Rehabilitation has been a buzzword in the insurance industry for years, but now the emphasis has changed with the introduction of the Government's Revitalising Health and Safety strategy. This strategy, along with the Securing Health Together strategy, has placed occupational health back on the agenda, working alongside rehabilitation practices.

The concept of occupational health – the effects of work on health, and health on work – is fundamentally important to all employers. Providing a safe and healthy environment that works to develop and maintain a productive business, while simultaneously complying with legal and regulatory requirements, should be the aim of every business.

A business that suffers from constant disruptions in the workplace, such as sickness, absenteeism and workplace injuries cannot run as effectively as its competitors, cannot maintain smooth operations and cannot attract or retain quality staff.

The government's two initiatives, launched in 2000, are a two-pronged attack on work-related health issues, focusing on preventative health and safety measures and rehabilitation programmes. The plan aims to further reduce rates of work-related accidents and ill health by:

  • raising awareness of key risk areas
  • educating businesses on best practice
  • promoting occupational health as a key preventative measure
  • a stricter enforcement of regulations
  • a more balanced distribution of the cost of health and safety failures
  • introducing tougher sentences for offenders
  • assisting those who suffer from a work-related injury or illness to return to work.

    It is a simple idea of prevention and cure, designed to help both employees and employers. Building on the effective use of rehabilitation in the workplace, this approach offers a comprehensive solution to managing employees, with onerous consequences for those who do not comply.

    Do employers need help in this area? Recent evidence has suggested that some employers do not know their sickness absence rates, let alone have any formal strategies in place to combat them.

    But absenteeism isn't the only target. Poor productivity levels, lack of personal commitment and a poor attitude to work can all be symptoms that something is fundamentally wrong.

    The process of maintaining a healthy and safe work environment is a continuous one. The workplace needs to be regularly assessed and any employee injuries or illnesses effectively managed. However safe the workplace is, accidents will never be totally eradicated.

    A recent report by the Health and Safety Commission highlighted that workplace-related deaths were increasing – a 35% increase in 2000, compared with 1999. Therefore, it is vital to look at both preventative and rehabilitative techniques as a joint initiative – not one in isolation of the other.

    Developing a strategy
    There are a number of initiatives that can reduce workplace accidents and absenteeism and their direct or indirect effect on the business. To name but a few, these could include:

  • Introduction of effective absenteeism – reporting procedures to monitor employee attendance and to trigger alarm bells over specific trends in employee absences. Employers need to understand and address the needs of their staff and demonstrate an understanding of the links between work and health
  • Occupational health audits – to examine and review existing occupational health systems
  • Pre-placement health assessments – providing guidance on fitness to work based on job/task description
  • Specialist occupational advice, including areas such as stress counselling, return to work counselling and trauma management counselling
  • Drug-testing procedures – developing regulatory-approved procedures in combating drug abuse.

    Developing a return to work strategy or rehabilitation policy goes hand in hand with these initiatives. Apart from monitoring employee absenteeism procedures, a company also needs to manage the return to work process. By showing the employer is committed to the welfare of its employees from the outset, and as a proactive not reactive statement, it is far more likely that employees will buy into the concept of rehabilitation.

    Rehabilitation is, by definition, “the restoring of an individual as far as possible to the level of pre-accident health and lifestyle”. The focus, therefore, is not purely on medical rehabilitation, but also on vocational rehabilitation. When an employee suffers an injury in the workplace, it is often the case that they physically cannot perform the tasks of their original job. They require assistance, both medically and vocationally, in reintegrating back into the working and social environment.

    There is a relatively new profession emerging in the UK to deal with such reintegration: the case manager. Usually with a medical background, this profession has been established for some time in many countries worldwide including US, Canada, South Africa and Australia.

    Co-ordinating progress
    Medical case management involves co-ordinating all of the services required by the patient, including any specialists or agencies, such as home assistance or nursing care, and benefit agencies.

    Case managers liaise with all parties involved, keeping everyone informed of progress. A case manager must also be able to anticipate problems before they arise and provide practical solutions to any difficulties.

    Another important role in the rehabilitation process is that of the vocational case manager or consultant. Working alongside the medical case manager, it is their responsibility to assist the patient in returning to productive and meaningful employment, whether this means in their existing job or within their existing company or even in a new career with a new company.

    This combined effort of medical and vocational assistance helps in the effective rehabilitation of the employee. However, in order to create rehabilitation policies in the workplace that work for both employer and employee, the following elements must be considered:

    Commitment and leadership
    Effective leadership involves the commitment to ensure the incidence of workplace injury, absenteeism and lost productivity is kept to a minimum. At the same time, it is important that, when an injury occurs, managerial commitment to effective case management is highly visible and that the proper process is followed. The rehabilitation policy should contain a statement of managerial commitment to the return to work process and be formally endorsed by the company's executive.

    Clarity about roles and responsibilities
    The roles and responsibilities of all stakeholders in achieving the early and safe return to work of injured employees should be clearly defined to ensure all parties have a clear understanding of what is expected of them during the return to work process. This may include line managers and supervisors, co-workers, and central human resource staff.

    Whole organisation ownership through consultation and communication
    Genuine employee ownership of such a policy can only be achieved with consultation. Companies should develop return to work procedures in consultation with employee associations and safety representatives.

    An organisation's rehabilitation policy, together with its occupational health and safety plan, will define its approach to injury prevention and management and will ideally be integrated into the organisation's strategic human resources framework. Maximising worker potential through effective rehabilitation is good for business and makes good sense.

  • Meredith Tweedie is the AIG medical and rehabilitation programme manager and a former senior NHS occupational therapist.