Search

Objective: To explore the patterns of sickness absence in National Health Service (NHS) staff attributable to mental ill health during the first wave of the Covid19 epidemic in March to July 2020 Design: Case-referent analysis of a secondary data set Setting: NHS Trusts in England Participants: Pseudonymised data on 959,356 employees who were continuously employed by NHS trusts during 1 January 2019 to 31 July 2020 Main Outcome Measures: Trends in the burden of sickness absence due to mental ill health from 2019 to 2020 according to demographic, regional and occupational characteristics. Results: Over the study period, 164,202 new sickness absence episodes for mental ill health were recorded in 12.5% (119,525) of the study sample. There was a spike of sickness absence for mental ill health in March-April 2020 (899,730 days lost) compared with 519,807 days in March and April 2019; the surge was driven by an increase in new episodes of long-term absence and had diminished by May and June 2020. The increase was greatest in those aged >60 years (227%) and among employees of Asian and Black ethnic origin (109%-136%). Among doctors and dentists the number of days absent declined by 12.7%. The biggest increase was in London (122%) and the smallest in the East Midlands (43.7%); the variation between regions reflected the rates of Covid19 sickness absence during the same period. Conclusion: Although the Covid19 epidemic led to an increase in sickness absence attributed to mental ill health in NHS staff, this had substantially declined by May and June 2020, corresponding with the decrease in pressures at work as the first wave of the epidemic subsided.

Objective To quantify occupational risks of Covid-19 among healthcare staff during the first wave of the pandemic in England Methods Using pseudonymised data on 902,813 individuals continuously employed by 191 National Health Service trusts during 1.1.19 to 31.7.20, we explored demographic and occupational risk factors for sickness absence ascribed to Covid-19 during 9.3.20 to 31.7.20 (n = 92,880). We estimated odds ratios (ORs) by multivariate logistic regression. Results With adjustment for employing trust, demographic characteristics, and previous frequency of sickness absence, risk relative to administrative/clerical occupations was highest in additional clinical services (a group that included care assistants) (OR 2.31), registered nursing and midwifery professionals (OR 2.28) and allied health professionals (OR 1.94), and intermediate in doctors and dentists (OR 1.55). Differences in risk were higher after the employing trust had started to care for documented Covid-19 patients, and were reduced, but not eliminated, following additional adjustment for exposure to infected patients or materials, assessed by a job-exposure matrix. For prolonged Covid-19 sickness absence (episodes lasting >14 days), the variation in risk by staff group was somewhat greater. Conclusions After allowance for possible bias and confounding by non-occupational exposures, we estimated that relative risks for Covid-19 among most patient-facing occupations were between 1.5 and 2.5. The highest risks were in those working in additional clinical services, nursing and midwifery and in allied health professions. Better protective measures for these staff groups should be a priority. Covid-19 may meet criteria for compensation as an occupational disease in some healthcare occupations.

Objective To explore impacts of the COVID-19 pandemic on patterns of sickness absence among staff employed by the National Health Service (NHS) in England. Methods We analysed prospectively collected, pseudonymised data on 959,356 employees who were continuously employed by NHS trusts during 1 January 2019 to 31 July 2020, comparing the frequency of new sickness absence in 2020 with that at corresponding times in 2019. Results After exclusion of episodes directly related to COVID-19, the overall incidence of sickness absence during the initial 10 weeks of the pandemic (March-May 2020) was more than 20% lower than in corresponding weeks of 2019, but trends for specific categories of illness varied. Marked increases were observed for asthma (122%), infectious diseases (283%) and mental illness (42.3%), while reductions were apparent for gastrointestinal problems (48.4%), genitourinary/gynaecological disorders (33.8%), eye problems (42.7%), injury and fracture (27.7%), back problems (19.6%), other musculoskeletal disorders (29.3%), disorders of ear, nose and throat (32.7%), cough/flu (24.5%) and cancer (24.1%). A doubling of new absences for pregnancy-related disorders during 18 May to 19 July of 2020 was limited to women with earlier COVID-19 sickness absence. Conclusions Various factors will have contributed to the large and divergent changes that were observed. The findings add to concerns regarding delays in diagnosis and treatment of cancers, and support a need to plan for a large backlog of treatment for many other diseases. Further research should explore the rise in absence for pregnancy-related disorders among women with earlier COVID-19 sickness absence.

