6 Conclusions and recommendations
Over 13,000 cases contacted the service over a 4 year period, with 11,748 actually entering the programme. Cases are broadly thought to represent the demographics of workers in Scotland, although there are a greater proportion of older workers (>50) than in the working population. The number of cases managed in Board areas ranged from over 3,500 in Lanarkshire (although this included some cases from other Board areas) to 52 in Highland.
The findings of the evaluation indicate that the programme has had a positive benefit for cases, with all health measures showing a significant improvement and the qualitative feedback being very positive. Of the sample where data are available, 75% of cases were at work at entry and remained at work throughout the programme, while 18% (1,188) were absent at entry and had returned to work by the time they were discharged. At discharge, 85% thought that the service had helped them remain in work or return to work more quickly than if they had not had the service.
The analysis related to duration of sickness absence showed that older cases and cases with a mental health condition took longer to return to work. The cases that had been on sick leave for a longer time prior to entering the programme also took longer to return to work during the intervention.
The improvements in health and ability to work appear to be sustained at least 6 months after discharge from the programme.
The following recommendations are made for any future national service delivery with similar aims:
1. The continuance of an early intervention case managed service for individuals struggling at work or off work due to a health condition is supported by the results of this evaluation.
2. Seek to recruit a greater number of cases with mental health conditions into the service.
3. Encourage early access to the service, as there is evidence that those with shorter periods of absence before contacting the service returned to work more quickly.
4. Monitor the number of therapeutic sessions being provided, and refer those receiving a higher number to other support services.
5. Reduce variability in the service delivery model between Board areas to ensure equity of evidence based provision across Scotland.
6. Establish quality standards for the intervention process, which are subject to audit to ensure consistency of service delivery.
7. Ensuring timely discharge from the service and completion of the full discharge paperwork would allow the effect of any programme to be better evaluated.
8. Consider phased introduction of a service, which would allow for observing a control population receiving usual care.
9. Any new service would benefit from continuous quality improvement processes in place so that improvements in efficiency and effectiveness are introduced on an ongoing basis.