Insight from the Trailblazer project on supporting musculoskeletal conditions

In this episode Professor Kevin Daniels of the Evolve team at the University of East Anglia speaks with Elizabeth Bachrad, Head of Programme Strategy for Business for Health. Business for Health is a Community Interest Company that focuses on the impact of business on health outcomes. Elizabeth describes findings from the process evaluation of a Trailblazer project supporting people with musculoskeletal conditions. She highlights that what makes the Trailblazer programme interesting is that it doesn't treat employment and health as separate problems.

Business for Health led the process evaluation of the MSK Trailblazer programme, MSK for musculoskeletal conditions, in partnership with Unity Insights and with support from West and North London ICB and local government partners. www.businessforhealth.org 

Transcript

00:00:04 Helen Fitzhugh

Welcome to the Evolve Workplace Wellbeing podcast.

00:00:07 Helen Fitzhugh

This podcast is part of a toolkit of free evidence-informed workplace wellbeing resources provided by the Workplace Wellbeing Research Team at the University of East Anglia in the UK.

00:00:18 Helen Fitzhugh

You can find the resources on www.evolveworkplacewellbeing.org.

00:00:27 Kevin Daniels

Welcome to the Evolve Wellbeing Podcast.

00:00:29 Kevin Daniels

I have Elizabeth Bachrad with me today.

00:00:31 Kevin Daniels

She's going to be talking about some really interesting work that she's involved in evaluating.

00:00:37 Kevin Daniels

So if I could start, Elizabeth, if you could introduce yourself.

00:00:42 Kevin Daniels

Where do you work and what do you do?

00:00:44 Kevin Daniels

And could you tell us a bit about the Trailblazer project?

00:00:47 Elizabeth Bachrad

Yeah, absolutely.

00:00:49 Elizabeth Bachrad

So I'm Elizabeth Bachrad.

00:00:50 Elizabeth Bachrad

I'm a population health researcher and practitioner and head of programme strategy for business for health here in the UK.

00:00:58 Elizabeth Bachrad

I work at the intersection of health work systems change and prevention, particularly looking at how we create healthier populations.

00:01:06 Elizabeth Bachrad

So I also work on

00:01:07 Elizabeth Bachrad

strengthening economic participation and workforce resilience.

00:01:11 Elizabeth Bachrad

So for this project, Business for Health led the process evaluation of the MSK Trailblazer programme, MSK for musculoskeletal conditions, in partnership with Unity Insights and with support from West and North London ICB and local government partners.

00:01:27 Elizabeth Bachrad

And the MSK Trailblazer is part of the government's Get Britain working agenda and focuses on supporting people with musculoskeletal conditions, things like chronic pain, arthritis,

00:01:37 Elizabeth Bachrad

for persistent joint conditions, who are economically inactive, meaning they're not working or not looking for work.

00:01:43 Elizabeth Bachrad

And what makes this programme interesting is that it doesn't treat employment and health as separate problems.

00:01:49 Elizabeth Bachrad

Instead, it tries to integrate with physiotherapy, employment support, coaching, welfare advice, and community services into one joined up pathway.

00:01:59 Elizabeth Bachrad

And as evaluators, we aren't just asking, did it work?

00:02:02 Elizabeth Bachrad

We're asking what works for whom, under what conditions and why.

00:02:06 Elizabeth Bachrad

And that's the core of the Realist evaluation.

00:02:09 Kevin Daniels

That's great.

00:02:09 Kevin Daniels

We're all about evidence on this podcast.

00:02:11 Kevin Daniels

That's brilliant.

00:02:12 Kevin Daniels

Can you tell us a little bit about Business for Health?

00:02:14 Kevin Daniels

You're a not-for-profit.

00:02:16 Elizabeth Bachrad

Yeah, so we're a community interest company and our main focus is to look at the impact of business on health outcomes.

00:02:22 Elizabeth Bachrad

And we do that through stewardship of employers, investors, government policy advocacy, and also the worker voice and getting to look at how we can design ways of work that standardize data systems as well as resource flows and how we can work as a coalition to better improve health outcomes through business.

00:02:44 Kevin Daniels

That's brilliant.

00:02:45 Kevin Daniels

Thank you.

00:02:45 Kevin Daniels

So how did you get involved in the Trailblazer project and how did your interest in it come about?

00:02:51 Elizabeth Bachrad

So a lot of my work sits around the relationship between health and economic participation.

00:02:55 Elizabeth Bachrad

So this project aligned very naturally with my interest.

