Joy Reymond explores how rehabilitation programmes can help employers encourage their employees back to work as quickly as possible, regardless of the severity of illness or injury
When it comes to protecting against the impact of long-term employee sickness absence, no business can afford to put itself at risk. Sickness absence can play havoc with any company's bottom line, regardless of size, with devastating effects on employee morale and productivity of employees.
According to the Confederation of British Industry/Axa Absence survey 2007, workplace sickness absence cost the UK economy more than £13bn in 2006, with more than 40% of overall time lost attributable to prolonged absence. Despite these figures, many employers know very little about the products available to help them stay on top of these costs.
Group income protection (IP) coupled with occupational rehabilitation is an effective way of helping reduce overall staff absence costs and improve efficiency. Many employers assume rehabilitation is only needed by those with severe illnesses or permanent impairment. But in reality, rehabilitation is an effective tool for dealing with illnesses and injuries of all kinds - from stress and mild psychological problems, to musculoskeletal injuries and severe medical problems.
The general term 'rehabilitation' refers to a service designed to restore an individual's level of functioning. There is a useful distinction to be made between medical rehabilitation and vocational rehabilitation although distinctions may often be blurred. Medical rehabilitation such as physiotherapy focuses on the physical recuperation of individuals who have suffered illness or injury. Vocational rehabilitation focuses on helping individuals return to work and looks at the impact of physical functioning and deals with emotional and psychological factors associated with illness or injury. In particular, it examines how these factors impact on functioning in the workplace.
IP mitigates the direct costs of long-term sickness absence and, when it includes a rehabilitation service, can reduce many indirect costs as well. Modern policies recognise the value of rehabilitation and offer it as an integral part of their policies. This approach is particularly useful for the effective management of prolonged and difficult absences. When an employee has made some progress but is struggling to make a full recovery, it is vital they are engaged in a plan to re-enter the workplace. Work is now recognised as a part of the recovery process rather than something that should be delayed until the patient is fully better, and effective rehabilitation can start that process towards recovery and return to work. Long-term absence from work is recognised as one of the greatest risks to health and wellbeing and needs to be treated just as seriously as more traditional health risks such as smoking, diet and blood pressure.
When rehabilitation is linked to the claims process, the insurer can offer partial benefits to employees whose return to work requires alternative duties or restricted hours. This provides a seamless and co-ordinated service between the rehabilitation support during their return to work and financial support geared to their level of productivity.
Early intervention constitutes best practice as a dedicated vocational rehabilitation consultant can work with clients from the outset or even before an absence becomes problematic, which increases the chances of successful rehabilitation.
One of the great strengths of vocational rehabilitation is that, while respecting the medical process, it seeks to 'de-medicalise' sickness absence management. It recognises that a diagnosis is helpful in understanding a person's condition but is not the most important factor in influencing return to work. As a result, a vocational rehabilitation consultant will usually look to the social and psychological influences at work and home that may impact on a person's recovery and return to work. In addition, vocational rehabilitation can help employers resolve issues surrounding an employee's absence, reducing the amount of management and human resources time that would otherwise be spent tackling the problem.
So what makes some rehabilitation programmes more successful than others? A tailored service, drawing on the strengths and skills of the individual providers, can often distinguish successful cases.
Many employers see sickness absence as just a cost of doing business. But there is a lot employers can do to keep this cost down. It is crucial for IP providers to work closely with employers to help them understand the drivers of their sickness absence and to manage the factors that influence employees' decisions to be at work. Vocational rehabilitation consultants are well-placed to provide this additional service as they are closely linked with employers and their employees in managing absence. To make the most of this expertise, it is becoming increasingly important to offer rehabilitation services as an integral part of IP schemes.
Workplace rehabilitation programmes are becoming more popular as more organisations recognise the importance of the health value of being in work. Employers and employees alike are realising it can be therapeutic for a person to be at work even when they are not completely well and equally, staying away from work can sometimes worsen that illness and prolong recovery. Some employers are now actively promoting this positive message to staff and implementing it in their approach to sickness absence. They are also working constructively with front-line management to identify and tackle work issues that may be exacerbating absence.
With UK companies losing billions of pounds every year to employee sickness absence, the business case for workplace rehabilitation and adequate absence management continues to gain momentum. The potential cost savings for business could be staggering: Research conducted on behalf of the Association of British Insurers has revealed UK employers could save between £3bn and £4.3bn a year by implementing effective rehabilitation practices.
The future of rehabilitation services is challenging but at the same time very exciting. Dame Carol Black's recent Working for a Healthier Tomorrow report has identified major flaws in the way the UK currently manages sickness absence and proposes several bold solutions including Fit for Work Services. These services would be radically different from the traditional sick-note approach to sickness absence and would offer employers support and information they need to help their employees back to work.
Responding to this challenge will require a major shift for the fledgling rehabilitation industry, but also offers the opportunity for the various professions - occupational health, occupational rehabilitation, case management and human resources - to work together more effectively to achieve the common goal of returning an employee to work. Employers are beginning to recognise the value of rehabilitation as an integral part of their claims service and they, in turn, are demanding more from their IP providers. Only those offering a joined-up claims and rehabilitation service will be able to effectively meet this challenge and thrive.
Joy Reymond is head of rehabilitation services at Unum
John Clarke - Rehabilitation case study
McArdle's disease (GSD type V) is one of a group of rare genetic diseases which involves the use, storage, conversion and processing of glycogen which fuels the muscles. It is an ongoing progressive condition without a known cure and there is no specific treatment for the disease.
John's condition was diagnosed in 1994. His functional ability had been deteriorating steadily in the last decade, from being able to walk with a stick to becoming dependent on a wheelchair.
The Unum approach
John's case was referred to Unum's Rehabilitation Services in 2001. His vocational rehabilitation consultant worked supported him in his role and recommended suitable adjustments to accommodate his condition. His situation is reviewed regularly and he has also received support from his human resources manager. The focus of vocational rehabilitation intervention has been to identify equipment adjustments, including the necessary IT equipment which would support home working and help reduce the physical demands on John. A detailed ergonomic assessment was performed which recommended, among other adjustments, a specialised electric wheelchair allowing for greater mobility.
John is currently working an average of five hours a day, based mainly at home with occasional external meetings which he attends in his electric wheelchair using a specially adapted car. Without the suggested equipment adjustments and funding, it would not be possible for him to continue working at the current level.
"The onset of illness leading to disability is a frightening experience at any point in your life. When it happened to me, I really needed sound advice and support to help me cope and adapt. Although the Group IP policy provided a financial safety net, I wanted to continue to work as far as I was able. My employer understood this and worked in a positive and constructive way to support me in this goal which has helped me greatly to continue working and lead as normal a life as possible."
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