Recruitment and retention: options for disability management

According to the Department for Education and Employment (DfEE): "Employers who are most successful in attracting disabled applicants to work for them - and thus getting the best person for the job - are: those companies which start off by having a leadership commitment to equal opportunities; which have specified equal opportunities policies, and especially those which pay attention to the arrangements for disabled employees; which have trained their managers and workforce in disability awareness and which have helped their employees to confront the misconceptions about what disabled people can do; and which are familiar with their duties and responsibilities under the DDA, and have acted to comply."¹

DISABILITY POLICIES

A survey of employers carried out by Industrial Relations Services (IRS) in October 1996, just before the DDA employment provisions came into force, found that the vast majority (87%) of respondents' organisations had a written policy on disabled people.² Although the survey was to some extent self-selecting, the 218 organisations in the report employed nearly 2 million workers. About half had already made, or were in the process of making, changes to their policies in the light of the DDA. Policy revisions included sections dealing with "reasonable adjustments" and changes to the recruitment and selection procedures.

Our Management Review survey (chapter seven ), mailed out in March 2000, finds a similarly high proportion (83%) of employers reporting having a written policy or statement on the employment of disabled people. The promotion of equal opportunities and the elimination of barriers to employing "the best person for the job" are the most common reasons given for introducing a policy, ahead of DDA compliance, social responsibility and improving customer service (see model equal opportunities statement in figure 3.1 ). Company handbooks are the most commonly used method of communicating the policy to employees, followed by posters or leaflets, meetings and letters. Six companies had used e-mail to communicate their policies.

Figure 3.1: Equal opportunities statement

The DfEE gives an example of a company statement on employing disabled people in its guidance Employing disabled people: a good practice guide for managers and employers¹:

"The company wholeheartedly supports the principle of equal opportunities in employment and opposes all forms of unlawful or unfair discrimination on the grounds of disability, race, religion, nationality, ethnic or national origin, age, sex, marital status or sexual orientation.

"We believe that it is in the company's best interests, and those of all who work in it, to ensure that the human resources, talents and skills available throughout the community are considered when employment opportunities arise. To this end, within the framework of the law, we are committed, wherever practicable, to achieving and maintaining a workforce which broadly reflects the local community in which we operate.

"Every possible step will be taken to ensure that individuals are treated equally and fairly and that decisions on recruitment, selection, training, promotion and career management are based solely on objective- and job-related criteria.

"When recruiting and retaining employees with disabilities we will make use of the good practice information available, and where necessary seek advice from disability agencies and the Employment Service."

Source: Department for Education and Employment.

In the 1996 IRS survey, employers were asked who had prime responsibility for ensuring compliance with the DDA. In 56% of organisations the responsibility fell to human resource (HR) or personnel managers. Just 19% allocated responsibility to an equal opportunities manager.² In the more recent Management Review survey, 14% of organisations report employing a dedicated disability manager. Of the 12 employers with a dedicated manager, just two are from the private sector. Our latest survey also reveals that the majority of companies have provided guidance and training on the DDA for HR personnel and line managers (chapter seven ).

DISABILITY AUDITS

There is no obligation on employers to carry out an audit of the number of disabled employees in their workforce. However, the information gained would be essential to confirm compliance with equal opportunities policies (on selection, promotion and redundancies, for example) or to measure the impact of disability management initiatives. Similarly, employers are well advised to carry out audits of compliance with the various duties under the DDA.

The 1996 IRS survey found that just 28% of responding organisations had carried out an audit (the figure is likely to have been an overestimate bearing in mind the self-selecting nature of postal surveys).² About two-thirds of those organisations that had not so far carried out an audit had plans to do so in the near future.

Our Management Review survey finds that just under half of organisations have carried out a DDA compliance audit; with more public sector organisations (60%) doing so than private sector firms (30%). Many have undertaken audits within the past year.

One company responding to the 1996 IRS survey rated its audit exercise as "hugely successful" because it identified 22 employees "who considered themselves as having a disability", compared with the situation prior to the survey where the company was aware of just one disabled employee.

The 1996 IRS survey also identified the need for sensitivity in communicating to employees the reasons for requesting new or revised information about a person's disability.³ Confidentiality of information and presenting the audit in a positive light are crucial in this context. One local authority in the survey, Oxfordshire County Council, sent a letter to employees stating that: "We are therefore offering all employees the opportunity to let us know if they are disabled under the terms of the new law, and to tell us of any steps we could take to help them work more easily or more effectively."³

Another public sector employer, Chesterfield Borough Council, reported a poor response to a previous voluntary monitoring exercise. However, it received a 100% response (from 1,578 employees) when it sent a mandatory questionnaire to all employees, covering a range of equal opportunities questions, including disability. The survey was organised by the equal opportunities department following extensive liaison with all departments, trade union representatives and a commitment from the chief executive. Confidentiality was guaranteed. Eight per cent of the workforce felt that they matched the DDA definition of disability, with an under-representation at senior staff levels.³

The 1996 IRS survey found that employers were most likely to monitor the proportion of disabled people at the job application stage, and least likely to monitor it when making redundancies (see figure 3.2 ). Respondents were also asked, in 1996, if they had carried out reviews of existing facilities for compliance with the DDA: physical access to buildings and the wording of job advertisements were the areas most likely to be reviewed (figure 3.3 ).² Of those who had not already done so, the majority claimed to be planning reviews in the near future.

