Rehabilitation - A short guide to the evidence

172 million working days were lost due to sickness absence last year. 34 million of these were due to an injury or illness caused by work.

For most people who become ill or are injured, their main priority is to get their health back as soon as possible. Usually a person will get better by themselves, but often the person will need help and support in recovering. If they have been off work for a long time they may also need help in regaining their confidence in getting back to work

If the illness lasts more than just a few days, the first point of contact for the vast majority of workers will be to see their GP who may give them a 'sick note' and may recommend either some form of prescription or, occasionally, a referral to another health care professional. In non-urgent cases this can take several months. Until the end of the period covered by the sick note, or the GP says the person is well enough to return to work, there is usually no contact with the employer.

Unfortunately this means that many people are not getting the support and treatment necessary to help them get better and return to work when they feel confident to do so. This may be either as things were before, at reduced duties or with adjustments to their work, working conditions or equipment.

The lack of access to proper support means that every year many thousands of workers are off work for much longer than necessary, come back to work without getting proper treatment, or simply leave their job all together.

For many years the TUC has been calling for access to early vocational rehabilitation for all workers. What does this mean?

The most common health problems and mental health problems, musculoskeletal conditions such as back pain or RSI, and breathing difficulties. These make up over two-thirds of long-term sickness absence, Incapacity Benefits and ill health retirement. These conditions should be manageable and are a prime target for vocational rehabilitation. Unfortunately there is no national occupational health scheme in the UK, most GPs have very little training on occupational health and return to work issues, and very few employers have access to good occupational health advice or rehabilitation scheme

In 2008 the Department of Work and Pensions published a review of rehabilitation called 'What Works, For Whom and When?' http://www.workingforhealth.gov.uk/documents/vocational-rehabilitation.pdf

Vocational rehabilitation was defined for the review as: 'whatever helps someone who has a health problem to stay at, return to and remain in work.'

The authors concluded that 'Evidence shows that being out of work is bad for physical and mental health - while being in work can help recovery and lead to improved health outcomes. Therefore, helping people with health problems to stay at or return to work is beneficial for them, their families, business and society.'

The TUC would broadly endorse that, however, for many workers the type of work they do actually leads to ill-health or can make a condition worse. Forcing workers to return to work before they feel ready can lead to a relapse or a delay in recovery. In addition, if it is work itself that caused an illness in the first place (as is the case in many work related stress illnesses and muscular-skeletal disorders like back pain and (RSI), then it is also important to remove the causes.

The review showed that there is now a strong scientific evidence base for many aspects of vocational rehabilitation. While at present, rehabilitation is usually offered after a serious injury, the review shows that early rehabilitation can be very effective in many of the most common health problems that can lead to long-term sickness absence, including mental health illnesses such as depression and anxiety.

The concept of early intervention is central to vocational rehabilitation, because the longer anyone is off work, the greater the obstacles to return to work and the more difficult vocational rehabilitation becomes. Doing something early is simpler, more cost-effective, and helps to prevent people going on to long-term sickness absence.

However simply seeing early access to rehabilitation as the solution to all types of sickness absence could make things worse. For most people with a back pain or anxiety the condition is temporary and the body will heal itself without any medical support. Often it is not even necessary to stay off work, and sometimes workers find it beneficial to stay at work if they find that the work they do does not make the condition worse. Medicalising these conditions will not necessarily help the person recover, and may be a barrier to their recovery. On the other hand if a condition is not improving, or getting worse, then early intervention is necessary.

Most people with common health problems can be helped to return to work by following a few basic principles of healthcare and workplace management. Healthcare and employers both have a key role- effective vocational rehabilitation depends on work-focused healthcare and accommodating workplaces: both are necessary: and must be coordinated. It is obvious that individual circumstances will differ between cases, suggesting a degree of discretion should be applied by the employer . However the key to success is seeing the worker themselves as central to the process and ensuring that they feel they are in control of the process.

The TUC recommends that employers follow the guidance on sickness absence produced by the HSE. Advice for safety representatives on the guidance can be found at http://www.hse.gov.uk/pubns/web02.pdf

What does this mean for workers?

• The earlier you get help the better. What you need is a combination of healthcare focused on getting back to work and help from your employer.
• Staying at work or returning to work once you feel up to it often helps your recovery even though you are not 100% better, but only if you do not feel forced back to work, and it was not anything about your work that made you ill in the first place..
• Staying in touch with your workplace while you are off sick may help your return to work.
• Occupational health services should be accessible and confidential.
• Often it can be useful if your doctor lets your employer know what they need to do to help you back to work. If necessary, temporary adjustments to your job can help you return to work earlier.
• If you feel that you want to return to work before fully recovered talk it over with your doctor and, if you have any concerns speak to your safety representative or other union rep. You should never go back against medical advice.