I welcome Mr. John Church, chief executive officer of Arthritis Ireland, Mr. Stephen Bevan of the Work Foundation and our former colleague Ms Liz O'Donnell.
Musculoskeletal Disorders: Discussion with Arthritis Ireland and the Work Foundation
Mr. John Church
I thank the committee for affording us the time to present an interesting report. Arthritis Ireland has been dealing with work disability through arthritis for several years. Arthritis affects 15% of the population and seven out of ten people with rheumatoid arthritis must leave the workforce within five years. It is a significant issue and we are here to present a further study from 2009 that builds upon it. It is entitled "Fit For Work?" Ireland was one of 24 countries to participate in the study. Mr. Stephen Bevan is the chief executive of the Work Foundation, a charity based in the UK. He oversaw all 24 reports. It is interesting to compare Ireland to others. When we are considering job creation and the number of jobs promised by various Government forces, we ask the question whether the workforce is fit for work. The report considers the 7 million working days lost to absenteeism due to arthritis, which is twice the number due to stress and mental health. These are the two areas considered to be the highest. Before I present the Irish data, Mr. Stephen Bevan will present the key findings at a European level.
Mr. Stephen Bevan
The Work Foundation is a charity based in the UK that considers labour market policy. We have two main programmes of work, the first of which examines what Ireland calls the smart economy and the UK calls the knowledge economy. We have done a great deal of work to identify the knowledge economy and where the UK Government can invest to improve jobs and the growth of industries to make the UK economy more competitive. The second programme considers the health and well-being of the workforce as an input to the productive capacity of the economy.
The Fit For Work project examines the extent to which, across Europe, the European workforce is fit enough, post-recession, to contribute to economic growth and competitiveness. We have identified musculoskeletal conditions that affect more than 100 million people across Europe as a particular drain on the productive capacity of the workforce across Europe. More than 40 million European workers have musculoskeletal conditions caused by their work. This affects their performance in their job and their ability to participate fully in the labour market. One of our concerns is that at a time when labour markets across Europe are depressed, those with long-term chronic health conditions are often the first victims of a shake-out of the labour market. The longer people are away from work and jobless, the more difficult it is for them to return to work.
As a family of conditions, musculoskeletal conditions account for 50% of all work-related disorders and 60% of permanent work incapacity across the EU. It costs the EU approximately €240 billion in direct and indirect costs, including lost productivity. That amounts to 2% of GDP across Europe. The European Commission is drafting a new directive on musculoskeletal conditions, which will pull together existing regulation about the workplace provision and labour market regulation. This will have a direct impact on Ireland. We hosted an event today at which Mr. Jim Higgins, MEP, spoke. This is a major issue across Europe, of which economies and national governments need to take notice. The key finding of our study is that it is a latent problem in Ireland. Because of the age profile of the Irish workforce, it will hit the country in the next 20 years. We have a great opportunity to do something about it whereas other countries with older workforces have the problem now.
Mr. John Church
The Irish-specific findings are interesting. We looked at work absenteeism and found that, of the 14 million days lost in total, one half were attributable to musculoskeletal diseases. That is twice the number attributable to mental health or stress. The total cost to the economy of those 7 million lost days is €750 million per annum, which imposes a significant cost on the Exchequer from a problem that can be fixed. Up to 49% of people with MSDs were limited in the kind of work they were able to perform and many Irish people with musculoskeletal diseases experience damaging delays in diagnosis. Many leave work unnecessarily, mainly because of the lack of consultant rheumatologists here, where we have the lowest number in Europe at one per 400,000 head of population as compared to one per 80,000 in the UK. In many constituencies there are delays of up to four years in seeing a consultant. If the people affected are of working age it will lead to absence from work because of disability. Some 25% of workers with rheumatoid arthritis must give up work within five years of diagnosis, which illustrates the severity and quick-acting nature of the disease.
