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Transcript – Programme 8: Work and Benefits

Is work good for us? We dis­cuss work­ing with chron­ic pain and the ben­e­fits system

To lis­ten to this pro­gramme, please click here.

In the wake of the government’s intro­duc­tion of the Employ­ment and Sup­port Allowance (ESA) which will see all peo­ple already on inca­pac­i­ty ben­e­fits reassessed for their abil­i­ty to work by 2014, Air­ing Pain dis­cuss­es ben­e­fit reforms as well as how work affects those liv­ing in pain and how they can stay in, or get back into, work.

Chris Main, Pro­fes­sor of Clin­i­cal Psy­chol­o­gy at Keele Uni­ver­si­ty, and Elaine Heaver of the Bath Cen­tre for Pain Research take us through the evi­dence show­ing the health ben­e­fits from being in work and explain how GPs now give ‘fit notes’ as well as sick notes. Paul Wat­son gives some advice on how to stay in work and talk to your employ­er and Dr Shilpa Patel talks about the bar­ri­ers faced by unem­ployed peo­ple with chron­ic pain.

Issues cov­ered in this pro­gramme include: Work, ben­e­fits, pol­i­cy, wel­fare reform, patient con­cerns, phased return to work, work­place adap­ta­tions, stig­ma, mis­con­cep­tions, acces­si­bil­i­ty, insom­nia, dis­cussing pain, bar­ri­ers to the work­place and train­ing schemes.

Paul Evans: Hel­lo, and wel­come to Air­ing Pain. This pro­gramme is brought to you by Pain Con­cern and sup­port­ed by an edu­ca­tion­al grant from Napp Phar­ma­ceu­ti­cals. I’m Paul Evans.

Shilpa Patel: Peo­ple I’ve spo­ken to in my role as a psy­chol­o­gist with­in the NHS (Nation­al Health Ser­vice) and see­ing chron­ic pain patients reg­u­lar­ly, do want to go back to work and they would love to work if they could find some­thing that would suit them and they’d be able to man­age with the pain condition.

Evans: Our aim on Air­ing Pain is to be guid­ed by you on the top­ics we cov­er and through our pan­el of experts we try and get answers to the ques­tions you raise on our mes­sage board, mail, elec­tron­ic or oth­er­wise. So today we’re focus­ing on work issues for those of us with chron­ic pain. It’s a huge and con­tentious area, espe­cial­ly in the con­text of the Work Capa­bil­i­ty Assess­ment and Employ­ment and Sup­port Allowance – the ESA, which replaced a range of inca­pac­i­ty ben­e­fits for all new claimants back in Octo­ber 2008. From Octo­ber 2010 until 2014 those still receiv­ing the old­er style inca­pac­i­ty ben­e­fits will be reassessed in their abil­i­ty to work and if, in the view of the Depart­ment of Work Con­ven­tions, they’re found capa­ble, they’ll be moved to what they describe as ‘oth­er ben­e­fits more appro­pri­ate to their circumstances’.

Now the fear is that peo­ple who are found to be capa­ble of work will be moved to Job Seek­ers Allowance, which for some peo­ple could mean a reduc­tion of around £25 a week in their benefit.

At the out­set of this pro­gramme I’d like to pass on a request for your help from the Long Term Con­di­tions Alliance, Scot­land. They’re col­lect­ing data on how the wel­fare reforms affect peo­ple. They’d like peo­ple who’ve already been affect­ed, and those who are con­cerned about how they might be affect­ed in the future, to tell them about their expe­ri­ences. So, if that applies to you or some­one you know, then we at Pain Con­cern will be glad to pass on your expe­ri­ences. I’ll tell you how to get in touch with us at the end of the pro­gramme, so please have a pen or pen­cil and paper handy to take down the details.

But first the ques­tion has to be asked: is work good for us? And to answer it is Chris Maine, who’s Pro­fes­sor of Clin­i­cal Psy­chol­o­gy at Keele University.