Figure 3.2: Monitoring of disabled people

Source: "Implementing the DDA: an EOR survey of employers ", Equal Opportunities Review, 71, pp.20-25.

The same question was asked in the Management Review survey. While care has to be taken in comparing the two sets of data - since different employers were involved - it is interesting to note that more employers than before appear to be reviewing their job advertisements, selection procedures, job descriptions, promotion/transfer arrangements and selection for training (see figure 3.3). Around 80% of all employers in our latest survey review the wording of job advertisements and selection procedures as part of their management of disability.

Figure 3.3: Areas reviewed for DDA compliance

As noted earlier, monitoring "physical access to buildings" was the most frequently reported review activity in 1996; the proportion doing so in March 2000 (about 70%) has not changed. However, both private and public sector organisations rank this as the top priority for planned reviews (see chapter seven for details) - presumably in response to part III of the DDA and the forthcoming requirements to ensure disabled people's access to goods and services.

Monitoring is key to the ongoing disability management at HSBC Bank (case study one, chapter seven). According to HR manager Heidi Meier: "If we identify any trends - such as few disabled people being recruited - then questions would be raised and we would work with the appropriate department to see if there were ways, for example, to encourage people to apply to us."

RECRUITMENT

According to the Institute of Employment Studies survey on The recruitment and retention of people with disabilities, the two most common methods employed by employers to attract disabled applicants are advertisements welcoming applications from disabled people and specific requests to Jobcentres and career offices.⁴ The disability "two-ticks" symbol (see chapter eight), is seen as important in this context. According to the IES, just 8% of a random sample of employers and 21% of employers using the disability symbol, found it "easy" to attract disabled applicants.⁴

Are employers prepared to spend money on recruiting disabled people?

According to a telephone-based survey carried out by the IES in 1994, most employers were prepared to pay something to adapt or alter the workplace to accommodate disabled recruits. The IES received a fairly poor response to a question specifying just how much employers would be prepared to pay, but was able to conclude that: "Between a half and two-thirds of those specifying a sum in the two samples said that they would be prepared to pay between £100 and £1,000."⁴ It is important to bear in mind that these data were collected before the passing of the DDA in 1995.

Recruitment initiatives

The October 1996 IRS survey of employers found that 60% of respondents guaranteed interviews to disabled applicants who met the job specifications, with 7% of companies planning to introduce this guarantee in the near future.² Fifty-six per cent included statements in their job advertisements welcoming applications from disabled persons (a further 12% planned to introduce such statements). Just under a third offered job information in alternative formats (such as large print or tape for visually impaired people).

Many companies in the survey sent advertisements to specialist disability journals and to disability organisations. Just over 40% of respondents used the "two-ticks" disability symbol, though more were planning to do this. Four organisations, all of which were in the public sector, reported providing work-experience placements for disabled people.

Our Management Review survey found that 41% of responding organisations are using the "two-ticks" symbol - no real change from the 1996 IRS survey. Public sector organisations (63%) are far more likely to use the symbol than private companies and other organisations (19%). Large employers were more likely to adopt the symbol than smaller organisations.

Most employers in our survey make use of the Employment Service Disability Advisers or Disability Service Teams, while many (particularly in the private sector) use other Employment Service schemes, such as Access to Work, Supported Employment and Job Introduction (see chapter seven for full survey details).

The Management Review survey identified a range of initiatives by employers to encourage the recruitment of disabled people. BBC Resources Wales, Reuters (UK), the London Borough of Barnet, and Homebase, among others, had set up work experience/placement opportunities for disabled people. The University of Leicester circulates the curricula vitae of disabled people seeking employment to all departments, and Ayrshire and Arran NHS Trust has a local initiative aimed at people with mental health problems. Suttons Consumer Products supports the employment of disabled people by taking contract work from a local disabled workers centre.

A third of our surveyed organisations are members of the Employers Forum on Disability, which requires a commitment to follow 10 key points of best practice in the employment of disabled people, including fair recruitment. Two of our case study employers, HSBC Bank and The Post Office (chapter seven) are "gold card" members of the Forum.

Half the survey organisations have links with other disability organisations, such as the RNIB and RNID.

The right person for the right job

There are two elements to the successful recruitment of disabled people - both require a systematic analysis of the key elements of the job and an assessment of the abilities of the candidate, taking into account possible reasonable adjustments to the work and workplace (see good practice extract in figure 3.4).

The first is to ensure that an ideal candidate is not rejected because of a surmountable problem related to his or her disability. The second applies to any person, regardless of disability: that an individual should not be recruited (or promoted) into a job for which he or she is clearly not suited, after taking into account possible workplace/work adjustments. Some pointers to good employment practice are given in the box.