Ireland needs a workforce which is fit for work, post-recession. Ill health in the working-age population is economically inefficient and socially corrosive. Once a worker, especially one with a long-term or chronic health condition, loses his or her place in the labour market it is very difficult to return. It is an avoidable waste of human capital and productive capacity which affects our competitiveness, particularly in the current climate. Compared with other EU countries Ireland has a young workforce so we have a chance to do something about it. The MSD problem will get worse and it is thought that, by 2030, 60% of our population will be aged over 50 so we now have a window of opportunity to fix the problem.
Arthritis Ireland calls for a national plan for musculoskeletal diseases, similar to what has already been implemented in the UK under the national service framework which sets clinical priorities, recommends care pathways and looks at the optimum number of clinical specialists needed, focusing on GP and employer training. Most employers do not know what to do when an employee is out with back pain. It has traditionally been an issue of occupational health but we should show real leadership and ensure that management is able to deal with the issue.
We also call for the appointment of a national clinical director, as has been done in the UK. The issue affects 15% of the population and we already have a clinical director for cancer. GP training is necessary to help workers with MSDs as most GPs do not recognise the conditions of inflammatory arthritis. They have not been taught to do so in medical school so there is a significant gap in understanding at GP level.
Early diagnosis is a significant opportunity. All the medical evidence shows that if arthritis is detected early it will prevent long-term disability and create the potential to go back to work. We also call for cross-departmental collaboration as it is not the sole responsibility of one Department, such as the Department of Health and Children. Mr. Bevan will talk about what has happened in the UK and how they have made significant savings for the Exchequer.
Mr. Stephen Bevan
There are a couple of principles. First, where possible it is important to help people to retain their jobs. Lots of active labour market policy in various European countries focuses on giving people access to work once they have lost their jobs but, by early intervention, one can enable people to avoid losing their jobs in the first place. I will give a couple of examples of where the principles are being put into practice in the UK. The Royal Mail is a very large employer which had a huge issue with absence from work and people leaving work prematurely because of illness or injury. In 2003 absence due to sickness ran at 7% per year, which amounted to 16 days lost per employee and cost £1 million per day in lost productive capacity. It had a big impact on customer service and meant the British Government started looking at private contractors to take some of the work away from the Royal Mail. A high proportion of long-term absences were due to musculoskeletal conditions. There was a culture of entitlement in which people felt they deserved a few days off if they were tired but not genuinely ill and the organisation felt it needed to deal with that. It introduced a number of interventions over three or four years aimed at nipping the problem in the bud rather than letting cases drag on for years. Such intervention included health screening and health clinics with a focus on early access to medical intervention, occupational health advice and physiotherapy for people who might benefit. The organisation set up a number of rehabilitation centres and worked collaboratively with GPs to help them focus on the capacity of workers rather than their incapacity.
Part of the psychology of the problem is that too many parts of the system, such as GPs, employers and workers themselves, focus on what they cannot do rather than on what they can do. From 6 April the UK has introduced a change to the system in which a sick note is replaced by a fit note. The Royal Mail worked on this before the formal fit note came into being and it has had a big effect. It has enabled the employer to work with medical practitioners to identify what the individual worker can do. This contributes greatly to the ability of sufferers to stay in work as it keeps them attached to the workplace. Research shows that detachment from the labour market has a big impact on people's future job prospects. As a result of these measures, in 2009 the Royal Mail reduced sick absences to an average of 4.5%, or ten days per employee, and it now has 3,600 more employees available each day to deliver the mail, which has saved the organisation £230 million net of the cost of the intervention since 2003. It has also had great success in returning people who had been away from work to full-time work.
