By Tracey Ward, Head of Business Development & Marketing at Generali UK Employee Benefits
Over 2 million people in the UK with self-reported Long Covid have now had symptoms for at least a year. It can present significant challenges in the workplace because, unlike with long-term conditions such as cancer and diabetes, the prevalence rates for Long Covid are greatest in the working age population (35-69 years). It can also present significant challenges – for the healthcare sector and the workplace – because the symptoms can be many and varied, also physical and psychological. So, the question is, will Long Covid encourage all of us – insurers, wellbeing providers, practitioners, employers and government – to reimagine the long-term condition support we provide to employees? This is the question we posed to our two experts as part of a recent podcast.*
It’s an incredibly timely question, considering the current UK government focus on the ‘economically active’, with those on long-term sick leave a big part of that focus, as set out in the Health & Disability White Paper that accompanied the 2023 Spring Budget. Latest statistics reveal that half a million more people (2.5m in 2022) are out of the UK labour force because of long-term sickness than they were before the pandemic (2m in 2019).
The long-term condition problem: at all ages
Around 15 million people in England alone have a long-term condition – that’s a condition that has to be managed with drugs or treatment, such as diabetes, heart disease, stroke or cancer. And the number of people with multiple long-term conditions (multi-morbidity) is ever rising. Two thirds of adults aged over 65 are expected to be living with multiple health conditions by 2035; bringing with it rising demand for prevention and management.
Some conditions are obviously much more prevalent than others at working ages. All arguably demand a joined-up physical/psychological focus and, potentially, bespoke interventions. There is definitely no room for one size fits all approach.
So, what are the trends, the latest thinking in support, and the barriers to progress? Here are some key insights from our experts; Dr Julie Denning, Managing Director & Chartered Health Psychologist at Working To Wellbeing and Chair of the Vocational Rehabilitation Association. Also, Generali UK’s early intervention and rehabilitation expert Kay Needle.
Tracey: You’re both speaking directly with clients, so what long-term condition trends are you seeing right now?
Kay: What hasn’t really changed for us much over the last decade are the most common causes of workplace absence: mental health, musculoskeletal and cancer. But we have seen a few things emerging over the last two to three years. Obviously Long Covid has been a big, big part of that. But I think what we’re all poor at is talking about the relationship between our mental wellbeing, our physical wellbeing and other health conditions. Workplace absences are recorded in siloes. Support is consequently provided in siloes.
Julie: I think the NHS can be siloed too. It deals with one illness, but doesn’t necessarily think across different illnesses. That was one thing that came up with the initial discussions around Long Covid: one of the guidelines saying we need to be thinking much more about a joined-up approach because Long Covid was affecting so many different parts of the body.
There’s most definitely a need to trend towards viewing physical and mental health in an interconnected way. With cancer, for example, the individual might be type one diabetic. Or you might have someone who has persistent pain, but they also experience mental ill health. You might have someone with Long Covid who’s had a diagnosis of lymphoma prior to this. You know, you’ve got all these different things coming into play. So you need to be taking a really individualistic approach, when it comes to assessing how to help people improve their functionality.
Tracey: Is it fair to say that the focus – at least by the media, and perhaps also (because of the media) by employers – is on Long Covid, when this might be less of a problem than some other long-term conditions?
Kay: The thing with Long Covid is that it’s affecting people between the ages of 35 to 49 more than any other age group. This will undoubtedly be contributing to the rise in economic inactivity that the UK government is quoting, with thousands of people having left employment due to Long Covid. And the thing is, we don’t know how long it’s going to be with people for, whereas when we’re supporting someone with cancer, for example, there’s a fairly clear timeline for cancer treatment. It might be 18 months or even two years but there tends to be an endpoint. Also, it’s worth bearing in mind that while cancer might be more prevalent – with an estimated 3 million people living with cancer in the UK right now – incidence rates for all cancers combined are highest in people aged 85 to 89. Annually, more than a third of all cancer cases in the UK are diagnosed in people aged 75 and over. So prevalence might be higher than Long Covid but it’s impact on the workplace is less so.
The same goes for diabetes, another big long-term condition. It is estimated that more than 5 million people in the UK are living with diabetes. But, again, evidence shows an association between age and higher diabetes prevalence, with an estimated third of all diabetes diagnoses in adults aged 65 or over.
Julie: And everyone experiences Long Covid in a different way as well. So a lot more research needs to go into understanding it. Early intervention is key to improving the likelihood of a return to work, wherever possible.
Kay: I think that’s really key. It isn’t financially practical – or necessarily good for your health and wellbeing – to say that you’re just not going to work at all for 1-2 years or more. We’re seeing that a lot of people with Long Covid do have some work capacity, so they don’t need to be fully out of work. But then it’s a case of how employers manage that conversation around what the employee can do safely, sustainably and realistically. It’s about work being seen as part of the rehabilitation journey and how we support employers to achieve that.
Tracey: So, what is the latest thinking in terms of workplace support for people with long-term conditions?
Julie: I think we’re a long way off that yet, because I think the conversation has been dominated by a focus on musculoskeletal conditions and mental health. These might also be considered long-term conditions, but have well evidenced support pathways now available in each instance. I don’t think Long Covid has fully hit the employer radar yet. And, to be fair, it’s not surprising considering the massive shift in thinking and working that we’ve only just gone through as part of the Covid-19 pandemic. I think a focus on Long Covid will require employers to pivot their thinking again, to turn sickness absence policy on its head and really look at what the individual needs, rather than having a policy that’s for the whole population. One size simply doesn’t fit all when it comes to long term conditions.
Kay: I agree. And I think as an insurance industry we’ve got a role to play in helping employers view all the pathway support available to them via a product like group income protection, in a joined-up way. We need to help them integrate existing support with Occupational Health, for example, and help HR and people managers understand how to empower individuals to take ownership of their own health and wellbeing. Because, with long-term conditions, it’s not just about putting in place an intervention, returning someone to work and then moving on. They are going to continue to struggle, with fluctuating symptoms, throughout their career. So, an ongoing and open dialogue across employees, employers, Occupational Health and insurers is really key.
*To listen to the full 30-minute #Wellbeing360 podcast, entitled ‘Episode 7: From long term conditions to multi-morbidity’, download it for free here https://www.generali.co.uk/Media/Podcasts.html
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