Fit for Work Europe Annual Conference

Summary Report

A Fit for Work Coalition Summary November 2011

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Fit for Work a growing initiative

More than two hundred delegates from countries around the world attended the 3rd Annual Fit for Work Europe Conference, held at Royal Belgian Institute of Natural Sciences Brussels, and The European Parliament, Brussels. Welcoming delegates, Professor Steve Bevan of The Work Foundation and Founding President, Fit for Work Europe Coalition, said that the third annual conference represented a milestone, marking Fit for Works move from relatively humble beginnings to a truly global initiative. Work is good for health and wellbeing it is healthy for patients and the wider society. Work makes economic sense and should be promoted as a priority clinical outcome for patients, he said. The 2011 meeting brought together a broad coalition of European and national politicians, economists, and occupational health specialists, plus rheumatology, arthritis, and other healthcare experts to consider practical steps and solutions towards making musculoskeletal diseases a public health and work priority at both EU and national levels. The primary focus of this years conference was the pressing need for National Action Plans to address muscle and joint pain in Europe a problem which is currently costing workers and economies up to the 240 billion a year . Despite the soaring costs of this problem, few countries have plans or infrastructures to keep people in work. A keynote speaker at the European Parliament session of this years conference was Lech Wasa, former President of Poland, Nobel Peace Prize Winner 1983, and now the global Fit for Work Ambassador. "We must fight internationally to improve the lives of those living - and working - with pain. But only coordinated action at national level will keep workers well enough to participate fully in society, including being able to stay in jobs they have worked hard to get," he said.

Figure 1. Lech Wasa addresses delegates

"One hundred million Europeans suffer with a chronic MSD - over 40 million of whom are workers - with up to 40% having to give up work due to their condition. This is unacceptable in the 21st century, when simple things such as earlier intervention and coordinated care at national level can make such a difference to people living with MSDs, he added. 2

Action plans
Effective policy and practice change at national level will only be the result of a unified evidence-based approach to the management of MSDs, delegates heard. Specifically, national MSD action plans must: Make MSDs a national public health priority, along with other serious chronic conditions Allocate adequate funding for early intervention and treatment of MSDs Establish 'staying in work' as a valid clinical measure of successful management of MSDs Advocate including work productivity (i.e., societal costs) in health economic/health technology assessments

Conference floor: Practical steps Ireland and Spain show the way
Practical steps and solutions towards making MSDs a health and work priority at the national and EU levels were discussed by keynote speaker Professor Oliver FitzGerald, National QCCD Programme Lead for Rheumatology, Ireland. An important message from Professor FitzGeralds talk was the importance of engaging the medical profession in attempts to improve work retention.

Figure 2. Dame Carol Black chairs the mornings panel discussion

We are encouraging our colleagues to think beyond physical symptoms, to encourage early intervention both for musculoskeletal pain and also for other conditions like inflammatory arthritis, to promote self management, to support managers with job design interventions, to focus on capacity and not incapacity, and we are emphasising to rheumatologist the importance of communicating with all of the other stakeholders, including patients, employees, GPs, physiotherapists, employers and policymakers, the overall message that work is good for you and that we should try to maintain our patients in the workplace as much as possible, he said. Professor Juan A. Jover, Rheumatology Service, Hospital Clnico San Carlos, Madrid, Spain showed that national goals can be turned into clinical reality if bottlenecks preventing people 3

with MSDs returning to work can be identified and remedied. He described extremely costeffective initiatives undertaken in Spain, where population-based clinical programs offered to patients with recent-onset work disability caused by MSDs have enabled thousands of people to return to work earlier, saving millions of days off work, with consequent cost saving in long-term disability compensation.

Workshop challenge
Moving forward at the national level was the challenge set for delegates in the final session of the mornings proceedings. Splitting into five working groups, delegates were tasked with identify actions that would raise awareness of MSDs amongst national stakeholders in spheres of health, social affairs and employment.