Dr. Steve Boorman, the chief medical officer of the Royal Mail, was asked by the Department of Health to conduct a review of the health of the NHS workforce, the principle being that, as an employer, the UK Government could not lecture private sector employers about the health of their workforces unless it had its own house in order. The Work Foundation contributed research to Dr. Boorman's review. He calculated that reducing sickness absence in the NHS to the average of the private sector would increase the number of staff available to deliver patient care by 15,000 per day, representing a saving of approximately £500 million per year. A very significant proportion of absences from work in the NHS are attributable to musculoskeletal conditions. I understand a study carried out in Ireland on health service workers has come up with a similar finding to those in the UK, with 30% of absences in the HSE attributable to musculoskeletal conditions.
We also found there were hidden problems of which employers need to take note. The most notable of these is ‘presenteeism', which is where people come to work but do not work to their full productive capacity because of ill health, often in the shape of chronic or long-term conditions. We found that 70% of nurses, for example, reported that they had come to work in the previous month when being off sick would have been justified. That is a significant burden and a hidden drag on the productivity and quality of care in the NHS. Some studies have shown that presenteeism is at least 50% more expensive than absenteeism. There is a big issue about the extent to which the productive capacity of the workforce is affected by their ill health. Those two examples from the UK suggest that early intervention can make a big difference, particularly if it is focused on building on people's existing capacity to work and focusing on their ability to stay in work, rather than losing them to the labour market altogether.
I thank Mr. Church and Mr. Bevan for their contributions. I have just two questions. First, as regards the study with Royal Mail, was there a particular reason that company was picked? Was it anything to do with the nature of the work its employees do, or was it the number of people working there? Second, there was mention of a new directive that is under consideration at European level. Can Mr. Bevan elaborate on that? What can we expect from it and how advanced is it?
Mr. Stephen Bevan
Royal Mail is a large employer. It is the biggest employer of young men in the UK. Because of the nature of the work, there is a higher risk of having work-related musculoskeletal conditions because of the physical nature of the work, including lifting. One of the things they were clear about when they analysed their own data was that lots of people were leaving the workforce, or having extended periods of sickness absence from work — while still employed and, therefore, being paid — for a very long time. They felt they needed to do something about it, not just in terms of keeping people in work but also because it was costing them a lot of money. They wanted to challenge this entitlement culture. That was a significant part of it. For both reasons, it was a significant problem. In addition, they felt they had a duty of care to their employees and they wanted to improve their productivity.
What was the response of Royal Mail to this, and more particularly of its employees?
Mr. Stephen Bevan
Initially, there was some scepticism, particularly amongst people from the trade union side because they were concerned that people whom they thought were genuinely ill would be forced back to work. However, it quickly became clear that the approach they had taken was very supportive. It was not about pointing the finger at people but about diagnosing the nature of their problem accurately and then finding interventions that best met their needs. They did try gimmicks. For example, they had a raffle for a car, which meant that if people had no sickness absence during a whole year, they were entered into that raffle and could win a car. That had an impact on short-term sickness absence, but it did not last very long. However, it raised the profile of the issue and the intention Royal Mail had of being a caring and responsible employer. It is now widely regarded as a leading player in this area.
The second question was about the directive. There are a number of directives already, which focus on specific workplace risks such as the use of display-screen equipment, for example. Where people were using computers or working at call centres there was perhaps an increased risk of repetitive strain injury, and neck and shoulder injuries. The European Union has no competence on health and therefore it looks at workplace-related musculoskeletal conditions only. For example, Mr. Church was talking about rheumatoid arthritis. Because that is not caused by work, it is not currently part of the legislative coverage. Inflammatory conditions are not included as part of the current directives. The European Union is therefore interested in musculoskeletal conditions that are caused by one's work, including back, neck, shoulder or wrist pain.
The new directive is essentially a pulling together of existing regulations. At the moment, if people have rheumatoid arthritis and the condition is made worse by their job, they are not currently covered by any of the directives. We have been working with the European Commission on the draft directive. Our recommendation is that, rather than changing the legislation, there are two issues we want it to take into account in the guidance that goes with the new directive. First, that inflammatory and rheumatic conditions should be included, and the damaging impact of poor working conditions should be acknowledged and, second, that people who have musculoskeletal conditions are at higher risk of developing mental illness. That is not currently reflected in the regulation. We are hoping that the guidance will reflect those two aspects.
