] – how to relax and things like that"
• Peter felt the support had helped with his daily life, in particular with his sleep. While he was applying for work regularly and claiming universal credit, he was struggling to gain employment due to his criminal record.
• HWS signposted Peer to services that help those with a criminal record to gain employment but these services were unavailable due to Covid-19.
• Following the onset of the pandemic, Peter's mental health had improved, but he was still seeking work with his criminal record holding him back.
• Peter said "I am still using the techniques, mainly breathing techniques, relaxation, letting it go."
• By the end of 2020, Peter was still looking for work and claiming universal credit. He said "I couldn't fault Health and Work at all not gonna knock it. I think it's so important, mental health affects people so badly…unfortunately the people I've dealt with have just failed me because of my history"
• Peter said "I've done my time and I worked on things while I was inside and got treatment there…I think people don't think about it like that…they don't see that someone might have changed from the past."

Linda's story

• Linda lives in Dundee. She had been working in customer service for over 20 years when she lost her job due to long periods of sick leave. Linda was experiencing both physical and mental health problems, and part of this was caused by her job being "a horrible place to work". Linda's GP referred her to HWS.
• Once Linda phone HWS it was "very straightforward" and she was seen within a week. Linda accessed physiotherapy through HWS and accessed counselling elsewhere.
• Linda was really impressed with the support from the HWS physiotherapist. By January, thing were "much easier" for Linda and this had positive effects on her work: "When I first lost my job I thought that's it…but then getting the right support, I got back into work after a couple of weeks."
• Linda said "She explained everything that was wrong with my back… she cared, she wanted me to be better… [she took into] account the whole of me rather than just what was bothering me at the time."
• Linda began working from home in Spring 2020 due to Covid-19. She felt that working from home was positive, and said she would like to continue working in this way.
• By May, Linda was back with a new employer – she felt the physiotherapy had been the best element of the support she received, and that a change in employer had also contributed to her improved wellbeing.
• Linda said "In my last job, I had been there 20 years, then had difficult personal circumstances and they said my work wasn't good enough – my self-esteem was rubbish…".
• By the end of 2020, Linda reflected that not only had HWS helped her physically, but by making her feel that her illness was "not her fault" it had helped her to boost her confidence. She was continuing to use he techniques she had learned through physiotherapy.
• Linda said "HWS really helped… they showed me that it was the employer that was the problem, not me. With my depression, and thing being really difficult, I needed that support."

Alan's story

• Alan lives in Fife and works as a driver. He was injured and the pain form his injury was affecting his sleep, which affected his ability to work. He was referred to HWS by his GP.
• Alan was keen to try HWS as a way to help him stay in work. He was really impressed by how quickly he accessed physiotherapy through HWS. "From first goin to see my GP, I was seeing a physio within a month. That was amazing cos normally you're waiting several months."
• Alan said he felt a difference "almost immediately" after the physio and was "more or less back to normal" after 6 sessions. He felt the level of support was right for him and that he had been listened to.
• Alan said "It meant that I avoided having to take time off work. It was getting to the point where I was struggling to sleep at night so I wasn't fit to do my work. If I'd been self-employed at that time, I wouldn't have been able to lighten the load."
• As a self-employed driver, his business was affected by COVID-19 with a reduction in the number of customers available. However, he was able to work when work was available, thanks to HWS.
• It took Alan a month to six weeks to fully recover from his injury, and in May 2020 reflected that HWS had definitely helped him get back into work.
• Alan said "I'm much better, I occasionally still get twinges but nothing like it was before. The physio was really good, she gave me stuff to work on at home as well."
• Alan couldn't think of any way he would improve HWS "because the service really worked" for him. Alan would definitely recommend HWS as it "does what it says on the tin… it avoid you having to take time off work".
• Alan said "I go the support and I got better so I can't really say more than that!"