Putting ideas to the test

Read some of the more right-leaning newspapers in this country and it is all too easy to come to the conclusion that the long-term sick and incapacitated are little more than a bunch of lazy, work-shy wastrels and malingerers.

Certainly, workers on long-term sick leave cost the country and the economy a great deal. As the latest Health & Safety Executive (HSE) guidance has stressed (see news), long-term sickness absence costs UK businesses more than 3£.8bn a year. And while it represents just 5 per cent of cases, it accounts for 33 per cent of working days lost.

There are, of course, people who play the system, just as there are people who are genuinely unable to work. But among the thousands of people at any one time on long-term sick leave there are many who want to get back into the workplace and are frustrated that they cannot.
Many employers bemoan the loss of valued and experienced workers, and feel equally frustrated they cannot do more to bring them back into play.

It was with this is mind – an optimism that many would like to work and the savings both in benefits and extra productivity this would bring – that the Department of Work and Pensions (DWP) last year launched a series of pilots to look at this issue.

The Job Retention and Rehabilitation Pilots (JRRPs) kicked off around the country in April 2003, and are due to be completed in April next year.
The six pilots – in Glasgow, Sheffield, Birmingham, Kent, Tyneside and Teesside – are simply designed to test new ways of getting sick employees back to work, and are working with around 7,500 volunteers in total. Once completed, the pilots will be evaluated and a report drawn up by December of next year.

Nick Brown, who was the minister of work at the time, described the pilots as ‘cutting edge’, going on to add: “Evidence shows that the earlier people off work because of sickness receive help, the better their chance of returning to their job.

“The research project will test how extra health and workplace support can help people get well again, return to work and keep their jobs,” he said.

The project, which is only covering those who have been off work for between six and 26 weeks, is being funded by both the DWP and the Department of Health and supported by the Scottish Executive and the HSE.

The pilots
The pilots are operating under different names: WorkCare in Sheffield, Birmingham and west Kent; HealthyReturn in greater Glasgow; and Routeback on Tyneside and Teesside.

WorkCare in Sheffield has been studying some 700 people in a randomised control trial. The two-year trial has been split into four groups, explains project manager Charlotte Hall.

First there is a control group. Beyond that, a group where the effect of addressing specific health needs, such as using physiotherapy, occupational therapy, looking at cognitive behaviour and so on, is being studied.

The third group is being assessed on how workplace changes – ergonomic assessments, mediation between staff and employers, adjustments to equipment or duties and so on – can have a positive effect. The final group is looking at a combined approach.

The project is being evaluated by the National Centre for Social Research, which is undertaking both a qualitative and quantative analysis of the project.

“This is, certainly for the DWP, a relatively new thing, to carry out a randomised control trial,” says Hall.

“The theory is that early intervention could work much more effectively in getting people back into the workplace. What we are doing is testing that theory over the long term,” she adds.

The 20-strong WorkCare team consists of a range of professionals, including OH nurses, welfare rights advisers, physiotherapists, occupational therapists and mental health professionals. There is also a budget to refer people on, if needed, for surgery in the private sector.
Because the pilot is purely voluntary, people were recruited in a number of ways. Large and small employers were targeted, as were GPs.

Leaflets encouraging people to approach the pilot were included within sick pay slips or inserted within sick note certification pads. Employers were encouraged to go back through their records and sound people out. There was also a radio campaign. Other outlets used by the pilots have included Job Centres and Citizens’ Advice Bureaux.

“A lot of employers are genuinely concerned about harassing sick workers and do not want to be contacting their employees all the time,” concedes Hall. “But there is a lot of evidence of the importance of keeping in touch when people are off sick.”

She adds: “It is not about getting people back at any cost, it is about getting them back to an appropriate situation that is not detrimental to their health.”

Results so far
As the pilot still has a relatively long period to run, and will then still need to be properly evaluated, Hall, for one, is cautious about drawing too many firm conclusions. But, while anecdotal, some interesting findings are already being gleaned.

