Mr. John Church:

Thank you Dr. Thornhill and members of the committee. In the interests of time I have left some of the slides to the background. Ireland is one of 24 countries that took part in a survey that looked at musculoskeletal diseases, following which we formed a coalition of key stakeholders and interested parties. At the back of the slides members will see that we have assembled some key stakeholders from various sectors, physicians and allied help professionals such as the Irish College of General Practitioners, ICGP, and the Royal College of Physicians of Ireland, employers represented by IBEC, employees represented by ICTU, health insurers, HSE as policy makers and patient groups. We have a good broad representation. This is not a disability lobby. We are not here to plea to save HSE money, but to present a solution to a significant problem which will save the Exchequer significant funds and we are seeking a champion within the House to take this on. We are calling for support to establish a cross-departmental group to work with the coalition on this issue. Dr. Thornhill outlined the potential savings, a sum of €250 million.

That is one third of the total bill the Minister pays out in illness benefit every year. In fact, if we put in place a solution for MSDs, we would also address every other illness. Therefore, the potential pot at issue is bigger and the amount paid out each year could be up to €940 million.

I will take the committee through the report findings. One significant finding is that MSDs are the most commonly reported cause of work-related ill-health in Ireland. The total cost to the Exchequer is €750 million per year or 7 million lost working days per annum. Of the figure of €750 million, more than €250 million is spent on illness benefit - that is to say, almost one third of the bill is spent on illness benefit related to MSDs. The condition accounts for twice the number of days lost through stress. We know from our research that 25% of people with rheumatoid arthritis stop work within five years of the first symptoms.

There is critical data indicating the prevalence of MSDs as a significant issue. The average duration of illness benefit payment is 11 weeks, but for MSDs the duration is twice that, at 22 weeks. We also know that one third of all recipients of illness benefit payments migrate to long-term disability benefit payment, which is another pot of €640 million. It is fair to conclude that MSDs must be a part of that figure of €640 million. At this stage, the committee will be beginning to understand the significant savings that could be achieved by addressing this issue.

According to the Institute of Public Health in Ireland, 12% of all adults have been clinically diagnosed with a MSD and that figure will rise to 13% in the coming ten years. Interestingly, when we compare Ireland with the other 23 countries that took part in the research, we find our contribution or our bill relating to illness benefit is 30% of the total, whereas in the rest of Europe it is 50%. I suggest we have a window of opportunity if we act now. Currently, we have no national policy on intervention or integration between the health services, employer and employee. If we simply address this issue there are potential savings, and not only for the Exchequer. This is an investment for the employer and it is also an investment in the well-being of the employee.

The report recommendations call for early and proactive intervention by the employer but also by a case manager. My colleague, Dr. Robert Ryan, will go into this in more detail. The ethos of what we are discussing is a focus on the capacity of the employee and not on incapacity. With that in mind, we advocate considering a phased return to work. We are also keen to address imaginative job design, which is central to rehabilitation. This relates to the physical layout of workstations, flexible working times and so on. We are also calling for health professionals to consider work as a clinical outcome. This means they should consider the patient before them as an employee who may wish to and have to return to work. The idea is to consider how quickly the patient can get back to work as a clinical outcome.

There are plenty of case histories showing the benefit of early intervention and why it works. Most of the data is from outside Ireland but there are some Irish examples as well, which we will go into. Generally, most companies in our research have absenteeism rates of less than 3%. The IBEC report gives a rate of between 1.6% and 3.7%, and the public sector rates run on average at 4.9%, but with some sites reporting absenteeism of 7% across large employee bases. Given the significant employee numbers at issue, even a 1% reduction in absenteeism could have a significant impact on illness benefit payments, which are a cost to the Exchequer. It would have a significant effect on employer productivity and, naturally, on employee well-being. I will leave most of the examples to my colleague, Dr. Robert Ryan. There are some significant examples to show why we should do this quickly. I will hand the committee over to Professor Oliver FitzGerald, who will go through a short piece on MSDs.