LRD Booklets August 2002

Rehabilitation - an LRD guide

Introduction

Every year 27,000 people leave work permanently because of work-related injuries and illness. According to government research, up to a sixth of people who are off sick for six weeks or more never return to the workforce. And only 10% who are off work for 28 weeks or more ever return to work.

However increasing attention is now being paid to the rehabilitation of workers following injury or illness by both the government and the TUC.

Welcoming the government announcement in July this year that the Health and Safety Commission and the Health and Safety Executive (HSC and HSE) will be moved to the Department for Work and Pensions (DWP), TUC general secretary John Monks said: "This move has joined up a crucial part of Government. Now the three key pillars of health and safety - prevention, rehabilitation and compensation - have been brought together. The Commission can now start work on an exciting challenge - to create a unified health and safety system which provides not only safety and health at work, but a route out of poverty and disablement for people injured or made ill. It was sixty years ago that Beveridge called for the welfare state to provide not just the NHS, but a comprehensive system of rehabilitation, and now that goal is within reach".

The term "rehabilitation" is used to describe not only treatment and therapy for injuries and illnesses, but also adaptations to work and the workplace to allow workers to be retained, or to provide work opportunities for sick or disabled people.

The TUC says that Britain's record on preventing workplace injuries and illness is, by international standards, good. But, it says, "Our record on rehabilitation, by contrast, is appalling. The Association of British Insurers (ABI) estimates that the chances of returning to work after a major injury are 50% in Sweden, 30% in the USA and just 15% in Britain. Hundreds of thousands of workers in Britain with relatively simple musculo-skeletal complaints and stress-related illnesses are taking extended time off work or retiring prematurely when rehabilitation could get them back to work in weeks."

The costs of this failure to rehabilitate workers are enormous for all concerned. Each week there are 3,000 successful new claims for incapacity benefit,with the overall bill costing the government £7 billion per year. And employers and workers also lose out. Employment minister Margaret Hodge said: "Not only are employers losing talented, skilled employees, but those people are facing the isolation and social exclusion that long-term unemployment brings."

Despite these huge personal and financial losses, there has until recently been little focus on the provision of rehabilitation services to enable sick or disabled workers to return to work. Senior policy officer (prevention, rehabilitation and compensation) at the TUC, Owen Tudor, told a conference of the Chartered Society of Physiotherapy in 2001: "Over the past few years, the TUC has been ploughing an occasionally lonely furrow on the subject".

And presenting a paper to the TUC Rehabilitation Initiative Steering Committee in 1999, Patricia Thornton of the Social Policy Research Unit at the University of York, said: "In thinking about proposals for rehabilitation for work-injured workers, and others who become ill or disabled, in the UK we start with a blank slate compared with the other countries we have looked at....The UK is very unusual in having a state system for work-related injury or disease which does not provide rehabilitation or intervention for return to work".

However the government, as well as unions and employers, is now looking more closely at the issue of rehabilitation.

Government commitments

A number of government initiatives are underway. The Healthy Workplace initiative, jointly run by the Department of Health and the HSC and HSE, is aimed at encouraging better access to occupational health services and helping to provide a bridge between the prevention of work-related ill health, treatment and rehabilitation.

In addition, the 2000 HSE report, Securing health together - A long-term strategy for England, Scotland and Wales, sets out a long-term occupational health strategy aimed at, among other things, "reducing sickness absence, improving rehabilitation after ill health, and helping people into work". The strategy represents a joint commitment by government bodies concerned with occupational health and other interested parties outside the government to work together to improve work opportunities for people not currently in employment due to ill health or disability.

Under the government's New Deal for Disabled People, which helps disabled people into work, consideration is to be given to the best ways of strengthening retention and rehabilitation services for people in work who become disabled or have persistent sickness.

Most importantly, the Revitalising health and safety strategy statement, published jointly by the government and the HSC in July 2000, includes a commitment on rehabilitation policies.

The statement sets out a number of targets for reducing injury and illness by the year 2010:

* a 10% reduction in fatalities and major injuries;

* a 20% reduction in occupational illness; and

* a 30% reduction in resulting sickness absence.

According to the TUC there is no chance that this last target will be met unless employers are under a duty to plan for the rehabilitation of victims, and if there is not a major expansion in the services available to those victims. It pressed very hard to get Ministers and the HSC to include a commitment on rehabilitation policies in the strategy.

Action point 31 of the document states: "The Health and Safety Commission will consult on whether the duty on employers under health and safety law to ensure the continuing health of employees at work, including action to rehabilitate where appropriate, can usefully be clarified or strengthened. For example, organisations might be required to set out their approach to rehabilitation within their health and safety policy".

TUC action

The TUC is now pushing for these commitments to be fulfilled. Through a series of conferences bringing together employers, trade unionists, insurers and practitioners, it called for greater practical commitment to rehabilitation. Two TUC reports on the issue, Getting Britain Back to Work and Restoring health, returning to work, made a strong case for rehabilitation to become part of required health and safety provision at workplace level.

Against this background it also commissioned the Labour Research Department (LRD) to carry out research on rehabilitation in workplaces, funded by the Department for Work and Pensions (DWP). This asked union representatives in 1,200 workplaces about what was done for people whose ill-health or injury affected their ability to work, and identified what makes a good rehabilitation and retention system.

The report of this research, Rehabilitation and Retention: what works is what matters, concludes that there are seven steps employers need to take to provide effective rehabilitation. These measures can prevent workplace injuries and illnesses, cut the number of days lost in sickness absence as a result of work-related illness and injury, and prevent workers from permanently leaving the workforce because of workplace injury and ill-health.

The seven steps are explained in chapter 2 of this booklet, which sets out the key areas for developing an effective rehabilitation framework and describes how union representatives can work with employers to develop successful rehabilitation programmes in the workplace.

The TUC research also included nine case studies of organisations identified as having good practice in relation to rehabilitation, and examples are given throughout the booklet.

Chapter 3 provides practical examples of good practice on rehabilitation, covering issues such as returning to different or altered work, changing hours or making adaptations to the workplace, and highlights the issues that union representatives need to look out for when considering rehabilitation.

The TUC research Rehabilitation and Retention: what works is what matters is available on the TUC website at www.tuc.org.uk. The full report and the case studies are also available to download from the site.