Rethinking long-term conditions and disability – why the government's new 'Improving lives' white paper is important

Dr Sara Booth discusses the government's recently published Improving lives: the future of work, health and disability white paper, which sets out policy changes intended to ‘transform employment prospects for disabled people and those with long term health conditions (LTC).'

The new initiative stems from the irrefutable evidence that people living with disability and/or LTC (LTCD) are disadvantaged in
 the workplace and more likely to leave employment ‘as a result of a wide range of barriers and historic injustices’. With increasing numbers of people surviving once-fatal illnesses, accidents or limiting disabilities, there is increasing concern that it is economically essential for people with LTCD to be able to enter and remain in work, rather than claim benefits.

The loss of skills and experience, the limitations on workplace diversity, and the devastating personal impact of losing a career, are also recognised as damaging to society. The NHS is the largest employer in Europe, so these ideas should have particular resonance, particularly for retaining doctors who are expensive to train and whose skills and experience are in short supply.

The white paper is essential reading for anyone involved in caring for doctors with an LTCD and helping them to find ways to stay working in the NHS. It will also help doctors living with an LTCD to understand the range of options they already have for getting ‘adjustments’, to dismantling the barriers that mitigate against their chances of working effectively. The annual RCP wellbeing survey showed that 6% of physicians self-report a condition that requires them to have time off work intermittently.

It will also help doctors living with an LTCD to understand the range of options they already have for getting ‘adjustments’, to dismantling the barriers that mitigate against their chances of working effectively.

Dr Sara Booth, associate lecturer at the University of Cambridge.

The adjustments that may be needed to keep a doctor with an LTCD in work often overlap with those of doctors entering the ‘Indian summer’ of their careers, who wish to continue working. Such adjustments
may be about devising a work pattern with greater flexibility, or a lower level of intensity and/or a predictable, limited workload.

As former RCP Medical Workforce Unit director Dr Harriet Gordon has demonstrated, thinking creatively about how to retain individuals’ skills and experience in the workplace benefits everyone. The difference is implementing these changes for people at an age when most doctors are working at full capacity, and the necessity for the adjustments may be less understood by management and colleagues. Sadly, the little data that we have suggest doctors often feel compelled to hide or minimise their illnesses or the stress, sometimes with tragic results

Fortunately, there are initiatives to tackle the high incidence of addiction, substance abuse, stress and mental health problems in the medical workforce. These services are currently limited in their geographical and professional reach – but they are a start. Two such examples are a recent CPD module from 
the Royal Australian College of Physicians and the NHS’ Practitoner Health Programme.

The problems of doctors living with disabilities and long-term conditions
have not been specifically addressed,
but there are now laws and public policy
 in place that mean a workplace should
be adapted to support an individual’s conditions or disability, rather than the employee struggling on without support. (See the government’s Fit for Work and Access to Work.) The implementation of these adjustments seems to be haphazard with some excellent examples of creative thinking but with gaps elsewhere.

If a specific piece of equipment can overcome a disability it will usually be provided, though there may be delays in its provision. In common with all workplaces, retaining people with fluctuating conditions, particularly invisible ones, seems particularly problematic. Those with rarer illnesses may also struggle to get the appropriate level of specialist occupational health support they require. A change in the pattern of working, with greater flexibility and enforced limits on workload, or how work is delivered, are often more important than equipment. 

Interest is growing for supporting doctors, as seen by the health and wellbeing committee at the RCP, and a GMC work programme to update their guidance on supporting disabled medical students and doctors.

Dr Sara Booth, associate lecturer at the University of Cambridge.

It seems that many doctors with LTCD feel well-supported at medical school or university but struggle to get the same level of support thereafter. There may also be barriers in getting CCTs if trainees cannot reach every competency on a training programme, even if irrelevant to their long- term choice of career. 

Illness can develop at any stage of a doctor’s career but the incidence increases with age. As retirement rates increase, so too will the need to accommodate those with ill-health. There are many careers within medicine, with huge variation in the physical demands that they make – expert career advice at any age to help people find careers compatible with their LTCD could pay dividends. Doctors and their advisers in occupational health and unions are often restricted by their knowledge and ideas about the change possible for people with LTCD. 

Interest is growing for supporting doctors with LTCD, as seen by the formation of the health and wellbeing committee at the RCP, and a GMC work programme to update their guidance on supporting disabled medical students and doctors. 

The medical profession (and the health care system in general) has adapted to the changes necessary to integrate working parents in the workforce, and there are many examples of flexible working patterns providing excellent service provision. Similar learning needs to happen for people with LTCD. There are many reasons why doctors, in the course of a decades-long career, may need periods of flexibility in their working lives, including bereavement and the adjustments that need to follow, illness in spouse, parent or child as well as ill-health.

The workforce that cares for people with LTCD could set a wonderful example for fully integrating those who live with these conditions within it. Flexibility and creativity in workforce planning will be good for everyone, and so will the opportunity to work alongside people who accommodate LTCD in their lives.

Dr Sara Booth is a retired consultant physician and associate lecturer at the University of Cambridge. 

This article, as well as key finding's from the latest survey on consultant wellbeing, appears in April's Commentary magazine.