00:02:58 Elizabeth Bachrad

But for years we've talked about employment as a social determinant of health and actually work even as a health outcome.

00:03:05 Elizabeth Bachrad

But we've spent far less time asking how health systems and not just the NHS, but everything that sits outside of the health system in terms of community.

00:03:13 Elizabeth Bachrad

and how they can support people to stay in, return to, or thrive in work.

00:03:18 Elizabeth Bachrad

And I call this the demand side of work and health.

00:03:20 Elizabeth Bachrad

And so what drew me to the trailblazer was that it recognized something really important.

00:03:25 Elizabeth Bachrad

People don't experience their lives in silos, but our services often operate in silos.

00:03:30 Elizabeth Bachrad

So someone with chronic MSK pain might simultaneously be navigating NHS waiting lists, financial stress, declining confidence, social isolation, the benefit systems, and fears about employability.

00:03:43 Elizabeth Bachrad

So

00:03:43 Elizabeth Bachrad

Historically, we've tended to respond to these issues very separately.

00:03:47 Elizabeth Bachrad

And the trailblazer model attempts to bridge those worlds, health, work, welfare, and community support in a much more person-centred way.

00:03:55 Elizabeth Bachrad

So yes, we got commissioned to do this, but from a research perspective, it's also a fascinating implementation challenge because each borough across London has slightly different contexts, infrastructures, and pathways, and that gives us the opportunity to explore not just outcomes, but how the local systems shape outcomes.

00:04:13 Kevin Daniels

That's absolutely fascinating to see the whole system in place as well.

00:04:20 Kevin Daniels

And could you give us an indication about the scale of the problem that trailblazers are addressing, either at a London level or a national level?

00:04:29 Elizabeth Bachrad

Yeah, absolutely.

00:04:30 Elizabeth Bachrad

The scale is enormous.

00:04:32 Elizabeth Bachrad

So let's try to get our heads around how big this is and what the challenge creates.

00:04:36 Elizabeth Bachrad

Musculoskeletal conditions are one of the leading causes of sickness absence and economic inactivity in the UK.

00:04:43 Elizabeth Bachrad

In 2024 alone, conditions accounted for 15.5% of all recorded sickness absence, making them the second most common cause of sickness absence after minor illnesses.

00:04:54 Elizabeth Bachrad

And on top of that, more than 30 million working days are lost every year due to MSK conditions.

00:05:00 Elizabeth Bachrad

which gives us a sense of both the human and economic burden associated with poor MSK health.

00:05:05 Elizabeth Bachrad

So the Trailblazer itself operates across 12 London boroughs and targets around 1,200 adults with MSK conditions who are economically inactive.

00:05:15 Elizabeth Bachrad

And that number is growing as the programme continues to run.

00:05:18 Elizabeth Bachrad

But what's really striking from the early evaluation data is that the programme is reaching

00:05:24 Elizabeth Bachrad

populations facing multiple layers of disadvantage.

00:05:26 Elizabeth Bachrad

So they're doing well with getting participants living in the most deprived communities, which align closely with the NHS Core 20 approach, which is looking at the most deprived 20% of the national population as identified in the index of multiple deprivation.

00:05:43 Elizabeth Bachrad

And it also has strong engagement from ethnically diverse communities, particularly Asian and Black Londoners.

00:05:50 Elizabeth Bachrad

And what's really interesting

00:05:52 Elizabeth Bachrad

especially for later on when we do the economic evaluation, is that many participants are in later working age groups, so particularly people in their late 50s and early 60s.

00:06:02 Elizabeth Bachrad

But beyond the statistics, there's a broader system issue.

00:06:05 Elizabeth Bachrad

We're often asking people to return to work before they feel physically or psychologically ready to do so.

00:06:12 Elizabeth Bachrad

that scale of the problem is one of the biggest themes that we found is that participants need health before work support, meaning that pain management, that confidence rebuilding and trust before the employment pathways feel realistic.

00:06:26 Elizabeth Bachrad

And I think I'll just take a note on the wider public health point here and the scale of the problem is that we know that good work can be protective for health.

00:06:35 Elizabeth Bachrad

But poor health can also become a major barrier to accessing or sustaining good work.

00:06:40 Elizabeth Bachrad

So programmes like the Trailblazer sit right at that intersection between prevention, health equity, and economic participation.

00:06:48 Kevin Daniels

Yes, so you got to, you got the vicious circle and the virtuous circle and you operating here as well.

00:06:55 Kevin Daniels

So if you, as soon as you can get people back to work

00:06:58 Kevin Daniels

a virtuous circle kicks in of course.

