Health Works A review of the Scottish Governments Healthy Working Lives Strategy A report on implementation May 2013

Executive Summary

In 2009, the Scottish Government undertook a review of its health and work strategy Healthy Working Lives: a plan for action, published in 2004. This was informed by the results of the activities on recommendations since 2004 and by emerging evidence, including Working for a Healthier Tomorrow, the review of the health of Britain's working-age population by Dame Carol Black.

The conclusions were published in November 2009 as Health Works: a review of the Scottish Government's Healthy Working Lives strategy.

Health Works identified 25 key actions to be undertaken to advance the health and work agenda in Scotland. These can be grouped into five main themes.

1. Supporting and promoting healthy workplaces - much of this work has been led through the Scottish Centre for Healthy Working Lives in collaboration with the business community, Scottish trade unions and a range of partner organisations. The Centre maintains an informative and supportive website which promotes the services and resources it has available to improve, develop and maintain safe and healthy workplaces. Its telephone advice line is a key access point to the service and this is widely used across Scotland.

2. NHS and the Scottish Health Offer - seven principles have been described within the Scottish Health Offer and these are increasingly being adopted and embedded into routine practice by NHS staff.

3. Developing standards, learning and sharing - prior to Health Works, practice was widely variable in terms of provision and standards. The recommendations of the review have provided a focus for the mapping and coordination of service delivery. The adoption of a case management approach for people with health and work issues has enabled access to a range of interventions tailored to individual need.

Networks have been established across Scotland and across areas of special interest. Vocational rehabilitation has become a recognised part of rehabilitation and two national vocational rehabilitation mental health posts were created in 2011.

Educational opportunities have been developed, including an employability training programme for health staff and training for trade union representatives.

The Health Works Development Fund was launched in 2012. This provides small grants to enable new initiatives or redesign within the NHS to be taken forward.

4. Partnership working - the NHS has a specific role in early intervention and is often the first point of contact for a person who has health and work issues. Developing effective links to employability services is increasing and collaborations are now in place through the Scottish Centre working with local enterprise networks and business organisations. The NHS has representation on employability partnerships and works on joint initiatives with partners including social service, third sector organisations and Jobcentre Plus.

5. Outcomes and measuring success - the first evaluation of the Working Health Service projects in the East of Scotland in May 2011 reported improved health outcomes for their clients. More recent data from the service, which is now Scotland-wide, reports 81% of clients having partially or fully resolved health issues at discharge.

In mental health the implementation of evidence-based supported employment is increasing and outcomes from these services are encouraging. Recent data from NHS Lothian's "The WORKS" project shows 43% of patients achieving a paid employment outcome.

The Health Works Outcomes Framework has been trialled and now implemented in a number of NHS boards and the action plans that are emerging from the logic models will form a clear basis for measurement of improvements.

The redesign of the musculoskeletal pathway, which has been commenced in three NHS boards in partnership with NHS 24, has a robust evaluation plan which includes health and work outcomes. Early indications show that 9% of patients in this pathway would benefit from access to vocational rehabilitation as part of their treatment plan.

Overall, delivery on the actions in Health Works has been good and there have been measurable changes in attitude and culture towards the role and connection between health and work. This has been particularly observed within the practice of healthcare professionals.

The Scottish Government has worked with other administrations through the Health, Work and Wellbeing strategy and there have been notable developments in the introduction of the fit note, the Healthy Working Lives Advice Line and the Fit for Work service pilots.

While there is still significant work needed to maintain momentum, Health Works has already delivered change in how the links between health and work are perceived by employers, healthcare professionals and policy-makers.