UnumProvident Centre for Psychosocial and Disability Research Newsletter

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UnumProvident Centre for Psychosocial and Disability Research

Inside • Introduction • Update • Events Summary • Research Updates • Staff Focus • Publications • Forthcoming Events • Working with Partners • The Biopsychosocial Model



Introduction Dr Peter Dewis, UnumProvident The UnumProvident Centre for Psychosocial and Disability Research at Cardiff University was launched in July 2004. Much of the first year was spent recruiting staff and fitting out the premises. Midway through 2005, the team embarked on an exciting research programme. Some of the details of this are set out later in this bulletin, but essentially a comprehensive programme is underway to investigate the way that the common health problems, which underlie much of today’s sickness absence, affect people in everyday life. From this we will get a much better understanding of why some people return to work promptly, while others with apparently the same medical problems, become long term sickness absentees. By its very nature, high quality academic research takes a long time to deliver its full benefits. This does not mean that the centre has not been very active in a number of other areas. The events summary on page three indicates the way in which key members of the unit have been involved in a variety of conferences and symposia. It is through events like these that the body of informed opinion on any subject is taken forward. I hope that you were able to attend at least one of these events and that you found it of interest. If you have not received details of them in the past and would like to, please forward your details to Pauline Waters on 01306 873283. I think it is true to say that without the academic debate stimulated by the Unit, we would not have developed our thinking on the bio-psychosocial model of illness in the way we have. Without this developing understanding, we would not have been in a position to make the changes we did to our claims team structure in November. The brochure we sent out to announce these changes entitled “Evolving” gives much more information about the bio-psychosocial model. We have received a very positive response to making these changes and I believe they are among the first positive fruits of our partnership with Cardiff.


There are a couple of other areas of activity I would like to highlight. The Unit has been heavily involved in the issue of GP certification of sickness absence. All those concerned with understanding how long term sickness can affect individuals and employers will know how important this issue is. The article by Debbie Cohen describes some exciting work done in relation to GP training which will be able to help them deal with this difficult problem. We have great hopes that this developing training package will be taken up widely by the medical profession. I was also delighted that the Unit have been asked to participate in Cardiff University’s Undergraduate Medical examination to Cover Sickness Certification. This is the first time this subject has been included on an undergraduate training course and I hope it is a lead which will be followed by other universities. Professor Mansel Aylward, the Unit’s director, along with Professor Gordon Waddell, recently published a seminal academic work entitled “The Scientific and Conceptual Basis of Incapacity Benefit”. This work explores the rationale for the way we should approach the payment of state benefits to sick and disabled people. The thinking behind this work has been influential in dictating the shape of the government’s recent programme of welfare reform and is an indication of the high regard in which the Unit is held. I hope you will find something of interest in the bulletin. I intend this to be a regular feature of our developing partnership with Cardiff University which will keep you abreast of the way our understanding of the biopsychosocial field develops. We are confident that new ways of approaching sickness absence will emerge which will enable us to help more and more people keep their dreams and ambitions alive by being able to return to productive and fulfilling working lives.

Psychosocial and Disability Research

Update Media Media interest in the UnumProvident Centre for Psychosocial and Disability Research has been growing and the Director, Professor Mansel Aylward, has given many television, print and radio interviews. He recently appeared on BBC Wales’s “am/pm” politics programme to comment on the EU Presidency Conference on Economic Inactivity & Ill Health, held in Cardiff on 23-24 November 2005. This sparked more press interest, especially in The Western Mail, the likes which can be seen at: http://icwales.icnetwork.co.uk/0300business/0100news/ The debate around measuring happiness was taken up by the media with gusto, as Mansel was interviewed for comments he made, claiming people were “happier in the depression”: http://icwales.icnetwork.co.uk/0100news/0200wales/ It is with great pleasure that we welcome Dr Jonathon Gray back to Wales and to the UnumProvident Centre for Psychosocial and Disability Research. Jonathon was previously at the Institute for Healthcare Improvement (IHI) at Harvard University, Boston, and is now in the preliminary stages of establishing an IHI in Wales with our partner organisations, Cardiff University and the Wales Centre for Health. We also welcome Katie Price as Research Secretary and Eleanor Higgins as Secretary. To find out more about the activities of the Centre and any breaking news, visit http://www.cardiff.ac.uk/psych/ cpdr/index.html

