As Medical Officer at Legal & General, Dr Tarun Gupta provides clinical opinion on group income protection cases and thought leadership on clinical topics and guidelines. In an extensive interview, he shares some insights on his role at our network partner Legal & General and identifies major trends in the health area. He also explains why employers, insurers and healthcare systems should join forces to minimize the impact of crises on their people. Please enjoy reading his answers to my questions.
What inspired you to join Legal & General as their Medical Officer, as part of their Group Protection insurance business?
As a General Practitioner, my team and I focus on promoting health and preventing disease, as well as supporting people when they are unwell, both acutely and with chronic conditions. For those with one or more chronic conditions, the impact can be considerable, both physically and psychologically, with several implications for their work and social life.
My clinical interest is Occupational Medicine, a branch of medicine that examines the impact of ‘health on work’ and ‘work on health’. Over the last five years, I have had the fortune of working with several corporate clients as their Occupational Physician, exposing me to complex cases of long-term sickness absence, ill-health early retirement applications and the role of income protection, both individual and group.
L&G are a sector leader in Group Protection, with a diverse client list, ranging from travel companies to banks. What stood out for me, however, is our culture and focus on innovation, where the team and our leadership are constantly striving to provide more impact for our clients. I was encouraged to work across several areas of the business from the outset, ranging from delivering continuous professional education sessions, to regularly joining our multi-disciplinary case review meetings, alongside reviewing individual cases to explore how we can best support a given employee.
In particular, the team has a clear focus on early intervention and offers support where appropriate, such as physiotherapy, psychological therapy (via selected partners), alongside regular clinical specialist reviews to monitor progress, while providing the financial support the income protection policy is intended for, when illness or injury means someone can’t work long term.
I joined the team shortly after the onset of the Covid-19 Pandemic and it was very exciting to work with the leadership team and apply my clinical skill in a different context to design our Post Covid support offer with our business partners, given the limited clinical evidence base at the time.
What are the most significant trends you see in the health area, in terms of their impact on employees and employers – either positive or negative?
There are three inter-linked trends that I think are relevant and have a considerable impact on both employees and employers.
Firstly, psychological well-being is high on the C-suite agenda. My impression is that while the Covid-19 Pandemic initially focused on employee safety, the focus quickly shifted to employee wellbeing and the role that employers can play in determining quality of life for employees and their families, with the rise of home and ‘hybrid’ ways of working. Employers are increasingly alert to the need to consider wellbeing more holistically and expand their offering in this arena, with employees also expecting and demanding more from their employers.
I believe this trend will accelerate and we will continue to see employers taking steps around prevention and proactively supporting employees with their psychological wellbeing, given the blurring between professional and personal lives and the potential for ‘isolation’ with new ways of working. I have noticed the emergence of Chief Medical Officers in corporates, to provide clinical leadership and a greater recognition of the parity between mental and physical health, for instance.
Secondly, we have an increasingly ageing population and therefore workforce, with several people suffering with one or more long-term conditions (such as diabetes, arthritis, kidney disease, a heart condition or cancer). Recent ONS data suggests that just over 13 million people of working age in the UK have a long-term health condition.
This has several implications from an Occupational Medicine perspective, including the considerations for health and safety at work and the need for employers to facilitate ‘reasonable adjustments’ in line with relevant legislation, which can be challenging, depending on the size and nature of the employer. Furthermore, and linked to the first trend to some degree, current evidence indicates that having a long-term condition makes an individual more prone to depression and can exacerbate the condition in those with existing depression, making treatment more complex and requiring a ‘joined-up’ approach.
Thirdly, the widespread adoption and implementation of digital platforms has transformed how employees access and think about health and wellbeing, in my view. In particular, the key issues of access to care and ownership of one’s healthcare data have changed considerably in the last few years.
 People with long-term health conditions
Employers are increasingly recognizing this trend and several have included access to remote / digital GP services as part of their employment offer (sometimes as part of income protection policies) and there are several apps for employees to monitor their own health.
