Each year, due to sickness or injury,
25,000 people leave work never to return.
The rehabilitation system in the UK is getting an overhaul - and not before time, according to Yvette Essen.

If you live in the UK, your chances of getting back to work after a serious injury are considerably worse than those of folk in other Western countries.

Strange that, as the UK has the lowest rate of fatal injuries per 100,000 employees of any country in Europe and the third best record in over-three-day injuries.

But a person left paraplegic after an accident has a 14% chance of returning to full-time employment in the UK, compared with 32% in the US and 50% in Scandinavia.

Becoming too ill to work is a worrying issue in this country. Since 1997, injury claims have risen at twice the rate of general inflation and, according to the Health and Safety Executive (HSE), on average one million people are injured and two million suffer ill-health caused by work annually. Out of these, 25,000 leave work never to return.

The Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (RIDDOR) - the official means of recording absence - reveal that over one million people suffer a workplace injury each year, while more than two million suffer from ill-health in their job.

Accidents will always happen, no matter which part of the world you live in. But why are UK inhabitants less likely to return to their job?

A number of factors are responsible. Gemma Hawes, assistant manager of liability at the Association of British Insurers (ABI), blames the culture of employer's liability as a key contributor: "The UK operates a liability system that requires the apportionment of blame. This confrontational regime can delay a person accessing rehabilitation care at the right time.

"In comparison, countries such as the US, Scandinavia and Australia, operate workers' compensation or no-fault schemes, so the moment a person is injured they are offered services," she says.

In addition, finding the right treatment to get an ailing worker back on their feet can be pot luck. "There are real issues of service provision in the UK," says Hawes. "Services are patchy with little coordination between the numerous agencies that can play a part in a rehabilitation programme."

Treatment - sooner the better
In October 1999, the International Underwriting Association (IUA), in conjunction with the ABI, published the second UK Bodily Injury Awards Study looking at legal and actuarial trends within the motor claims sector.

This included a rehabilitation section "to investigate practical ways for insurers, reinsurers and lawyers to become involved in the rehabilitation of claimants who have sustained bodily injury".

It pointed out that the quicker rehabilitation was available to an injured person, the better their recovery and the greater the likelihood of returning to a normal lifestyle.

As a result of the report, the profile of rehabilitation has risen.

"The business case has not yet been made - that it saves money - but there is a belief that it could be, based upon experience in other countries," says Hawes. "That said, those insurers providing rehabilitation have noticed a switch in costs away from legal fees, given that rehabilitation works best in a non-confrontational environment."

Fred Middleton, director of the spinal injuries unit at the Royal National Orthopaedic Hospital, says: "You can reduce the length of stay of a spinal injury patient from nine to four months with rehabilitation and effective care management.

"Most of the reasons why spinal patients cannot be discharged are to do with issues of access to their own homes."

Door handles being too high and doors not being wide enough are some of the difficulties a disabled patient may face.

Norman Cottington is the managing director of The Injury Care Clinics (TICCS) and president of the Bodily Injury Claims Management Association (BICMA). He is also an active member of the IUA-ABI rehabilitation working party, and was responsible for the guide to rehabilitation, which appeared in the report.

"The NHS is good at emergencies but has been letting people down very badly in aftercare," he says. "Part of the solution lies in determining just who should be conducting aftercare assessments."

Get together
As part of the report, Cottington helped write the Code of Best Practice on Rehabilitation, Early Intervention and Medical Treatment in Personal Injury Claims, which said that rehabilitation should be considered at the earliest opportunity and also identified a shortage of case managers as a serious problem.

Case managers are trained to act as advocates for the injured person. They liaise with all parties including the GP, lawyers, physiotherapists and relevant governmental agencies. Their role is to ensure that the patient receives the most appropriate treatment in a timely fashion.

Since publication, Cottington has launched a case management division within TICCS, which has now conducted more than 250 assessments.

It works with clients in joint agreement with the insurer and solicitor and functions completely outside the litigation process, refusing to provide legal evidence. It exists solely to help the injured party.

Cottington is now compiling a list of insurers and solicitors who actively support rehabilitation. He believes that publishing the names of both parties on the internet will facilitate their getting together.

Long and winding road
In May, Cottington also sent a letter to solicitors, insurers and members of the Forum of Insurance Lawyers, Association of Personal Injury Lawyers and the Motor Accident and Solicitor Society asking them to sign up in principle to the implementation of the project proposals.

Mark Baylis, IUA spokesman and editor of the report, says: "Bodily injury claims have been rising by 13% per annum for the last decade at least.

"It is in everyone's interest - insurers, employers and especially the injured people - to make greater use of opportunities for rehabilitation.

"There has been a huge amount of publicity about this since the publication of the report.

It has provided a tremendous stimulus for rehabilitation but there is still a long way to go."

Case management - a new profession
The second UK Bodily Injury Awards Study identified case managers as the best people to help a person get back to work.

The Case Management Society of the UK (CMS UK) has recently been established to regulate case management in the UK and provide a governing body.

Helen Merfield, who is a CMS UK committee member and who has recently set up her own company, Health & Case Management, says: "There is a new profession emerging in the UK: the medical and vocational case manager.

"A medical case manager usually has a medical background in areas such as nursing, physiotherapy or occupational therapy. Their role is to act as the patient's advocate, ensuring that they get a tailor-made rehabilitation programme, delivered in the most cost-effective manner.

"Case managers co-ordinate all the services required by the patient, including treatment specialists, home help, nursing care and benefit agencies. They must also understand what the barriers are to recovery and be able to anticipate problems before they arise.

"Another key professional in this field is the vocational case manager who usually has an occupational psychologist background or relevant educational qualifications. Their role is to work with the medical case manager and the patient to assist them back into productive and meaningful employment."

The role of employers in the rehabilitation process

Employers are key in helping staff to return to work.

"They have to encourage an environment where people are not afraid to report injuries and seek treatment," says Gemma Hawes, assistant manager of liability at the Association of British Insurers. "A measure of the success of rehabilitation is that you can return a person to work - ideally with the same employer.

"This benefits the employer as they retain a member of staff in whom they've invested time and money plus, of course, the injured person retains their role and position in society."

Training unskilled new workers can be expensive, and constantly getting rid of employees can result in low morale and, consequently, low productivity levels. But the employer still needs to be patient in rehabilitation cases.

"The employer may have to adapt the working environment, provide new training and facilitate flexible working hours - so he or she must be open-minded and cooperative," says Hawes.

"Where it isn't possible to return an injured person to their pre-injury job, they might need to retrain. In this case a new employer needs to be found. For this approach to work, employers in general have to be willing to accept disabled people into their workplaces."