The National Institute for Health and Clinical Excellence (NICE) recently published guidance to the NHS on the most effective ways of treating people suffering from non-specific low back pain, which has lasted for more than six weeks but less than 12 months.
The scale of the ‘back’ problem is quite apparent. The Chartered Institute of Personnel & Development (CIPD) annual survey report 2008 considers the main causes of long term absence, which is defined as anything longer than four weeks. In the case of manual workers 55.2% of employers cited back pain as a leading cause of absence and for non-manual workers the figure was 41.7%. This possibly goes some way to explaining why NICE has issued formal guidance aimed at addressing the negative impact this condition could have on individuals, employers and society, as well as the cost to the benefits system.
DELIVERY DOUBTS
Sceptics of the guidance may argue that this is a way of directing patients to lower cost and potentially less effective (or certainly not proven) treatments. They will also no doubt question whether the NHS has the resources and capability to deliver this type of service consistently and indeed whether a multi-disciplinary approach to interventions would be a more effective way of managing the treatment and rehabilitation process.
However, with the government policy objective of allowing individuals to access the right type of treatment as quickly as possible it is clearly right and proper that the NHS applies a consistent clinical approach to treating low back pain. It is not too contentious to suggest that early and accurate diagnosis followed by treatments that are tailored to an individual’s needs is the right way to go as this is the most effective way of ensuring that low back pain does not become a chronic condition. Indeed, access to treatment quickly could help prevent individuals spiralling into a psychological decline.
From a healthcare and risk benefits perspective, providers are already well aware of the negative impact back disorders can have on both short and longer term absence. Whether demand for treatment escalates, particularly under private medical insurance arrangements remains to be seen. It could be the case that there are more claims for treatments, such as acupuncture and osteopathy, although this will no doubt be dependant on whether the scheme includes such complementary therapies, as some contracts will and some will not.
Demand for treatment may also be dependant on whether access to treatment is quicker via the NHS or private route. The NICE guidance is light on detail in terms of how quickly and effectively the services can be accessed on the NHS.
INSURERS LEAD THE WAY
Some providers already seem well placed to help individuals deal with this condition. For example, Aviva offers their corporate private medical insurance clients with access to their Back Up service. This service effectively means that individuals suffering from a back condition can by-pass their GP and access a rehabilitation service offering clinical advice and support. Being able to inform and educate individuals about their condition and providing them with quick access to treatment if required should undoubtedly be beneficial to both the employer and employee in terms of keeping the employee in work or getting them back to work quicker.
It is not just the healthcare providers that are switched on to the back issue. Legal & General offers a ‘Back to basics’ approach to musculoskeletal conditions, which can include treatments such as pain management clinics, physiotherapy, functional capacity evaluations and cognitive behavioural therapy. Utilising this type of service should in theory give the individual suffering with a musculoskeletal type condition the best possible chance to return to work as quickly as possible.
THE PSYCHOLOGICAL COMPONENT
In addition to clinical treatments, the NICE guidance (and both of the examples above) recognises the importance of behavioural therapies. There is often a psychological impact associated with this type of condition and it is important that providers in the risk and healthcare market, and indeed employers, acknowledge this. Offering treatments that address both the clinical and behavioural aspects of the condition should support the rehabilitation process and linking an employee assistance programme (EAP) into the process, or providing access to cognitive behavioural therapy, could be an effective way of providing the behavioural component.
The challenge to all risk and healthcare providers is to offer these types of services, or at least be able to signpost individuals to relevant services, so that employees can access the right type of treatment and receive the right type of advice as quickly as possible.
The challenge for intermediaries is to ensure that employers are aware of the services available from their provider so they can utilise them as appropriate, possibly in accordance with any occupational health services they currently have, and ideally keep people in work, even if it is at a reduced capacity, or get them back to work as quickly as possible.
BACK PAIN IN NUMBERS
Low back pain affects around one-third of the UK adult population each year
Back pain costs nearly five million working days a year in the UK
75% of GPs say back pain is one of the top three conditions for which they write sick notes for absences of seven days or more
84% of people with back pain return to work by the end of four weeks of sickness absence