Mike Floyd, director of the Rehabilitation and Resource Centre at City University, London, argues: "For the DDA to have maximum impact, there need to be substantial improvements in the process whereby an individual's ability to do a specific job is assessed."⁵ Floyd claims that this is "tackled in a very amateurish way in many organisations".

JOB RETENTION

Speaking in a House of Commons debate on disabled people, Derek Foster, MP of Bishop Aukland, remarked: "Two-thirds of disabled people of working age become disabled at work. It is all to easy for employers to find a quick excuse to get rid of them and we should pay great attention to considering how we can encourage people who suddenly become ill to continue in employment, because that is to everyone's benefit."⁶

While, presumably, Foster was not suggesting that work actually causes the disability in two-thirds of working-age disabled people, he has hit on an important fact of life: as people get older they are more likely to develop a health condition that limits their ability to carry out day-to-day tasks or has an impact on their work. There are strong societal reasons why we might wish employers to accommodate workers as they become less than 100% fit - not least of which is the potential burden on the benefits system of large numbers of people no longer in employment and no longer paying income tax and national insurance. (The impact of disability legislation on job retention is summarised in figure 3.5)

Figure 3.5: Impact of disability legislation on the retention of existing employees

Interventions to keep people in work following chronic illness or injury historically have not been high priorities in the UK⁸. Until the DDA came into force, there were few obligations on employers to retain disabled workers in their jobs. however, the DDA, coupled with more forward-thinking attitudes among businesses, has changed this.

The DDA imposes duties on employers to adopt fair policies towards disabled applicants and employees; yet it is in the accommodation of existing workers who become disabled that the DDA seems to have had most impact. Indeed, the number of cases brought under the Act relating to dismissal far outweigh the number of cases alleging unjustified discrimination at recruitment⁸. Similarly, in the United States, 84.6% of all complaints filed with the US Equal Employment Opportunity Commission in the first year of the Americans with Disabilities Act 1990 involved currently employed workers; 38% and 18% of these, respectively, alleged discriminatory dismissal or a failure to provide reasonable adjustments⁹. It follows that employers mindful of litigation are likely to concentrate their efforts on policies and practice to reduce discrimination against existing staff who become disabled during their employment.

Speaking at the Joseph Rowntree Foundation seminar on Job retention in the context of long-term illness, Bruce Stafford of the Centre for Research in Social Policy at Loughborough University claimed that: "Maximising job retention is important, because there is a high cost to people leaving the workforce due to long-standing illnesses. For society as a whole, there are increased claims for disability benefits and lower tax revenues. Private insurance companies face claims for compensation and early payment of pensions. Employers lose staff with expertise and knowledge of their business and can incur recruitment and training costs. For the individuals concerned, leaving work can weaken their sense of self-esteem and undermine their independence. For all these reasons there is a policy interest in finding ways to ensure people at risk of losing their jobs due to sickness or disability are given the maximum chance of being retained."⁷

All good reasons for keeping people at work, but do employers see job retention in the same light?

Employers' willingness to accommodate disability

According to the DfEE: "There are sound business reasons to retain employees who become disabled. They cost money to recruit and train, as well as having the skills for the job, and knowledge of the company's products and methods of working."¹ Retaining someone in employment, however, may require adjustments to the way someone works, to the job itself (such as the required duties) and to the workplace, and may require the provision of special equipment and training - some or all of which may cost money. How willing are employers to make adjustments to accommodate employees who become disabled?

Nearly all respondents to an IES survey on The recruitment and retention of people with disabilities "reported that they would be prepared to take positive steps to retain an existing employee in employment if they became disabled".⁴ IES reports that the majority of employers would be prepared to pay more to accommodate an existing worker than for a disabled job applicant.⁴

The most common measures that employers were prepared to take in this context were: special leave (88% of a random sample of employers would instigate this measure); training/retraining (81%); flexible working (79%); on-the-job support (77%); job-sharing (65%); counselling (62%); workplace/premises modifications (57%); special equipment (56%) and home working (17%).⁴ Registered users of the Employment Service's "two-ticks" disability symbol were even more likely to be prepared to adopt such measures.

A survey of 77 employers by the Middlesex University Business School, undertaken just prior to the enforcement of the DDA in 1996, found that about 60% of respondents had written procedures for the return to work of employees absent through illness or injury.¹⁰ The most frequently reported options were adjustment to working hours (46% of employers); counselling (41%); "light work" (40%); transfer to other work (38%); equipment or tool modification (27%); "job duty redefinition" (24%); retraining (23%); occupational and physical therapy (15%); home employment (14%); and the provision of rehabilitation (11%).

The report's author, Ian Cunningham, drew "cause for concern" at the relative scarcity of rehabilitation and occupational/physical therapy among the job-retention options. He noted, furthermore, that even the comparatively straightforward options of adjustments to working hours, transfer to other tasks and light work "fell far short of universal provision among participants".¹⁰

The Middlesex University study found that relatively few employers used rehabilitation specialists in the return-to-work process: just 19% used expert help, such as ergonomists and disability managers.¹⁰

According to Phil James, professor of employee relations at Middlesex University: "Relatively few employers make provision for the rehabilitation of ill and injured workers, with the result that most of them rely on the NHS. [Research] also suggests that while most employers are willing to accommodate the needs of disabled workers (including those with long-term health problems), only a minority seem likely to have arrangements in place to ensure that such needs are addressed through the application of a systematic policy framework, and further points to the fact that many disabled people who have left employment feel they could have remained employed had supportive action been taken."