Chris Maine: There’s been some impor­tant gov­ern­ment reviews that have come out in the last year or two which real­ly have looked at all the evi­dence there is for the effect of work­ing and of not work­ing on peo­ple. Peo­ple that are off work devel­op more ill­ness and they actu­al­ly die more quick­ly, so we know, par­tic­u­lar­ly in stud­ies of old­er peo­ple, that after they’ve retired, get­ting engaged in some­thing – par­tic­i­pat­ing – is real­ly very impor­tant to coun­ter­act the effects of changes that have come about with retire­ment and some­times social iso­la­tion. And, of course, if peo­ple have got pain and they’re on their own, they’re more like­ly to get a bit depressed with things, so it’s real­ly impor­tant to man­age the pain rather than it man­ag­ing you.

And one of the things we’re inter­est­ed in doing at Keele Uni­ver­si­ty is look­ing at how phys­io­ther­a­pists and oth­er health­care pro­fes­sion­als are deal­ing with con­cerns about work that are raised by the patients. And very often the pro­fes­sion­als don’t feel all that well-equipped to deal with work issues. But things are chang­ing – the new ‘fit notes’ instead of ‘sick notes’ that have come in, I think, over a peri­od of time, are giv­ing an impor­tant mes­sage: that work is in fact good for people.

Evans: Chris Maine of Keele University.

Elaine Heaver of the Bath Cen­tre for Pain Research is con­duct­ing stud­ies into these issues and specif­i­cal­ly focus­ing on the rhetoric we’ve just heard that work is good for us. Now explain the dif­fer­ence between a ‘sick note’ and a ‘fit note’.

Elaine Heaver: The main ratio­nale behind the fit note is that one doesn’t have to be 100% fit in order to work and that actu­al­ly an ear­li­er return to work than has been tra­di­tion­al can be quite ben­e­fi­cial for peo­ple. Also that there are very active things employ­ers can do, such as putting in place phased return to work, or work­place adap­ta­tions like a dif­fer­ent chair or a dif­fer­ent desk or spe­cial mouse­mats, those kinds of things, or big­ger changes that might need to happen.

And the idea is also to focus on capac­i­ty, not inca­pac­i­ty. And it is based around some very good evi­dence that work is good for a lot of us a lot of the time and most of the peo­ple I inter­viewed didn’t dis­agree with that, but some of the issues around the fit note that came up in our study were to do with how that is prac­ti­cal, par­tic­u­lar­ly in a small work­place, for exam­ple, and peo­ple feel­ing a lit­tle bit pushed some­times to go back to work before they were ready. And the GP now on the sick note, he or she just used to say, ‘You are fit’; ‘You aren’t fit.’ And now peo­ple may have seen these, they can either say, ‘You may be fit for some work now, tak­ing into account the fol­low­ing advice’ or ‘You’re not fit’, so the lan­guage has changed quite sub­stan­tial­ly as well.

Evans: Elaine Heaver.

Now whether it’s a fit note or a sick note seems irrel­e­vant when you are indeed in work but at the same time fac­ing the stress of los­ing a job because of your con­di­tion. And that’s exact­ly the wor­ry that one of our lis­ten­ers has con­tact­ed us about: ‘I’ve been diag­nosed with fibromyal­gia and I’m wor­ried that I’m going to lose my job. How can I stay in work?’ Well we’ve con­tact­ed lead­ing pain expert and phys­io­ther­a­pist Pro­fes­sor Paul Wat­son of Leices­ter Gen­er­al Hos­pi­tal on your behalf…

Paul Wat­son: Now this is some­thing a lot of peo­ple face. And the first thing that any­body needs to do is actu­al­ly dis­cuss it with their employ­er. Often peo­ple will strug­gle to remain at work – they feel that, par­tic­u­lar­ly in the eco­nom­ic cli­mate we have at the moment, ‘The last thing I want to do is men­tion to my employ­er that I’m hav­ing a hard time because I’ll be the first one to lose my job.’ I can under­stand how peo­ple feel like that, but it’s always going to be very dif­fi­cult to make any work­place adap­ta­tions unless you talk to your employ­er first. It’s also help­ful to talk to some­body who under­stands about keep­ing peo­ple in work, work reten­tion and return to work, so you need either a phys­io­ther­a­pist who has expe­ri­ence in advis­ing peo­ple on return­ing to work or an occu­pa­tion­al ther­a­pist and then, once you have peo­ple to advise you, to approach your employer.