I am particularly impressed with and proud of Legal & General’s leadership in this area. The group protection business has recently partnered with long-term condition management support service CONNECTPlus to introduce an evidence-based app, which will play a key role in our personalized, multi-disciplinary team (MDT) pathways, empowering employees to better control their condition and improve their health, both at home and work. The app focuses on six long-term conditions, including cancer, stroke, multiple sclerosis, diabetes, rheumatoid arthritis and Post-Covid-19 syndrome, with features ranging from health trackers and scores to monitor pain or symptoms (useful information for the treating specialist or GP) and patient information videos, articles and blogs to provide support, as well as medication reminders and appointment reminders. A further benefit is that line managers and HR are able to access the app and so are better informed about the impact long-term conditions have on employees.
How important do you consider a holistic approach to healthcare which addresses mental, physical, social and financial wellbeing?
This is absolutely critical, in my experience. When assessing any patient, doctors are trained to consider the ‘bio-psycho-social’ model, which explores the impact of that issue on someone physically, psychologically and socially (to include work and home life). This is particularly relevant for long-term conditions or more serious problems. Indeed, without a broader understanding of how that problem affects that individual and their expectations from treatment, it is not possible to agree a joint management plan with the patient, which will likely result in poor concordance / compliance and therefore a poor outcome.
There is now an increasing awareness of a fourth ‘pillar’ which looks at finances and I believe Legal & General have captured this focus well in our offer.
The wellbeing framework Legal & General Group Protection uses provides the guardrails for all development across its products and services. It is designed with mental wellbeing as the foundation, to support employees when they need it most. Imagine this as a horizontal with a series of 3 pillars above – financial, social and physical. All of these interact and Legal & General is working hard to help intermediaries, employers and employees understand this so that they can take an informed and empowered approach to managing wellbeing.
The pandemic has changed our world and put a lot of strain on people. Do employers have to build new mindsets and workplace cultures to address these changes? Who is the most impacted within the workforce by this change?
I would say that ‘health-savvy’ executives and business leaders already appreciate that a focus on wellbeing can have a significant impact on the organization’s culture, the way in which works get done and how that business is perceived externally, by customers, stakeholders and other authorities.
It is not so much about building new mindsets and workplace cultures, in my view, but demonstrating effective leadership and agility to proactively embrace change that is required. I believe the pandemic served as a catalyst for innovation, with more and more employees looking to their employers to provide not only information about the pandemic, but also asking them how they planned to support them more generally. It also served to further ‘blur’ the lines between professional and personal lives more than ever before, with employers looking for more dialogue with their employees and seeking their ideas on how to improve how work is delivered and performed.
Every industry and sector faces its own challenges, especially during the current economic climate and as we emerge from the pandemic into a period of higher inflation and the possibility of a looming recession. The furlough scheme (in effect an income protection offer from the government) was designed to support those employers and employees whose businesses could not operate during the pandemic, such as the hospitality sector, where people could not work from home.
I should point out that remote working also posed several challenges for people of all ages, but particularly people in the early stages of their career, who lost the informal mentoring and learning that usually happens in an office environment, and for people who do not have accommodation that incorporates space for a home office. For people in the latter group there was an initial flurry in musculo-skeletal cases in my Occupational Health clinic that related to poor ergonomics at home, some of which evolved into income protection cases, unfortunately.
On the other hand, I am aware that people in the later stages of their career embraced remote / hybrid working more, as it enabled them to reach colleagues more easily and spend more time with family due to less time spent travelling, with associated benefits from a psychological perspective.
What role do employers play in helping employees strengthen their mental wellbeing? What part does job design play?
This is a brilliant question and probably one that did not feature strongly in the human capital management discussions in the past. How you look after your people as an employer – and this includes the wellbeing offer – has become critical in attracting and retaining talent. Job design is an important part of Occupational Health.
Some of the big US tech companies started very early to provide employees with access to places at work where they can take a break. This included resting areas, pool tables or gyms, for example, and is a recognition that employers can provide an environment that enables employees to meet several needs, especially when people are spending a lot of their time at work. We have also seen the development of more digital offerings for informal chats and groups within organizations for people to express themselves and to enhance their psychological wellbeing.