00:07:00 Kevin Daniels

It's an interesting statistic that with musculoskeletal being secondary to sort of infection.

00:07:06 Kevin Daniels

So if you take infections out which aren't generally aren't chronic, so musculoskeletal is the leading chronic condition that's keeping people off work and it will be keeping people off work for significant, you know, not just frequency but duration as well.

00:07:19 Kevin Daniels

So there's a huge, huge problem.

00:07:21 Kevin Daniels

Is there anything that you haven't covered that's specific to trial?

00:07:26 Kevin Daniels

in terms of the approach taken or novel unique that you haven't covered so far?

00:07:32 Elizabeth Bachrad

Well, I think what's really interesting about it is that it's a whole person or whole system approach.

00:07:38 Elizabeth Bachrad

We don't really see that with a lot of interventions.

00:07:41 Elizabeth Bachrad

So rather than seeing unemployment as simply a labour market issue or MSK pain as purely a clinical issue, the programme recognizes the interaction between health, competence, identity, social support and employability.

00:07:55 Elizabeth Bachrad

And that's a lot to take in.

00:07:56 Elizabeth Bachrad

So practically that means bringing together physiotherapy, health and employment coaching, welfare support, local community organizations, and NHS linked pathways into more integrated delivery models.

00:08:10 Elizabeth Bachrad

So a major innovation was the community appointment day model.

00:08:14 Elizabeth Bachrad

We see these in MSK hubs where the community comes together at a single point of access where people can meet multiple services at once rather than navigating fragmented systems independently.

00:08:25 Elizabeth Bachrad

And one of the most important mechanisms

00:08:26 Elizabeth Bachrad

we identified was trust.

00:08:28 Elizabeth Bachrad

And this is largely due to describing feelings of being listened to, respected, and understood.

00:08:35 Elizabeth Bachrad

It sounds really simple, but this relational trust became a key mechanism for engagement.

00:08:41 Elizabeth Bachrad

So we found that when people felt psychologically safe and supported, they were more willing to engage in the services like physiotherapy, employment support, or longer term planning.

00:08:51 Elizabeth Bachrad

So the intervention wasn't just delivering services, it was actually rebuilding confidence and agency in people.

00:08:58 Kevin Daniels

That opens up an awful lot of questions about the complexity of the evaluation.

00:09:04 Kevin Daniels

So there's one thing I just noticed, you've got so much going on, how can you figure out what's working?

00:09:10 Elizabeth Bachrad

Yeah.

00:09:10 Kevin Daniels

So you know, sort of, you know, what things are working conjointly as well, not just, you know, sort of isolating a single effect, but isolating effects where two things have to happen together.

00:09:21 Elizabeth Bachrad

Yeah, I mean, this came up in problems and even just running the evaluation itself.

00:09:26 Elizabeth Bachrad

So

00:09:27 Elizabeth Bachrad

when a realist evaluation looks at the context, the mechanisms, and then the outcomes associated with that.

00:09:33 Elizabeth Bachrad

And I have probably over 50 of those configurations.

00:09:39 Elizabeth Bachrad

So the key is to really look at the biggest challenge in that these integrated programmes are often sitting on highly fragmented systems.

00:09:48 Elizabeth Bachrad

So while the programme itself is aiming to join things up, the underlying infrastructure frequently wasn't joined up at all.

00:09:54 Elizabeth Bachrad

So how are we then identifying what works?

00:09:58 Elizabeth Bachrad

And part of this really matters because implementation quality is directly affected by those operational friction points.

00:10:07 Elizabeth Bachrad

And so we encountered, for example, inconsistent bar level data systems,

00:10:13 Elizabeth Bachrad

delays in data governance approvals, incomplete data entry, various NHS waiting list practices, and multiple reporting platforms.

00:10:21 Elizabeth Bachrad

So that's created quite a challenge of understanding what works.

00:10:25 Elizabeth Bachrad

And the different boroughs have different levels of NHS integration, physiotherapy access, venue quality, and local partnerships.

00:10:34 Elizabeth Bachrad

So I think that's really an important lesson for policy is that these interventions don't operate in a vacuum.

00:10:40 Elizabeth Bachrad

So context matters enormously and that's what we're looking at.

00:10:44 Elizabeth Bachrad

And I think when we think about evaluation outcomes, even the process outcomes, even in those configurations that I talked about around context and mechanisms, they come well into the programme delivery.

00:10:57 Elizabeth Bachrad

And so when we're looking at

00:11:00 Elizabeth Bachrad

outcomes, the programme has already bid for future funding to keep it going without really knowing if it's effective.