Evans: So, hav­ing opened the top­ic on how work ben­e­fits us, the pos­i­tives, if you like, what are the neg­a­tives? Chris Maine…

Maine: Pain can affect work in a num­ber of ways: it can affect things that they actu­al­ly do; it can affect their tol­er­ance for sit­ting and main­tain­ing pos­tures of var­i­ous sorts and, of course, if they’re not sleep­ing too well, they may get real­ly tired and this may affect their con­cen­tra­tion. Some patients, of course, will be on med­i­cine and some med­i­cine does have side effects, which can affect their per­for­mance or con­cen­tra­tion and so forth.

Pain can be a bar­ri­er to peo­ple work­ing entire­ly and of course on some of our reha­bil­i­ta­tion pro­grammes we focus par­tic­u­lar­ly on the obsta­cles to get­ting back to work. Some of these are prac­ti­cal things, like peo­ple need­ing help, for exam­ple, with advice about cer­tain types of chair or cer­tain ways of doing their work per­haps. But a lot of it is to do with the patients them­selves, the employ­ees, and the fact that they’ve lost con­fi­dence in how to cope at work. And of course some­times we have unsym­pa­thet­ic work­ing sit­u­a­tions with man­agers or col­leagues that are caus­ing dif­fi­cul­ties and this can be an addi­tion­al stress.

Evans: It doesn’t take much to adapt. It’s not even the work­place in many things, it’s adapt­ing people’s minds to allow peo­ple to work, isn’t it?

Heaver: Absolute­ly, I real­ly agree. It’s about a sort of mind­set of the per­son, the peo­ple around them, their fam­i­ly, their friends, their doc­tor and par­tic­u­lar­ly, obvi­ous­ly, their employ­ees and their employ­ers. And, again, I inter­viewed quite a few teach­ers and they tend­ed to have good sup­port from col­leagues, because teach­ing is such a, sort of, voca­tion and such a full on kind of job that they felt peo­ple were will­ing to per­haps cov­er one les­son for them here or there, do some­thing like that, anoth­er lady talked about a school who’d tak­en her off cov­er duty so she wasn’t hav­ing to move from place to place around the school building.

Evans: Of course in a school you can relieve teach­ers of play­ground duties, lunch duties, you can’t relieve them of a class of thir­ty shout­ing children.

Heaver: No, and one of the very sim­ple exam­ples I can give you where the mind-set had not been shift­ed in a way that was help­ful to her is this par­tic­u­lar par­tic­i­pant had to go to the hos­pi­tal every six weeks for a day and she knew that and the school knew that and they knew that they took her on, but every time she had to go to this hos­pi­tal appoint­ment she was made to fill in all of these forms and go and ask the cov­er super­vi­sor and she felt she was being hum­bled, in a way that was not help­ful to her by doing that, and as they knew the whole year in advance which day she would need to be off, that could have been organ­ised in one fell swoop at the begin­ning of the year, and she just wouldn’t have felt that she had this stig­ma attached.

Evans: Elaine Heaver and before her, Chris Maine. Doc­tor Shilpa Patel is a research fel­low at the Uni­ver­si­ty of War­wick and she’s also a health psy­chol­o­gist with Mil­ton Keynes NHS Foun­da­tion Trust. Now, the sub­jects of her research into the rela­tion­ship between those with chron­ic pain and work were all unem­ployed people.

Patel: Some peo­ple are very under­stand­ing and are very aware of chron­ic pain, some employ­ers and some organ­i­sa­tions; oth­ers, I think more it’s about the lack of under­stand­ing and the knowl­edge about how chron­ic pain affects some­body and how things like pac­ing activ­i­ties are impor­tant dur­ing the day. So if you’ve got some­body, for exam­ple, doing an office type job, it’s impor­tant for them to, if they’ve got a back pain con­di­tion for exam­ple, reg­u­lar­ly take a break, maybe walk around, have a stretch, it’s impor­tant to do those things but, you know, you’re there to work and some­times that can go out the window.

I know there’s much more being done to try and increase aware­ness with­in work­places about dis­abil­i­ties and things like that, so it’ll be inter­est­ing to see where we will be in, sort of, ten years time, as to see what employ­ers are like then, but at the moment it very much depends on who your employ­er is and how under­stand­ing they are.