Figure 3. One of the workshops in full swing

Chairing the feedback sessions from these workshops, Neil Betteridge Vice-President EULAR-PARE noted several key recommendations: In terms of making workability a key measure of the successful clinical management of MSDs, it was recommended that FfW should agree a universal tool or measure for defining workability This should employ a simple scale and be accessible and usable by all health care professionals. Turning to policies which can be promoted to allow for reasonable workplace accommodation for workers with MSDs to maximise their productivity and well-being, it was recommended that GPs should receive more training in occupational health. In order to ensure that patients are involved in every stage of MSD treatment decisions, it was recommended that patients receive advance information prior to consultation and that this be personalised, relevant, and of high-quality. The key components of a national action plan on MSDs should be flexible, evidence based, attractive to employers, and must include early diagnosis and appropriate treatment. In terms of which policies can be promoted at a governmental level, the welfare and health arms of government need to work in alignment to encourage early intervention in MSDs 4

EU Focus Encouraging scope for action at political level

The focus for the afternoons presentations which fittingly took place in European Parliament chamber was: Addressing MSD and work capacity in EU health and employment policies. Fit for Work Europe was honoured by Lech Wasa presence at the conference, where, as reported above, he stressed the importance of, and his commitment to, recognizing workers rights and the striving for a healthy workforce. Edite Estrela, MEP, Chair of European Parliament Interest Group on Rheumatic and Musculoskeletal Diseases, addressed the importance of MSDs and work capacity in EU policy development. I have been actively supporting Fit for Work Europe for nearly three years and I believe that the issue of musculoskeletal disorders in the workforce is something which we must all focus on. MSDs are the leading cause of disability and inactivity among Europes working age population resulting in more sickness absence and more cost than any other condition, she said. Now is the time to talk about action. Members of the European Parliament, colleagues from the European Commission and Council have a clear role to play in raising awareness and taking action on MSDs. I pledge my support in continually promoting this issue in the EU Parliament, Ms Estrela added.

Prerequisite for productivity

Isabel de la Mata, Principal Advisor, DG SANCO, European Commission addressed the importance of placing MSDs within a European framework for the management of chronic conditions. She pointed out that MSDs such as arthritis and rheumatic disease affects up to 100 million people across the EU. These are millions of people with a constant undermining of their quality of life, and their ability to live and work as they would wish, she said. Acknowledging the importance of a healthy population as a prerequisite for economic productivity and prosperity, Ms de la Mata noted that other important initiatives such as the EU Strategy Together for Health and the European Innovation Partnership on Active and Healthy Ageing encompassed goals that showed constructive synergy with those of Fit for Work. Dr Patricia Reilly, Cabinet member of Maire Geoghegan-Quinn, Commissioner for Research, Innovation and Science, examined Fit for Work as an innovation model, fostering innovation management for a healthier Europe. Speaking on behalf of the Commissioner, Dr Reilly said that good health and quality of life are crucial for EU citizens and for economic and social development. It is clear to us that a healthy workforce is key to meeting the challenges we face with an ageing population particularly given the current severe financial constraints. We simply cannot afford to let our workforce suffer unnecessary pain or illness or indeed unnecessary or reduced productivity. We need a healthy happy workforce and a population that is fit for work.

Major changes on the way

Turning to how to ensure that MSDs receive due focus in the workplace across the EU, Stephen Hughes, MEP said that major changes were about to take place at the EU level. We have been calling for action on MSDs at the EU level since the mid 1990s specifically a Framework Directive on the ergonomic design of work stations and work places. Progress has been slow, he added, however he believes that relevant proposals will now be adopted within a matter of months. Another MEP, Jean Lambert stressed the importance of employment policies to help fight social exclusion. She underlined the importance of encouraging flexible hours and other work policies in order that people with MSDs can get back into the labour market. Other important initiative for boosting work participation, and reducing health inequalities were described by Professor Peter Goldblatt, Co-Director, European Review on the Social Determinants of Health and the Health Divide, University College, London. Professor Goldblatt stressed the importance of early intervention. He argued that appropriate education at young age would improve individual life skills and boost the control that young people have over their lives. In turn this could reduce adversity in the work environment.

Workforce retention
When young people enter work, how are they to be kept in long term employment especially when considering MSDs and EU employment policies? asked Eva Trk, Deputy Head of Cabinet for Lszl Andor, Commissioner for Employment, Social Affairs and Inclusion. She said that the Commissioners priorities were to increase employment to 75% to reduce the numbers of people living in poverty and social exclusion by 20 million. The Commissioner also has a responsibility for Health and Safety at Work. I think it is important to look at Health and Safety legislation, not as a burden but as a support to companies and employees, she said. Whilst she acknowledged that some legislation governing health and safety had been slow in development (such as that discussed by MEP Stephen Hughes), she said that this was in order that full impact assessments could be performed. Commenting on the proceedings, and on the Coalition's work to date, President of the European Parliament, Jerzy Buzek said, "Partnerships such as Fit for Work Europe are excellent examples of how the EU and Member States may work together to achieve ambitious goals. EU Institutions, specifically, those of us in the European Parliament support the efforts of Fit for Work to ensure every Member States has the evidence and ultimately the resources to make MSDs a health priority."