Events Summary The UnumProvident Centre at Cardiff has been well represented at various conferences, meetings and speaking engagements: UK Welsh NHS Confederation Annual Conference, Cardiff: Mansel held a session entitled, ’C’mon along, let’s get happy!’ This presentation and interactive

session looked at how happiness in the Western World has not improved since 1950 in the face of greater prosperity and healthcare and asks, “why not?” What are the effects of happiness on health, work, and family relationships? Pathways to Work Conference, Cardiff: Organised with the RSM, Mansel gave a speech on the Pathways initiative which he originally developed during his time as Chief Medical Adviser at the Department for Work & Pensions (DWP). Sharing Best Practice in Pain Management, Bath: Mansel gave an overview of current approaches to Pain Management. This two day conference addressed many Hospital Trust and Pain Consultants from across the UK. EU Presidency Conference on Economic Inactivity and Ill Health - Challenges and Solutions, Cardiff: Mansel was one of a number of members who held discussion workshops around issues of challenges to communities, approaches adopted and collaborations formulated. Reforming Incapacity Benefit Conference, London: Mansel participated in an initial panel discussion chaired by Lord Archie Kirkwood, former Chair of the DWP select committee, before giving a talk on ‘Challenging the path to inactivity and occupational rehabilitation’. UnumProvident’s Chief Medical Officer, Professor Michael O’Donnell, also presented at this event. The Cardiff Institute for Society, Health & Ethics (CISHE) Conference, Cardiff: Mansel delivered the welcome address of the conference on developing an ethical framework for public health. An Ergonomics and Rehabilitation Conference was held in Nottingham in November to bring together practitioners and clinicians in order to share expertise. Mansel was invited to speak on health problems related to Incapacity Benefit. Europe Mansel was invited by the Catholic University of Leuven, Belgium, to deliver the key note lecture at the launch of the University’s academic training programme in insurance and disability medicine.



Research Updates Dr Rhiannon Buck & Maria Barnes: Common Health Complaints The Centre’s current main area of research is an ongoing programme of investigation into the bio-psychosocial aspects of common health complaints (CHCs) and their perceptions. Rhiannon Buck and Maria Barnes have been compiling a literature review on CHCs and symptom perception, and developing an in-depth research programme. This study will to explore perceptions around CHCs: why do some people with common health complaints not recover as expected? Why do people with similar symptoms choose different courses of action? Phase I: Maria Barnes Phase I runs until February 2006, and involves conducting a series of focus groups to gather qualitative information on public perceptions of what common health complaints are and what people do about them, particularly in terms of seeking information and advice, and their effect on psychosocial functioning, including work and sickness absence. For CHCs, personal factors are not simply secondary contextual influences, but rather an integral part of how the condition is perceived. These perceptions – by the individual, their family, health professionals, employers and co-workers – influence behaviour. Phase II: Rhiannon Buck Phase II will begin in spring 2006 and will involve a large scale survey designed to identify psychosocial predictors of responses to symptoms of CHCs, particularly in identifying risk factors for chronicity. The ultimate aim of this project is to develop a clinical screening tool for psychosocial risk factors for use in general practice and occupational health settings that will identify individuals at risk of developing problems with CHCs so that they can be targeted for early, appropriate, and effective interventions. 4

Professor Michael O’Donnell, UnumProvident’s CMO comments: “We will be able to identify those likely to need intensive rehabilitation support and develop more effective ways of developing this.” Dr Debbie Cohen: Sick Note or Bust Dr Debbie Cohen has been conducting a seminal study on the GP consultation around fitness for work. This project, funded by the Department for Work & Pensions, has been running since September 2004 and has focused on the development of a learning programme informed by Motivational Interviewing and the construction and evaluation of the learning programme. Phase I was completed in May 2005 and was constructed using action research methodology involving five focus groups of 8 GPs each. The main themes that evolved from these focus groups included: that the consultation was often dysfunctional and did not follow best practice; to improve the consultation GPs needed to ‘stand back’; ‘put the patient centre stage’ and move away from a ‘defensive negotiation’ mode. This data was then used to construct Phase II of the project; a web-based learning programme for GPs. A ‘Sick Note or Bust’ interactive CD has been developed and copies produced ready for the project’s next stage. A website has been created to allow evaluation of the project and attitudinal change of GPs to the fitness for work consultation. The evaluation consists of a scenario based questionnaire in which GPs will be asked to comment on their attitudes to the fitness for work scenarios pre and post intervention. Michael O’Donnell comments: “This research is an important first step in developing a real collaborative approach with claimants’ GPs to ensure we are doing all we can to help them.” The CD is being sent to GP Deaneries across the UK and over the next 4 to 5 months we hope to recruit up to 150 GPs nationwide. If you would like to look at the website just log on to www.snorb.co.uk