Wat­son: If there’s a work­place that’s caus­ing peo­ple symp­toms, then a respon­si­ble employ­er should actu­al­ly do some­thing about that by assess­ing the work­place. Because some­times the mod­i­fi­ca­tions can be quite sim­ple, that could be done. It may well be that you have to dis­cuss chang­ing work­ing hours and once again, you know, that obvi­ous­ly has to involve the employ­er, the human rela­tions depart­ment, etc. It may also be help­ful get­ting a union rep in to advise you as well, if only to be a friend to facil­i­tate discussions.

There is also a scheme called Access to Work in some places, where you can get help from your local Job Cen­tre, if any spe­cial­ist equip­ment is required, so if you need a chair – a more com­fort­able chair or a more adapt­able chair – or if you need a change to your work envi­ron­ment which needs spe­cial­ist equip­ment, then you can go and dis­cuss that with the Access to Work peo­ple. You can access them through the job cen­tre or through the DWP web­site to find out more about it.

But the very impor­tant thing is for you all to talk and dis­cuss a way for­ward, for the employ­er, one of the health­care prac­ti­tion­ers and the per­son try­ing to remain in work them­self to get togeth­er and dis­cuss a man­age­ment plan, and I think the soon­er you do that, the bet­ter. Because what often hap­pens is peo­ple strug­gle, they then start tak­ing lit­tle bits of time off work, the employ­er starts get­ting annoyed, they start get­ting into dis­ci­pli­nary issues when real­ly it’s a health­care issue, so the soon­er you dis­cuss it, the bet­ter for every­body concerned.

Evans: Paul Wat­son. Now it seems to me that there’s a strong dan­ger that the new rules we’re talk­ing about put small to medi­um employ­ers, SMEs, at a dis­tinct dis­ad­van­tage in com­par­i­son with larg­er com­pa­nies. Elaine Heaver again…

Heaver: The gov­ern­ment has to be fair and when I say ‘the gov­ern­ment’ I mean both Labour and the coali­tion. They have put in place mech­a­nisms for small­er employ­ers to be able to access occu­pa­tion­al health lines, for exam­ple, and there’s some­thing called the Chal­lenge Fund where­by an employ­er who needs, say, a new chair, a bet­ter chair for an employ­ee can get 90 per cent of the cost back. But one of the things we found in our study is a lot of employ­ers sim­ply were not aware of these means of sup­port, so were obvi­ous­ly not using them. But it did seem to be, as a broad rule of thumb, that the big­ger the com­pa­ny, the bet­ter the chances were of find­ing a more suit­able role for the employ­ee, where­as small­er com­pa­nies real­ly strug­gled with that.

Evans: One thing some peo­ple have told me is that employ­ers might want some­one who’s reg­is­tered dis­abled on their books for oth­er rea­sons – for box-tick­ing, if you like – but some­body who is sick real­ly is a bit of a burden.

Heaver: Mmm, inter­est­ing point. The sort of dis­tinc­tions between the use of lan­guage about being sick and dis­abled and whether or not it’s use­ful in a polit­i­cal­ly cor­rect sense to have a dis­abled per­son in your com­pa­ny, where­as if your employ­ee is sick then the employ­er might shy away… And cer­tain­ly, from that point of view… I went to a con­fer­ence about a year ago that was designed for employ­ers who want­ed to improve the work health and well­be­ing of their employ­ees’ lives and there were a cou­ple of ses­sions that were quite shock­ing where, for exam­ple, in one par­tic­u­lar ses­sion, a lawyer stood up and said, ‘If some­body starts to become sick, just get rid of them, just pay them off, it will be, you know, bet­ter for you in the long-term, finan­cial­ly and in terms of bother.’

But actu­al­ly one very big com­pa­ny round here had been incred­i­bly sup­port­ive of employ­ees, espe­cial­ly employ­ees who have some expe­ri­ence because they recog­nised it’s not just a sick per­son, it is an actu­al human being that they’re deal­ing with. And from a busi­ness point of view they recog­nise that per­son car­ries a lot of expe­ri­ence, so there have been cas­es both ways, where just because some­body is sick it’s not the end of the road and that is one of the pos­i­tive things I want to stress.

Evans: Elaine Heaver. You’re lis­ten­ing to Air­ing Pain, pre­sent­ed this week by me, Paul Evans, and brought to you by Pain Con­cern, the UK Char­i­ty pro­vid­ing infor­ma­tion and sup­port for peo­ple who live with pain. Now, as I’ve said, one of our aims on Air­ing Pain is to find answers to ques­tions you’ve raised with us, so please do take advan­tage of this oppor­tu­ni­ty to con­nect with our experts via our mes­sage board, email and not for­get­ting pen and paper.