Economic imperative
Drawing the conference to a close, MEP Dr Antonyia Parvanova, Co-President, Fit for Work Europe Coalition said that policy makers must ensure that health and work agendas promote positive health outcomes and labour market retention. National and EU legislation should reflect these goals.

The business community should recognise that workers with MSDs who are supported at work are more productive. Both employees and health care funders should support early diagnosis and appropriate intervention, recognising the potential cost savings of such policies. Individuals with MSDs need to play an active role in self management and get involved in advocacy. Finally we call on health professionals, especially GPs, to adopt positive attitudes towards workability rather than disability, she said.

Figure 4. Antonyia Parvanova issues her closing call to action at the European Parliament

Dr Parvanova stressed the importance of implementing these approaches, for the economic development of Europe. This is about the economy. This is about GDP. It is about contributing to the economy. In some member states we now have two employees supporting a single retirees pension. In other member states it is one-to-one. In ten to twenty years time it will be worse; four pensioners will be covered by one worker, she said. "Today, we know the European Union, via its institutional support for the activities of Fit for Work Europe, acknowledges the impact of MSDs on our economies and the need for actions to be taken. Now, we must focus our efforts on supporting national governments, helping them to make the case for making MSDs and the health of the working population a priority in their health systems, to improve outcomes in health and work," said Mrs Antonia Parvanova, the MEP host of the summit in Brussels, and a co-president of the Coalition. "Only then will we effectively support those citizens living with chronic pain."

Appendix 1 The following section denotes key points from each of the conference presentations. The presentations are in the order they appeared on the agenda. Session 1: 10.00 14.00 Royal Belgian Institute of Natural Sciences, Brussels Change with Us: Practical steps and solutions towards making musculoskeletal diseases (MSDs) a public health and work priority at the EU and national levels
Fit for Work Annual Event Welcome Address Professor Steve Bevan Work is good for health and wellbeing it is healthy for both patients and the wider society Work also makes sound economic sense Work should be promoted as a priority clinical outcome for patients

Why isn't work routinely considered in health care decision making? Leela Barham Work should be considered in healthcare decision making Failing to take a societal perspective could lead to inferior allocation decisions Some countries such as Sweden and Netherlands are already adopting this societal perspective, so it can be done! Making Europe Fit for Work: What needs to be done to set up effective systems at national level? John Church The Irish experience MSDs are the most commonly reported cause of work related ill health in Ireland costing 750 million a year with 7m lost working days per annum. 25% of people with rheumatoid arthritis stop work within five years of suffering their first symptoms. Inadequate healthcare resources are a problem, however, progress has been made with the appointment of seven new rheumatologists and 24 new physiotherapists in Ireland. If the Fit Note can be introduced, this will make a substantial difference as will building a Coalition of key stakeholders in Ireland. Dr Sarah Bazin Physiotherapists role Early intervention with physiotherapy can help prevent people losing working time by getting them back to work on full normal duties. Physiotherapy can also facilitate a managed return to work if alternative or modified duties are required. Physiotherapy can deliver a cost effective service for employers. Professor Paul Watson Physiotherapists and MSDs People with MSDs face similar problems in many countries, including a disproportionate focus on medication and treatments and too little emphasis on work/function. Doctors tend to sign off people from work, emphasising what individuals with MSDs cannot, rather than can do. Absence management and illness is not integrated With better communication between HCP and workplace, plus the availability of modified duties/modified workplace, more people with MSDs could continue being productive. Return to work and societal cost evaluation should be mandatory in EU funded healthcare research.