Psychosocial and Disability Research

The Biopsychosocial Model By Professor Mansel Aylward CB Professor Mansel Aylward recently retired as the Department for Work and Pensions’ Chief Medical Adviser to take up the Chair at the UnumProvident Centre for Psychosocial and Disability Research at Cardiff University. Professor Aylward fully endorses the Biopsychosocial Model of disability which UnumProvident uses in disability assessments. Why is it that in disability assessment medicine we see two individuals, the same age and with the same illness or pathological condition, but with very different resulting levels of disability? How, as medical disability analysts, do we assess the level of disability in people with conditions whose effects are predominantly or wholly subjective? People with “medically unexplained symptoms” – conditions for which there is limited or no recognised pathological basis, such as chronic fatigue, fibromyalgia, chronic low back pain – feature regularly in disability assessments for state benefits. How do we evaluate and reasonably validate the functional limitations that affect people with such conditions? As doctors, most of us have been brought up on the biomedical model of disease and disability, in which we expect symptoms to be underpinned by demonstrable pathological change and tangible clinical findings. How do we resolve the apparent paradox of symptoms that cannot be explained, because there are no pathological features or clinical signs? Understanding Understanding the Biopsychosocial Model helps us. What the Biopsychosocial Model of disability says is that disability is influenced not just by health-related factors, but also by personal beliefs, attitudes, and behaviour; and by the societal environment in which the person lives. So, a person’s level of disability can be influenced by his or her beliefs, for example: ‘If I’m active my back hurts, and that must be causing even more damage, so I’d better rest’. Or alternatively: ‘I know that being active will tire me, but just sitting around isn’t doing me any

good either, so I’ll plan an activity programme that I can cope with’. Biopsychosocial factors can aggravate or prolong disability – they can act as obstacles to recovery. They can also act as barriers to work. ‘I couldn’t go back to work, my job involves standing all day and I can’t manage it, and I ’m not trained to do any other sort of work.’ It’s important to recognise that such people aren’t malingering: they genuinely believe activity/work will be detrimental to them. There is a growing conceptual and evidence base for the effectiveness of applying the Biopsychosocial Model in addressing people’s attitudes and beliefs. A significant strand of the government’s proposed reform of Incapacity Benefit is based on engaging with people to help them understand their beliefs about themselves and their condition, to minimise those beliefs and behaviours that are creating obstacles to recovery, and to maximise positive coping strategies. Evidence The key to using the Biopsychosocial Model to assess disability is to consider and weigh all the evidence, objective and subjective, including the influence of the person’s attitudes and beliefs on their behaviour. Positive beliefs and attitudes will tend to minimise disability – negative ones will tend to increase it. As always, the key is to check whether the evidence is consistent, in accordance with the principles of disability assessment, given the circumstances of the individual in question. The Biopsychosocial Model also recognises the close links between poor health, disability, personal beliefs and attitudes, social disadvantage, and poverty. There’s strong scientific evidence that many of the common health problems which manifest themselves largely through subjective symptoms are manageable, and long-term incapacity is not inevitable, provided people are given the right opportunities, support and encouragement. By incorporating the Biopsychosocial Model into disability assessment, we can identify critically important information on obstacles to recovery, which in many cases can be tackled by an integrated package of support such as that offered in the Pathways to Work pilots and as provided by UnumProvident’s Claims Management and Rehabilitation Services.



