The complexities, challenges and uncertainties surrounding long Covid means it is time for a wholesale rethink around rehabilitation, return to work and even fitness to work following a Covid-19 infection, argues Dr Julie Denning.
Long Covid should encourage all of us, occupational health and healthcare practitioners, government, employers, insurers and employee benefit and wellbeing providers, to reimagine the support we provide to employees.
Indeed, the government has already made a step in that direction, at least where disabilities and long-term health conditions are concerned, with its long-awaited response to the Health is everyone’s business consultation on proposals to reduce ill health-related job loss. The challenge now is to translate the rhetoric into reality. And long Covid could well provide that springboard.
In this article, I intend to set out the case for how and why absence management needs to be reimagined. This centres on our opinion that ‘work’ and, more specifically, ‘work-ability’ should represent a health outcome.
Including work as a health outcome would help establish a much-needed framework for support designed around what people can do, when, why and how.
It would be a framework that introduces flexibility and a focus on genuine early intervention as opposed to the traditional and, arguably very limiting, assessment based on whether people are ‘absent’ or ‘not absent’.
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Crucially, it would be a framework that engages the entire organisation, not just HR. It would become about convincing management, obtaining support from line managers, proving the case, sharing best practice and, ultimately, allowing for genuine partnership-working across all parties, including vocational rehabilitation, occupational health, health and safety, HR and third party suppliers, such as insurers and wellbeing service providers.
Why might long Covid fuel this fire? Long Covid can be incredibly debilitating; it is most prevalent amongst those of working age (35-69 years), and those with another activity-limiting health condition or disability, according to latest data from the Office for National Statistics (ONS).
And to make things even more challenging, its symptoms have a tendency to come and go. It is a very new illness and it will take time to understand it fully, so it isn’t classified as a ‘disability’ under the Equality Act 2010, or not yet at least.
However, in certain cases, it does seem to meet the disability definition, namely that of a physical or mental impairment that has a ‘substantial and long-term’ negative effect on a person’s ability to do normal day-to-day activities. ‘Long term’ in this context means the impairment:
- Has lasted or will last for at least 12 months.
- Can come and go or is likely to last for the rest of the person’s life.
Rather than trying to figure out if an employee’s condition is a disability, it is probably a good idea for employers to focus on the reasonable adjustments they can make now. Better this, than let case law decide later. Especially considering the government’s concerted push for employers to help people with a disability or long-term health condition stay in work and enjoy good work, as mentioned earlier.
The need to consider reasonable adjustments sooner rather than later is also important considering the potential long-term and unpredictable nature of the problem.
Data published by the ONS in August reveals that around 380,000 people in the UK have reported having symptoms of long Covid for at least a year after their initial infection. That represents two-fifths (40.2%) of all people in the UK who have self-reported long Covid symptoms (945,000 in total or 1.46% of the population).
Symptoms, such as fatigue, shortness of breath, muscle ache and loss of smell, adversely affected the day-to-day activities of 611,000 people (64.7% of those with self-reported Long Covid), with 182,000 (19.3%) reporting that their ability to undertake their day-to-day activities had been “limited a lot”.
Is long Covid encouraging a total rethink?
Guidelines from official bodies, such as by the conciliation service Acas, have always made it clear that the employer should only talk with the employee about any support they may need ‘when the employee feels able to return to work’.
HR policy and procedure is structured according to these long-held guidelines. This makes it very difficult for practitioners to garner support at a management level for any kind of structured, consistent programme of assessment and support for employees at an earlier stage, other than simply ‘making contact’.
It’s arguably no longer enough – or appropriate – to wait for an employee to deem themselves able to return to work before rehabilitative support (as opposed to just regular contact) kicks in. This can be a difficult assessment for the employee to make, especially where a condition like long Covid, which has a tendency to come and go, is concerned.”
It’s arguably no longer enough – or appropriate – to wait for an employee to deem themselves able to return to work before rehabilitative support (as opposed to just regular contact) kicks in. This can be a difficult assessment for the employee to make, especially where a condition like long Covid, which has a tendency to come and go, is concerned.
But of course, this need for a rethink around official guidelines isn’t just confined to long Covid. There are countless other long-term conditions to consider. In fact, about 15 million people in England have a long-term condition or chronic disease: for example, diabetes, chronic obstructive pulmonary disease, arthritis and hypertension.
Need for a more joined-up approach
And it is not only government that is looking to employers to help come up with a solution. A framework for wellbeing that involves targeted rehabilitation of a multidisciplinary nature at a much earlier stage to help people improve their work-ability – and training for line managers where required – is being talked about a lot. But the governance around this, the official framework, is often lacking.
Such a framework is increasingly being discussed by group income protection insurers in particular, in a bid to bring their added-value wellbeing services to the fore, to intervene ideally from day zero and to focus on getting people back to work often before a claim even kicks in.
This brings obvious benefits to the insurer of course, but also to the employer in terms of lower premiums and of course the employee in terms of ongoing support, being helped to get back on their feet as soon as possible. Or, in the case of long Covid, being afforded flexibility to help manage life and work as symptoms come and go.
Of course, this kind of support can’t be achieved by insurers in isolation, or indeed by any of us – practitioners too – in isolation. It requires a much more concerted and joined-up approach.
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Such support would speak volumes about organisational culture, purpose and values; all of things that leadership is striving for more than ever in the pandemic economy and beyond.
- In subsequent articles, exclusive to OHW+ members, Dr Julie Denning will take a look at how long Covid can be managed within the workplace, including in terms of partnership working, framework design and implementation and making best use of existing wellbeing and benefit resources.
References
‘Government response: Health is everyone’s business’, Department for Work and Pensions, Department of Health and Social Care, July 2021, https://www.gov.uk/government/consultations/health-is-everyones-business-proposals-to-reduce-ill-health-related-job-loss/outcome/government-response-health-is-everyones-business
‘Prevalence of ongoing symptoms following coronavirus (COVID-19) infection in the UK: 5 August 2021’, Office for National Statistics, August 2021, https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/bulletins/prevalenceofongoingsymptomsfollowingcoronaviruscovid19infectionintheuk/5august2021
‘The law’, Health & Safety Executive, Equality Act 2010, https://www.hse.gov.uk/disability/law.htm
‘Abence from work: returning to work after absence’, Acas, https://www.acas.org.uk/absence-from-work/returning-to-work-after-absence
‘Long-term conditions and multi-morbidity’, The King’s Fund, https://www.kingsfund.org.uk/projects/time-think-differently/trends-disease-and-disability-long-term-conditions-multi-morbidity