The October 1996 IRS survey, undertaken just before the DDA employment provisions came into force, asked employers which of the 12 types of adjustment listed in the DfEE Code of Practice to the DDA they had used.2,¹¹ "Acquiring or modifying equipment" was the most frequently used form of adjustment reported by employers in the survey, with "modifying instructions or reference manuals" the least used.

The question was repeated in the Management Review survey. Although the DDA employment provisions had been in force for more than three years at the time of our latest survey, there appears to be little change in the pattern of adjustments considered by employers (figure 3.6). The only noticeable difference is a slight increase in the consideration of altering working hours or transferring the worker to an alternative post.

Figure 3.6: "Reasonable adjustments" carried out by employers

INTEGRATED DISABILITY MANAGEMENT

Lack of a consistent approach to disability management means that many well-intentioned employers fail to deliver adequate rehabilitation and accommodation initiatives.

Findings from the Middlesex University study endorse this. According to James: "While many employers are willing to consider adjusting working hours and job tasks in order to help employees return to work, few of them have well-structured and adequately resourced systems in place to ensure that such adjustments are considered and implemented in a systematic, consistent and appropriate way. For example, it was found that line managers varied considerably in terms of how they approached the management of absence; devolved budgetary systems often meant that such managers did not possess the finances necessary to make job accommodations; and it was frequently far from clear who had the primary responsibility for coordinating the return-to-work process."¹²

Many employers, particularly larger concerns, may wish to devise an holistic approach to disability management, integrating the various options to facilitate healthcare, return to work, rehabilitation and job/workplace accommodation. An integrated approach to disability management emphasises the need to make adjustments to overcome barriers to disabled employees either continuing in their employment or returning to work, following injury or ill health. It can accelerate the return to work, for example by involving specialists such as occupational therapists and ergonomists, and can involve measures to prevent the deterioration of the disabled employee, such as through back care programmes for workers suffering low back pain.

Disability management may also involve health and safety initiatives to prevent employees becoming disabled through work and will thus work across occupational disciplines - from human resources to occupational health (OH - see below) and, possibly coordinated by a dedicated disability manager. Integrated disability management has the advantages of:

It is important to emphasise that successful initiatives make use of a range of specialists from different disciplines, again more feasible with an integrated approach to disability management. According to Dr Fiona Ford, clinical lecturer in primary care at the University of Liverpool: "It is clear that sickness absence from work, the development of chronic incapacity and the possibility of work resumption are transitions influenced by the workplace and social environment, the physical disease process and the worker's psychological response to illness. The most important factors predicting return to work after illness or injury are the worker's intention to return and a favourable employment situation. The most effective interventions to promote job retention include a biopsychosocial approach to healthcare provision, are frequently multi-disciplinary in nature, and need to be orientated towards work resumption as a final outcome."¹³

Active and multi-disciplinary disability management has proved effective at the Post Office, where "case management" is the key to success. The Post Office's chief medical adviser, Dr Richard Welch, told a TUC conference on rehabilitation in May 2000 that employee absences linked to musculoskeletal disorders - largely the result of driver injuries and handling and lifting parcels and coins (post offices are the largest handlers of coins in the UK) - had fallen by 15% a year for each of the previous two years, following the establishment of a set of explicit "rehabilitation requirements".¹⁴ These include: a clear understanding of roles and responsibilities; willing participants; active case management; and setting outcome measures.

According to Welch, case conferences are an essential element in the rehabilitation process. Depending on circumstances, these might include an OH physician, nurse, a management representative, HR and, possibly, a union representative. Their primary aim is to ensure that a "solid decision" is made on who should run the case, with clear objectives being developed.

ACTIVE DISABILITY MANAGEMENT - OPTIONS FOR EMPLOYERS

Early intervention strategies

There is a growing trend among employers to actively manage absence - a practice fuelled by estimates that absence costs businesses up to £13 billion a year (1997 estimate by the Industrial Society) and by the Government's demands that public sector employers cut sickness absence levels by 30% by 2003.¹⁵

Many employers use absence triggers - points after a certain period, or accumulated days, of absence - at which a manager will make contact with the absent employee or initiate a return-to-work interview. Some employers will actively manage absence even after a single day's sick leave; however, the real benefit may be in the prevention of long-term sickness and the work-disabling impact of illness or injury.

According to Patricia Thornton of the Social Policy Research Unit at the University of York: "Early intervention might prevent a slide into longer-term sickness, if accompanied by advice to the patient from a rehabilitation practitioner, or a sympathetic and non-punitive return-to-work interview, to identify work features which exacerbate ill health."⁸

Our case study of HSBC Bank indicates the importance to the worker of retaining contact with the workplace and colleagues during extended periods of sickness. Many OH practitioners also advocate bringing people back to work for periods as short as half a day a week in the early stages of the return to work. This has the advantage of familiarising the employee with any ongoing changes at the workplace, overcoming psychological barriers to returning to work following a lengthy absence, and providing social support from colleagues.