Legal & General, for instance, is a leader in providing internal training modules to recognize early signs of behavioral changes within the teams – a dip in mood, a change in punctuality, people becoming more quiet at work, or less productive.
Coming back to the job design aspect, everybody in an organization has a role to look after the person next to them, independently from the level of seniority. Managers in positions with people reporting to them though, need to have much greater awareness and to be proactive in picking up on early signs where somebody might need help. There is also much greater focus on work outcomes, rather than rigidly defining how work is performed or delivered, with ‘hybrid’ working becoming the norm, in my experience. Employers also are much more aware that employees can be more productive at different times of the day and need greater control of their schedule, for instance.
Legal & General has close links with Business in the Community and Louise Aston, its Wellbeing Director, has joined our new Wellbeing Advisory Board. BitC have some great insights and guidance for employers in their most recent report, “Your job can be good for you” that I would encourage anyone interested in job design and wellbeing to take some time to read.
As I have mentioned before, the pandemic has ‘blurred’ the line between professional and personal lives. Many employees and even their employers have seen inside each other’s homes via Team or Zoom video calls, they have got to know the names of their pets and children (due to home schooling and children being at home during the working day) – we are definitely in a new world.
 Your Job Can Be Good For You - Business in the Community (bitc.org.uk)
Will digital health solutions still be important now that we are post-pandemic?
Digital solutions are here to stay, becoming more widely accepted and deployed. If you look at the NHS for example, once you have the adoption of digital platforms for remote consultation by a major health care system, it leads to innovation and a much wider acceptance.
We are now seeing a more ‘tailored’ approach around how to safely and effectively use digital solutions to improve access and ensure high quality care. For instance, initial assessments for surgery and suspected cancer are very likely to be face-to-face with a clinician, but several follow-up clinics, where investigations or examination is not required, can be delivered remotely. This can boost the capacity of follow-up clinics, enabling more people to be reviewed in a given clinic and therefore reducing follow-up time and improving outcomes by picking up complications and managing them earlier.
As I mentioned earlier, digital health solutions are also becoming a much wider feature in long-term condition management and enabling people to ‘own’ their health data and feel more in control of their health, which is here to stay, in my view.
In your opinion do employers recognize that they need to support their employees struggling with the long-term effects of Covid-19 infection and what impact is this condition currently having on the workforce?
From my clinics in both General Practice and Occupational Medicine, I am increasingly aware that employers are looking into this area and considering their approach, as the condition becomes more widely known and diagnosed.
Most people recover from Covid-19 within four weeks (acute Covid-19), followed by a phase known as ‘ongoing symptomatic Covid-19’ between weeks four and twelve, with Post-Covid-19 syndrome defined as signs and symptoms of infection consistent with Covid-19 lasting more than twelve weeks.
The term Long Covid is defined by NICE as signs and symptoms persisting after the first four weeks, so encompasses both ongoing symptomatic and Post-Covid-19 syndrome.
In terms of numbers, a recent survey estimates 919,000 people to be suffering from Post Covid with symptoms of weakness and tiredness and 591,000 to be experiencing shortness of breath as a part of Post Covid symptoms.
The NHS launched dedicated Post Covid clinics in late 2020 for people with ongoing symptoms problems to ensure rapid access and ‘joined-up’ multi-disciplinary care, with a focus on improving functional ability, which have certainly been of benefit, in my view.
 NICE definitions are: Acute COVID-19 - Signs and symptoms of COVID 19 for up to 4 weeks. Ongoing symptomatic COVID-19 - Signs and symptoms of COVID 19 from 4 weeks up to 12 weeks. Post-COVID-19 syndrome - Signs and symptoms that develop during or after an infection consistent with COVID 19, continue for more than 12 weeks and are not explained by an alternative diagnosis.
How can insurers support employers who are reporting this condition in their workforce?