00:11:06 Elizabeth Bachrad

And so that's one of those issues about capturing robust evidence simultaneously while it's being delivered.

00:11:13 Kevin Daniels

Yes, I suppose it's again, so many questions being raised by this.

00:11:18 Kevin Daniels

So if it's difficult enough to scale across London boroughs, I'm thinking out on

00:11:24 Kevin Daniels

that here in rural Norfolk, how are you going to transfer to Suffolk and Norfolk or Yorkshire or Scotland or which is, obviously health is devolved as well.

00:11:36 Kevin Daniels

So that's just mind boggling how you might scale something like this.

00:11:41 Kevin Daniels

Have you given any thought to that how you might transfer the mechanisms of transferability?

00:11:46 Elizabeth Bachrad

Yeah, absolutely.

00:11:47 Elizabeth Bachrad

And a few things stand out.

00:11:48 Elizabeth Bachrad

So first, in order to scale and in order to prove effectiveness, we need better shared infrastructure

00:11:54 Elizabeth Bachrad

and particularly shared data systems and clear minimum operating standards.

00:11:59 Elizabeth Bachrad

So this is part of the implementation infrastructure that we're looking at.

00:12:03 Elizabeth Bachrad

And we also need some fidelity to those models.

00:12:06 Elizabeth Bachrad

So if we're going to scale, implementation science needs to become more central to public policy.

00:12:13 Elizabeth Bachrad

If we're funding these interventions without adequately funding the conditions required to implement them well, we don't know if they have transferability.

00:12:20 Elizabeth Bachrad

And just for a few examples,

00:12:23 Elizabeth Bachrad

Relational coaching takes time.

00:12:25 Elizabeth Bachrad

Trust building takes continuity.

00:12:28 Elizabeth Bachrad

And integrated working requires coordination capacity.

00:12:30 Elizabeth Bachrad

We're seeing ICSs, ICBs combining, restructuring, devolving, cutting staff.

00:12:38 Elizabeth Bachrad

So we're up against, again, a fragmented system.

00:12:42 Elizabeth Bachrad

But there needs to be greater recognition that local adaptation is inevitable.

00:12:47 Elizabeth Bachrad

So if we can create a clearer framework to make that happen, then we're looking at an effective London wide minimum delivery model.

00:12:53 Elizabeth Bachrad

And that is clear standards around community appointment days, referral pathways, staffing ratios, data collection and integrated working.

00:13:02 Elizabeth Bachrad

And without that, the variation actually becomes inequitable.

00:13:06 Elizabeth Bachrad

So if we can lock those down, those minimum operating standards, then we have a chance for scaling.

00:13:14 Kevin Daniels

Okay, great.

00:13:14 Kevin Daniels

And I suppose one of the other thing that pops out from talking about the complexity of how things are different in different areas.

00:13:23 Kevin Daniels

Some of the mechanisms are dependent on relationships between the service providers and it's not standalone.

00:13:31 Kevin Daniels

So there's an element of having to work on how the services work together.

00:13:35 Kevin Daniels

Is that a fair point?

00:13:38 Elizabeth Bachrad

Absolutely.

00:13:38 Elizabeth Bachrad

How services work together and largely looking at communication, but the shared infrastructure, you know, what is it that is required of partners when they come to these community appointment days?

00:13:50 Elizabeth Bachrad

How do they understand the programme itself?

00:13:53 Elizabeth Bachrad

Because the pathways to the pathways need to be more solid for people coming through the system.

00:13:59 Kevin Daniels

Do you find.

00:14:01 Kevin Daniels

Again, you talked about confidence being such an important outcome for the service users, but that presumably is not what the person funding or the people funding the evaluation want.

00:14:12 Kevin Daniels

They want people back in work.

00:14:13 Kevin Daniels

So it's kind of a non-monetized benefit, I suppose.

00:14:16 Kevin Daniels

Is that what that means?

00:14:18 Elizabeth Bachrad

Yeah.

00:14:18 Elizabeth Bachrad

it's a fair point.

00:14:20 Elizabeth Bachrad

And what we're trying to demonstrate is that protecting that relational delivery will give those outcomes.

00:14:26 Elizabeth Bachrad

And it sounds counterintuitive in a systems or an economic

00:14:31 Elizabeth Bachrad

discussion, but the evidence repeatedly showed that these relationships were not peripheral, they were central.

00:14:37 Elizabeth Bachrad

So let's take it back a moment.

00:14:39 Elizabeth Bachrad

If we look at staff being able to manage their caseloads and the time to build rapport, participants reported greater trust, higher motivation, improved confidence, and stronger engagement with the services.