New guidance on the management of low back pain - the biggest single cause of disability - from the Faculty of Occupational Medicine (FOM) reports "strong evidence" that extended sickness absence can be detrimental to an individual with this type of injury.¹⁶ According to the FOM: "The longer a worker is off work with low back pain, the lower their chances of ever returning to work. Once a worker is off work for four to 12 weeks they have a 10-40% risk (depending on the setting) of still being off work at one year; after one to two years' absence it is unlikely they will return to any form of work in the foreseeable future, irrespective of further treatment."

The FOM recommends that, where possible, the worker should remain in his or her job, or return at an early stage, even if there is some residual pain, without waiting until the pain has completely gone. A summary of the guidance is given in figure 3.7.

Work hardening

Multidisciplinary rehabilitation programmes, typically described as "work hardening" or "work conditioning" - involving anything from occupational therapy to prosthetics - became popular with employers in the United States, Canada and Australia in the 1980s and 1990s. Work hardening uses intensive and individualised rehabilitation in an attempt to get the worker back to work in as short a time as possible and to prevent the functional impairment of disability. The programmes combine treatment, physiotherapy and "simulated work tasks". Back and other musculoskeletal injuries comprise the biggest class of conditions tackled by work hardening.

Workers' compensation insurers, such as the US giant Liberty Mutual, develop work hardening programmes for their client companies.¹⁷ Some insurers have their own dedicated rehabilitation clinics for injured workers while others contract services through hospitals. Work hardening programmes have become less popular in recent years with an increased emphasis on keeping the worker in employment - perhaps on adapted duties - and delivering the rehabilitation service at the worksite¹⁸. These tend to reduce workers' compensation costs and may, in addition, have therapeutic benefits. Evidence compiled by the FOM (above) suggests that, at least for back injuries, keeping the worker in his or her job during recovery, or returning to work as soon as possible, has considerable clinical benefits for the worker.¹⁶

With US employers bearing the financial burden for the medical care of a work-injured employee - through compulsory workers' compensation insurance - it is in their interest to return an injured worker to productive work (and thus off compensation) as soon as possible. The cost-benefit equation is very different in the US from that in the UK where companies are not usually responsible for funding the treatment of injured employees (still chiefly provided by the NHS), and sick pay for long-term sickness absence is refunded through National Insurance. Nevertheless, the hidden costs of long-term absence, unnecessary medical retirement and loss of experienced workers make accelerated return to work an attractive proposition for employers on both sides of the Atlantic (see figure 3.8).

Figure 3.8: Role of insurers in rehabilitation of work-injured workers

Employers are required by law to have in place insurance against liability for injury and ill health to workers (Employer's Liability (Compulsory Insurance) Act 1969). Because claims for compensation very often include loss of future earnings for workers unable to return to their full earnings capacity, there is an incentive to encourage rehabilitation as part of the employer's liability claims management process.

Speaking at a TUC conference on rehabilitation in May 2000, Arthur Lightbody, head of casualty claims at AIG Europe, argued that "insurers are in a unique position to influence employers through the provision of employers' liability cover".¹⁴ In addition to incentives and advice on accident prevention, Lightbody said that claims handling by insurers "should focus on rehabilitation as much as legal liability". The adversarial nature of claims handling needs to go through a culture change, he remarked. This means notifying the insurer and dealing with rehabilitation very early on, together with a range of rehabilitation initiatives, including a graduated return to work, retraining and the support of a vocational consultant if alternative employment is needed.

AIG Europe has established a rehabilitation subsidiary, which, together with the adoption of new approaches to claims management, has meant that litigation costs had "plummeted", said Lightbody. The greater use of rehabilitation has led to a decrease in claims for future loss of earnings. The overall incentive for employers to improve rehabilitation services, says Lightbody, is a decrease in the cost of employers' premiums.

In the UK, a dedicated return-to-work programme was developed in 1995 for Strathclyde Police in conjunction with Caledonian University's Division of Occupational Therapy.¹⁸ The programme combined elements of work hardening with graded return to work. Twice-weekly sessions, totalling seven hours a week, addressed the "physical conditioning and job-simulation needs of patients", while an additional three-hour session dealt with "concurrent or related psychosocial issues". Individual employees were "free to decide" whether they wished to receive the service. The programme also included worksite visits by the therapists "to gain an appreciation of the specific job requirements, tasks and demands of policing".