But before we con­tin­ue please bear in mind that whilst we believe the infor­ma­tion and opin­ions on Air­ing Pain are accu­rate, based on the best judge­ments avail­able, you should always con­sult your health pro­fes­sion­al on any mat­ter relat­ing to your health and well­be­ing. He or she is the only per­son who knows you and your cir­cum­stances and there­fore the appro­pri­ate action to take on your behalf.

Today we’re focus­ing on work issues raised by you on our mes­sage board. Now the pre­vi­ous lis­ten­er was ask­ing how he or she could stay in work. Anoth­er lis­ten­er with neu­ro­path­ic pain says: ‘I’ve been out of work for two years. How can I get back to work?’ Pro­fes­sor Paul Watson.

Wat­son: This is a relat­ed top­ic but also dif­fer­ent in that it’s much more com­plex. If peo­ple still have con­tact with their employ­er, I think it’s impor­tant to actu­al­ly dis­cuss with their employ­er that they would like to come back to some form of work. I think that, once again, talk­ing with the phys­io­ther­a­pist and occu­pa­tion­al ther­a­pist, to dis­cuss the type of work which may be pos­si­ble… But you’re only real­ly going to know what type of work is pos­si­ble by actu­al­ly try­ing it out. And there­fore if you have con­tact with your employ­er, get­ting in touch and say­ing, you know, ‘I’d like to come back, are there any open­ings?’ and dis­cuss the num­ber of hours that you think that you might be able to do, say just for a cou­ple of hours a day and then see how you go, so that would be one way.

How­ev­er, unfor­tu­nate­ly, most peo­ple who have been out of work for two years usu­al­ly haven’t got a job to go back to – their job has gone or they’ve been made redun­dant or they’ve had to retire on ill health grounds. So the vast major­i­ty of peo­ple who’ve been out of work for two years usu­al­ly haven’t got a job to go back to.

Evans: Paul Wat­son. A fur­ther stres­sor and chal­lenge for some­one with per­sis­tent pain is in try­ing to con­vince peo­ple of the full impact the ill­ness has on their lives. For exam­ple, fill­ing out an appli­ca­tion for Dis­abil­i­ty Liv­ing Allowance or Employ­ment Sup­port Allowance can be a major cause for con­cern. Elaine Heaver again.

Heaver: The kinds of ques­tions that are asked in a new work capa­bil­i­ty assess­ment, was a par­tic­u­lar prob­lem for peo­ple, because our par­tic­i­pants with chron­ic pain felt these kinds of ques­tions on these kinds of forms do not cap­ture the expe­ri­ence of the ill­ness itself. A very sim­ple exam­ple, a lot of the chron­ic pain patients talked about its fluc­tu­at­ing nature and some of the ques­tions, as I’m sure peo­ple will be aware, say things like, ‘can you lift a heavy bag of shop­ping? can you turn on a tap? can you do this? can you do that? how far can you walk?’

And peo­ple said to me, ‘Yes, I can do those things, but then I might be flat on my back for three days.’ And there isn’t space with­in that form to express what these activ­i­ties’ impact might be on the rest of their lives. So that was a real­ly big issue and one that we have thought about rais­ing with the DWP and we have had some com­mu­ni­ca­tion with them on that. They say that their advi­sors are trained to take into account worst case sce­nar­ios, but it’s often very dif­fi­cult by the nature of writ­ten com­mu­ni­ca­tion, as opposed to an oral inter­view with some­body… the form can become very prob­lem­at­ic in that way because it’s almost too objec­tive to cap­ture what’s hap­pen­ing for peo­ple in their every­day lives.

Evans: That’s right, it’s easy for me to say to you, ‘I can do some­thing today, and… I could do it last week, but I can’t guar­an­tee that I can do it tomorrow.’

Heaver: Yeah, absolute­ly, I mean that word ‘guar­an­tee’ is key, I think, in terms of… I start­ed look­ing at chron­ic pain patients at work – peo­ple felt very strong­ly, ‘Well who is going to employ me?’ – employ­a­bil­i­ty was a big issue that wasn’t picked up by the gov­ern­ment, peo­ple felt.