“What we are finding is people are saying that it is great to have someone supporting them, acting as an advocate on their behalf. They value having a personal case worker supporting them, speaking to their employer and their GP,” she says.

“In some cases, employers can be reluctant to have staff back at work, or they are keen for them to be 100 per cent fit. But it is clear that being at work can speed up recovery,” she adds.

Employers will often not have considered or, worse, dismissed options such as reduced hours, a phased return or adjustments to the job role as impractical. In fact, they may involve little or no upheaval or extra cost.

“We had one client who was not able to work and we were able to go in and negotiate on their hours and allow them to do some work from home. In another, we helped pay for a specially-adapted desk,” says Hall.

“We can act as an advocate for the employee, negotiating with the employer and speaking up for them. But it has to be said the majority of employers have been very supportive of this project and have been glad to work with us,” she says.

The other pilots have, by and large, followed a similar path. On Tyneside (covering Newcastle, North Tyneside, Gateshead and South Tyneside) and Teesside (Middlesbrough, Stockton, Hartlepool, parts of Darlington and Redcar), for instance, some 1,600 people have been recruited.
Much like Sheffield, the 3.2m pilot, led by Professor Chris Drinkwater of Northumbria University, is using specialist caseworkers to collect baseline data and obtain informed consent from the client.

In the healthcare group, patients are assessed by a trained practice nurse who acts as a caseworker. He or she can also buy a range of interventions, within a budget of up to 1,000 per person. Interventions can include things such as rapid access to physiotherapy or cardiac rehabilitation and brief cognitive therapy for those with mental health problems.

For the workplace group it is, again, a question of an assessment from an experienced employment professional, often an OH nurse.
Enhanced interventions can include a workplace audit, including buying extra equipment or making adaptations.

The combined healthcare/workplace groups have again been assessed by an OH nurse, with the aim of, as it puts it, providing “a combination of appropriately tailored and enhanced healthcare and workplace options”.

Where does OH fit in?
So, where does this all leave OH? One of the issues that Hall, for one, has identified is that many OH professionals spend a lot of their time and effort getting people back 100 per cent.

In fact, their time might be better spent simply getting them back into a work environment, even if they are not fully better, as this can strongly aid the recovery process, she suggests.

“Recovering back at work can actually be extremely good. After six months off sick, two-thirds of people have symptoms of mild to moderate depression, irrespective of their diagnosis,” she explains.

“We are not seeing people until after six weeks, and even that is often too late for proper intervention. It may be that you can get better results after three or four weeks,” she argues.

The big proviso here, of course, is whether the illness or injury has been caused by the workplace, either directly or indirectly, and what measures, if any, have been taken to address this.

Ben Willmott, adviser at the Chartered Institute of Personnel and Development (CIPD) agrees that, in general, attitudes to rehabilitation across the UK are not consistent, with the amount of support and help workers get varying widely.

“Best practice pilots, or pilots designed to explore possible good practice, are definitely a positive thing,” he says. “Hopefully, lessons can be learned and progress made on a wider front.”

It is on this wider front that the biggest question marks lie. A series of relatively small-scale pilots is all well and good. But a permanent, national network of workplace health advocates for the long-term sick? An army of specialist assessors or caseworkers that GPs, job centres and employers can call on? It’s hard to see this one getting the financial green light.

What can’t be disputed, and should probably be applauded, is that at least the problem of the long-term sick is finally being looked at. The answers may not yet be clear – indeed there may be no easy answers. But starting the debate and trying to thrash out some solutions is a big step in the right direction, argue both Hall and Willmott.

Simply providing a leg up, or even giving a voice to workers who have been off long-term and almost given up hope of ever getting back, is a human, moral and financial gain.

OH professionals would be well advised to watch this one closely.

Copies of next year’s final evaluation report will be available to OH professionals and other interested parties from the DWP’s Paul Noakes, on 020 7962 8557 or by e-mail at [email protected]

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