Long-term health conditions (LTHC) are illnesses and diseases for which there is no cure.
You will have heard of some – diabetes, arthritis, asthma, multiple sclerosis (MS), depression, anxiety, inflammatory bowel disease (IBD very different from IBS) family. I hope that from these examples you are starting to recognise that they are common.
Many if not most medical conditions are not curable but are managed with treatments; therapies (physio, psychology, hydro, manipulative), medications, surgery, lifestyle moderations.
It is said that 10 million people have a long-term health condition in the UK. It is age and socio-economic biased – more occurrence in over 60s (58% over 60s, 14% under 40s), the poorest social class (unskilled) have 60% higher prevalence than the higher social classes (professional) and 30% more severe. So I think, being a little provocative, this raises issues for business on the corporate social responsibility (CSR) perspectives; what are your wages like and how do low wages affect the health outcomes of your employees, what percentage of your employee base is over 60; what jobs do they do and what is the impact on the wider public health of the nation? But let’s stick to work rather than trying to mend the whole of the UK!
The other complexity is that LTHC do not exist in isolation; often multiple conditions are present and having an effect on each other. So, it is complicated for the individual and you as an employer. And that leads me to my first suggestion – acceptance; that this will be time demanding, require flexible policies and understanding the individual. It is also where we of course as occupational health professionals can guide you through the processes towards decisions that you will be faced with.
The topic of long-term health conditions is huge so I have limited to, in my opinion, to the top 6 key principles to apply in managing long-term health conditions.
- Manage the individual not the condition. So, what I mean by this is that it can be very easy to gather information about health conditions but not understand how it impacts the individual, how treatments have an effect or not or result in side effects, understand how lifestyle, social aspects, thought processes all combine to influence the daily life and ability of the person. Some people who have a long-term health conditions may still see themselves as healthy and well where as another person with the same condition and symptoms will see themselves as sick. These different perspectives affect abilities and are influenced by cultural, social, economic, environmental factors. A distressing circumstance which I have encountered often is that a manager will not be trusting what an individual says about symptoms because it is different from employee x who had the same condition or similar symptoms but not affecting work abilities to the same extent. This results in the individual’s health being compounded through raised anxiety and frustration. In addition, work communications will be affected through loss of trust so then the situation can become more difficult to manage.
- Involve occupational health professionals (Nurses registered with the Nursing and Midwifery Council – NMC and Doctors registered with the General medical council – GMC who have gained a wide range and time in clinical practice and then done further specialist training – degree and diploma levels in occupational health). We understand how long-term conditions impact the person (the details in the first bullet point), the person’s ability to work and what can help in treatments, lifestyles, workplace adjustments to enable the person to live and work well with the condition(s). We are of course bound by legislation and professional codes about confidentiality; thus giving the individual security to be able to talk candidly, but we are skilled in working with the individual to be able to translate the medical diagnosis, treatments, individual’s perspectives into work relevant advice to return to communicate with you in the form of a report usually.
- Involve the occupational health professionals at the right time. If the individual is off sick for 4 weeks, then refer to OH; is the simple guidance however!!! If the person is waiting to start treatments or outcomes of investigations, then ring OH to help decide an appropriate time to refer. The reason for the 4 weeks is that as sickness absence increases so do anxieties about work, mental and physical de-conditioning, loss of work relationships and connections, loss of work confidence and focus which build to result in it being more difficult to return to work. OH encourages the individual to remain in contact with work, be work focused as well as caring for self, be active (within limitations) at home which contribute to the individual returning safely and sooner.Another suggested referral point is at the point of diagnosis. This is a good time to refer as it will allow for a plan to be discussed, agreed with all parties and implemented that details how the illness and treatments affects the individual, adjustments, time scales, abilities and limitations, thus controlling or preventing issues from the start.
- Have a sickness absence policy in which there is guidance about managing people who have conditions which are likely to mean that the demands of the Equality Act apply, for instance you may decide that it is appropriate to discount all, or a proportion of sickness absence associated with the Equality Act condition.
- Be flexible, this is probably the most effective adjustment in my experience and brings individual’s great relief. LTHC often but not always (diabetes and asthma if well managed will have very little symptom fluctuation, where as something like multiple sclerosis will have more fluctuation day to day and periods of severe symptom levels) have symptoms that fluctuate on a day to day basis and affect work abilities. Flexi location – able to work from home or locations closer to home. Fatigue is a very common effect of a LTHC so avoiding a commute to work, being able to get up later, the home environment is less demanding (mental energy) will result in the individual being able to put more energy towards work. Flexi time; so able to start and finish later; health conditions often impact sleep, other conditions such as the inflammatory bowel diseases and arthritis symptoms can be but not always be worse in the morning; so being able to have a little more time in the morning before leaving for work can assist the individual. Be flexible with the work demands, if you have targets check that they are achievable to the individual and reflect any limitations.
- Regular well-being reviews, the frequency of these will vary according to the individual’s symptom fluctuation and length of time that the individual has known about the condition. The content can be reviewing work demands, ensuring the demands are appropriate and the individual feels able to complete them, review adjustments to ensure they remain relevant and give positive feedback. Giving positive feedback as a routine management action is essential to good working relationships and work performance for all with or without a LTHC. Those with a LTHC often find that their confidence and self-belief is affected. This in its self affects work abilities through being fearful of change, hesitant about working out and beyond own comfort zone, less likely to suggest ideas etc. Giving person specific positive feedback will build confidence, trust and relationships. Person specific means that you identify exactly the action(s) of the individual rather than the outcomes of the team.
By Anna Harrington Occupational Health Advisor (OHA) and NMC Registered Nurse (RN)
