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1 Health Management Limited has been appointed as the supplier to deliver Fit for Work (previously Health and Work Service) in England and Wales. The following is a personal account of a service user s journey. Susan s Journey My name is Susan Brown. I have been off work for 4 weeks with depression and have been going to my GP, Dr Page, for Fit notes to give to my manager, at Baker s Foods. I feel bad about being off work because they depend on me but that only makes me feel worse and I really can t face going back. In addition I have a little girl and I enjoy being at home with her more than working, but I can t afford to reduce my hours to be with her because I m so in debt. When I got to 4 weeks sick, Dr Page talked to me about the Government s new Health and Work service. He said that instead of giving me a Fit Note he was, if I agreed, going to refer me to the Service; someone would call me in the next day or so to work with me to develop a Return to Work plan to help me get back to work. He said that the service would not send any information back to him or my employer without my consent and that the service was voluntary. He told me other patients had found the service helpful. I said I needed to know more about that and he gave me a leaflet, and I agreed to be referred, because I realized I could be off a long time, and I m worried about losing my job. Dr Page made the referral and I took the leaflet home with me to read about the service while I waited for the call. A day later I was phoned by a nurse called Cathy. She explained that she would be my case manager and that she had received the referral from Dr Page and wanted to talk to me about it in more detail, if I was happy to proceed. She said she would need about an hour at most to thoroughly assess me and that together we would agree a set of actions that would help me go back to work. She said I could do that now or she would call back when more convenient. I asked her to call back in the afternoon I had not slept last night and couldn t face the idea of an hour on the phone. She phoned back as agreed at 2. She confirmed my identity and re-confirmed that I had consented to the service. After checking my details again she talked to me about my health, how the depression had started, and my treatment. I was surprised that she also asked me about other things in my life that were stopping me returning to work. Together we discussed my child care concerns, the fact that I hadn t dealt with my debts, and how I felt about my job and employer. She even asked me if I like my job, which I don t really. She was kind and seemed genuinely interested in me. We agreed that there were some things I could do to help me feel better. As well as continuing to see my GP, she suggested using my employers free counseling service, and staying in touch with my boss regularly. Cathy suggested I speak to the Money Advice Line so

2 that I can sort out my monthly expenses and work out if I could afford to work part time so that I can spend more time with my daughter. She also gave me some general health advice about making sure that I do some exercise regularly and continue to see friend. She said these will help with my recovery. Cathy said she would telephone me in a couple of days to see if I was on track, and that she would suggest to my employer that when I do go back to work, it will be on reduced hours, building up to my full hours over a four weeks. She repeated the details of my action plan and I agreed to do my best. We set a target date of 3 rd May to return to work which seemed reasonable. I felt a lot happier after the call someone was interested enough in me to spend that time helping me. I started to follow the actions in my Plan. Cathy ed me a copy of the Plan and a link to a website where I found lots of interesting information on depression. Particularly interesting were the Expert Patient testimonials which showed me how people with my condition manage in the workplace and handy tips to help me get up in the morning (it s mornings I find most difficult.). I followed Cathy s advice and got some advice from Money Advice Service. Although I can t afford to work part time yet, if I keep clearing my debts I may be able to do so in six months. This has really motivated me and I feel much more positive. The counseling I received through the EAP has been great! I have learnt some coping strategies and how to improve my work life balance, so that we I am with my daughter I don t worry about work. I am getting out for a walk every day, and am even planning to stop smoking soon. I still feel low sometimes, but I think my recovery has been much quicker because I ve managed to deal with a lot of my problems. I ve been in touch with my boss who says that he has received helpful advice from the service, and I am returning as planned on 3 rd May, working only part time for a few weeks, which makes me feel I ll be able to cope. In fact I m looking forward to seeing my colleagues again. Cathy ed me again on the 1 st May to remind me that my return to work date was coming up and to encourage me to call her back if I had any concerns. She congratulated me on getting this far and wished me well for my return to the workplace. She also reminded me that copies of my plans had, as agreed gone to my GP and my employer and that, if ever I needed any more help or advice, she sent me of the address for the service website. Dr Page s Journey I have referred to the HWS on several occasions. It started in September 2014, but I was aware of the Governments intention to launch the service from the spring when articles started appearing in Pulse magazine, and I noticed it was being promoted by NAPC. Even when I logged on to my s at Drs.net I found information aimed at GPs, inc surveys and blogs. I sometimes don t feel I have the right expertise to deal with long term sickness absence cases. I fully appreciate that it s important to get someone back to work, but I find it difficult to give meaningful holistic advice within a 10minute consultation. We had also received a visit to the practice by the GP Engagement Team, so I felt fully

