Back to Work: Laran Chetty and the health and work centre

Robert Millett visits a CSP award-winning occupational health service that provides staff with specialist physiotherapy management and holistic care.

Being at work can be bad for your health. According to statistics released by the Health and Safety Executive (HSE)  more than 28 million working days were lost in the UK last year due to work-related illness and workplace injury.
But one NHS trust in London is successfully tackling this situation with an occupational health service that provides staff with physiotherapy, workplace and ergonomic assessments and a holistic approach to their problems.
The health and work centre is part of the Royal Free London NHS trust. It is located a short walk away from Royal Free London hospital in Hampstead and opened in 2008. Since then it has reduced the hospital’s levels of staff sickness absence due to musculoskeletal disorders (MSDs). This has been achieved by offering a multidisciplinary range of therapies and by promoting a healthy and active lifestyle in every session.
Laran Chetty, a specialist occupational health physiotherapist, has spearheaded the project. He says: ‘The service is about more than just providing an assessment and treatment session. The focus is much broader, as we are also looking at the health and wellbeing of staff and ensuring that they are empowered to manage their work and life.’  
About 10,000 contracted staff at the Royal Free hospital are eligible to use the service, and on average Mr Chetty treats about 5,500 staff a year. 
He says that, in his experience, managers at the trust are more than happy for their staff to take time off to attend the centre. ‘Many of them have been treated here themselves and they know that the return of investment is having less staff off work.’
The centre’s holistic approach to patients has produced clinically effective and cost-saving results for the north London trust.
Data collected shows that the latest return to work outcomes at discharge have seen 89 per cent of patients recommended fit to stay or return to work.
In addition, the centre has seen a 93 per cent improvement in spinal, upper, and lower limb disorders among staff. And there has been a huge drop in the number of staff being re-referred for treatment, reducing from 15 per cent to less than three per cent in the last two years. As a result waiting times for treatments are being cut and the capacity for new patients to be seen at the centre is increasing.
These impressive outcomes were recently recognised by the CSP, with Mr Chetty triumphing in the promoting activity and healthy lifestyle category of the society’s 2014 annual awards.
And because the centre has proven so successful the trust now wants to replicate the model at two other hospital sites.
‘Plans are underway for me to extend the service to Barnet and Chase Farm hospital, so I’m now in the process of setting up a pilot,’ says Mr Chetty.

Empowering patients

The centre’s physiotherapy service was originally introduced to address staff sickness absence due to a high incidence of MSDs in the trust. The initial aim was simply to provide an employee-focused service that would help staff who were struggling to stay at work or return to their duties. 
But the service has gradually evolved and Mr Chetty has developed his role and broadened its focus.
‘I’m always looking for new ways to help people with more than just their health but with their wellbeing as well,’ he says.
‘So now I use a bio-psychosocial model of care and I have the autonomy to have longer sessions with staff, and their managers, in order to address a variety of health and wellbeing issues.’
As a result the service now strives to support staff by not only offering them one-to-one physio assessments and treatment, but by also encouraging them to maintain active and healthy lifestyles. Staff, in turn, can promote the same ideas to their patients, family and friends, and even to the wider community. 
Mr Chetty is part of a multidisciplinary occupational health and wellbeing team, which includes an occupational health physician, a clinical psychologist and occupational health advisers.
Working together they provide staff with a holistic package of care that is designed to treat work-related MSD injuries, address the root causes and encourage positive lifestyle changes that can keep people healthy.
‘The treatment is tailored to what each staff member needs – so there is no traditional format – and is entirely dependent on their needs,’ says Mr Chetty.
‘So if I find that there is a psychological problem involved as well as a physical health problem then I will link in with the psychologist.’
Mr Chetty says a typical day involves carrying out physiotherapy assessments and treatments, attending case conferences, writing management reports and promoting health.
‘I see about 15 new patients a week and the rest is follow-up and meetings with managers, case conferences and ergonomic workplace assessments,’ he says.
‘I look to give up to eight treatment sessions, but if they need more or less we do that. But it averages around four sessions for each patient.’
Like other occupational health clinics the centre treats many patients with lower back pain.
‘And after that the most common type are repetitive upper limb injuries,’ says Mr Chetty.
The centre treats a variety of staff, ranging from trust executives through to doctors, nurses, therapists, managers, office worker, cleaners and domestic staff. 
‘The lower the band the staff member is on, the more physical the role tends to be, and so they often have more physical injuries. Whereas those who are in management tend to be more desk-based. And while they also have MSD injuries they tend to be more stress related.’
Physiotherapists also present with the same MSDs as other people, says Mr Chetty, but they tend to have more hand-related problems, with thumbs and wrists frequently affected.
‘The cause may be their type of work but the trigger could be that their workstation is not set up properly and they are over-reaching or over-stretching,’ he says.
‘So it’s always about trying to find that balance between the cause of the problem and managing the symptoms and the triggers,’ says Mr Chetty. 

Buddy scheme

The centre also links staff into health promotion activities that they can continue with independently.
Staff can be referred on to a range of activities. These include yoga, walking groups, Pilates, counselling and access to support services for personal problems such as debt.
And a buddy system has been established to help connect people, allowing them to offer ongoing mutual support as they take up activities.
Mr Chetty explains: ‘There are some members of staff who have completed an activity and had a positive experience, and they are able to help new staff members who are starting or struggling to complete a programme. 
‘Some staff just find it helpful to speak to someone before they try out the referral we’ve made for them.’
Staff are matched by activity rather than by role. ‘So you could have a senior member of staff supporting a much junior member of staff, or vice versa,’ says Mr Chetty.
‘And sometimes the boundaries of banding and of titles are broken by those interpersonal relationships.’ 
Some of the activity providers are independent, while others are linked to the hospital. As a result some services are free and others are partly subsidised for staff.
‘We have a 24-hour counselling service that is paid for, and an employee assistance programme,’ says Mr Chetty.
‘If someone comes in and they have personal problems, which may not be work related but which do impact on their work – for example debt or marriage problems – then we can refer them to a service that will give them specific advice.’
Mr Chetty says helping people to solve their personal problems reduces the impact they have on work and improves productivity.
‘Outside problems do impact on work and if we don’t address them then we are not truly addressing sickness absence.
‘It’s not just work that causes people to go off sick, people also have personal issues, so we need to be looking at problems holistically and trying to help people manage better.’
Mr Chetty, who picked up his prestigious CSP award at a ceremony in central London last November, adds: ‘And the stretches are really helping too.’ fl

Case study: Maria Lemba

Maria Lemba, a senior occupational health nurse at the trust, recently self-referred to the centre as a patient. 
‘I was having shoulder, neck and back pain,’ she says.
‘Laran did a workstation assessment and found it was because I was using my phone without a headset. So I had a course of acupuncture, and five sessions of back treatment exercises.’
As well as providing Mrs Lemba with a headset Mr Chetty also identified other issues relating to her workstation, so a footstool was ordered and she received a new chair.
He also showed her how to complete a set of daily stretching exercises, which she now performs three times a day.
‘My first acupuncture session was on a Friday and by the Monday I was feeling much better,’ says Mrs Lemba. ‘And the stretches are really helping too.’
Robert Millett

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