After recognizing that the existing health systems were under significant strain during the pandemic, many insurers assumed a major role in taking the lead on some of the Post Covid management, even before the NHS rolled out their clinics.
Speaking for Legal & General, we have always focused on supporting our clients and their employees with their wellbeing and worked quickly with our partners to launch our early intervention care package for people with ongoing symptoms of Covid-19 in November 2020. The package included assessment and rehabilitation time to equip employees to recover from symptoms such as fatigue and short of breath. The offer was very well received. Our income protection product can provide financial support, access to rehabilitation services and ongoing support for those affected by Post Covid, where the severity of the symptoms precludes work.
We have recently established a Wellbeing Advisory Board, along with several partners, with Post Covid-19 syndrome featuring as the first issue on the agenda, for instance, to provide employers with a ‘one-stop’, curated resource that shares best practice from a clinical and managerial perspective. The Board’s primary goal is to help employers and employees find and use practical information quickly and easily. It recognizes that there’s so much information that it can be challenging to unravel, understand and act on the information that’s out there.
It goes without saying that just as the world felt like it had time to breathe, we are seeing yet more uncertainty and challenges for businesses and employees due to the Ukraine conflict and the cost-of-living crisis. How can employers help their employees through this time?
We live in a world where change and uncertainty has been the new ‘normal’ for a while. Nonetheless, it does appear that a multitude of issues are coming together at the same time at present, with associated volatility and ambiguity. These issues can translate into stress and serve as triggers for mental health conditions, such as anxiety and depression, for instance, rapidly becoming medical or occupational health problems.
Employers should develop a strong ‘framework’ to support their employees, as we discussed earlier, with a focus on the wider wellbeing of their employees. This will enable them to proactively manage new ‘shocks’ as they emerge, rather than react passively. In terms of practical steps, this means developing a corporate culture that embraces diversity and inclusion and demonstrates clear purpose. Some employers are addressing the cost-of-living crisis explicitly and taking steps to support their employees, while working with government at the same time. Several employers have taken a clear, public stance on the Ukraine conflict and provided platforms internally for employees to share their views, comment on the steps their employer should take to support people impacted by the crisis, provide psychological support for those who need it and review their business models, for instance.
Products and services such as access to an employee assistance program (EAP) for psychological support, occupational health and income protection policies can, alongside strong leadership, vastly mitigate the impact of crises on employees and result in a more productive and happier workforce, which ultimately benefits the organization and wider economy.
Dr Tarun Gupta is the Medical Officer for Group Protection at Legal & General and has around 20 years’ experience working in the NHS and private sector as a GP, Clinical Commissioner and Occupational Physician. He started his career in investment banking. Tarun serves as a resource for the claims and rehabilitation teams and provides medical opinion on complex cases, applying his expertise to comprehensively assess functional ability, interpret disparate medical evidence and address appeals, including decisions by the Financial Ombudsman Service.
Tarun earned his medical degree from St George’s, University of London and also holds a First Class degree in PPE from Oxford University, alongside postgraduate qualifications in Clinical Psychiatry, Occupational Medicine and Legal Medicine. He is a Fellow of the Royal College of General Practitioners. Currently, he serves on the AMUS committee, the L&G Wellbeing Advisory Board and a clinical guideline committee with NICE.
About Legal & General
Established in 1836, Legal & General is one of the UK's leading financial services groups and a major global investor, with over £1.4 trillion in total assets under management at 9 March 2022 of which a third is international. We also provide powerful asset origination capabilities. Together, these underpin our leading retirement and protection solutions: we are a leading international player in pension risk transfer, in UK and US life insurance, and in UK workplace pensions and retirement income. Through inclusive capitalism, we aim to build a better society by investing in long-term assets that benefit everyone.
We’re a leading provider of Group Protection cover in the UK with 90 years of expertise and knowledge. We looked after over 5,500 group protection policies and provided protection to almost 1.8 million employees at the end of 2021.
For more information please see here https://www.legalandgeneral.com
[[[pdf]]]AGB Expert Talk - Dr Tarun Gupta