Dr. Robert Ryan:

I am a working occupational physician. I see cases in which these medical problems arise in employment and I am involved in managing them. My task in this case was to determine whether there were examples in my practice that might give a tangible sense to committee members of the potential outcomes. In a general sense we are looking at better health outcomes for employees, but part of the process will involve an earlier return to work and substantial cost savings. I have referenced several examples to demonstrate our point.

Our role with the Dublin Airport Authority included work on an absence management programme and an early intervention programme for musculoskeletal injuries. The idea was that we would see staff members at an early opportunity when they became unwell. The programme resulted in a 25% reduction in overall absence and a 62% reduction in long-term absences, which were rather significant savings. Another project that allowed us to monitor the effect of intervention by an occupational health service involved the Department of Education and Skills. We introduced the first national occupational health service for teachers and special needs assistants. A review at the end of the first period indicated that levels of absence due to sickness had been reduced by 17% - that is, by 70,000 teacher days per annum. This benefit represented a 12-fold return on the cost of the service merely through a reduction in substitute teaching costs and without counting any other benefits that might accrue. In the next phase of our project with the Department of Education and Skills, the referral point will come down from 12 weeks to four weeks. We have introduced a team of case managers who make contact with teachers and special needs assistants who are out of work and assist them in managing the condition as well as assisting the school in managing their medical complaints and absences. My expectation is that the reduction in absence we realised in the first phase of the service will be augmented by our earlier intervention.

A well-documented example outside our jurisdiction is that of the Royal Mail in the UK, which introduced more active management not only of MSDs but of all health-related issues that resulted in work absence. Over a three-year period, its level of absence decreased from 7% to 4.5%, resulting in savings of £270 million against an outlay of £46 million. There are examples that demonstrate that early intervention using occupational health measures not only is good for the employees but should result in significant savings for the employer and perhaps the State.

The solution is to introduce nationally agreed standards for early intervention, developed by the Fit for Work coalition, under the auspices of the HSE. Ideally, intervention should be carried out as early as possible, perhaps as early as day five, by an occupational health team. The best way to achieve this is to establish a national case management system to facilitate early intervention. Large companies may be able to resource that within their existing occupational health services, but smaller companies should have access to outsourced case management services. The case manager is the link between the employee, the employer and the health professionals providing care to the individual. We also propose that we need a dialogue with general practitioners and to develop guidelines with the Irish College of General Practitioners in the area of sick certification to extend the usefulness of this and its role within the terms of rehabilitation and return to work. The coalition believes that a cross-departmental approach is necessary to implement the Fit for Work programme, and it is suggested that a high-level appointment would allow policy to be effected at a national level.