00:14:51 Elizabeth Bachrad

But when the systems became overstretched, delivery became more transactional.

00:14:54 Elizabeth Bachrad

So we're going to see different outcomes.

00:14:57 Elizabeth Bachrad

And so one

00:14:58 Elizabeth Bachrad

major recommendation we had was reducing that excessive caseload pressure and improving staff support structures.

00:15:05 Elizabeth Bachrad

So we're going more up the stream on the demand side of what we're asking of people.

00:15:11 Elizabeth Bachrad

And that looked at prioritizing the communication between the physios and the coaches, strengthening employer engagement so that they understand

00:15:20 Elizabeth Bachrad

what's needed for reasonable adjustments or supporting people back into work.

00:15:25 Elizabeth Bachrad

And most importantly, and I think this would run true for any type of economic or overall impact evaluation, is investing in the interoperable data infrastructure.

00:15:37 Elizabeth Bachrad

We need these integrated systems in order to understand the most effective outcomes.

00:15:41 Kevin Daniels

It seems like you were implementing improvements as you were going along.

00:15:46 Elizabeth Bachrad

Absolutely.

00:15:46 Elizabeth Bachrad

And it's a broad recognition that they're building the plane as they're flying it.

00:15:51 Elizabeth Bachrad

But that's okay.

00:15:53 Elizabeth Bachrad

I think one of the things that I'd like to see over more of these types of trailblazers or interventions is some rapid evaluation that gives the chance to course correct or to iterate or to recognize what's really working and put more effort into that.

00:16:08 Elizabeth Bachrad

They are continuing to be up against many different

00:16:11 Elizabeth Bachrad

interventions working in the same space.

00:16:14 Elizabeth Bachrad

So work well, connect to work, disability confident.

00:16:17 Elizabeth Bachrad

And what that's doing is creating a talent pool shortage of coaches that can effectively manage these skills, but also give them the confidence to help people navigate these pathways.

00:16:29 Elizabeth Bachrad

It's really a downstream problem as well as it is the impact of the downstream participants.

00:16:35 Kevin Daniels

All of this, of course, again, makes

00:16:38 Kevin Daniels

your job as an evaluator much harder because what you started off with is not what you ended up with.

00:16:47 Kevin Daniels

Again, is that something you were able to take into account?

00:16:51 Elizabeth Bachrad

I think that's the beauty of a realist evaluation framework is context matters so much.

00:16:58 Elizabeth Bachrad

So how do we ground the evidence that we're seeing into a highly adaptable, iterative

00:17:07 Elizabeth Bachrad

mindset to be able to shift to meet the needs of not only the staff implementing the intervention, but the people participating because if they are co-designers of this, of the eventual outcome, then they're going to have more agency and abilities to navigate these extremely fragmented pathways.

00:17:28 Elizabeth Bachrad

But participants recognize this and a lot of them do give feedback and it's

00:17:34 Elizabeth Bachrad

It's hard when you're running a machine in a way, but the Shaw Trust, the key enablers of delivering that intervention are very keen to stay on top of this.

00:17:44 Elizabeth Bachrad

And they recognize the scale of the problem, and they also recognize the scale of their strengths to enable effective delivery.

00:17:52 Kevin Daniels

I suppose that leads me to a question around is there anything that kind of worked that shouldn't or anything that was worked but in a way that it shouldn't have worked?

00:18:03 Kevin Daniels

I mean, because realistic valuation is quite good at spotting these unexpected things, isn't it, if it's with an open mindset?

00:18:10 Elizabeth Bachrad

Yeah, it's a really good question.

00:18:14 Elizabeth Bachrad

The target numbers are employment starts or employment returns.

00:18:19 Elizabeth Bachrad

And when you put those KPIs against a relational service, that really can have a negative impact on how it's delivered.

00:18:32 Elizabeth Bachrad

And so I think the fidelity to the model is going to be the trickiest part to maintain, but it is the most important.

00:18:39 Elizabeth Bachrad

So how do you put fidelity on relationship building?

00:18:43 Elizabeth Bachrad

And so that to me will be a key factor in how the success of this intervention continues.

00:18:50 Elizabeth Bachrad

And that's a bit of accountability.

00:18:53 Elizabeth Bachrad

It's oversight.

00:18:54 Elizabeth Bachrad

It's also having some tough conversations, but also encouraging and empowering conversations because these people are in it to help people, right?

