Government strategy will focus on long-term sickness
The government is seeking to focus attention on rehabilitation, but the time it needs to develop a new national approach is likely to be longer than most cases of long-term sick leave.
Learning points There will be no new government approach to vocational rehabilitation in the near future, as the DWP believes that the evidence for what works is "contradictory and inconclusive".
The government also believes that more than one approach may be needed to cater for workers with different needs.
The DWP has produced a framework to help with the development of a new approach, focusing on the necessary processes and machinery, and with a strong emphasis on building an evidence base.
The HSE has launched a range of materials to support employers and employees in the management of long-term absence, including new guidance and a trial software tool to aid the recording of absence.
These developments can be seen in the context of central government policy to reduce the number of people claiming long-term disability benefits, including incapacity benefit.
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Recently, two government bodies have launched initiatives to tackle long-term absence. The Department for Work and Pensions (DWP) published a report on setting up a national framework to help rehabilitate workers on long-term sick leave, while the Health and Safety Executive (HSE) issued a manager's guide to handling long-term absence.
Both of these initiatives should be viewed in the context of the central government policy to shift people off long-term disability benefits - incapacity benefit (IB), in particular - and into work. This drive is itself part of the prime minister's aim to "build an opportunity society".
In a speech to the University of London in November 2004, the prime minister said that, for too many people, the welfare state "is one which simply pays out benefits, trapping people into long-term or even lifelong dependency". He added that it is vital to bring the cost of the benefits system down "if we are to deal with rising costs in areas where we need to spend more".
The costs of IB are forecast to fall by £750 million as a result of seven Pathways to Work pilot schemes designed to move people off IB and into work, and will continue to fall as the government comes "forward with further reforms to help people back to work," Tony Blair told his audience.
Other government ministers have also raised the profile of this back-to-work policy in recent months. Alan Johnson, work and pensions secretary, told an autumn conference of the Royal Society of Medicine that a growing body of general practitioners now agrees that signing people off long-term sick is not always the best way to deal with health problems.
DWP figures released in October 2004 suggest that the Pathways to Work pilot schemes are doubling the number of people coming off IB compared with other, non-pilot areas.
The Pathways pilots involve a combination of work-focused interviews with personal advisers, the opportunity to gain access to rehabilitation support from the NHS and a £40 weekly return-to-work credit, and currently target new IB claimants and existing ones who volunteer. The scheme is being extended in 2005 to those who have been on IB for more than a year - potentially a much harder group to work with.
The TUC, however, argues it is a "myth" that there are easy savings to be made by cracking down on IB claimants. A TUC report in October concludes that 40% of those receiving benefits are either too ill to work without suffering real pain and fatigue, or want to work but cannot find any, often as a result of employer prejudice. The TUC does support the Pathways to Work pilots, however, and other initiatives designed to "help rather than force" claimants into work - estimating that the planned roll-out of Pathways next year will fill 110,000 jobs and save £110 million a year in benefits.
Framework but no new approach
There will be no new, government-sponsored national approach to vocational rehabilitation in the UK in the foreseeable future, the DWP announced in its report on a framework for vocational rehabilitation published earlier this autumn1.
The DWP states that it is not in a position to recommend a new approach due to the lack of robust evidence on what works. The "evidence for what is effective vocational rehabilitation is contradictory and inconclusive in the UK", it concludes. The DWP argues that it will also be "challenging" to produce a single approach covering the wide range of potential clients using vocational rehabilitation, and that "we may have to accept that perhaps more than one new approach" is required.
However, the department remains committed to developing a new approach in future and has produced a framework - which concentrates on putting the necessary machinery and processes in place - as a first step towards this. The DWP also stresses that the early focus of a new government approach to rehabilitation should be on helping those in work stay there, or return to work after long-term sick leave.
It believes that those who are not in work, and who may have been on benefits for some time, are better served by other DWP plans, including the Pathways to Work pilots mentioned above.