Evans: And that fits my own expe­ri­ence in the pri­vate sec­tor too. The out­come of a process that took near­ly a year from when I’d become too ill to work was that the occu­pa­tion­al health doc­tor con­tract­ed by my employ­er con­clud­ed that my, ‘func­tion­al capa­bil­i­ty must now be deemed to be per­ma­nent­ly impaired’ and that I was ‘per­ma­nent­ly inca­pable of car­ry­ing out my role’.

So, if I were to apply for a new job suit­ing my expe­ri­ences and capa­bil­i­ties, I may well be able to impress my prospec­tive employ­ers at the inter­view whilst at the same time show­ing no vis­i­ble signs of being chron­i­cal­ly ill. So how, in all hon­esty, could I accept a job where I or the employ­er wouldn’t know from day to day whether I’d be fit enough to turn up the fol­low­ing day?

Wat­son: There are, increas­ing­ly, a num­ber of employ­ers who are quite will­ing to take peo­ple on on a tri­al basis. The Depart­ment of Work and Pen­sions in Job Cen­tres had tried to set up, with a num­ber of employ­ers, who would just take peo­ple on a short job expe­ri­ence. Now I know some­times peo­ple feel that, ‘Well, I’m work­ing for noth­ing.’ I know we all have mixed views about that, but I think the only way peo­ple are going to know how much they can do is actu­al­ly by engag­ing in some type of work­place activity.

Now, there’s also things peo­ple can do at home, because if you think that you are going to have to do a job for, sort of, two or three hours a day, per­haps peo­ple can set up activ­i­ties that might mim­ic that in the home. I know this might sound a lit­tle bit off the wall, but if you are required to, say, sit at a com­put­er, you could start build­ing up your sit­ting tol­er­ance. So it would be that you would sit and per­haps do some work sit­ting down at desk or at a table, so you can go to an employ­er quite con­fi­dent­ly and say, ‘Well, I can sit as long as I can get up five min­utes every half an hour, I can sit at a com­put­er for two hours, three hours’, or some­thing like that.

If you are look­ing for a more phys­i­cal job, per­haps you could look at doing some sim­ple tasks around the gar­den or in the house so you can assess what your phys­i­cal capac­i­ty is, and you can say, ‘Well I know I can pick up and lift things up to a cer­tain weight so many times a day. I can, you know, bend and lift. I can pick these things up.’ So you get an idea of the sort of phys­i­cal capac­i­ty that you have. And that sort of thing, in addi­tion to advice from a phys­io­ther­a­pist or an occu­pa­tion­al ther­a­pist can give you a lit­tle bit more idea and con­fi­dence in what you phys­i­cal­ly can do before you start apply­ing for jobs.

Evans: Did you find any of your par­tic­i­pants tak­ing blame them­selves for not being able to work?

Heaver: That’s a real­ly inter­est­ing ques­tion, the sort of blame that peo­ple put on them­selves. The biggest issue that came up with that was wor­ry­ing about what oth­er peo­ple think of you, because they can’t always see what’s going on for you and what’s wrong and there­fore inter­nal­is­ing some of that stig­ma, that cer­tain­ly was a big issue and peo­ple had to work very hard. That came up not just with employ­ers but a lot with neigh­bours. Peo­ple were say­ing, you know, ‘I wor­ry, because my neigh­bours know I’m off sick for six months or what­ev­er peri­od of time and they see me walk­ing around town and they don’t know that a) I’m sup­posed to do some walk­ing every day and b) again, it has a big impact on me and how I am the day after.’

And I remem­ber par­tic­u­lar­ly one fair­ly young par­tic­i­pant being very angry because they felt that yes, she was work­ing but at the expense of absolute­ly every­thing else in her life; she had no phys­i­cal or men­tal ener­gy left at all in the evenings or at the week­ends, but she felt that soci­ety, by which she appeared to mean both peo­ple very close to her and very broad­ly – soci­ety, the media, papers, etc. – would judge her so harsh­ly if she stopped work­ing and tried to cre­ate a bet­ter bal­ance for her­self, it wasn’t some­thing she was yet pre­pared to do.

Evans: That’s right, it’s a pow­er­ful thing, isn’t it, where our employ­ers or neigh­bours or what­ev­er, they see you work­ing 100 per cent, but they don’t actu­al­ly see or realise that 100 per cent is 100 per cent and there is noth­ing left at the end of the day.