BACKGROUND: Chronic pain is a common cause of health-related incapacity for work in the UK. Individualised Placement and Support (IPS) is a systematic approach to rehabilitation with emphasis on early funded work placement. It is effective in helping people with severe mental illness to gain employment but has not been tested for chronic pain. OBJECTIVE: To inform the design of a definitive randomised controlled trial to assess the effectiveness of IPS for people unemployed due to chronic pain. METHODS: A mixed methods feasibility study comprising qualitative interviews and focus groups with key stakeholders, alongside a pilot trial. STUDY PARTICIPANTS: Health care professionals from primary care (PCPs), Employment Support Workers (ESWs), employers, clients who participated in an IPS programme, individuals aged 18-64 years with chronic pain unemployed for at least three months. INTERVENTION: An IPS programme integrated with a personalised, responsive pain management plan, backed up by communication with the GP and rapid access to community-based pain services. OUTCOME(S): Stakeholder views about a trial and methods of recruitment. The feasibility and acceptability of the IPS intervention, study processes (including methods to recruit participants from primary care, training and support needs of the ESWs to integrate with pain services, acceptability of randomisation, Treatment As Usual (TAU) comparator) and scoping of outcome measures for a definitive trial. RESULTS: All stakeholders viewed a trial as feasible and important and saw the relevance of employment interventions in this group. Using all suggested methods, recruitment was feasible through primary care but slow and resource-intensive. Recruitment through pain services was more efficient. Fifty people with chronic pain were recruited (37 from primary care and 13 from pain services). Randomisation was acceptable: 22 were allocated to IPS and 28 to TAU. TAU was found acceptable. Retention of TAU participants was acceptable throughout 12-months. However, follow-up of IPS recipients using postal questionnaires proved challenging, especially when the participant started paid work, and new approaches would be needed for a trial. Clients, ESWs, PCPs and employers contributed to manualisation of the intervention. HARMS: No adverse events were reported. CONCLUSION: A definitive trial is not feasible if recruitment is through primary care until employment status is collected systematically or linkage of employment and healthcare databases is possible. The trial may be possible through pain services but clients may differ. Retention of participants proved challenging and methods for achieving this would need to be developed. The intervention has been manualised.

BackgroundWide international variation in the prevalence of disabling low back pain (LBP) among working populations is not explained by known risk factors. It would be useful to know whether the drivers of this variation are specific to the spine or factors that predispose to musculoskeletal pain more generally.MethodsBaseline information about musculoskeletal pain and risk factors was elicited from 11 710 participants aged 20–59 years, who were sampled from 45 occupational groups in 18 countries. Wider propensity to pain was characterized by the number of anatomical sites outside the low back that had been painful in the 12 months before baseline (‘pain propensity index’). After a mean interval of 14 months, 9055 participants (77.3%) provided follow‐up data on disabling LBP in the past month. Baseline risk factors for disabling LBP at follow‐up were assessed by random intercept Poisson regression.ResultsAfter allowance for other known and suspected risk factors, pain propensity showed the strongest association with disabling LBP (prevalence rate ratios up to 2.6, 95% CI: 2.2–3.1; population attributable fraction 39.8%). Across the 45 occupational groups, the prevalence of disabling LBP varied sevenfold (much more than within‐country differences between nurses and office workers), and correlated with mean pain propensity index (r = 0.58).ConclusionsWithin our study, major international variation in the prevalence of disabling LBP appeared to be driven largely by factors predisposing to musculoskeletal pain at multiple anatomical sites rather than by risk factors specific to the spine.SignificanceOur findings indicate that differences in general propensity to musculoskeletal pain are a major driver of large international variation in the prevalence of disabling low back pain among people of working age.