Initiatives by Government and industry to address the use of rehabilitation for getting people back to work are becoming more commonplace. Robert Fielding explains
The principal objective of the employers' liability (EL) system is to secure restitution for those who are harmed through the negligence of their employer.
In the UK, this is seen almost exclusively in terms of financial compensation. This contrasts sharply with the approach adopted by many overseas workers to compensation systems, where rehabilitation plays a much bigger role.
In its broadest terms, vocational rehabilitation is the process whereby those who are ill, injured or have a disability are helped to access, maintain or return to employment or another useful occupation.
Fairer solution
Minimising the extent and adverse effects of injuries can be a better, fairer solution for all parties than assessing a financial value for injury or illness. There is also increasing evidence that there can be financial benefits from action too.
Rehabilitation trials by a major insurer in relation to low-end motor insurance claims have indicated an overall cost saving of 7%-10%. The Association of British Insurers (ABI) believes the potential may be higher and has recently published findings from research which suggests that major opportunities are being missed by motor and EL insurers.
A report published in June 2003 showed that the Government committed itself to providing a forum for businesses, unions and insurers to develop proposals for increasing the use of rehabilitation. In October 2003, a conference took place involving more than 40 stakeholders from Government, the Trade Union Congress, the legal profession, the insurance industry, trade associations and occupational health providers.
Rehabilitation also formed a significant part of the Department for Work and Pensions (DWP) report, Review of EL Compulsory Insurance, which was published at the end of 2003.
The DWP and the ABI are shortly to announce a national plan for the full-scale provision of rehabilitation in the UK.
Similarly, the Government is already investing more than £40 million in the rehabilitation elements of its Job Retention and Rehabilitation and Pathways to Work pilots that are designed to help those coming into the benefit system or already on long-term inactive benefits to re-enter the open job market.
But the rehabilitation increasingly being promoted by insurers in the context of liability claims is just one part of an overall picture. Work is also being done by employers and the Health and Safety Executive (HSE) on occupational health in the workplace.
In a welfare to work context, the DWP's aim is to enhance rehabilitation provision through engaging primarily the NHS and private and voluntary sectors to help people with manageable health problems or disabilities return or move into employment. Alongside the development and provision of identifiable employment rehabilitation services, the DWP is also seeking to build return to work activity as a normal part of everyday clinical and other specialist advice.
Positive research
Similarly, as part of its Securing Health Together initiative, the HSE is already working with employers to improve advice about, and access to, the provision of occupational health. In particular, it is targeting its efforts on key priority programmes relating to stress and musculoskeletal disorders that, jointly, account for more than 50% of work-related ill health. The HSE has clear targets to reduce both the incidence of work-related injury and ill health, as well as the time off per incident.
These actions by the Government focus on absence management which is increasingly a part of the agenda of business organisations, such as the Confederation of British Industry.
Rehabilitation is a growing issue for insurers too. As well as the schemes provided both by insurers and risk management consultants, the ABI has recently commissioned significant and positive research into the case for rehabilitation.
Strong evidence
Neither the Government nor the private sector is presently well placed to answer the question of what works for whom, and in what circumstances. Whether from the perspective of the Government's benefit expenditure, or a company's bottom line, a key requirement for increased rehabilitation is being able to show that tangible investment up-front will lead to equally tangible savings further down the line.
The Government wants the benefits of rehabilitation to be shared by all parties to ensure that they all have a reason to co-operate when rehabilitation is appropriate. In terms of facilitating a return to work for those for whom a natural healing process or traditional health care is not sufficient, there is increasing evidence to support the effectiveness of a multi-dimensional approach.
This would combine, as necessary, interventions that are both medically-focused - whether mental or physical - or addressing other obstacles to work, such as ergonomic changes or working hours.
Evidence is now proving that the early application of such interventions is a major factor affecting job retention or return to work. Conversely, there is evidence that inactivity and a lack of intervention is associated with physical and mental deterioration and lower chances of a return to work.
GPs attending the What about the workers? conference at the Royal Society of Medicine were shown how keeping people off work when they could be undertaking adapted duties is detrimental to patients' long-term health and prospects.
Recent evidence also suggests such an approach to rehabilitation can be effective in relation to some of the most common conditions of work-related ill health and injury, such as mental health, musculoskeletal and cardio-respiratory problems.
Intervention
For instance, a Canadian programme of combined intervention for sufferers of back problems led to return to work 2.4 times faster than usual care, and reduced subsequent sickness absence by 70% over the next six years.
In the UK, according to the HSE, back pain alone accounts for 17% of all days off work due to ill-health caused or made worse by work. Some GPs are still recommending bed rest for back sufferers when it is widely acknowledged that staying active is best for the vast majority.
However, while there is considerable evidence to support the broad concepts of vocational rehabilitation, we do not yet know what factors are most critical in which circumstances. More precise evidence is needed about the details of effective interventions. And as a first step, the Government is now committing to develop and publish a framework for vocational rehabilitation. This framework will be a significant step forward.
Robert Fielding is operations director at FirstAssist
COVER notes
• The principal objective of the EL system in the UK is to secure restitution for those who are harmed through the negligence of their employer.
• A report published in June 2003 showed that the Government committed itself to providing a forum for business, unions and insurers to develop proposals for increasing the use of rehabilitation.
• The Government is investing more than £40 million in the rehabilitation elements of its Job Retention and Rehabilitation and Pathways to Work pilots.