Heaver: Yeah, yeah, and just lit­tle things again, you know, two… more than two peo­ple actu­al­ly, real­ly specif­i­cal­ly talked about com­mut­ing in Lon­don on the tube and how prob­lem­at­ic that is. And the sto­ry with this was that they would get the dis­abled seat because they real­ly need­ed it and then would be asked to move in quite nasty ways, not even, some­times, because some­body else want­ed it, just because anoth­er pas­sen­ger saw them sit­ting there, saw they looked phys­i­cal­ly fine, per­haps they didn’t have a stick, per­haps they just looked OK on that day, but that was a real­ly big prob­lem again in terms of how soci­ety was view­ing peo­ple and how peo­ple were hav­ing to inter­nalise that.

Evans: Elaine Heaver’s research is mov­ing into a sec­ond phase. And this is where you can help.

Heaver: One of the find­ings from the first study was just how impor­tant it is to get employ­ers to be real­ly think­ing about how to help peo­ple return to work or retain cur­rent work­ers, but if any­body out there is inter­est­ed in par­tic­i­pat­ing in the next phase of the study, which is real­ly focus­ing on employ­ers and employ­ees and how we can make the sys­tem bet­ter in that way, please con­tact me. And if any­body is an employ­er who’s lis­ten­ing to this, or if any­body has an employ­er that they think would be inter­est­ed, we would love to inter­view them.

Evans: And if you can help Elaine Heaver then please con­tact us at Pain Con­cern and we’ll pass on the details. I’ll give you con­tact infor­ma­tion at the end of the programme.

You’re lis­ten­ing to Air­ing Pain with me, Paul Evans, and we’re dis­cussing issues around employ­ment for those of us with chron­ic pain. So what are the bar­ri­ers we set our­selves in get­ting back into the work­place? And if the Depart­ment of Work and Pen­sions is so anx­ious to get us there, what are they doing to help? Paul Wat­son, fol­lowed by Shilpa Patel…

Wat­son: The Depart­ment of Work and Pen­sions have been try­ing to set up schemes to help peo­ple back into work, so there are a num­ber of train­ing schemes avail­able. Now I know peo­ple can be quite cyn­i­cal about train­ing schemes, because it’s just a way of keep­ing unem­ployed peo­ple enter­tained rather than actu­al­ly being help­ful, but there are a lot of new pro­grammes being set up. The first thing is, that if peo­ple are unable to go back to the work that they had before, because it’s too stren­u­ous or what­ev­er, is to iden­ti­fy the skills that they actu­al­ly have got which an employ­er would like.

Patel: I spoke to peo­ple that worked in the trade indus­try, peo­ple that were man­agers – there was a range of peo­ple that I spoke to – peo­ple that did lots of labo­ri­ous work and to be out of work and then try­ing to find work relat­ed to some­thing that you orig­i­nal­ly did but can’t do that because of your phys­i­cal pain prob­lem was quite daunt­ing – to then go into anoth­er indus­try and do some­thing else. Peo­ple often found that very scary to then think, ‘I’ve got to retrain, do some­thing else’, espe­cial­ly if you’ve done some­thing for many years. So yeah, retrain­ing and feel­ing, ‘Maybe I haven’t got the skills for some­thing else’, they were all bar­ri­ers to try­ing to get your foot back into the workplace.

Wat­son: I’ve worked a lot with peo­ple who are try­ing to get back to work and they are very neg­a­tive about the skills that they have and I’ve seen this time and again where peo­ple say, ‘Well I’ve worked in a par­tic­u­lar job for 20 years, that’s all I know and all I’ve done.’ Well, that’s not true, because when you talk to peo­ple they have got per­son man­age­ment skills, they’ve got numer­a­cy, lit­er­a­cy skills, they might have com­put­er skills and these are things that an employ­er needs to know about when you’re look­ing for a job.

So you need to spend some time, per­haps with some­body from the job cen­tre, writ­ing down the skills that you have got. And that, some­times, you need some­one to coax those out of you, because peo­ple don’t read­i­ly say, ‘Well I’m good at this, I’m good at that.’ Often when you’ve lost your job you have quite a neg­a­tive view of your­self and you tend to only see your­self in your pre­vi­ous role, so you need to sit down with some­body to iden­ti­fy the skills you have that an employ­er wants.