We know that if people are trying to return to work, the biggest single barrier is not necessarily their physical condition, but their psychological well-being. If people have chronic physical conditions they are more likely to have depressive illness at the same time. We argue that those two factors should be taken fully into account in the directive.
I thank the delegates for their presentations. I have an interest in this subject. As my party's spokesperson on enterprise, trade and employment, I have some responsibility for active labour market policy, along with Deputy Olwyn Enright. As a GP by training, I would be involved in certification and health care. I have had an opportunity to examine how they do things a bit differently in Britain, particularly with the fit note, and also in the Netherlands where they use external doctors, which is an interesting idea.
Mr. Bevan is correct to say that musculoskeletal disease is under-diagnosed in the community and the diagnosis is late as well. It is improving, particularly with some of the rapid access clinics that now exist. However, I think doctors are sometimes slow to refer. Part of the reason for that is the fact that in hospital medicine, one does not see many cases like this. The early presentations always occur only in general practice, yet one has to have seen enough of them before one realises what one is seeing. That is the nature of medicine.
Musculoskeletal disease is a grey area, as Mr. Bevan knows. It is a little bit like the virus that people get certified or diagnosed with. Often, when the doctor does not know what is going on, or does think there is something going on, it gets put down as musculoskeletal or as a virus. Very often, back pain is really depression, but is put down as back pain. Other people do not understand this, although Mr. Bevan would. It is not that it is in somebody's head, but back pain, headache or irritable bowel are often just physical manifestations of depression. One must put that into the mix too. It is interesting when Mr. Bevan says that we lose as many days to musculoskeletal disease as to psychiatric illness. They can often be linked or be the same thing.
I also have a particular interest in welfare reform. It is interesting to see that about 20% of our adult working age population are now on some form of welfare. About 12% are on the dole, while 7% are on disability or illness benefit, and 3% are one-parent families. It is already a huge number. Of course, some of those are working but by and large most are not. Very often what is happening in Ireland with disability and illness is that somebody gets certified and a cheque is written for the next six months, so they never go back to work. I would therefore endorse the approach Mr. Bevan spoke about, to move from incapacity to capacity. The report came out over a year ago. I think I got it last summer.
Mr. John Church
That would be correct.
I took it with me on holidays to Italy. Being the strange person that I am, the reports I want to read go into a box and come on holidays with me. Before I read it, I thought it was going to be all the usual stuff — we need more money for X, Y and Z, loads of time off and all the rest of it. When I read it, I saw that it was not like that at all. It is actually a very progressive approach to what we should be doing in terms of managing illness and chronic illness in the workplace. I do not have many questions to pose, but I very much endorse the view that Mr. Bevan has put forward. It is now a case of getting that done and making some progress in this area. There is a cost to it of course but it makes eminent sense. In the medium to long term, there is also a substantial saving from it. I would be in favour of the kind of approach that Mr. Bevan is putting forward.
I welcome our discussion of this important subject concerning employment. I come from a rural, farming background. The damp climate in the winter months can be difficult for farming and those employed in the agricultural industry. I see from the presentation that there is a figure of 7% absenteeism in Royal Mail, which I think is somewhat on the low side. If one takes the figures for the farming sector and rural Ireland generally, they would be much higher than that. One can follow families down the line, so is it inherited? A number of areas can affect people. In the rheumatoid area, we have the famous gout, which is associated with wealth. I do not know if that is true. Is that taken into account because it can have serious effects on people who never take a drink of brandy or eat high-quality red meat? How should I sort out people who are working in rural areas in damp winter weather when it takes effect? Many people take anti-inflammatory tablets, which are not good. I am not a medical person and I cannot compete with Deputy Varadkar who was a medical student and is a medical doctor. Constituents tell me they should not be on anti-inflammatory tablets for 60 days at a rate of one per day. How can we overcome this problem?
