Bad back to the future

Musculoskeletal problems are costing the nation a fortune. Sam Barrett finds getting the right treatment early on is crucial

For an employer, back pain can be seriously bad for business. The problem affects eight out of 10 people at some time during their lives and accounts for almost 19 million lost working days a year at a cost of up to F5 billion to the UK economy. That is why it is crucial that employers have a strategy for tackling musculoskeletal problems in the workplace.

Relying on the NHS is far from satisfactory. “Early intervention is essential if you want to treat the problem and reduce the length of absence,” says Dudley Lusted, head of corporate healthcare development at Axa PPP healthcare. “Although some cases do require further investigation, most people will respond well to a few sessions of physiotherapy. Unfortunately, the waiting time for physiotherapy on the NHS is around 50 days, which, as well as potentially delaying an employee’s return to work, can significantly reduce the chances of the treatment being successful.”

Because early intervention is key to treating musculoskeletal problems effectively, Lusted recommends having a robust sickness absence management system in place.

“It’s very easy for a GP to write a sick note for back pain and the employee’s off work for two weeks. If your sickness absence system can look beyond the sick note and at the reason the employee is off then you can fast track them into treatment and get them back to work,” he explains.

When it comes to accessing treatment, self-funding is an option. Larger employers might want to bring a physiotherapy service in-house, especially where musculoskeletal problems are a major cause of absence. Where this isn’t an option, paying for employees to be fast-tracked into physiotherapy can work well. Costing around F30 a session, and a course of three or four sessions usually sufficient to treat a musculoskeletal problem, Lusted says it’s worth considering. “If you compare the costs of treatment with the potential cost of absence then it’s a no-brainer,” he adds.

Rather than take a pay-as-you-go approach, many employers prefer to take out medical insurance to pick up the cost of treatment for musculoskeletal problems. As this also covers scans, consultations and surgery it reduces the employer’s financial risk.

Where musculoskeletal problems are a major problem, for instance where the workforce is largely manual, a more targeted medical insurance proposition such as Axa PPP healthcare’s Back to Health plan can represent good value. Costing between 30 and 40 per cent of the price of standard corporate medical insurance, this picks up the tab for treatment where the employee’s condition prevents them from undertaking their normal duties.

But whether a comprehensive scheme or a more restricted one, Mike Izzard, managing director of Premier Choice Group and chairman of the Association of Medical Insurance Intermediaries, says he has noted a worrying trend when it comes to musculoskeletal problems. “There’s been a surge in claims costs, possibly because the claims aren’t managed properly. Orthopaedic surgery under the age of 50 is a major issue but more consultants are referring people for this, especially if they have medical insurance,” he says.

To counter this surgical epidemic and to help keep medical insurance premiums at a manageable level, he recommends having access to a second opinion, either through a company doctor or occupational health department or through a specialist service such as Best Doctors. Bringing expertise in-house has a further advantage as Izzard explains.

“If an employer has in-house medical services this can remove the need for the employee to see their GP about musculoskeletal problems, thereby reducing the risk of their being signed off for a couple of weeks,” he says.

If your sickness absence system can look beyond the sick note and at the reason the employee is off then you can fast track them into treatment and get them back to work

When it comes to meeting treatment costs, cash plans are another option. “Cash plans can be a good means of tackling musculoskeletal problems,” says Izzard. “Although they don’t give you access to surgery, which might be a good thing given the haste with which some specialists recommend it, they do cover physiotherapy and consultations.”

Plans generally limit the amount an employee can claim on physiotherapy each year, usually lumping it in within other therapies such as chiropractic and osteopathy. For example, Simply Health has a F150 a year limit on its F1 a week employer paid plan while Westfield Health’s Foresight plan gives up to F120 a year. Some plans also include scans, which may be required where a problem doesn’t respond to physiotherapy, as well as an allowance for specialist consultations.

They also offer a key advantage over medical insurance, as Jill Davies, chief executive of Westfield Health, explains: “There’s no need for policyholders to obtain a recommendation from their GP or consultant before they start a course of therapy treatments.”

Given the range of treatments available for musculoskeletal problems, as well as the risk of inflated claims costs that Izzard has noted, several of the medical insurers have also developed preferred treatment methods. Earlier this year Aviva UK Health rolled out its Back-Up service to all its corporate medical insurance clients, having initially only offered it to large corporates.

With this service, an employee with back pain can call the firm, who will arrange for a case manager to call them to carry out an assessment and recommend treatment. “We can arrange for the assessment to take place within a couple of hours,” explains Mark Sharpe, clinical development manager at Aviva UK Health. “The case manager will take into account psychological factors such as how the person feels about their back pain as well as symptoms and put together an appropriate treatment plan.”

For milder cases, this treatment plan might simply be following a series of exercises set out on Aviva’s website. “Most people who are assessed get some form of face-to-face treatment. Most will see a physiotherapist through our national network but a few do get referred to a specialist and this will also be case managed to ensure they receive the most appropriate treatment,” adds Sharpe.

If you compare the costs of treatment with the potential cost of absence then it’s a bit of a no-brainer

The Aviva service also sidesteps the need to see a GP for a referral, which Sharpe admits has meant something of a re-education process. “For the last 18 years we’ve been telling people to get a referral from their GP before they could have any treatment but now we’re encouraging them to call us first,” he says. “We’ve been marketing this to both employers and employees.”

Results have been positive. Back-Up was only launched to large corporate clients at the beginning of the year, of those employees that used it, 50 per cent said it prevented them taking time off or restricting their duties. Further, among the 25 per cent that were absent prior to using the service, 100 per cent successfully returned to work as a result of using it.

Bupa is also looking at ways it can deliver more effective treatment to policyholders suffering from musculoskeletal problems and earlier this year it teamed up with APOS to introduce its treatment system to the UK. With this, patients have their gait analysed and, based on the results of this, are given customised footwear that reduces pain and retrains the posture so the problem doesn’t recur.

Dr Peter Mace, assistant medical director at Bupa Wellness, says: “It’s a much more personalised approach and although it doesn’t work for everyone we’re seeing people recovering quicker and going back to work sooner than with more traditional treatment.”

Bupa offers the treatment for knee, hip and lower back pain to private patients but is only trialling it for knee pain for its medical insurance clients. “If an employee is suffering with knee pain they can apply for APOS treatment,” adds Dr Mace. “They can speak to someone on the claims helpline who will be able to assess their suitability for it.”

Prevention is better than cure

While health and safety legislation takes care of the serious risks such as heavy lifting, educating employees about looking after their backs can reduce the likelihood of their developing musculoskeletal problems. “We are looking at raising awareness of what causes back problems. The trouble is people don’t tend to be that interested when they don’t have a problem so getting them to engage is difficult,” says Mark Sharpe, clinical development manager at Aviva UK Health.

Encouraging even small changes among employees can be beneficial. “So many employees sit at desks all day long. Encouraging them to take micro breaks and walk around can help prevent them developing problems,” says Dr Peter Mace, assistant medical director at Bupa Wellness. These behavioural changes can be complemented by work station assessments.

Another area where education could be beneficial is among employees who drive as part of their work duties. For these employees, adjusting seats and taking regular breaks can reduce the likelihood of back problems.

“So many employees sit at desks all day”

Unfortunately though, AXA PPP healthcare’s Dudley Lusted agrees with Sharpe on the effectiveness of preventative measures. He adds: “It would be great if an employer could dedicate time and money to educating employees about back care but, with finite budgets, the cleverer approach is to focus on those employees that develop problems and enable them to access appropriate treatment as early as possible.”

Dudley Lusted, head of corporate healthcare development, Axa PPP healthcare