Rehabilitation structure needed
In summary, the DWP's early work on rehabilitation will focus on the structures necessary to develop a new approach by:
ensuring that the government's activities on vocational rehabilitation are consistent and complement each other. The minister for work, Jane Kennedy, is to oversee the delivery of the framework;
setting up a Framework for Vocational Rehabilitation Steering Group to develop the new approach, including representatives from stakeholders such as the TUC, CBI, insurers and lawyers. This group will produce strategic ideas and advice on the approach's direction, and will consider how to make best use of resources including funding;
setting up a Research Working Group and a Standards and Accreditation Working Group. This work will include the production of a good practice guide to the robust evaluation of vocational rehabilitation interventions and services. A research programme is proposed, some of which will focus on demonstrating a more conclusive business case for vocational rehabilitation, because the DWP believes "establishing the benefits of vocational rehabilitation will be key to securing engagement and encouraging increased use of vocational rehabilitation";
examining further the role of vocational rehabilitation in employers' liability (EL) insurance. A pilot scheme for resolving EL claims effectively, quickly and with more transparency is under way, focusing on low-value (up to £10,000) accident claims, and will test ways of improving the existing process. As well as reducing the costs of claims, the pilot also aims to increase opportunities for rehabilitation through earlier notification of accidents;
developing new guidance and additional tools for those looking for advice on vocational rehabilitation; and
making sure the public sector, as an employer, sets appropriate examples in its practice in this area. A new Health, Safety and Productivity Taskforce (led by the minister, Jane Kennedy) is to take forward proposals on how to obtain productivity improvements in the public sector through better sickness absence management. The chancellor announced a review of absence management in his most recent spending review, and the main issues for the taskforce will be cutting absence, improving occupational health and using the government's role as a purchaser to influence practice in other sectors.
HSE changes gear on absence
The HSE has drawn together a range of materials, including new guidance on managing sickness absence and return-to-work, to coincide with the launch of the DWP framework2. The materials include a leaflet for employees on returning to work, a "deskaid" for small and medium-sized businesses, and a trial software tool for employers to record absence. The HSE's aim is to affirm good practice in "examplar" organisations and, through tailored products, to help others get started or improve current absence management approaches.
The HSE guidance on long-term absence is based on a six-step process:
recording sickness absence;
keeping in contact with absent staff;
planning and undertaking workplace adjustments;
using professional advice;
return-to-work planning; and
coordinating the return-to-work process.
The guidance also has a useful "dos and don'ts" section (see box ) and tips on what to include in a long-term absence policy. It stresses that managing absence is not best left to medical people, and that getting back to work is part of the process of recovering from ill health or adjusting to disability. Most of those who find it hard to return to work do not have rare or complicated illnesses, but mild to moderate mental health problems, or musculoskeletal conditions, it adds.
An inability to return to work points to problems that healthcare alone cannot fix, the HSE says - for example, social and other non-medical work-related barriers. The HSE guidance states that no law requires employers to consider rehabilitation, although the Disabillity Discrimination Act 1995 does require employers to make reasonable adjustments for those it covers. Health and safety legislation also imposes a responsibility on employers to protect employees after they return to work if they have become more vulnerable to risks as a result of illness or injury.
This article was written by Sarah Silcox, a
freelance writer and trainer on employee health issues, sarahsilcox@waitrose.com.
1. Building capacity for work: a UK framework for vocational
rehabilitation, Department for Work and Pensions,
October 2004, www.dwp.gov.uk.
2.
Managing sickness
absence and return to work: an employer's and manager's guide, HSE, HSG249, £9.95 or free from www.hse.gov.uk.
See also the new sickness absence area on the HSE website.
The HSE suggests that return-to-work policies contain the following elements: a statement on the employer's commitment to helping employees return to work;
confirmation that employees can expect the organisation to: work with union representatives to make the policy work; make reasonable adjustments; support returns-to-work, agree plans with everyone affected; and ensure that employees affected by ill health or disability will be treated equally, fairly and consistently;
details of how sickness absence should be recorded;
time-off provisions for medical appointments;
details of procedures for maintaining contact with staff on sick leave;
return-to-work interview arrangements;
links between the return-to-work and other policies;
employers with access to HR or occupational health support are encouraged to include details of: actions that line managers should take; responsibilities for implementing plans; sources of advice in and outside the organisation; and details of the information required when referring employees to OH or other medical referrals; and
employers facing particular problems with stress-related illness are encouraged to set out: the employer's commitment to raising awareness of the condition; the steps that managers should take to identify and prevent excessive pressure at work (including adjustments to working practices and hours); advice on dealing with and preventing harassment and bullying; and a commitment to use the HSE's guidance on stress management.
Source: "Managing sickness absence and return to work: an employer's and manager's guide", HSE, 2004. |