Mr. John Church
I will attempt to address some of those points. Regarding the question of whether arthritis is hereditary, a significant number of musculoskeletal diseases are hereditary or have a genetic link. This includes rheumatoid arthritis, ankylosing spondylitis and other arthritis conditions that are difficult to pronounce. They come under the umbrella of inflammatory arthritis or an auto-immune disease. If one has one of those diseases, it is somewhere in the family. An environmental factor like a virus, stress or sickness triggers it. One can go through one's life being predisposed to rheumatoid arthritis but never contract it. We know very little about it but we know there is an hereditary link. The other side of arthritis is the wear and tear aspect. We are all going in that direction and the population is definitely heading there. Those who play high-impact sports like GAA and rugby will certainly experience osteoarthritis and wear and tear arthritis much earlier than the rest of the population.
Regarding gout, fortunately it is one of the conditions that can be cured. There is good medication on the market. It is related to diet and lifestyle. It is caused by a deposit of uric acid in the toe or the extremities but it can be taken care of and eliminated, unlike rheumatoid arthritis, which cannot be cured.
I do not want to interrupt but I had two constituents who had to retire from work because of gout. They were not high-living people. Alcoholic drink was not their problem. Perhaps they were having high-quality food at home.
Mr. John Church
I cannot speak about those specific cases. There are other elements but the factors are diet and lifestyle and there are genetic elements also. It is one rheumatic disease that can be eliminated and cured.
Regarding what we can do in rural areas, Arthritis Ireland found a higher incidence of arthritis in the farming community. We noticed this recently when examining statistics from the CSO. We are trying to engage with the farming community through our voluntary branch networks to provide a service to the farming community. Farming is a high-intensity, labour-intensive sector so there is a higher propensity to suffer from osteoarthritis. If farmers must give up their work there is a significant economic impact.
It would be very useful to work with farming organisations through the branch network because there is not a farming family that has not been affected. That is particularly true this year, which was cold and difficult for farmers. This would be a welcome move and I recommend the delegation talks to farming organisations such as the IFA, which is very influential and has 80,000 to 100,000 members.
Mr. John Church
We are in touch with the IFA. We have 20 voluntary branches covering most counties. We hope to increase the number. Through public information meetings we encounter a significant proportion of the farming industry, which backs up our data that this is a cohort of the population significantly affected.
Mr. Stephen Bevan
I will make a number of supplementary points. It is clear from our study that workers in certain industries are more susceptible to musculoskeletal conditions, not just inflammatory conditions but also back pain. This is well known. The quality of data provided by governments and other bodies on the extent of sickness absence from work and the prevalence of these conditions in the working age population is universally poor. This problem is not confined to Ireland. It is difficult to get good information on the extent to which these conditions are being experienced by people and the productivity and economic impact. One of our recommendations is for more work on data on these issues so that we can manage them more effectively.
I welcome Mr. Bevan and Mr. Church, who crossed paths with me in a previous life. Mr. Bevan referred to the need for good information. I am surprised at the statistics he provides referring to 50% of 14 million working days lost being due to this illness. Is Mr. Bevan sure of that statistic? How did he come up with this given the lack of good information? In respect of other musculoskeletal disorders, are we talking about these arising because of the work situation rather than someone having it independently of the work environment?
Mr. Stephen Bevan
To answer the second question, it includes both, where work is the cause and where musculoskeletal disorders, such as inflammatory conditions, already exist. This covers everyone.
