Employer initiatives: Looking for the holy grail of rehabilitation

More than a third of the total days lost through sickness absence were accounted for by long-term illness, yet these cases made up just 5 per cent of the total number, the CBI/AXA’s annual survey of sickness absence found last year. No wonder the ‘holy grail’ of finding a successful rehabilitation strategy is finally being pursued by more employers than ever before.

This is evident from the fact the survey found that 62 per cent of the companies that responded have now got rehabilitation policies in place – up from 51 per cent the previous year.

What constitutes an effective rehabilitation strategy, however, is not always immediately obvious. The content of the policies sampled in the survey varied widely – flexible working was offered by 89 per cent of companies that had a rehabilitation policy and counselling by 80 per cent, while only 35 per cent provided access to any form of medical care or treatment. Yet, those companies reported the lowest absence rates, with an average of 7.4 days, compared to 8.0 days for those using flexible working, and 8.1 days for those providing counselling.

So what makes a really effective rehabilitation policy and how can OH staff put pressure on their organisation to implement one? Some answers will be coming in over the course of the next couple of years, as the results of two important pilot schemes run by the Department of Health (DoH) and Department of Work and Pensions (DWP) start to be evaluated.

The first pilot, the Job Retention and Rehabilitation Pilot (JRRP), has just finished its recruitment phase. The project is designed to study the effectiveness of interventions aimed at getting people back into work and retaining their job after sickness leave of between six and 26 weeks.
The pilot aims to test the effectiveness of three different types of interventions for those who are off work because of sickness, injury or a disability to get back to, and remain in, work.

The pilot is open to employed and self-employed volunteers who live and work in the specific pilot areas, have been off work because of sickness, injury or disability for between six and 26 weeks, and are worried about losing their job. Volunteers are randomly assigned to one of four groups.

All volunteers in an intervention group receive an early and boosted person-centred, case-managed approach to either a workplace focused, healthcare, or a combination of the two. The fourth group is the control group. All volunteer participants continue to receive existing services. This is one of the first times that a randomised control trial has been used to inform the development of welfare to work policy in the UK.

The second, the incapacity benefit reform plots, leading on from the DWP Green Paper, Pathways to Work, offers early, sustained support from Jobcentre Plus, the NHS and the voluntary sector, to support people with health conditions and disabilities. The condition management programme – one of a range of choices packages – provides individual, focused help to manage their condition and improve confidence in returning to work.

Early results of the pilots are promising; there are significantly improved return-to-work rates, compares with the same districts a year ago. In December, the Government announced a 220m investment in the scheme, which will extend it across a third of the country. As part of the pilot, a range of support will also be made available to GPs, including improved training materials for doctors to help them support patients to get them back to work effectively.

The DoH team and Cathy Harrison, a nurse consultant in OH seconded to the DoH who is working across both pilots, hope that the results of both pilots will have a profound effect on the way rehabilitation is viewed by employers and employees alike.

“I would hope that we can change the way that sickness is viewed in relation to health,” says Harrison. “Helping people back to work should be one of the main focuses of occupational health, and health professionals alike, and this should revolutionise the way that people think about both common health problems and long-term conditions in relation to employment.

We need to help both organisations and individuals remove the barriers to returning to work.’

However, Suzanne Guest, of rehabilitation specialists Human Focus, which is currently running two of the JRRP pilots, says a lot of firms have yet to reach square one. “Many companies don’t even know what their sickness absence rate is,” she points out. “They are not even keeping the information.”

Her firm, however, is usually called in to consult on individual employees; often cases that are deemed very difficult to resolve. “We adopt a case management approach,” she says. “Often we will give a presentation to occupational health and they will mention that they have a particular case, but they don’t think they are suitable for us – and we say that they are very suitable.”

Guest says Human Focus will adopt motivational interviewing techniques, for instance, to target misconceptions and false assumptions on the part of sick employees. “A lot of our clients have got claims in and nobody has ever sat down and explained that a large portion of their claim will be recouped by the Benefits Agency. A mate down the pub has told them they’ll get half a million but we try to get them to look at the reality, which is what they stand to gain by going back to work.”

Stress is another growing area within the long-term sickness absence statistics, of course. “We have a high success rate with anxiety cases,” says Guest. “We get 90 per cent back to work by helping them to learn to manage their own condition.”

Recreation and hobbies are often one of the first things that a sick employee abandons, so Human Focus has found that one important strategy for rehabilitating employees is helping them to enjoy their favourite hobby again. Guest finds that employers are generally willing to play along. “Most people give us a free hand,” she says. “Although some employers do raise eyebrows when they see someone has had time off to go and play badminton.”

Another interesting approach to rehabilitation has been pioneered by AXA/PPP Healthcare, through a new early intervention service called Back to Health (see case study on page 17).

According to Dudley Lusted, head of corporate healthcare development at AXA/PPP Healthcare, Back to Health is a form of medical insurance that only pays for treatment of medical conditions that stop employees doing their job. This means that the cost of cover is only about a third of traditional corporate cover, making it easier for employers to cover manual workers.

But where is the money for good-quality rehabilitation going to come from? Another look at the CBI survey shows that although the headline figure of 62 per cent of firms having a rehabilitation policy is impressive, this masks great disparities, with just 50 per cent of firms employing between 50 and 200 people having such a policy in place, dropping to just 15 per cent of firms employing fewer than 50 staff.

“The issue for us is that there are not enough resources. Access to good-quality services is so patchy that if they don’t invest vast sums of money, we are not going to see any benefits,” says Carol Bannister, OH adviser at the Royal College of Nursing. “Unless the Government is going to make large sums of money available, we are looking at a private/public partnership – but that [the private sector] is where the experience is concentrated at the moment.”

Bannister doesn’t necessarily agree that NHS Plus is the best vehicle for delivery. “I don’t think it matters who delivers it, but we don’t want to see it locked to a sickness model. Really good practices are coming out of the insurance companies, for instance, and it would be awful to lose that [in order to allow the NHS to dominate the delivery of rehabilitation services].”

Many successful approaches involve a combination of public and private provision, according to Bannister. “Some great rehabilitation work is being done by the fire service,” she says. “I went to see one in Liverpool that is doing fantastic work. The fire service there was providing treatment privately where they knew the NHS was too slow and didn’t properly understand the needs of the workforce.”

One of the weaknesses Bannister identifies in the way rehabilitation is currently delivered is the timescale involved. “Six weeks isn’t an appropriate time to start the process. We need to target sickness absence in the crucial period before six weeks. That’s when you really need to be doing the active rehabilitation,” she says.

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