In the first eight months, the Strathclyde programme dealt with 42 employee referrals with a range of conditions including back pain, fractures, post-viral syndrome, hand injury and depression. During this period, 15 of the "clients" completed or were discharged from the return-to-work programme. Twelve of the 15 were able to resume or continue employment with the police service, with nine fully operational and three remaining on "light duties". Two opted for medical retirement and one "dropped out". Joanne Pratt and her colleagues from Caledonian University describe the early findings of the study as "positive" and note that "managers have widely supported employees' attendance on the programme."¹⁸

Disability leave

Another option for helping people to stay in work despite a disability is for employers to sanction "disability leave" - a period of special leave to allow the consideration and execution of adjustments to get the person back into productive work. The employee's job is protected while he or she undergoes assessment and, if necessary, retraining.¹⁹

A pilot disability leave initiative was launched by the RNIB in 1992.²⁰ Eighteen employers took part, including Barclays Bank, Bristol City Council, McDonald's Restaurants and the Metropolitan Police.

According to the Gillian Paschkes-Bell of the RNIB, disability leave can be seen as a "reasonable adjustment" under the DDA.²¹ "Leave should be offered as part of a strategy for bringing about the employee's return to work," she argues. "Like maternity leave, it should not be regarded as sick leave. It is more like sending someone off to learn a new skill than letting them stay at home in bed."

Some employers in the RNIB pilot retained the employee on full or partial salary, while others protected the job while the disabled worker went on to sickness or disability benefits during the disability leave.²¹ The latter strategy can, however, present problems if the employee's return to work is gradual: benefits cease as soon as the employee receives any salary, even on greatly reduced hours. This can create financial difficulties for the employee during the rehabilitation.

Disability leave has not yet received widespread support by employers, though this may, in part, be owing to a lack of awareness of the scheme.¹² Nevertheless, there are clear psychological benefits for employees who need to undergo a considerable period of rehabilitation or retraining following the onset or progression of a disability if their job is protected during the intervening period. Sadly, as the Middlesex University survey of employers found, the employment situation is rarely conducive to rehabilitation: "Detailed discussion of the position of a long-term absent employee not infrequently took place against the background of an employee's possible dismissal or retirement."¹²

REHABILITATION AND THE ROLE OF OCCUPATIONAL HEALTH SERVICES

James at Middlesex University considers rehabilitation to consist of two main elements:

He argues that OH professionals can contribute significantly to help disabled workers return to work, and attributes the relatively low level of vocational rehabilitation among employers to "the low coverage" of OH services (just 8% of private sector workplaces have access to OH services), "linked to the fact that rarely do they include such specialists as physiotherapists and occupational therapists".²²

Where services do exist, James sees OH staff having a major role in managing long-term absence and disability, typically consisting of:

A Middlesex University survey on absence management found that many organisations referred staff to OH departments after certain periods of absence.¹² However, the referral trigger point varied from company to company - up to eight weeks at a local authority and just two weeks at a manufacturer. The study also identified the importance of promoting the OH service intervention in a positive light: referral to OH can be perceived as a punitive measure by employees, in which case the benefits in aiding rehabilitation and return to work are hampered.¹² Where surveyed organisations made use of OH services "interviewees reported that they were contributing to the establishment of a more effective return-to-work process".¹²

Susanne Bruyère, director of the programme on employment and disability at the New York State School of Industrial and Labor Relations, sees a key role for OH nurses in disability management.²³ OH nurses are frequently the only full-time OH professionals in an organisation and have a special position in protecting the interests of the employee and employer alike. Bruyère argues that the range of abilities of OH nurses enables them to "respond to the subsequent needs of particular employees and of the employer on issues related to disability and reasonable adjustment … The OH nurse's role is often one of making recommendations to management on the implications of any resultant impairment from an illness or injury for the future employment of this individual, in terms of future exposure to risks, fitness for specified jobs and alternative jobs within their companies". She also identifies the OH nurse's role in the direct provision of care to disabled employees, including counselling and support, advising on rehabilitation strategies and coordinating occupational healthcare from other providers.

Bruyère's view is borne out by a survey of human resource professionals, undertaken in 1999 by the IRS journal Occupational Health Review.²⁴ It found that OH nurses headed the list of professionals who carried out disability assessments in respondents' organisations. Forty-five per cent of respondents said that OH nurses carried out DDA assessments; more than line managers, human resources, safety managers or occupational physicians. OH professionals play a key role in disability management in the Post Office (case study, chapter seven).

Improving access to OH services

Whereas access to OH services is low in the private sector, there is almost universal access in the public sector.²² Many public sector organisations - particularly NHS trusts - are now offering their OH services to other employers.²⁵ The Secretary of State for Health, Alan Milburn, said in March 2000 that he is keen to see NHS OH services extended to local businesses and praised trusts such as the Walsall Hospitals NHS and the Royal Berkshire and Battle Hospital NHS trust for marketing their services to local firms.²⁶ Such measures, in principle, create a potential for smaller organisations, notoriously poor in OH provision, to buy in OH services to help with disability management.¹² An example of this is given in our case study of the Isle of Wight Healthcare NHS Trust and its programme to promote back care among workers in local businesses (chapter seven).