The quality of data is poor and in getting these statistics together we tried to pull together data from a number of sources. These sources include social surveys, national surveys conducted by the Irish Government, some studies by IBEC and various other studies. None of these provided definitive answers by itself so we used our knowledge of the area to put together a best guess or an estimate based on the data produced by national studies and employer studies. It would be better for policymakers if the evidence on which they base policy was more definitive. Part of the purpose of our study, which we have done in 23 other countries, is to raise the profile of the issue. Hopefully in the countries where we have done this work, more effort will be put into making sure the data used to inform policy making is definitive, up to date and with better defined measures of musculoskeletal diseases.
Mr. Bevan referred to the example of Royal Mail, where a 7% absenteeism rate was reduced to 4.5%. Would this not have happened with improved management of absenteeism?
Mr. Stephen Bevan
There are different degrees of improved management. Measuring something usually has the effect of reducing it.
Showing an interest or measuring it tends to reduce it.
Mr. Stephen Bevan
One flushes out leniency and the sense of entitlement. In some organisations, as soon as one measures something it increases because one is flushing out under-recording but generally measuring something and ensuring people understand the employer is interested reduces absences in the first place. This usually affects short-term illness absence or casual absences. These can be viruses or stomach complaints, short-term non-specific conditions. Across Europe, we have seen a growth in long-term sickness absence, which is usually for genuine reasons of poor health. We have seen an increase in the proportion of people with depression and anxiety, which has trebled in the UK since the early 1990s. That is more difficult because most managers find it very difficult to manage someone with a long-term chronic health condition. It often requires medication or surgical procedures and it is difficult to know the boundary of competence. That is where people need expertise from GPs or occupational health support. It is getting more difficult to manage these matters as the population ages.
Why a national plan for MSDs only? I accept that Mr. Bevan has an interest in the area but why not have screening for everything?
Mr. Stephen Bevan
We are learning from the experience of national plans for cancer in the UK and Ireland. We do not wish to diminish the importance of cancer but MSDs affect a larger proportion of the workforce and have a significant impact, economically and on the labour market. There appears to be a lack of co-ordinated policy making across all countries, both from a clinical and labour market perspective. In five years, a GP in the UK only receives two hours' training in occupational medicine, which demonstrates the disconnection between policy makers in employment and labour markets and those in health.
The UK now has a co-ordinated effort between the Department of Work and Pensions and the Department of Health with the appointment of Dame Carol Black as our national director for health. She will be able to bring the two disciplines together and make a strong argument that it is important to prioritise these issues.
Has the Work Foundation done any work on the potential cost of screening?
I thank the delegates for their presentation and look forward to reading their booklets. They mentioned early intervention and rehabilitation as well as medication. I have come across MSD sufferers who find it very difficult to avail of rehabilitation and early intervention but other illnesses qualify one for a medical card or a disabled tax drivers' concession. I welcome the delegates' comments on the possibilities of people with MSDs obtaining a medical card or tax concessions.
In the work environment, what level of discrimination, if any, exists towards people with MSDs? How does that affect sufferers who work in front-office jobs but who cannot carry out their duties, even though they wish to do so? What is an appropriate way to deal with such cases?
Some people make a claim for social welfare but are refused because they look fine, though they can then appeal to a medical referee. I note the delegates' comments about lack of co-ordination and clinical understanding.
I have two minutes to get to the Seanad Chamber for a vote but I will read the Official Report for the delegates' replies.
Mr. John Church
All three questions are related. The lack of early intervention is down to the lack of specialists here in the shape of rheumatologists. It is also down to the lack of understanding among GPs of how to identify musculoskeletal diseases. This is a case of primary care professionals not knowing what to do. We are calling for early intervention by physiotherapists trained in musculoskeletal disease, so that a GP or an employer would know that they could refer a patient or employee to an appropriate medical centre. Most studies show that less than 5% of people on an orthopaedic waiting list need surgery as the remainder can be treated through physiotherapy.
Senator Callely asked about social welfare claims. This goes back to the lack of understanding about arthritis and its impact on the population, which Arthritis Ireland is endeavouring to put right. All sufferers have issues relating to medical cards, means testing and so on.