You can also iden­ti­fy the skills that you don’t have and need to work on, so these might be to do with improv­ing people’s numer­a­cy, improv­ing lit­er­a­cy, try­ing to get some com­put­er skills, etc. Now a lot of peo­ple also find that actu­al­ly hav­ing a short ses­sion in vol­un­tary work is help­ful, because there are a num­ber of things that peo­ple who have been out of work for a while have to face and one is that they don’t have any­body to give them a ref­er­ence and, of course, employ­ers always ask for a ref­er­ence – ‘Well what can you do? how good is your time­keep­ing?’ etc. So by doing a short peri­od of vol­un­tary work, that has worked for some peo­ple because they have a ref­er­ence from a respect­ed per­son that says, ‘This per­son has attend­ed, they were reg­u­lar­ly doing x num­ber of hours a week, they were always punc­tu­al, pleas­ant etc.’ and that can go quite a long way to an employ­er, is to have a reference.

Evans: Paul Watson.

Now before we end the pro­gramme I’d like to make an appeal on behalf of Pain Con­cern, the UK char­i­ty pro­vid­ing infor­ma­tion and sup­port for peo­ple, like me, who live with chron­ic pain. They are the dri­ving force behind these fort­night­ly Air­ing Pain pro­grammes. But the pro­grammes are not just for the 7.8 mil­lion peo­ple in the UK who live with chron­ic pain, it’s for our fam­i­lies, friends, car­ers, sup­port­ers and also for the health pro­fes­sion­als who wish to hear and share their views and strate­gies with col­leagues and patients. If you’re in any of these cat­e­gories and feel that you or some­one you know has ben­e­fit­ed from lis­ten­ing to these pro­grammes and would like them to con­tin­ue, then please con­sid­er mak­ing a dona­tion to secure Air­ing Pain’s future. Just go to our web­site at where you’ll find a ‘Make Dona­tion’ but­ton at the bot­tom of the page.

And don’t for­get that you can still down­load all the pre­vi­ous edi­tions of Air­ing Pain from the same web­site. If you don’t want to or can’t donate, well, that’s fine, we’d love to hear from you any­way, either to put a ques­tion to our pan­el of experts or just to make a com­ment about the pro­gramme. Either con­tact us through our web­site, blog, mes­sage board, email, face­book or twit­ter, or if you pre­fer good old-fash­ioned pen and paper then the address to write to is: […]

And final­ly, if you’re an employ­er who can help Elaine Heaver at the Bath Cen­tre for Pain Research, or the Long Term Con­di­tions Alliance Scot­land, then you can also con­tact them through us. And we’ll make sure they receive every­thing. Appeal over, and I’ll leave you with one final piece of advice from Pro­fes­sor Paul Watson.

Wat­son: If you do find a job, it’s very impor­tant that you dis­cuss return­ing to work with ben­e­fits advi­sors. The rea­son being is there are a num­ber of ben­e­fits con­tin­gent on return­ing to work, these keep chang­ing and I’m sure they’ll change again, so when you do go back to work, you always dis­cuss with a ben­e­fits advi­sor first. They can tell you of all the sorts of schemes, to do with return to work cred­its, etc. etc. which are con­stant­ly chang­ing, so you’ll have a good idea of how much bet­ter off you’re like­ly to be and also what hap­pens if you are unable to sus­tain the job. And it’s very impor­tant that you talk to ben­e­fits advi­sors before­hand because they can put you in the pic­ture, and once you’ve got that infor­ma­tion you can start to make a much more detailed plan, so please, don’t just rush out tomor­row and if you think there’s a job going and jump into it, talk to a ben­e­fits advi­sor first, because they can smooth the way and make things a lot easier.


  • Elaine Heaver, Researcher, Bath Cen­tre for Pain Research
  • Chris Main, Pro­fes­sor of Clin­i­cal Psy­chol­o­gy, Keele University
  • Dr Shilpa Patel, Research Fel­low, Uni­ver­si­ty of Warwick
  • Pro­fes­sor Paul Wat­son, Senior Lec­tur­er in Pain Man­age­ment and Reha­bil­i­ta­tion, Uni­ver­si­ty of Leicester.