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

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 [thu].

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."

Professor Ewan MacDonald

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."

Melanie McLean, from Catrine, has rheumatoid arthritis

CASE STUDY: 'I think of my disability now as an asset that drives me on.'

MELANIE McLean was determined that rheumatoid arthritis would not stand in the way of a career.

Although the 39-year-old, from Catrine in Ayrshire, compares the sometimes immobilising pain to "hot pokers" and "electric shocks", the married mother-of-one holds down a full-time job in communications and events with Arthritis Care. Since her condition deteriorated three years ago, she has worked from home.

She said: "For someone like me who has such a fluctuating condition that affects every part of me, working from home has been a godsend. Since returning to work after having my baby, Arthritis Care has been even more flexible with me.

"I work until 1pm and then 7-10pm at night, so I'm still doing my full time hours but in a way that works for me. My boss said 'use the afternoons to self-manage your condition, if you're not feeling great have a lie down' - who would have thought of an employer saying that?"

Mrs McLean was diagnosed with juvenile rheumatoid arthritis aged just eight after a fall in the school gym.

She said: "I fell over and hurt my ankle. I wasn't a big injury, but a few days later I fainted in class and the auxiliary nurse took me home. I fell asleep and when I woke up I couldn't move any part of my body. It was terrifying."

The condition saw her miss huge chunks of schooling while she was bedridden in hospital and a major flare-up during fourth year and secondary school put her Standard Grades on hold, eventually repeating the year. Nonetheless, she gained the qualifications go on to achieve an undergraduate degree in business, despite a complicated hip replacement in 2nd year leaving her to complete most of her study from bed with print outs of the course notes and tape recordings of lectures.

However, she felt nervous about how employers would react to her illness, which can mean relying on a wheelchair.

"It was very fast-paced and I just felt I couldn't fit in, even though I was really good at business and I'd got really good marks at university. It was almost as if I felt that I had to be three times as qualified, three times as good, three times as experienced as everyone else just to be on a par with them. In any application I had to tell employers about my disability and I just felt that would put anyone off employing me."

After completing a postgraduate degree in community development, however, she had a confidence boost after the council where she had completed a voluntary placement took her on as a full-time member of their social services team.

"It was the first time that I realised an employer would be lucky to have me - it was really empowering. It was a revelation to me that despite my physical impairment I absolutely was worth employing. It's about getting that first opportunity - that confidence boost. And because of what I’ve been through, I know I will work even harder and be more determined than an average employee, so I think of my disability now as an asset that drives me on."