I welcome the delegates and thank them for their interesting presentation. I listened to Deputy Varadkar and did not realise he had suffered from depression over the past 12 years.
Many people have back pain.
At least it has been diagnosed.
Free of charge.
Free of charge. The delegates spoke about working with GPs. Can they expand on their point that we need to focus on capacity rather than incapacity? Can they explain what they envisage for the Irish version of the UK's fit note?
Mr. John Church
A recent study by the Irish Society for Rheumatology showed that fewer than 20% of medical graduates rotated through orthopaedics or arthritis. Accordingly, when they get out into the workplace they do not recognise the symptoms of inflammatory diseases, even though one third of their waiting rooms is made up of people with a musculoskeletal disease. This is a training and education issue that we are trying to address through this and other initiatives with the HSE.
Mr. Bevan will comment on the question about capacity and incapacity. We are calling for a change in culture because there is a propensity for a GP to sign a sick note for a person indefinitely. The focus should be on allowing a sick person to spend some time out of the workforce but allowing him or her back within a certain period, or to do other work such as clerical or administrative work where he or she cannot do manual work.
Are we making progress?
Mr. John Church
We are not making any progress. We have fantastic examples outside Ireland so this is not just a theoretical discussion. We have plenty of time and the fit note referred to by Mr. Bevan is a very tangible way of fixing the problem. In the UK, as of 6 April it is NHS policy that a GP signs a fit note, not a sick note.
Can Mr. Bevan expand on the question of certification by exterior doctors? Irish doctors have patients with whom they have a personal relationship but the patients also pay them money. It is sometimes very hard not to give them what they want, which is often a sick note. In Holland, an exterior doctor signs the note in all cases.
Mr. Stephen Bevan
There is a legal requirement on all employers to retain the services of an occupational health specialist. The employer pays all the costs of sickness absence for the first 14 days and that concentrates the mind. It is also a requirement that an employer have a formal return-to-work plan, supported by an external occupational health expert. The focus is on early intervention and on getting back to work as soon as is reasonable but it is not about forcing people back to work.
Another example was given to me by a British employer recently. The employer received a sick note from a general practitioner which only read: "Knackered". That can be interpreted in many ways
Maybe it was a virus.
Mr. Stephen Bevan
If the purpose is to support targeted intervention so that a person is diagnosed appropriately and a decision can be made as to whether a return to work is a useful part of the employee's therapy and rehabilitation, writing a sick note such as the one to which I referred does not help. It can also be argued that writing the word "stress" is equally useless as stress is not a recognised medical condition. The purpose of a fit note is to better inform all the stakeholders, including the patient, about how interventions can help him or her return to work, perhaps on a phased or partial basis, so that he or she can eventually play a full part in society and earn income again. The danger is that people are signed off with non-specific conditions and no one talks to them for another six weeks, including their employer. The longer people are away from work, the more difficult it is for them to return. Therefore, the fit note is intended to change the nature of that discussion.
I missed the earlier discussion and apologise for that. Is Mr. Bevan saying that if a doctor signs the fit note, people may not be fit to do all their core duties, but they can come back and do some elements of their job?
Mr. Stephen Bevan
Exactly.
Mr. John Church
The focus is on getting the people back to work as quickly as possible, assuming they are fit to do so, because it is better for their overall health in the long term — and for their own mental health — to be back in the workplace and contributing socially.
Could pre-employment screeningidentify any of the predisposed factors involved?
Mr. Stephen Bevan
From a clinical point of view it is so, for many of these conditions. There are ethical issues. We have had this debate in the UK for quite a while. The view that many of us have come to is that, unless there is a compelling reason being predisposed to or having a condition directly affects a person's ability to perform important parts of his or her job, pre-employment health screening has no place. There is a lot of scepticism about whether or not it should be done. I understand the interest in it, but there are really big ethical issues associated with it.