3 prepared in making referrals through Choose and Book, which doesn t create any additional work for me. I ve known Susan, a single Mum to a three year old girl, since she was a child herself. I noticed that she began to attend the surgery more frequently and eventually burst into tears and told me about her hopelessness, insomnia and constant low mood. She had no social support, and although I referred her for counseling there is a six month wait in our area. I prescribed Susan antidepressants and gave her a fit note for four weeks of sickness absence. She was not sleeping and was certainly unfit for work. I reviewed her at the four week point, but she had improved very little, and was worried about bills, her daughter s child care and losing her job. I was disappointed she had made little progress and saw the warning signs for a long term absence. I discussed a referral to the HWS with Susan. I explained it was voluntary, designed to support and signpost her to the right sources of help, and it s aim was to help her return to work. I gave her a leaflet explaining the service in more detail, and recorded her consent in the notes. I did explain to Susan at that point that no information would be shared with either me or her employer without her consent, but that other patients in the practice had found the HWS very useful, and got back to work. This really reassured her. I made the referral very easily through Choose and Book, and submitted it electronically there and then. I told Susan to expect a call within a day or two, as other patients had told me they received the call back the same day as the referral. Two days later I received a return to work plan electronically, which detailed the barriers which the Case Manager, Cathy, had identified as blocking Susan s return to work. These were her depression, financial worries, and childcare / work-life balance issues. I was impressed to see that Cathy had signposted Susan to her employer s EAP for immediate counseling which I was unfortunately unaware of. In addition she had confirmed that Susan was compliant with her Medical treatment, but in view of her financial worries had been advised to contact Money Advice Service for advice. General health advice had also been given about engaging in regular exercise and maintaining good general health, including social activities. Cathy indicated that if there was a need for further case management she would send me an updated RtWP, and provided a contact telephone number should I wish to contact her. Susan had obviously felt comfortable enough to share her RtWP, as I also received the information sent to her employer Baker s Foods. This did not contain medical detail, but advised Mr Baker that Susan s anticipated RtW would be 3 rd May, and that the RtWP would act as a fit note for that period. It further advised that she had been signposted to the employer EAP programme and given general wellbeing and lifestyle advice specific to her needs. Cathy had advised Mr Baker to consider allowing Susan to return to work on a part time basis initially building up these hours over a four week period to her full contractual hours. Consent to release information to both parties was clearly documented. I did not hear anything more from the HWS, but did receive follow up from DWP a few weeks later. I reported I was very happy with the service.

4 At the end of May Susan came to see me. I was afraid she had relapsed. I was delighted to see that her return to work had gone well, she was continuing with counseling via the EAP, and wished me to prescribe patches to help her stop smoking as part of her more positive outlook on life, she felt empowered to make positive lifestyle choices. Mr Baker s Journey Susan has worked for me as my office assistant for almost a year. She has done well, but I ve noticed she has had difficulties with punctuality and often has to take annual leave at short notice to look after her daughter. In fact she cancelled her holiday to Devon recently because she didn t have enough leave. She started to look tired and told me that she was late because she couldn t get up in the mornings. I told her things had to improve, but she became tearful and I didn t know what else to do. We are only a small company and I m not an HR expert. She was often tearful and irritable in the office. One of the older women suggested she should see her GP. The next Monday Susan did not arrive for work. She phoned at lunch time to say she couldn t cope any more and everything was too much. She was in tears. I told her to go to her GP, and that I would phone her later to see how she got on. When I called back Susan was calmer, and told me that she had been diagnosed with depression and had a fit note signing her off work for at least four weeks. I was worried about the impact of her absence and how we d manage without her. I know that people with depression can be absent from work for many months. I had vaguely heard of the HWS from the news and internet, and began to look for more information. I found the web portal very useful. It had a section for employers about referring to the service, employment law and articles on specific health conditions. I read about depression and found that actually the outlook for a successful return to work was not as poor as I thought. I continued to use the website for advice, and on one occasion telephoned the advice line. I was able to talk with a Mental Health Nurse, Alice about how depression can affect people at work and general advice about support. I ve always been nervous about mentioning psychological issues but Alice said that I should stay in regular contact with Susan whilst she is off sick, and ask her about her progress in general terms so she feels positive about her return to work. This wasn t something I d considered before. I telephoned Susan to discuss making a referral via the employer s web portal to the HWS, but she told me that she had already been referred by her GP. She told me she was expecting the telephone assessment to take place the same afternoon. Two days later I received notification that the RtWP was available to view on line. I logged in and saw a clear and well structured summary of Susan s assessment, signed by her case manager Cathy. The plan did not contain any medical information, but told me that several barriers had been identified and that Susan had been appropriately signposted to seek support. One of these signposting was to our business employee helpline for free telephone counseling which I hadn t even considered! The estimated RtW date was given as 3rd May, and Cathy advised that I consider a graduated return to full time hours over a four week period, starting at 50% of her contractual hours,

5 preferably with late starts as depression commonly causes sleeping difficulties. There was also general information about some interventions, for example, extended counseling, possibly being tax exempt if recommended by the service. Cathy s contact telephone number was given in case I wanted to discuss any of the advice given. I stayed in contact with Susan every week, and she told me that she had followed the advice given (although she chose not to share some details with me, and I did not push her to tell me), and I knew she was on track to RTW as planned. I arranged a graduated return, and on the first day of her return we had a return to work meeting, at which I offered my support and flexibility as far as possible. Susan s return has been successful, and I can see that she is committed to remaining at work and staying well. She is walking to work, is reducing her smoking and her punctuality has greatly improved. She has asked me if she can reduce her working hours to four days a week after Christmas, and I m happy to accommodate that as she is a valued member of the team. I am sure that the HWS helped her feel more positive about being able to manage her health and personal circumstances, and I gave good feedback when I received follow up. I would definitely use the service in the future, if a GP doesn t refer.

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