1.1 WHSS service provision
The Working Health Services Scotland ( WHSS) programme was introduced in order to provide support to employees in small and medium sized enterprises ( SMEs)  in Scotland whose health condition was affecting their ability to work. It was funded by the Scottish Government and the UK Government's Department for Work and Pensions ( DWP). The programme offered telephone based case management and some face-to-face therapeutic support to those who were either off work due to a health condition or at risk of becoming absent due to the condition. The programme developed from the WHSS pilot programme which had been delivered in 3 Health Boards from 2008-2010 (Hanson et al, 2011). These Health Boards - Borders, Dundee & Tayside, and Lothian - therefore had established services at the start of this period of data collection. Other Health Boards were introducing the programme for the first time.
The service was provided in the following Health Board areas in Scotland: Ayrshire & Arran, Borders, Dumfries & Galloway, Dundee & Tayside, Fife, Forth Valley, Grampian, Greater Glasgow & Clyde, Highland, Lanarkshire, and Lothian. The small number of cases from the Western Isles, Orkney and Shetland Health Boards were managed by Lanarkshire, Grampian and Highland.
The service was coordinated and managed through Salus Occupational Health, a provider of occupational health and return to work services, based in NHS Lanarkshire. During the delivery of WHSS individual Health Boards reported to Salus, and the database on which the records were kept was hosted there. Salus had a team of case managers and were able to offer support to other Boards delivering the WHSS programme, in some cases taking over the provision of case management from those Boards part way through the evaluation period.
In March 2014 the DWP funding of WHSS stopped, although the Scottish Government funding continued; however, the overall funding for the programme was reduced from March 2014. In parallel with this, Fit For Work Scotland was introduced in 2014 to support employees who had been absent from work for 4 weeks or more; this service was for employees of any size of organisation, except the self-employed.
This evaluation covers cases enrolled into WHSS in the period between 26 th March 2010 and 31 st March 2014; discharge data up to 28 th July 2014 are included.
The terms of reference of this evaluation are to describe and evaluate the reach and impact of the WHSS programme, as delivered 2010-14.
1.2 Client referral
Clients could be referred into the service by their GP, other health professionals, or partner organisations, or could self-refer. Those that self-referred may have received information about the service (and the contact phone number) from their GP, employer, or through the advertising which promoted the service.
1.3 Data collection
1.3.1 Timing and methods of data collection
Data were collected from clients at the following points in their journey within the WHSS programme:
- Enrolment: The client's first contact with the service, which assessed their eligibility for the service. This was a telephone assessment by an administrator lasting approximately 5 minutes.
- Entry: A detailed telephone assessment by a case manager, lasting approximately 30 minutes, concerning their health condition(s), effect of this on their work ability, absence status and health measures. This was used by the case manager to identify appropriate support for the client.
- Therapy provision: The services received by the client (including case management, physiotherapy, counselling, occupational therapy, self-help materials etc.). Information was recorded on the type of service, the number of sessions and duration of provision of these services.
- Discharge: This was done at the point the case manager judged the client should be discharged from the service, either because their condition had improved, or the service was not able to support them further. This was a telephone based assessment lasting approximately 15 minutes with the case manager. This covered work ability, absence status and health measures, as well as subjective feedback about the service.
- 3 month post-discharge follow-up: A telephone assessment by an administrator, or a paper based assessment completed by the client, lasting about 5 minutes. It recorded health measures, work ability and absence status.
- 6 month post-discharge follow up: This was a repeat of the questionnaire used at 3 month follow up.
The data recorded at enrolment were collected by trained assessors who conducted interviews with clients over the phone. The data recorded at entry assessment and discharge was collected by the case managers, who also conducted interviews with clients over the phone. Records relating to therapeutic provision were recorded by therapeutic service providers who usually saw clients face to face. The 3 and 6 month post-discharge follow-up was undertaken by a trained assessor, or completed by the client on paper (returned by post) and transcribed onto the database. In some Boards, a therapy provider also acted as the case manager; in this situation, case management may have been undertaken face to face.
1.3.2 Data collected
Data were collected on a range of demographic details, as well as the primary (and secondary, if relevant) health conditions with which the clients were presenting. Data on their employment status (at work / off sick) were also recorded. They completed up to three standard, validated health questionnaires during their involvement with the programme. These were:
- EQ-5D . The European Quality of Life - 5 Dimension scale is a standardised instrument for use as a measure of health outcome. It asks responders to rate their health on 5 dimensions (mobility, self-care, usual activities, pain/ discomfort, anxiety / depression). During the course of the programme the tool was changed from the 3-point scale (March 2010 to end December 2011) to the 5-point scale (January 2012 - March 2014). All clients were asked to complete it at entry, discharge, and 3 month and 6 month follow-up. The EQ-5D also includes a Visual Analogue Scale ( VAS) to help people say how good or bad a health state is; clients were asked to indicate on a scale from 0 (worst state they could imagine) to 100 (best state they could imagine) how good or bad "your own health is today in your opinion".
- COPM . The Canadian Occupational Performance Measure asks clients to rate their ability to perform activities which they identify as important to them, and then to rate their satisfaction with their ability to perform these activities. Not all the clients were asked to complete the COPM; a request to complete it was based on the case manager's judgement of the client's condition. Those who completed it were asked to do so at entry and discharge.
- HADS . The Hospital Anxiety Depression Scale asks questions concerning feelings of both anxiety and depression. Again, not all clients were asked to complete it, if it was judged not to be relevant to their condition. Those who completed it were asked to do so at entry and discharge.
In addition, data were also recorded by the service providers concerning the number of services received by clients going through the programme.
1.4 NHS24 MSK pilot study
During the course of the WHSS programme, as part of the National Framework for Rehabilitation, a pilot of a new pathway to improve the management of musculoskeletal conditions in the general population was introduced in NHS Lanarkshire and subsequently extended to some other Health Boards. The revised pathway included telephone access to triage at NHS 24, and referral to self-management resources or revised treatment pathways, in the health service. This pilot was introduced in December 2012 and was for the general population including the employed. It was agreed that clients referred to the NHS 24 MSK pilot programme could be referred into WHSS if they met the WHSS eligibility criterion. This led to a considerable flow of additional cases into the WHSS service which led to the referral criteria for these NHS 24 patients being reviewed due to the extra demand this placed on WHSS; the criteria was changed (from 7 th February 2013) so that only those that were absent could refer to WHSS, to make the number of cases referred via this route manageable within the limited resources.