Anne Lise Hoffmann Danish perspective The Danish Government has made the prevention of MSDs a priority and has established a Prevention Fund as part of their recent welfare reform There needs to be shared responsibility of all stakeholders, including employers, employees, authorities, and the health care sector. There is still a need to prevent work-related MSDs and MSDs in general. In Denmark family physicians are obliged to report work-related MSDs Practical steps and solutions towards making MSDs a health and work priority at the national and EU levels Professor Oliver FitzGerald The medical profession need to be engaged in attempts to improve work retention. Health care professionals should be encouraged to: Think beyond the physical symptoms and encourage early intervention Promote self-management and support managers with job design interventions Focus on capacity not incapacity How to make a national priority into a clinical reality Professor Juan A. Jover National goals can be turned into clinical reality if bottlenecks preventing people with MSDs returning to work can be identified and remedied. Cost-effective initiatives undertaken in Spain have enabled thousands of people to return to work earlier. These interventions have saved millions of days off work, with consequent cost saving in long-term disability compensation.

Session 2: 15.00 18.00 European Parliament Addressing MSDs and work capacity in EU health and employment policies
Recognising workers rights; the importance of a healthy workforce Lech Wasa 100 million Europeans suffer with a chronic MSDs - over 40 million of whom are workers Of these nearly half (40%) have to give up work due to their condition. Early intervention and coordinated care can make a real difference to people living with MSDs Addressing MSDs and work capacity in EU policies Edite Estrela, MEP MSDs are the leading cause of disability and inactivity among Europes working age population, resulting in more sickness absence and more cost than any other condition. Members of the European Parliament, of the European Commission and Council have clear roles to play in raising awareness and taking action on MSDs. Edite Estrela pledges her support in continually promoting this issue in the EU Parliament. Placing MSDs within a European framework for the management of chronic conditions Isabel de la Mata MSDs such as arthritis and rheumatic disease affect up to 100 million people across the EU. A healthy population is a prerequisite for economic productivity and prosperity. Investment in health is as an engine of future economic growth. There is much scope for further research into chronic diseases and for action in health promotion and prevention to facilitate healthy choices for all citizens.

Fit for Work as an innovation model, fostering innovation management for a healthier Europe Dr Patricia Reilly Good health and quality of life are crucial for EU citizens and for economic and social development. A healthy workforce is essential if Europe is to meet the demographic challenges posed by ageing populations. Avoiding unnecessary pain or illness amongst EU workers is vital for optimum productivity and for maintaining a healthy happy workforce that is fit for work. Health care reimbursement systems need to be redesigned in Europe to better reward health promotion. How to give MSDs due focus in the workplace across the EU Stephen Hughes, MEP One in four workers report back pain up to 40 per cent in some of the newer States. MSDs are a priority for the EU in its Community strategy on occupational health and safety. They are also a recognised priority by the EU Member States and European Social partners. Proposals regarding the EU Framework Directive on the ergonomic design of work stations and work places should be adopted within a matter of months. The importance of employment policies to help fight social exclusion Jean Lambert, MEP Employment policies should be designed to help fight social exclusion. Employers should support flexible work hours and other work policies [such modified work station/work practices] that enable people with MSDs to return to the labour market. Boosting work participation, reducing health inequalities: the importance of early intervention Professor Peter Goldblatt Better management of MSDs can help reduce health inequalities. When discussing adverse working conditions, in addition to traditional occupational hazards, the workers psycho-social environment should also be considered. Early intervention is the key to boosting work participation and reducing health inequalities. Appropriate education at young age can improve individual life skills and thus reduce adversity in the work environment. The report of the Marmot Review [which independently evaluated health inequalities in England] and which is published as 'Fair Society, Healthy Lives is instructive. http://www.marmotreview.org Keeping people in work for the long-term. MSDs and European Union employment policies Eva Trk Lszl Andor, Commissioner for Employment, Social Affairs and Inclusion has two key priorities: To increase employment to 75% and to reduce the numbers of people living in poverty and social exclusion by 20 million. The Commissioner also has a responsibility for Health and Safety at Work and wishes to see more progress in this important area. Employers need to be encouraged to see Health and Safety legislation as important support for their business, rather than an administrative burden. EU Directives can help employers meet key health and safety goals, including those concerning MSDs. A Call to Action: Conclusions & Morning Workshop Recommendations Dr Antonyia Parvanova, MEP Policy makers must ensure that health and work agendas promote positive health outcomes and labour market retention. National/EU legislation should reflect these goals.

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The business community should recognise that workers with MSDs who are supported at work are more productive. Both employees and health care funders should support early diagnosis and appropriate intervention, recognising the potential cost savings of such policies. Individuals with MSDs need to play an active role in self management and get involved in advocacy. Health care professionals, especially GPs, need to adopt positive attitudes towards workability rather than disability.

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