Smashing the barriers

According to a CBI/Axa Absence Survey in 2008, of every 100 staff, five will be off sick for four weeks or more in a given year.

The recession has forced many companies to run very lean operations, which means that more than ever before, employers rely on every member of staff being actively at work. It also means that valuable business could be lost if a key member of staff is diagnosed with a medical problem which results in them being off work for a long period of time.

Add to this the pressure on employers to support the high proportion of staff that GPs consider ‘may be fit for some work’ when the proposed new Fit Note is introduced in April 2010 and there is obvious need for vocational rehabilitation services. But what is vocational rehabilitation?

Vocational rehabilitation is defined as whatever helps someone with a health problem to stay at, or return to and remain in work. Its aim is to restore the functional capacity of an individual and remove barriers to returning to work.

What this involves in practice is the provision of an assessment that identifies what the person can and cannot do safely as well as any other barriers to returning to work. It also means developing a return to work plan, which may involve a medical assessment, therapies or treatment as well as workplace modifications.

It is an approach that’s usually best managed by a case worker who has the relevant skills, experience and credibility to act as an impartial intermediary, who can plan, coordinate and deliver the appropriate interventions or services.

They would be able to evaluate the suggestions made by the GP in the new Fit Note which may include a phased return to work, amended duties or workplace adaptations, and also help the employer make the right decision for everyone concerned.

The case worker would coordinate and support any planned health, occupational or rehabilitation interventions or services and any return to work plan. They will liaise with everyone involved, including HR and the line managers as well as occupational health staff.
valuable assets

Staff are a company’s most valuable asset which is why it is important for employers to provide as much help and support as possible if their employee suffers from an illness or condition that prevents them going to work.

Unfortunately, if a member of staff is diagnosed with a back problem or suffering from stress, it is very likely that resource stretched GPs and the NHS will not be able to quickly provide the specialist treatment that they need.

Welfare reform act

Not only that, under the new Welfare Reform act, staff may only be eligible for the basic incapacity benefit, which only pays between £89.80 and £115.30 per week for a single person with no dependants. Employers will want to ensure that if their staff are not able to work, they are at least getting the help and support they need to return to work. If they have a group income protection arrangement, they will also be entitled to receive a proportion of their salary when the deferred period ends, provided they meet the appropriate definition of disability.

These services also help firms to meet their legal obligations. Under the Disability Discrimination Act 1995/2005 (DDA) and Employment Rights Act 1996, employers have to take reasonable steps to make sure they are not discriminating against disabled people. Through vocational rehabilitation, they should be able to get all the help they need to understand exactly what these acts require.

Also, under the Health & Safety at Work Act 1974 and associated Heath and Safety Executive regulations, they have ‘a duty of care’ to protect the health, safety and welfare of their employees while at work.

Vocational rehabilitation specialists can help companies fulfil their obligations under all these acts, as well as providing a useful audit trail of steps taken should a case ever go before an industrial tribunal.

No single professional group or service delivers vocational rehabilitation. It relies on a case worker or occupational health provider to co-ordinate the services required. Some companies employ their own in-house occupational health professionals who can act as co-ordinator. However, most small to medium sized companies would find it difficult to justify this ongoing cost and may consider purchasing occupational health services on an ad hoc basis. A list of approved members can be found on: www.vocationalrehabilitationassociation.org.uk

However, what is often overlooked is that many aspects of vocational rehabilitation are provided as an integral part of a group income protection policy, private medical insurance or employer liability insurance, and employers are not always taking full advantage of this valuable resource.

What does rehabilitation include?

The rehabilitation provider will typically arrange for the relevant specialist(s) to carry out an assessment and this could include one or more of the following:

An interview and work assessment. This will usually be carried out by one or more appropriate specialist (such as a physician, nurse or another professional specialising in occupational health, health and safety, rehabilitation or ergonomics).

Referrals

Where necessary, they will arrange for a referral to relevant specialists or services. This may include referral via an occupational health adviser (or encouragement to self-refer) to a GP, a specialist physician, nurse or another professional specialising in occupational health, health and safety, rehabilitation or ergonomics. It could also include referrals to:

• Physiotherapist
• Physchological support or interventions using social workers; clinical or occupational psychologists; specialist counsellors or therapists.
• Programme of multi-disciplinary interventions possibly over several weeks. Examples are:Cognitive behavioural therapy (CBT) or education and training on physical and mental coping strategies for work and everyday activities (this may be combined with exercise programmes).
• Counselling about return to work
• Workplace modifications
• Referral to physiotherapy services or vocational rehabilitation (including training).

Short sessions providing individually tailored advice on how to manage daily activities at home and at work (this could include advice on the benefits of being physically active and on relaxation techniques); encouragement to be physically active; referral to a physiotherapist or psychological services.

Helping people to develop problem solving and coping strategies using evidence-based psychological interventions. The aim is to overcome any barriers they have to returning to work and to support them to return.

Providing a multi-disciplinary back management programme to help employees with this condition return to work. It could be delivered by a GP with occupational health experience, a specialist professional (such as a physiotherapist) or a combination of others specialising in occupational health, health and safety, rehabilitation or ergonomics.

As an example, a programme could consist of an intensive session covering attitudes to health, structure and function of the back and posture and the link to symptoms, stress and coping strategies, posture exercises and relaxation.

A return-to-work plan

The rehabilitation provider will determine the level, type and frequency of interventions and services needed, including any psychological support and should also identify if any of the following is required:

• A gradual return to the original job using staged increases in hours and days worked (for example, starting with shorter hours and/or less days and gradually increasing them).
• A return to partial duties of the original job or temporary/permanent redeployment to another job.
• It should also evaluate the person’s health, social and employment situation, any barriers to returning to work (for example, work relationships) and their perceived confidence and ability to overcome these barriers including:
• Their current or previous rehabilitation experiences.
• The tasks they carry out at work – and their functional capacity to perform them (dealing with issues such as mobility, strength and fitness).
• Any workplace or work equipment modifications that are needed in line with the Disability Discrimination Act (including ergonomic modifications).

Linda Baker, is marketing development director at Legal & General