Co-morbidity round table – A problem multiplied

Co-morbidity – the compounding effect of multiple health conditions – is expected to have an increasing impact on productivity and performance as the UK’s workforce gets older.James Brockett reports

Prof Steve Bevan

Millions of people in the UK’s ageing workforce will develop more than one long-term health condition at the same time, yet it is a trend which employers are largely unprepared for.

That was the stark message from Professor Stephen Bevan of the Work Foundation when he spoke last week at Corporate Adviser’s round table Managing Health in an Ageing Workforce: Counting the cost of co-morbidity , in association with AXA PPP Healthcare.

Bevan referred to projections that predict 7 million sufferers from mental health problems in the working age population by 2030, 7 million people with musculo-skeletal disorders, 1.3 million with diabetes, 1 million with heart disease and 1.6 million with chronic respiratory illnesses. Around 4.5 million people of working age will have more than one such long-term condition, posing particular challenges for them and their employers, he warned.

“One of the things you learn when you start looking at any of these individual conditions is that no one of them is an island,” said Bevan. “On the face of it people might have one main condition, but actually they’ve probably either got or are at risk of having other conditions, which might materially affect the way that you treat them, as well as their ability to stay in work and be productive.”

Co-morbid mental health problems – which typically occur when an employee goes off sick with a physical health issue and then later developsdepression or anxiety – are a particularly common phenomenon. But many employers fail to recognise the risk until it is too late, neglecting to intervene early to deal with the original condition, failing to train line managers to spot stress and not providing adequate adjustments when managing a return to work.

But the statistics are clear that multiple medical problems, mental or physical, can derail efforts to rehabilitate an employee, said Bevan. He referred to a recent Australian study showing that while somebody with one long-term condition was 1.6 times more likely to be out of work than a healthy person, this rises to 2.3 for somebody with two conditions and 3.9 for somebody with three conditions.

“My sense is that we’re just beginning to develop a more subtle understanding of co-morbidity, but there is a lot more that needs to be done. We can’t hang about because it is a ticking time bomb waiting to go off,” said Bevan.

Employee benefit consultants attending the London event agreed that most employers they speak to have yet to get to grips with the challenge.

“Dealing with physical incapacity is generally recognised pretty well, but dealing with mental incapacity to work is not,” said Justin Crossland, senior consultant at Towers Watson. “It’s tick-box: if they’ve got the EAP, that’s it and they think you don’t have to worry about it. So the combination of those two aspects is a challenge. It’s not a thing that’s generally very well dealt with at the moment.”

Justin Crossland
Justin Crossland, Towers Watson

But Dr Steve Iley, head of medical services at Axa ICAS, said that the data in the field should now be compelling enough to persuade employers to wake up to the issue.

“There is a very poor understanding of this, but the way I explain it is: it doesn’t matter what that individual has gone off work with, by the time they are off for six months the probability is that they will have a commonmental health problem as well. There is evidence to back that up… and it starts to get the understanding across,” he said.

Some employers have already demonstrated best practice in the area. Bevan highlighted the example of BT, where employees with a potential long-term health problem are told about possible adjustments the employer could make before they even visit a GP, speeding up the process and increasing the likelihood of being issued with a constructive fit note by their doctor. Line managers have also been trained in how best to handle mental health issues,with the result that 70 per cent of those who spend six months off with such conditions make a sustainable return to work. Among UK businesses as a whole, this figure is just 15 per cent.

But while big employers have the resources and occupational health capacity to intervene early, small and medium-sized enterprises are often unable or unwilling to do the same, according to Steve Herbert, head of benefits strategy at Jelf Employee Benefits.

“I think you’ve got possibly three groups. If you take the example of a ten-person company, you know everybody and you tend to do what you need to do to help your staff,” said Herbert. “Then you’ve got the big companies, like BT, with a workforce of tens of thousands, where you’ve got the resource and the facilities in place and a structure you can work with. But then you’ve got everyone else in the middle. And I think everyone else in the middle is really the sticking point here. Because once you get to a certain size, you don’t have that individual contact with most of your staff so you don’t have the same moral responsibility. And you have got line managers in between who won’t have been trained… and just at the moment I’m struggling to see how we are going to persuade those people to part with cash. They will need a real business case to do so.”

Company culture is a crucial component to whether or not an employer is receptive to making such an investment. Katharine Moxham of Group Risk Development (Grid) said that this can often depend on the personal attitude of directors.

“The key is engaging the board,” said Moxham. “I worked with a client some years ago whose board wanted to see the absence stats every month. That made a huge difference to the way the organisation dealt with absence and the way it handled people in the workplace – the buy-in was just total. That’s what you need to achieve,” she said.

But as consultants can deal with a variety of stakeholders in an organisation, the picture can be made more complicated. Stephen Jarrett, healthcare practice head at Helm Godfrey, said that part of the problem is that a co-ordinated response from an organisation requires a number of corporatefunctions to be on board.

“It does come down to an employer deciding to put its hand in its pocket, but it’s also a question of what parties are involved and do those parties ever talk to one another?” he asked. “You have the situation where sometimes you may talk to an FD, sometimes you may talk to HR, sometimes you may talk to the managers themselves, and never the twain shall meet. I do find that a lot of the time you speak to different parties and they will put different views and have different ideas.”

Alex Bennett, health and risk consultant at Bluefin, said there while it was undoubtedly a challenge to get employers to invest in employee health in the current environment, it could be done if the right type of conversation was had.

“One way of making some progress is to try and encourage employers to map their risks against their current benefits and services, and to get involved in that redeployment argument. For a lot of us, our core income isabout the services and benefits employers already buy. But simply talking about that will not get you into this HR consulting area we’re talking about, such as line management training.”

And he added that technology was increasingly enabling those better quality conversations to take place.

“Every year it’s getting easier to access the profile of the workforce, have a view of what that looks like and then start to map what you’re currently doing and how effective it is. There’s certainly more here that can be done.”

AXA PPP healthcare
In association with AXA PPP healthcare

The debate over how employers respond to staff with long-term healthproblems is set to become ever more pressing as the UK population stays in work later, in the wake of the pensions crisis, changing demographics and the abolition of the default retirement age. There are currently 900,000 UK workers who are over 65, and this is the fasting growing demographic section of theworkforce; the average retirement age, currently 63 and a half, is rising quickly. Bevan pointed out that older people across the world are staying in work until an older age: South Korea, Iceland and Mexico have the most older workers with more than half of those aged 65-69 still in employment, while the figure is over 25 per cent in the USA, Canada, Australia, Norway, Ireland and Portugal. When employees’ potential working lives extend into their late 60s or even 70s, there is more at stake for employers when it comes to keeping them healthy.

Iley added: “It’s fairly rare in my experience that companies look at the endgame of the pension pots to see how much they are spending on ill-health retirements. Because managers don’t get involved; they just think, that’s an easy way out, those individuals are off my books and I don’t have to worry about them. But the company is still paying huge, huge amounts.”