The Government is keen to promote partnerships between organisations to improve community health in so-called Health Action Zones - linking health, regeneration, employment, education, housing and "anti-poverty initiatives". One Health Action Zone project focusing on the working environment was launched in the West Midlands in May 2000. "Workwell" is a joint venture between Sandwell Healthcare NHS Trust, Sandwell Health Authority, Business Link Sandwell and Sandwell Metropolitan Borough Council. The project is designed to promote employee health among businesses in the Sandwell catchment area and has three objectives:

Any business employing fewer than 250 employees can contact the project for help³². Workwell has already won £50,000 in Government funding for its initiative to reduce back pain among workers and has been granted a further £500,000 over three years until, it is hoped, it will become self-financing. It aims to work with around 50 companies in its first year.

Both the Workwell project and the back care scheme piloted by the Isle of Wight Healthcare NHS Trust are examples of new partnerships to help smaller businesses gain access to OH advice and services; the Department of Health and the Health and Safety Executive are keen to promote other partnerships as part of their "Healthy Workplace Initiative".

EARLY RETIREMENT

Early retirement is known to be used by some employers as a tool for dealing with long-term absence through ill health or disability.⁷ It can be an alternative to managing the absence or rehabilitating the disabled worker and may be viewed - perhaps erroneously - as a cost-effective way of dealing with a difficult issue. Offers of early retirement also feature in corporate downsizing, and those with an illness or disability may feel trapped in a "Hobson's choice" of accepting retirement or facing redundancy.

While some employees may wish to take early retirement - particularly where there are strong financial incentives to do so - there is increasing concern about the wasted resource and social implications of the trend for earlier retirement ages and the gradual replacement of older workers with younger, cheaper employees. A Times leader described British businesses as having a deeply embedded culture of ageism. "Ageism," it says, "is estimated to cost the country up to £26 billion a year in lost output. Many of these workers have skills the market needs; and demography dictates that it will need older workers more and more."²⁷

As we saw in chapter two, the likelihood of being disabled increases with age, and there is a danger that early retirement is the preferred option rather than strategies to accommodate disability. One-third of those out of work (economically active and inactive) between the ages of 50 and 65 are on sickness or disability benefits²⁸ and, according to some reports, this costs the taxpayer between £3 billion and £5 billion a year.²⁹

The Government has announced its intention to buck the trend for earlier retirement with plans to raise the minimum age at which tax advantages apply to occupational and private pensions from 50 to 55 years. It also proposes raising the retirement age for civil servants. These changes alone, however, will not tackle the problem of age discrimination in corporate culture which, by extrapolation, is likely to have the greatest impact on disabled workers. If The Times is right in its assertion that we are wasting a valuable resource of experienced workers, and that current attitudes are short-sighted, employers will need to take a more progressive look at their retirement policies, consider job retention and rehabilitation as a viable option for older workers and ensure that there are genuine incentives for employees to want to stay in work.

There is a strong argument that occupational pension schemes may encourage early retirement on grounds of ill health, either because the additional income available may be an incentive for employees to retire, or because employers with salary-related schemes can reduce costs. In salary-related schemes, the costs of continuing to employ someone close to retirement age are higher simply because the employer must contribute relatively more to the pension fund to achieve the same benefits as it did from contributions made earlier in the employee's working life. Pension scheme contributions can be much lower for younger workers because the fund has several years to grow through investments.

Speaking at a Joseph Rowntree Foundation seminar on Job retention in the context of long-term illness, Patricia Thornton drew attention to a possible link between the size of pension funds and trends in ill-health retirement. "Clearly the decision to retire cannot be made without reference to employers and pension funds, and there is suspicion that variations over time may reflect pension fund and employer practices as much as the actual rate of illness," Thornton says.⁸ She notes the "importance of job protection in preventing unnecessary job loss" and warns: "Despite the DDA, employers still exercise discretion in applying, or not applying, interventions to sustain employment."

WORK INTERVENTIONS AND SOCIAL SUPPORT

There is a strong argument that interventions by employers are insufficient to support workers through periods of incapacity unless there is a permanent health insurance or adequate social security benefits system in place. Support for this argument comes from a recent cross-national study on Work incapacity and reintegration. Six countries took part in the study, Denmark, Germany, Israel, the Netherlands, Sweden and the United States, under the auspices of the International Social Security Association.

The project examined various interventions on a cohort of employees who had been incapacitated by low back pain for a period of three months. The work resumption and relapse patterns for each employee were analysed over two years. A number of work interventions were tried: training and education; work changes; employment services aimed at return to work with a new employer; work incapacity assessments; job protection and benefit reduction. Some of the most interesting findings came from analysis of the Dutch cohort.³⁰ In the Netherlands, once an employee is certified sick he or she is protected against dismissal for two years - part of a support mechanism that seems to improve chances of successful work resumption.