Has any assessment been carried out on people with chronic pain or ME, which is chronic fatigue syndrome? I know it is unrelated to this but, nonetheless, some of the symptoms are similar, namely, chronic fatigue, weakness and inactivity. Does Mr. Bevan have any views on that? Has it cropped up as a factor?
Mr. Stephen Bevan
I am not a clinician, but I know there are different views on the extent to which conditions like ME, chronic fatigue syndrome, are physical or a combination of physical and psychological conditions. The key point is that they are clearly debilitating and affect people's ability to work. The danger with some of these conditions is that we assume that people can no longer make a contribution and we leave them until they get better. In terms of recent UK Government policy, we are saying that good jobs are good for people's health. If we can keep people attached to the labour market, even if it means that they come back to work one day per week initially, we can ease them back into work. If we abandon them to joblessness, they will be pretty much lost to the labour market for the rest of their working lives. Socially and economically that cannot be acceptable.
Mr. John Church
Chronic fatigue is a significant symptom, as is pain, within rheumatoid arthritis and inflammatory diseases. Our experience in Arthritis Ireland is that patients who are open and honest about having the disease end up having a better relationship with their employers and are afforded certain changes to their work environment, such as physical changes to their desks or computers. I would strongly argue that anybody who has a chronic arthritis disease is, in some ways, more productive than somebody who does not. That is because they have to get up earlier in the morning, are far better prepared and must make their own adaptations to diet and exercise. If they are on the new medication, which has been out for the last ten years, they can work as well if not better than any employee who does not have an arthritic disease.
Mr. Stephen Bevan
There is an issue which relates back to a previous question about discrimination. Our study found evidence that up to 30% of people who have rheumatoid arthritis do not disclose it to their employers because they are concerned it will have an effect on their careers and job security.
I was going to make that point.
Mr. Stephen Bevan
The same research shows that when people eventually disclose it to their employers, they are pleasantly surprised by how supportive most employers are. There is something about the culture of organisations that may not make it easy for people with these conditions to disclose that they have them. They should be encouraged to do so, however.
Sometimes people feel that they will be discriminated against by employers, or will not have an opportunity to obtain employment, even if they have something small in that context. I suppose there is an insurance issue as well in the context of being fit for employment. An amalgam of issues has to be tackled.
I want to thank Mr. Church and Mr. Bevan for their presentations and for assisting us in our deliberations. Having listened to their presentations, everything possible should be done to ensure that people with physical disadvantages are assisted to participate to the maximum ability in the working community. Nearly everybody wants to contribute to their own livelihoods. Sometimes all that is required is that a little extra thought and consideration are given to their special needs. That is the point that Mr. Church and Mr. Bevan were making. They have outlined how this can be done and I compliment them on doing so.
We will certainly be asking the relevant Minister to take note of what has been said here today. Two Ministers will probably be involved, as Deputy Varadkar said, namely, the Minister for Social Protection and the Minister for Enterprise, Trade and Innovation. They will study carefully the details in the report entitled Fit For Work? — Musculoskeletal Disorders and the Irish Labour Market. A former colleague, Liz O'Donnell, ensured that Deputy Varadkar had summertime reading. That is the thing about former Deputies, they know exactly how to get to people and make sure they do not have any time off.
There are some who think we do nothing in the recess.
That former Deputy would be well aware that we do not have much time off. Notwithstanding the fact that everybody thinks we have the month of August off, we do not. The report is a useful and qualitative study containing many important facts. Normally we would not have people like Mr. Church and Mr. Bevan appearing before our committee, so we wish to thank them for coming here. I also wish to thank Liz O'Donnell for ensuring that they had an opportunity to appear before this committee. That is another useful contribution to our overview of participation in the labour force and the labour market generally. We will certainly be pursuing the matter with the relevant Ministers.
The joint committee adjourned at 4.10 p.m. until 3 p.m. on Tuesday, 25 May 2010.