Rehabilitating the workforce

Organisational culture plays a major part in the way in which rehabilitation is dealt with and viewed by employers, a one-day conference on workplace rehabilitation (WR) was told in London last month.

‘Workplace rehabilitation’ were key words in OH in 2004, especially since the Health & Safety Commission (HSC) document, A strategy for workplace health and safety in Great Britain to 2010 and beyond,1 states that the HSC will work with government and other stakeholders in health and safety in getting people back to work through a much greater emphasis on rehabilitation, as a contribution to the wider government agenda.

The conference aimed to explore the problem facing those involved with WR, particularly from an OH perspective.

Dr Pauline Dibben opened the conference by explaining the research she had undertaken, commissioned by the HSE.2 Through a series of interviews and focus groups with area specialists and stakeholders, the research report came together and a conceptual framework was devised and evaluated.

Dibben said that, as a layman, she was surprised that workers viewed conditions such as ME totally differently from, say, back problems. Some of the external influences on rehabilitation related to the NHS and the views of the treating physicians. The new HSE Guidance on Managing Absence and Return to Work3 has been based on the framework from this research.

Simon Francis, from the Department of Work and Pensions (DWP), continued by introducing the new UK Framework for Vocational Rehabilitation,4 published at the end of October 2004. Most significantly, he said that vocational rehabilitation in the UK is yet another post code lottery.

He said the new framework provides a foundation from which to move forward. The DWP will provide leadership and maintain momentum, but not management, by providing a steering group for stakeholders to play an active part in the future development of vocational rehabilitation. Francis mentioned Waddell & Burton for their invaluable input and support to the document.5

The legislative aspects of WR were considered by Joan Lewis, and she referred to her article in the December issue of OH, which highlights some of the relevant case law.6

At present, the DWP, together with the Department of Health (DOH), has a series of pilot studies taking place across the country known as ‘The Job Retention and Rehabilitation Pilots’.

Dr Kit Harling introduced the work by exploring the meaning of sickness absence. Stating that, “Short-term sickness absence can only be controlled by management action, not medical intervention”, he defined long-term absence as more than four weeks and said that after six weeks mental health issues were important. His parting shot was taken from the government document Choosing Health: “Being off work damages health and shortens life”.7

The actual pilot study work was introduced by the two social researchers, Jane Sweeting and Laura Smethurst, who said there is a lack of robust sickness absence data in the UK. Not all accidents and illnesses are reported to the HSE, and the Labour Force Survey relies on self-reporting.
Also, there is little robust research in the UK to provide evidence on what types of intervention early in sickness absence returns people to work. The pilot studies are randomised control trails, designed to test the effectiveness of a person-centred case management approach and increased range of treatment in helping people return to work.

Val Hughes presented the OH role in rehabilitation and recuperative duties based on her book chapter.8 She stressed the benefits of early intervention, the multidisciplinary approach and the need for a clear, policy based referral process.
Finally, Rebecca Elliot and Susan Gee presented their case study of the rehabilitation model used on Bradford City Council and the evaluation of this model published in the OH article.9

If being off work damages health and shortens life, then is WR the way forward? Certainly no matter what preventative measures are put in place by public health, health promotion or health and safety, people will still become ill and need support in the form of WR to return to their full potential.

1. HSE (2004) A strategy for workplace health and safety in Great Britain to 2010 and beyond
2. HSE (2003) Job retention and vocational rehabilitation: the development and evaluation of a conceptual framework, HSE Research Report 106
3. HSE (2004) Managing Sickness Absence and Return to Work: an employers and managers guide, HSG 249
4. DWP (2004) Building Capacity for Work: a UK framework for vocational rehabilitation
5. Waddell G, Burton A K (2004) Concepts of Rehabilitation for the management of common health problems, London: TSO
6. Lewis J, Goldman L (2004) Workplace Rehabilitation, Occupational Health, Dec 2004
7. Department of Health (2004) Choosing Health: making healthier choices easier
8. Hughes V ed (2004) Tolley’s Guide to Employee Rehabilitation, London: Lexis Nexis Tolley
9. Elliot R, Gee S, (2003) Bouncing back, Occupational Health, April 2003

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