Many healthy returns

Return is part of a UK randomised control trial to help tackle the high
incidence of long-term sickness absence in the UK. But does providing help
actually help?  By Janie

need for better management of workplace absence is leading to occupational
health taking on a major role in the corporate, political and public agendas.

new ‘Strategy for Workplace Health and Safety in Great Britain to 2010 and
beyond’ (see page 10) has just been announced amid growing alarm over the
current high rates of sickness absence.1

2003, an annual absence survey by the CBI and Axa PPP healthcare, involving 545
companies across the UK, showed that in 2002, £11.6bn was paid to cover the
salaries of absent staff and up to £1.75bn, 15 per cent of that total, is feared
to be spent covering staff ‘pulling sickies’.2

year, an article entitled ‘Fast-lane life leads to burnout’, suggested that the
rising number of sicknotes issued by GPs were “simply a reflection of the
steadily increasing burden at home and work”.3 The author went on to suggest
that employers must start to accept that prevention is better than cure. In the
same article, Dr Chaand Nagpaul, a GP in Harrow, north-west London, said: “All
employers should have access to occupational health services, and the
Government should fund this.”

state-funded occupational healthcare to all UK staff would no doubt bring a
smile to the faces of the 66 per cent of employees who currently don’t have
access to OH. But, it is widely accepted that no British government is likely
to create such a service without real and robust evidence that it would benefit
many. The HealthyReturn trial may go some way in providing that evidence.

return pilot

with staff on sick leave is no mean feat. This is a group of individuals who
have nothing in common except their being off work, and the fact they will be
attending their GP at some regular interval. They have also never been
researched – until now.

on 1 April 2003, HealthyReturn is part of a UK randomised control trial
supported by the Department for Work and Pensions and the Department of Health.
The two-year study aims to attract 7,500 volunteers across the UK (1,600 in
Greater Glasgow) to investigate whether offering a boosted service can help a
person regain their health and return to work.

project is nationally known as the Job Retention and Rehabilitation Pilot, and
is the culmination of almost two years work. Partners and contractors across
the country have been involved in every stage of planning, and the research
trial is now in full flow. In Greater Glasgow, the lead contractor is the
University of Glasgow and the project is headed up by one of its senior
lecturers and consultant occupational physician, Dr Ewan Macdonald.

more about people who are off work sick and questioning what we can do as
practitioners to help and support them back to work has always been a priority
for those in occupational health,” he explains. “Now, other healthcare
professionals, business leaders and politicians are recognising the importance
of engaging with this sector of the population, too. What makes a person go off
work sick? Why do people lose their jobs through ill health? And what, if
anything, can be done to help prevent this?

two-year research project has the potential to help change the face of how we
deliver occupational health services across the country, and its results are
intended to help shape future Government policy,” he continues. “It is the
first ever study of its kind and, in my opinion, is a step in the right
direction for the future of occupational health.”

the evidence

does or does not help people regain their health and return to work following a
period of illness is currently unknown. But HealthyReturn and its counterparts
around the country aim to find out by collecting evidence that will allow the
Government to reach sound conclusions on future health provision for this

requires people to volunteer to take part, which can be done by calling its
freephone number – 0800 052 1012. Fully-trained operators at the contact centre
will guide callers through a computer-aided telephone interview, which is used
as a screening tool to determine a person’s eligibility to take part.

be eligible, a person must:

be employed or self-employed for a minimum of 16 hours per week

be currently off work due to illness, injury or disability for between six
weeks and six months

in the Greater Glasgow area, live and work within the following postcode areas:
G1 to G84, ML1 to ML9, PA to PA14, FK1, FK4 and FK6 (for other areas, see box).

eligible have their details sent to the National Centre for Social Research in
London, and each one is randomised into one of four groups:


Workplace care



the healthcare pathway, clients are offered a range of treatments, depending on
their condition, designed specifically to help them.

with lower back pain, for example, may choose a combination of physiotherapy
and massage to treat their symptoms while a client with a problem of stress at
work might opt for counselling or life coaching. Importantly, every client is
seen as an individual, and their action plan of treatments is drawn up with
their consent and involvement, and is reviewed regularly to ensure its
continuing relevance.

who are randomised into the workplace pathway are offered world-class standard
occupational therapy. The client is introduced to their occupational therapist
(OT) during the initial assessment with their case manager, and the whole
process is explained to them at this point. At their next appointment, the OT
carries out a functional capacity evaluation (FCE), which is widely recognised
as the gold standard of all OT assessments. The assessment takes approximately
three hours and looks at a whole variety of functions and tolerances, including
range of motion and job simulation.

closer look will also be taken of the client’s workstation and duties. Free
specialist help can also be offered at this stage in the form of occupational
health and safety advice.

combined pathway is, as the name suggests, a combination of both health and
workplace interventions. Any treatments offered within this pathway are
entirely dependant upon the individual’s symptoms.

control group never comes into contact with staff at HealthyReturn, but are
contacted and monitored by the National Centre for Social Research.

says: “What this research trial offers eligible volunteers is immediate and
free access to a range of services, dependant on their condition and into which
pathway they are randomised. As a Department of Work and Pensions and
Department of Health project, HealthyReturn can provide absolute guarantees
regarding the ethics and confidentiality of all the information gathered during
the course of the study – something that is likely to be important to both
clients and clinicians alike.”

the word

biggest challenge so far has been encouraging people to volunteer to take part.
It is surprising that, with only 34 per cent of UK staff having access to any
form of occupational health, more people have not chosen to take part so far.
However, it is recognised that raising awareness of the project and then encouraging
the required change in attitude and behaviour that makes people volunteer, is
not an easy task.

far, HealthyReturn has worked to engage with potential volunteers, GPs and
other primary care professionals, OH professionals, employers (through HR, personnel,
welfare and in-house occupational health), business organisations and union and
health and safety representatives.

a time when headlines such as ‘Sick-note system is a sham’ are common place,4
and the BMA has a whole section of workshops and events in Scotland in 2004
dedicated to employment law, surrounding issues such as sickness absence,5
perhaps projects such as HealthyReturn will now start to play more of a part in
helping to shape the future of occupational health.

Brown is communications manager, HealthyReturn


The Strategy for Workplace Health and Safety in Great Britain to 2010 and

CBI press release, Employers count the cost of ‘sickies’ as absence costs business
£11.6bn – new survey, 25 April 2003, Owen Bassett, CBI Press Office

Personnel Today, Fast-lane life leads to burnout, October 2003, Saudagar Singh,
HR director, Npower

BBC News website, Sicknote system ‘is a sham’, 22 December 2003

BMA Scotland newsletter, December 2003, BMA Workshops and Events, Mhairi

national picture

statistics show that 1,260 people have already volunteered to take part across
the country, and all service providers – including HealthyReturn – are now
calling on occupational health professionals to help raise awareness of such an
important piece of research.

details for all projects:

Glasgow: HealthyReturn 0800 052 1012

Teesside/Tyneside: RouteBack 0800 052 4038

Sheffield: WorkCare Sheffield 0800 052 6528

Birmingham: WorkCare 0800 052 1659

West Kent: WorkCare 0800 052 1659

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