Chronic ill health among working age population poses 'unsustainable drain' on NHS

On 28th September 2017 AbbVie/Healthy Working Lives Group organised a one day event at the Trades Hall Glasgow (Healthy working lives: Long term conditions don’t need to mean worklessness). Professor Ewan MacDonald with Dame Carol Black was interviewed by John Beattie and the recording can be accessed by listening to BBCiPlayer, the segments starts at 37mins.

Ewan was featured in the Herald earlier this week.  See the story below

LONG-TERM conditions will become an "unsustainable drain on the health service" unless more is done to keep people in work longer as the population ages, a leading academic has warned.

Professor Ewan MacDonald, whose research on healthy working lives has played a key role in developing Scottish Government policy, said older workers should be routinely offered apprenticeship-style "re-skilling" to enable them to remain in the workforce as their physical abilities change, and called for greater investment in rehabilitation. He suggested that patients could be sent to leisure centres to improve their aerobic fitness and physical strength in order to stay fit for work.

Prof MacDonald, an occupational physician and head of the Healthy Working Lives Group at Glasgow University, will discuss his latest research at a conference in Glasgow today (Thursday).

Currently 39 per cent of the working age population in Scotland has at least one long-term condition, but that is forecast to surge as the population ages and Scotland grapples with the fallout of an obesity epidemic.

Prof MacDonald said a failure to prevent and manage long-term conditions properly would be catastrophic as pension age increases to 68 or more.

He said: "We will have a population that will become increasingly workless, who are an unsustainable drain on the health service, and on the caring support services. We will not be able to retain skilled people at work, we will be being outdone as a nation because other countries with younger populations will be much more economically productive than ourselves, we will have the huge cost of worklessness, we will have increasing health inequalities, and as a nation we will not prosper if we don't do this. We need to change people's attitudes to chronic conditions."

Prof MacDonald is currently heading up a two-year study following 14,000 Scots who have been long-term unemployed.

He said: "The main cause now [of worklessness] is mental health, followed by musculoskeletal then respiratory, neurological, and cardiovascular illnesses. So for about 50 per cent, the primary long-term health problem is a mental health problem. That is probably not the primary cause of their worklessness, however. The problem is that when someone loses their job for chronic back pain or cardiac disease or they've been made redundant and they've got a health issue, pretty quickly a good few of them will get depressed."

He added that the research showed that the more educated an individual is the less likely they are to become workless with a chronic condition, and that homeowners with a mortgage were the most likely to return to employment after a period out of work.

He said: "People with the highest educational qualifications tend to live the longest, and they tend to be more employable. If you're a labourer, doing caring work or cleaning work, then you have to be relatively fit, whereas if you're a computer programmer and you're paralysed from the chest down you can still do your job.

"All the focus at the moment is on apprenticeships and young people being skilled up to enter work, but the problem is when the ageing worker is not able to continue doing exactly the same job We need re-skilling of older people. Education is as critical as any health intervention."

Prof MacDonald began his career helping to rehabilitate injured miners in the north of England in the 1980s, and stressed than even serious disabilities should not be a barrier to work for most people.

He said: "We used to get people who were pretty badly disabled - bilateral amputees and the like - and after six weeks of intensive rehabilitation we'd get 66-75 per cent of them back to work. "That was almost like a military-style rehabilitation, which is much more intensive than the NHS where you're lucky if you get six sessions of physiotherapy several months after you needed it.

"The health service needs to become much better at identifying rehabilitation needs for people.

"I'm not saying the health service should do it - a lot of it could be done in leisure centres to get people back to maximum fitness. One of the things we know from recent research done in Europe is that one of the predictors of people having extended working lives is aerobic fitness and physical fitness - grip strength. Your grip strength predicts mortality."


First published: 3 October 2017

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