PATients’ views of Health and WORK advice (PATcHWORK)

This study interviewed patients to find out their views of how, when and by whom, health and work advice and care should be offered in the UK.

At present, there are a variety of different models of how health and work advice might be best delivered. In order to help figure out which of these models is best, we need to know what patients would like, and why, before considering what other key stakeholders might think.

In this research, we interviewed adults aged 18 years and above, and who were either unemployed and who wanted to return to work, currently employed but off sick or who were at risk of losing their jobs due to health or attendance issues.

Background

This project was developed in discussion with CMHW members, PPIE members and policy making stakeholders, in response to a previous literature review of current sources of work and health advice and care for UK patients. This review showed the broad variety of support services which currently exist in the UK. In order to assess which of these might be most appropriate or acceptable, we then sought to collect and analyse patient preference for the content and format of health and work advice services.

Aims

In this qualitative study, our aim was to develop an in-depth understanding of how we can deliver health and work support for all from the patient’s perspective.

The specific objectives were to answer questions in the following 7 areas:

  • Type of support - what kind of guidance should health and work advisors be able to give?

  • Setting - where do patients think health and work support could be best accessed and why (for example, primary or secondary care services, IAPT services, Jobcentres etc)?

  • Timing - when do patients think health and work support would be helpful and why (for example at what point in a patient journey and how frequently should this occur)?

  • Modality - by which mode of delivery do patients prefer health and work advice and care to happen and why (for example in person, via telephone or video conferencing)? If in person services are preferred, where specifically do patients prefer this support to happen and why (for example at home, work or in a clinical setting)?

  • Who should deliver - who would patients prefer to receiving health and work support from, and why?

  • Links with other services - to what extent do patients think the person offering the advice and care should be linked into other services and settings?

  • Employer acceptance - to what extent do patients think employers would be receptive to information about how to support them and their health?

What did this research involve?

This study aimed to interview adults to find out their views of how, when and by whom, health and work advice and care should be offered in the UK.

We aimed to interview people who were:

  • Aged 18 years and over

  • Unemployed and wishing to return to work OR

  • Employed but currently off sick OR

  • At risk of losing their job due to health or attendance issues (either as defined by the patient, their employer or their healthcare professional)

We aimed to study a sample of patients, across different ethnicities, ages, genders, and with different kind of jobs. We used standard ONS categories for ethnicity and gender, and categorised age in strata (30-39, 40-49, 50-59 and 60-65) in order to capture people of working age, and different retirement cut-off ages.

For job categories, we used Standard Occupational Classification which is a common classification of occupation information in the UK.

What did the study find?

Overall we interviewed 15 people we who were off sick, unemployed or at risk of losing their jobs through ill-health. They were interviewed about the health and work support (H&WS) they would want.

The 15 participants had a mean age of about 49 (range 30–65), and most were female (11 of 15), White (13 of 15) and based in England (11 of 15, with 3 in Scotland and 1 in Northern Ireland). More than half (8) were self-employed, and all but one had education beyond school level.

Interviews raised the following key points

  • Problems raised: Participants described disability discrimination (some reported job loss or lost business after disclosing a condition), low awareness of H&WS among employees, employers and clinicians, and mistrust of managers and advisers over impartiality and confidentiality.

  • What helps people stay in work: Flexible working, support that is simple and easy to access, and feeling valued and supported by their employer. Several saw wellbeing programmes as “tick-box” exercises.

  • Preferred support: Participants wanted simple, holistic support in “one place” from medically trained advisers, with information on the NHS website and in medical waiting areas. They also wanted work to be discussed in routine medical consultations, with automated referrals from GP fit notes.

  • Implications: The authors suggest employers improve how accessible their policies are and train managers. They also argue the findings support a national occupational health service, with extra clinician training needed.

  • Caveats: The sample was small, voluntary and mostly female, White and self-employed, so the findings may not apply to everyone

Publications

Results from the study have been published in Occupational Medicine:

Study team

Chief investigator
Dr Kathleen Lin (Guy’s and St Thomas’ NHS Trust)

Research co-investigator
Dr Vaughan Parsons (Guy’s and St Thomas’ NHS Trust)

Centre institutions

Further information

If you have any queries about this research, please contact kathleen.lin@gstt.nhs.uk or vaughan.parsons@gstt.nhs.uk