00:19:02 Elizabeth Bachrad

So the

00:19:04 Elizabeth Bachrad

the intention is there, but with any sort of action, what we don't want to see is people from the top dictating how the intervention should look and people on the ground saying it's just not possible because of the infrastructure in place.

00:19:17 Elizabeth Bachrad

So those types of gaps will need to be closed as well if we want to scale.

00:19:20 Kevin Daniels

Yeah, that's absolutely fascinating.

00:19:22 Kevin Daniels

Of course, yeah, it's something that's actually at one level quite transactional, but can't work if it's

00:19:29 Kevin Daniels

if it's transactional.

00:19:30 Kevin Daniels

There's also, it's sort of, you're speaking, I was reminded of an evaluation.

00:19:35 Kevin Daniels

It was about gardening, actually, gardening intervention, which had absolutely no effect on the symptoms, but the people who were, it was depression, but the people who were taking part in the intervention said, no, we just want to carry on, don't take the gardening away just because you didn't think it worked.

00:19:52 Kevin Daniels

As far as we're concerned, it has worked.

00:19:54 Kevin Daniels

It's changed, but there was that kind of element that this is the intended outcome.

00:20:00 Kevin Daniels

But there was another outcome, which was a benefit.

00:20:04 Kevin Daniels

So I just wondered, we saw some of these things, because you did mention the funding earlier on, that you might need a longer evaluation period.

00:20:13 Elizabeth Bachrad

Yes and no.

00:20:14 Elizabeth Bachrad

I mean, the process evaluation has been done in terms of understanding those early implementation barriers.

00:20:21 Elizabeth Bachrad

And that's taken into context.

00:20:23 Elizabeth Bachrad

So we have been able to demonstrate what can be addressed pretty quickly now and moving forward.

00:20:30 Elizabeth Bachrad

And it doesn't mean it's easy, but one of the things that you just brought up is that, okay, so there's a lot of different outcomes that we want to highlight even on top of these employment returns, because we're also looking

00:20:43 Elizabeth Bachrad

at long-term value to society.

00:20:45 Elizabeth Bachrad

And so what that means is people's subjective well-being also matters.

00:20:50 Elizabeth Bachrad

How do they feel about their health and their employability and their skills?

00:20:54 Elizabeth Bachrad

So that's taken through an assessment called Dialogue Plus at different time points.

00:20:59 Elizabeth Bachrad

But we've also encountered chatting with the physios that we want some harder functional assessment outcomes related to their physical health.

00:21:10 Elizabeth Bachrad

Because what we see in an intervention like this,

00:21:13 Elizabeth Bachrad

that processes almost all of the social drivers of health is that people need to take transportation to get to work.

00:21:20 Elizabeth Bachrad

They have housing issues, they have childcare issues, right?

00:21:25 Elizabeth Bachrad

So if we are going to see the full impact to society, we wanna also understand what types of outcomes are happening on those levels.

00:21:35 Elizabeth Bachrad

And that's particularly interesting for the older age groups that are high users of this intervention.

00:21:42 Elizabeth Bachrad

is one would say, they're not going to be in the labour market for that long.

00:21:46 Elizabeth Bachrad

So the contribution to society and to the treasury bottom line is going to be minimal, but we're working longer because we have to.

00:21:55 Elizabeth Bachrad

But what if we actually worked longer in good health?

00:21:58 Elizabeth Bachrad

And I think that's a key message that I'd love to put across is that

00:22:03 Elizabeth Bachrad

we can have the opportunity to be healthier for longer, in work for longer, and that's so good for people and their communities and all of society.

00:22:13 Kevin Daniels

And it's interesting what you said there about, so just think that obviously let's go back to me being in rural Norfolk, transportation.

00:22:21 Kevin Daniels

So, you know, if transportation is an issue in London, then you can imagine what a barrier it would be where, you know, I once lived in a village where there was one bus a week.

00:22:31 Elizabeth Bachrad

Wow.

00:22:32 Kevin Daniels

In Buckinghamshire.

00:22:33 Kevin Daniels

So you do kind of have, you know, sort of issues, contextual issues, which are sort of magnified in some areas.

00:22:40 Kevin Daniels

So I suppose to follow up on that, in terms of priorities and sort of what if you were to move this intervention to another part of the country, what would be the major lessons that you would take to from this evaluation to try and, you know, implement a similar sort of thing somewhere else?

00:23:01 Elizabeth Bachrad

So I would say a couple of things.

00:23:02 Elizabeth Bachrad

that I mentioned previously around relational delivery.

00:23:05 Elizabeth Bachrad

We have to figure out the fidelity models to relational delivery, and that is being listened to, allowing for conversations that may not meet the KPIs in that moment.