Forthcoming Events January 2006 A launch party for Gordon Waddell & Mansel Aylward’s new book, “The Scientific and Conceptual Basis of Incapacity Benefit” will be held on Tuesday 31st January at the Savoy. February 2006 The annual University of Manchester seminar series will focus on strategies to get people back to work, at which Professor Mansel Aylward will be giving a presentation on vocational rehabilitation. March 2006 A conference on Happiness, Wellbeing, Health & Work is being planned as a result of the significant press interest following comments made by Professor Mansel Aylward that people were happier in the 1930s.

Working with Partners We have collaborated with various partners in many recent and on-going research projects, such as Cardiff University, the Wales Centre for Health, the Royal Society of Medicine (RSM) and Swansea and Keele Universities. These collaborations have raised the profile of the UnumProvident Centre for Psychosocial and Disability Research and continue to contribute to its reputation as a centre of expertise and knowledge. The Wales Centre for Health (WCfH) is a Welsh Assembly sponsored public body established to promote better health for the people of Wales. Its remit covers training and education of the public health sector, communicating with the public and undertaking research in order to positively effect a step change in the health of the people of Wales. Mansel was elected Chair in November 2004 and several areas of collaboration have ensued. Well-being in Work (WiW) is a collaborative research project with Swansea and Keele Universities, and the Wales Centre for Health, and has been developed in partnership with local organisations in Merthyr Tydfil. Its aim is to investigate the relationship between health and work, focusing on the impact of health and psychosocial factors on both performance at work and sickness absence. In the latter stages of the project, strategies for rehabilitation will also be explored. As Academic Sub-Dean for Wales, Professor Mansel Aylward works very closely with the Royal Society of Medicine (RSM). Recently, Mansel chaired various sessions in the Pathways to Work conference, as well as regularly attending RSM Council and Finance committee meetings, events and conferences. Following the short presentation made to Lord Philip Hunt of Kings Heath, Minister for Work and Pensions, Dr Debbie Cohen has been invited to present her work to Margaret Hodge, Minister of State at the Department for Work & Pensions with responsibility for Work.


Psychosocial and Disability Research

Staff Focus Katie Webb, 25, previously ran her own successful interior design business in Somerset before coming to Cardiff. Yet, after voluntary work in South Africa with children with cerebral palsy and teaching art to adults with learning disabilities, she felt the need to test herself academically and so returned to higher education.

Publications Waddell, G. & Aylward, M. (2005) The Scientific and Conceptual Basis of Incapacity Benefit. The Stationary Office, London.

Katie joined us as a Research Secretary on 1st November 2005. She is currently studying towards an MSc in Social Science Research Methods from Cardiff University where she was previously awarded a BA (Hons) in Education, accredited by the British Psychological Society. Katie’s work mainly involves supporting Maria Barnes and Rhiannon Buck in the development of a contacts database for the research and in the implementation of the CHCs focus groups for Phase I.

Halligan, P.W., & Wade, D.T. (Eds.) (2005). Effectiveness of Rehabilitation for Cognitive Deficits. Oxford University Press, UK.

On the work the UnumProvident Centre for Psychosocial and Disability Research carries out, Katie is very enthusiastic, stating, “the research we’re conducting here is so exciting because it has real influence and can actually make a difference to people’s lives.” She adds, “making condition management and vocational rehabilitation more accessible to people is a worthwhile cause and I’m very happy to be a part of it.”


• Professor Mansel Aylward CB – Director* • Professor Peter Halligan – Associate Director • Professor Gordon Waddell – Honorary Professor • Dr Debbie Cohen – Senior Medical Research Fellow • Dr Rhiannon Buck – Research Fellow* • Maria Barnes – Research Fellow* • Louise Morris – Administrator* • Joanne Menzies – Media Officer & Diary Secretary • Katie Webb – Research Secretary • Eleanor Higgins – Secretary

*Sponsored by UnumProvident


Newsletter Unum Limited, trading as UnumProvident, is authorised and regulated by the Financial Services Authority. Registered in England 983768. Registered office: Milton Court, Dorking, Surrey RH4 3LZ. Tel: 01306 887766 Fax: 01306 881394 Textphone: 01306 887784


Please note that telephone conversations and e-mail communications may be monitored from time to time for the purposes of training and in the interests of continually improving and developing the quality of the service we provide. Copyright Š Unum Limited 2005

UP1129 04/2006

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