The UK is lagging behind many other major world economies in its attitude to rehabilitation - and when we close the gap, we will save billions of pounds, writes Deborah Edwards
The Government's latest goal of getting a million incapacity benefit claimants back to work within a decade will undoubtedly increase awareness of the importance of rehabilitation.
However, if we want to catch up with our counterparts in the US, Australia and other parts of Europe and start reducing workplace absence costs, it is essential that we embrace rehabilitation.
Research by the London International Reinsurance Market Association in the late 1990s found that the UK lagged behind other industrialised countries in its long-term treatment of injuries.
The study highlighted that a paraplegic injured through work stood a 50% chance of returning to work in Scandinavia, a 30% chance of returning in the US and only a 15% chance of returning in the UK. Although this study took place over eight years ago, the statistics hold true today.
Currently only about 7% of employers' liability claimants and nearly 3% of motor personal injury claimants are undergoing rehabilitation programmes. And only a small proportion of insurers use rehabilitation services on a regular and consistent basis.
Rehabilitation has been continually talked about over the last few years but it has remained a fairly stagnant industry where minimal advances have been made.
It requires a collective effort from all stakeholders to use rehabilitation as an early intervention tool on personal injury claims.
UK employers pay a hefty price for workplace absences - over £13bn in 2005 according to the latest Confederation of Business Insurers (CBI) absence survey. However, do employers realise that if they do nothing about workplace absences their employees' chances of returning to work reduce considerably the longer the absence?
Each week, one million people will be off sick from work, equating to 4% of the working population. But following a six-month absence, there is only a 50% chance that an employee will return to work, and this drops to 25% after a 12-month absence. After two years, there is practically no chance that an employee will return to work.
The cost of ignoring rehabilitation may therefore be far greater than paying for rehabilitation in the first place.
For employers embracing rehabilitation, the starting point is to identify those absent employees who would benefit from and respond to the employer's input into rehabilitation.
Not all absent employees are candidates for active rehabilitation involvement from their employer. Employees who are in a queue for treatment or those who are receiving infrequent treatment or treatment that seems to lack measurable goals would, for example, not benefit from active rehabilitation.
Once it is established whether an employee would benefit from rehabilitation, the right rehabilitation services should be considered. This is generally done through the use of a case manager who has experience in co-ordinating services in the community.
The case manager should be able to communicate with the treatment teams within and outside the NHS to gain an understanding of the prognosis as well as insight into the person's motivation and underlying desire to return to work or to the life led before the accident or illness.
This is vital for the case manager in order to set realistic and time-measured goals for the eventual return to work.
Once goals and objectives are set, the case manager can troubleshoot complications, all the time encouraging the person to take responsibility for their own recovery and rehabilitation while providing support and access to services.
To achieve the identified goals case managers will utilise services and facilities local to the person.
They will gain access to those services through the NHS, social services or Government and local agencies.
A medical rehabilitation case manager will converse with other medical professionals involved in the rehabilitation programme.
Case managers can bridge the communications gap that often develops between the treatment team and the employer. They can also aid the GP's understanding of the patient's work role and ensure this is taken into account fully when deciding if the patient is fit for full or modified work.
A work trial for employees who have been away for an extended time is also advisable. This has the advantage of a gentler reintroduction to the workplace for someone who may have had some time away and is nervous about going back.
Two types of rehabilitation - medical and vocational case management - are used in the UK.
Medical case managers have a medical background and facilitate medical services, education and advice. They may work with the employer to return employees to their old position in the firm.
A vocational case manager focuses generally on the return-to-work aspect of rehabilitation, working closely with the claimant to ensure their return to work is based on previous work history, transferable skills and what their current physical capacity allows them to do.
Many people see rehabilitation as just being physiotherapy. However, many other services fall under the rehabilitation banner.
Psychotherapy, pain management, functional capacity evaluations, cognitive behavioural therapy (CBT) and MRI scans are forms of rehabilitation that have an impact on the claimant's return to health.
A pain management service, for example, is currently provided around the UK using services including physiotherapy, psychology, personal exercise programmes and CBT. These services work to help a claimant understand their injury further and how to deal with the pain.
Although costly, it is a key component in the rehabilitation of a claimant who is suffering from pain or a pain syndrome, and can result in someone gaining control over their pain and returning to their job.
Physiotherapy is still the most common treatment on a personal injury claim and is endorsed at a very early stage on specific injuries.
It is important to note that in many cases, physiotherapy may not be the only form of rehabilitation required. The right rehabilitation at the right time is key to a successful outcome.
Case management seeks to ensure the client is getting the right services and for the appropriate duration based on clearly defined goals.
Even though rehabilitation can come across as costly, recent research conducted by Greenstreet Berman on behalf of the Association of British Insurers found that UK employers could together save between £3bn and £4.3bn every year by implementing effective rehabilitation programmes. And as well as the financial benefits, employers should see improved relations with staff and increased motivation.
One UK case study found that each £1 spent on rehabilitation saved the employers £12. US research indicates savings ratios of between four to one and nine-and-a-half to one.
An Australian report found savings of more than $3.84m to the Queensland Department of Education from rehabilitation services that cost $82,050. A New Zealand study indicated that rehabilitation could cut absence by up to a half.
Deborah Edwards is a director at RTW Plus
Back-to-work case study: Making plans for Nigel
In a recent case Nigel, a 52-year-old warehouse worker, had a motorcycle accident, suffering a crush injury to his left foot, a fractured pelvis and ligament damage to his left knee.
While he was recovering at home following surgery Nigel was told, after talking to his GP and his employer, that he was going to be retired due to ill health. His physiotherapy had been discontinued, his mental well-being and morale were declining and his chances of getting another job were looking slim.
At this point the case manager, instructed by the employer's insurance company, liaised with the GP and explained his involvement in Nigel's rehabilitation and what he was hoping to achieve.
He then liaised with the employer to recognise that Nigel could take on alternative duties.
The case manager arranged further physiotherapy treatment and set up a case conference with the GP, the employer and Nigel to discuss what duties he could manage.
Nigel is now back at work, earning as much as he did before the accident.
The loss of earnings would have been substantial if he had been retired due to ill health but, through the case manager's intervention, a successful rehabilitation plan was put in place - showing the value of rehabilitation.
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