00:23:22 Elizabeth Bachrad

Looking at caseload management, looking at the systems that become overstretched and manage those, but one of the things I've been playing with a lot is the employer engagement side, so I'm calling this the supply-demand conundrum.

00:23:41 Elizabeth Bachrad

So we split out interventions and we have this for that and this for that.

00:23:44 Elizabeth Bachrad

And once you finish MSK Trailblazer, you can go to connect to work.

00:23:47 Elizabeth Bachrad

Once you're in work, you can do work well, which keeps you in work.

00:23:51 Elizabeth Bachrad

So we have these interventions, but the employer side, the demand side, we have to hold them more accountable to how they're engaging with this workforce.

00:24:01 Elizabeth Bachrad

If we really want to keep people in work, if we want to get people back into work, we're not fundamentally doing something right about how work is designed.

00:24:11 Elizabeth Bachrad

And so the second-half of this evaluation period where we're moving towards impact and economic side of it is looking more at that demand side and how employers are more involved in this picture.

00:24:27 Elizabeth Bachrad

And then I would be remiss not to mention data infrastructure.

00:24:33 Elizabeth Bachrad

The standardization is absolutely key.

00:24:35 Elizabeth Bachrad

I mean, we can't compare, we can't benchmark.

00:24:37 Elizabeth Bachrad

We actually are having trouble comparing across the boroughs to see what's more effective in each borough.

00:24:43 Elizabeth Bachrad

So those would be my three main things.

00:24:46 Kevin Daniels

And linking employment outcomes with health data as well is.

00:24:51 Elizabeth Bachrad

Yes, it's been near impossible.

00:24:53 Kevin Daniels

Yeah, so I'm involved in a group that hasn't even got as far as looking at that.

00:24:58 Kevin Daniels

I mean, on somewhere in the horizon, it's just getting their health data together.

00:25:03 Kevin Daniels

And that's around sort of health inequalities as well.

00:25:06 Kevin Daniels

And I suppose, I mean, the employer side is always the tricky one, isn't it?

00:25:12 Kevin Daniels

You know, compared to European countries where there's more employment legislation in this space than here.

00:25:20 Kevin Daniels

I mean, the employment rights bill might do something, but probably won't.

00:25:24 Kevin Daniels

And I think you're right about the joined upness, which

00:25:28 Kevin Daniels

I'm sure you hear as much as I do, this preventive side needs to be joined up with the rehabilitation side of things.

00:25:35 Kevin Daniels

And the government advice is not in one place, it's not under one piece of legislation.

00:25:42 Kevin Daniels

I think that's the thing we're, we're going to have to look forward at changing in the future for those of us in this community.

00:25:50 Kevin Daniels

But I wanted to ask you, more focused on you in the future.

00:25:53 Kevin Daniels

So what are you going to be doing next?

00:25:55 Kevin Daniels

What are your plans?

00:25:57 Elizabeth Bachrad

Oh, great.

00:25:58 Elizabeth Bachrad

Yeah.

00:25:59 Elizabeth Bachrad

Well, I'll just touch quickly on what's next with this one and then where I think it's going.

00:26:03 Elizabeth Bachrad

But I think the space is only becoming more important.

00:26:06 Elizabeth Bachrad

And we see this across the UK and internationally.

00:26:10 Elizabeth Bachrad

We're seeing rising economic inactivity linked to long-term health conditions, aging populations, of course, mental health pressures and widening inequalities.

00:26:18 Elizabeth Bachrad

And we work in this space, we work so hard in this space, and yet we see the gaps widening.

00:26:24 Elizabeth Bachrad

So what is it really going to take?

00:26:25 Elizabeth Bachrad

And I think the future challenge isn't simply getting people back into work.

00:26:29 Elizabeth Bachrad

It's designing systems that support people to participate meaningfully and sustainably and work while also protecting health and wellbeing.

00:26:37 Elizabeth Bachrad

So the next phase of the trailblazer is really moving from that early implementation insights into understanding those longer term impact value and scalability questions that you posed earlier.

00:26:49 Elizabeth Bachrad

But I think we want to think about, of course, reducing pressure on healthcare services, potentially reducing benefit dependency, longer term three to five year horizon scanning.

00:27:01 Elizabeth Bachrad

But I think we're missing a big piece of this.

00:27:04 Elizabeth Bachrad

And

00:27:05 Elizabeth Bachrad

It's not just who benefits most, but it's under what conditions and are outcomes equitably distributed across different communities and boroughs.

