It’s not just over-indulged Hollywood stars who have a delicate relationship with rehab. Rehabilitation in the workplace sense – getting the long-term sick back into work – is an area that confuses employers, and consequently, the temptation is to leave well alone.
But this makes no business sense at all. The cost of ignoring absentees is high the payback for getting them back into productive work immense. The government estimates that sickness absence costs the economy £12bn a year, while the Health and Safety Executive (HSE) reports that 30 million working days were lost in 2005-06. Ill health is a money pit into which both employers and taxpayers are pouring cash.
Now a report by NERA Economic Consulting has found 85% of GPs think that employers’ return-to-work provision is “poor”. This is despite the fact that for some time, the HR profession has been highlighting the need for GPs to break the habit of issuing sicknotes for minor ailments.
But how should HR departments address this problem? Is it an issue in which they should take the lead – or is there simply a need for better co-ordination with occupational health (OH) professionals?
According to professor Sayeed Khan, chief medical adviser at manufacturers’ organisation the EEF, both HR and OH should be involved – and should work to bring line managers in on the act. Sharing the responsibility will lead to a better understanding of the issues, he says.
“One obstacle is the perception that HR and the employer have about the diagnosis,” says Khan. “The perception is that if someone has leukaemia, for instance, then they can’t work. In fact, if that person is in remission, they may be perfectly well and fit for work. Whereas if someone has an ingrown toenail and can’t get their security boots on, then they are incapable of doing their job.”
When employers bring staff back into work, there needs to be clarity about the activities their job requires, and what they are capable of, Khan believes.
However, many employers fear that bringing staff back too early, or exposing them to job requirements that could make them feel worse, could land them in legal hot water. Couple this with having to deal with complex NHS paperwork, and some employers simply do nothing.
Yet time is of the essence when dealing with absenteeism. The Department for Work and Pensions estimates that one million people are signed off sick every week, at six months 3,000 are still absent, and of that 3,000, 80% will not have returned to work in 12 months.
The legal implications are clearly an issue of concern for employers, but compliance with the relevant laws – the Disability Discrimination Act, Employment Equality (Age) Regulations and health and safety at work legislation – should be part of any organisation’s remit in relation to all staff, not just those who are suffering from ill health.
Open up communication
The key is to open up lines of communication between management, HR and OH. Monitoring the progress of staff with health issues on a case management basis is an effective way of tackling this, whether they are still in work, on sick leave, being rehabilitated or are back working full time.
“Case conferences can bring in all the relevant people,” advises Dr Mark Simpson, managing director of health insurance provider AXA PPP.
Simpson suggests employers identify a trigger point at which time a case conference is held – for example, when someone has been absent for 30 days.
“Planning ahead is vital. You should have a plan in place as early as possible, and dialogue with the employee’s GP is important,” he says.
In addition, maintaining contact will make the eventual return to work more manageable. Again, many employers have shrunk from this, feeling that they may be accused of harassing incapacitated staff. But the reverse is true. “Making sure line managers have contact from the first week of absence is very different from having a gaping void until it is time for the individual to return to work again,” says Simpson.
“One way of helping line managers have this difficult conversation with staff is to have a script to follow. If they know exactly what to say, then they will be less worried about harassment. And it’s also a good idea to agree frequency of contact,” he adds.
For organisations where there is no internal OH department, using a third party can help. Barclays, for example, works with AXA PPP on its rehabilitation scheme.
But Jacquie Hill, Barclays’ head of health and HR policy, warns employers not to offload all responsibility for rehabilitation onto a third party. “The diversity of our organisation means we need to ensure that [AXA-PPP] fully understands the various working environments, such as a branch, contact centre or head office.”
To get rehabilitation right, most employers will probably have to involve a wide array of stakeholders and experts: HR, internal OH and line managers on the one hand, and NHS specialists, physiotherapists, counsellors and other health professionals on the other.
Each group will only deal with one aspect of rehabilitation and not the entire picture, explains Joy Reymond, head of rehabilitation services at insurance company UnumProvident. “It’s not a joined-up area. All of the various disciplines do a good job, but none are specialising in rehabilitation,” she says.
With this in mind, UnumProvident has designed a rehabilitation training scheme. The aim is to give all interest groups and professionals the choice of 25 training modules, which can help them improve their skills in this area.
Above all, training courses such as this will build awareness of how important good rehabilitation is. “It’s not something that should be seen as an annoying expense – this is a key part of running a successful business,” concludes Reymond.
Case study: Dyfed Powys Police
Dyfed Powys Police employs 2,000 staff. For the past three years, it has aimed to create a “high attendance culture” by adopting an integrated approach to managing staff.
“We have leadership from the top. The chief constable is driving this,” says occupational health (OH) manager Maria van der Pas. “It’s all about prevention and taking ownership of health.”
Staff have access to a number of schemes and support mechanisms. These include: fast-tracking private health treatments, an in-house OH service, wellbeing/fitness advisers, internal and external counselling services, conflict management, specialist cognitive behavioural therapy, and newly appointed ‘quality of life’ co-ordinators.
The overall policy is to change the culture of the organisation, making the rehabilitation of staff easier.
“It’s an ‘anything goes’ approach,” says Van der Pas. “We don’t expect people to be well before they return to work. We are completely flexible about the hours they do, and how they build up to working more frequently. They may come back for just two half days, then build up to four half days, and so on.”
Their progress is carefully followed up and case-managed by HR.
Van der Pas has a staff member in her own team who is currently recovering from a mental health condition. This has involved a gradual, phased return to work.
And across the organisation, this integrated approach is cutting the absentee rate. Dyfed is currently working to a target of nine days’ sick leave per employee per year, and its absence rates have fallen from 11.6 days per employee in 2004-05 to 8.35 for police staff and 9.82 for police officers in 2005-06.