00:27:15 Elizabeth Bachrad

So I think the bigger point here is that we need to look at demonstrating how integrated health and work approaches improve wellbeing and reduce downstream economic and system pressures.

00:27:29 Elizabeth Bachrad

And that's where we can strengthen the case for prevention oriented models much more broadly.

00:27:34 Elizabeth Bachrad

So for me personally, the next stage is continuing to explore this intersection, health systems, labour markets, prevention, and workforce wellbeing.

00:27:44 Elizabeth Bachrad

And I'm particularly interested in futures, so work futures, how our integrated care systems, whether we look at it in the UK lens or internationally, how they engage employers more in this issue, how we measure health as an economic assets,

00:28:03 Elizabeth Bachrad

And my nerdy way of looking at this is through implementation science and an academic lens to help scale relational community-based approaches and stop treating health and work as separate policy domains.

00:28:17 Elizabeth Bachrad

They really, we need systems that make people feel seen, supported, and capable again.

00:28:23 Kevin Daniels

That's brilliant.

00:28:25 Kevin Daniels

I do like you finishing with

00:28:27 Kevin Daniels

not treating work and health as separate policy domains because unfortunately nature does not obey the structure of governments.

00:28:35 Kevin Daniels

So Elizabeth, that was great.

00:28:39 Kevin Daniels

It's always fascinating talking to you and I've really enjoyed that chat.

00:28:45 Kevin Daniels

Is there anything that I could have asked you that you wanted to answer?

00:28:50 Elizabeth Bachrad

I think, I mean, overall, I think the next challenge for academics and policy makers is to understand the incentives to unlock these capabilities.

00:29:01 Elizabeth Bachrad

And I'm really interested, maybe we can look at futures and types of financing models.

00:29:07 Elizabeth Bachrad

And in development world, they look at outcomes-based financing

00:29:11 Elizabeth Bachrad

There's capabilities of shared accountability.

00:29:14 Elizabeth Bachrad

So we're sharing the risk, but we're also sharing the reward.

00:29:17 Elizabeth Bachrad

And I think those incentives really matter for people, for businesses, for communities.

00:29:23 Elizabeth Bachrad

And so government's role in this regulation matter.

00:29:27 Elizabeth Bachrad

So not really a question, but more of a question to you is how do we design the systems that also include some of those shared accountability mechanisms?

00:29:36 Elizabeth Bachrad

and unlock financing so that we can actually potentially decommission services that aren't useful or have high utility and commission and unlock innovation for businesses that really want to find those entry points and deliver the outcomes that we all desire.

00:29:54 Kevin Daniels

I think there's also within that shared accountability that sort of recognition that the different professions place slightly different roles and obviously in the multi-agency, multi-service intervention that you've been looking at.

00:30:08 Kevin Daniels

I mean, that's a big thing, but even within on the employer side, I think it's your HR, your occupational health, potentially facilities management, all sorts of things that govern the actual physical.

00:30:21 Kevin Daniels

work environment as well as a sort of, the social work environment.

00:30:26 Kevin Daniels

I think sort of understanding how the different professions can work with each other, either across organizational boundaries and within organizations.

00:30:35 Kevin Daniels

I think for me, if I was going to advise someone to start a PhD on a topic around this area, I think that would be the one I would choose for me.

00:30:44 Elizabeth Bachrad

Yeah, absolutely.

00:30:46 Elizabeth Bachrad

And my question is not how do we do systems change, but how do we operationalize into

00:30:51 Elizabeth Bachrad

systems change, and that's going to be our next biggest challenge for the future of working to help.

00:30:57 Kevin Daniels

I think you're right.

00:30:58 Kevin Daniels

There are clearly entities that can do it, so figuring out how those entities work would be a really great starting point.

00:31:05 Kevin Daniels

I didn't realize I was going to turn into the interviewee.

00:31:10 Elizabeth Bachrad

I always have more questions than answers when.

00:31:13 Kevin Daniels

It comes to this.

00:31:14 Kevin Daniels

That makes a fantastic researcher, doesn't it?

00:31:18 Kevin Daniels

Again, always great to talk to you, Elizabeth.

00:31:22 Kevin Daniels

Thank you for sharing your time and your insights with us today.

00:31:27 Elizabeth Bachrad

My pleasure, Kevin.

00:31:28 Elizabeth Bachrad

Thank you so much for the work you do.

00:31:32 Helen Fitzhugh

Please do visit www.evolveworkplacewellbeing.org.

00:31:37 Helen Fitzhugh

We look forward to seeing you next time.