The Dutch cohort study revealed high work resumption rates, "corresponding with high intervention rates", though this "does not automatically imply that these interventions have a sufficient effect".³⁰ The researchers noted that "baseline characteristics", such as age, gender and education, influenced work resumption to a greater extent than did interventions. They concluded, however, that: "The use of interventions can be regarded as an element in a pattern of return to work that is embedded in the social system. Looking at the high rates of therapeutic resumption and adaptation of working hours, it may be concluded that the Dutch system allows the employee a very gradual process of return to work. This is facilitated or stimulated by the benefits system which provides opportunities for gradual resumption, both in the [Dutch] Sickness Benefits Act and the Disability Benefits Act. Furthermore, workplace adaptations and change of content of the job are quite frequent for Dutch employees … In the Dutch situation, employee and employer together are held responsible for job retention."³⁰

The Dutch system, say the researchers, allows gradual work resumption to be combined with partial sickness/disability benefits. They argue that the job protection afforded to employees on long-term sickness absence improves the chances of successful return to work compared with other social support systems. They found that the Dutch cohort had a much higher return-to-work rate than, for example, the Danish counterpart and concluded that interventions alone are "not enough to bring people back to work. The system of job protection, which is relatively poor in Denmark, seems to have an important role: if there is no job to return to, then interventions make less sense".³⁰

Case management in rehabilitation and job retention is discussed in greater detail in chapter six, while the TUC's opinion of the current state of rehabilitation in the UK is summarised in figure 3.9.

FUTURE ACTION

Disability management is not something that can be set up once and then forgotten. It requires regular review and renewed interventions to make sure that measures continue to be effective and that good practice and legal compliance are maintained. Our survey of UK employers (chapter seven) reveals that nearly half of the surveyed organisations plan to take further action on disability management. Employers such as Brighton and Hove Council plan to set targets for employment, the Corporation of London is planning training for all staff to cover equal opportunities and disability awareness, and City Hospitals Sunderland NHS Trust is to implement a "city-wide initiative to get disabled people into employment". Major employers - such as our case study organisations, HSBC Bank and the Post Office - have a long history of disability management and will continue to develop services. Small businesses do not benefit from the human resource infrastructures of large organisations, but do have the same access to government schemes, such as Access to Work, to support from disability organisations, and may be able to benefit from new partnerships with larger employers in their locality. Obligations under the DDA on goods and service providers to remove barriers to disabled customers will provide added impetus to continue raising standards and awareness on disability issues for employers.

Figure 3.4: Good practice in recruitment

The following information is summarised from the DfEE's guidance Employing disabled people: a good practice guide for managers and employers¹.

"Job descriptions/person specification Check that these include only requirements which are clearly related to the duties. A good discipline is to focus on what the job is to accomplish - the inclusion of unnecessary, or marginal, requirements in a job specification can lead to discrimination.

Advertising Advertisements can be used to publicly welcome applications from people with disabilities. Make it clear that you can provide the vacancy information in different formats such as large print, tape, disk or e-mail, and that applications can be received in a similar fashion. Consider placing the advertisement with the Disability Employment Adviser at the Jobcentre.

Application forms The employer may need to make adjustments such as allowing a candidate to submit an application in a different format from that specified for candidates in general, eg typewritten, by telephone, on tape or by e-mail. It would normally be a reasonable adjustment for an employer to allow this. Good and successful practice is where an employer gives applicants - through standard questions in the job application - the opportunity to say whether any special provisions or facilities are required at interview. Employers can ask applicants on the application form if they are disabled. It can be helpful to ask whether the applicant believes that they will need the employer to make a reasonable adjustment in the selection or interview process, or in the job if the applicant is selected. Sharing this information at an early stage should be to the advantage of both applicant and employer.

Selection Review the job requirements and person specifications to make sure that they can all be justified in relation to the tasks to be performed in the job. Even where a qualification is justified generally, you should consider waiving it if a person who could not achieve it because of a disability would nevertheless be capable of performing well in the job.

Interviewing If you know in advance that a candidate will need some adjustments to attend or to take part in a selection interview, you will need to arrange this, where reasonable. Even if you do not know in advance, you should try to accommodate any needs a disabled person might have when they arrive. All selection interviews should be objective and non-biased. When interviewing people with disabilities, do not let any misconceptions about disability influence your view on whether a person can do the job. Asking about a disability should only be done in relation to the effect on someone's ability to do the job. It can be very useful to allow the individual to guide you through their qualities and limitations as they know their needs better than anyone else. This will help you to find out whether the person needs an adjustment to the job and what that adjustment might be. An important rule is not to make assumptions about an individual's ability to perform certain tasks. People with disabilities often develop innovative solutions to everyday tasks, with or without technical aids or personal support. Interviewing job candidates requires skills and understanding, and staff training in disability awareness can be a good way to reduce the risk of discriminatory attitudes affecting decisions.

Assessment testing It may be normal practice in your recruitment and selection procedures to carry out aptitude or other tests. For example, where a job involves practical skills which can be tested fairly readily, then it makes sense to confirm or test these at the time of the interview. It is very important, however, to examine selection tests - particularly if you have devised these in-house - to ensure they are free from any unjustifiable bias. You may need to revise the tests - or the way the results of such tests are assessed - to take account of specific disabled candidates, except where the nature and form of the test are necessary to assess a matter very relevant to the job.

Psychometric testing Such tests should only be carried out by people who are fully trained in their use and interpretation. Remember that when administering such tests there are various issues which can arise for people with disabilities. Most tests will not have been normed on disabled people, so bias could occur.

Health screening Some employers require all candidates for employment to have a medical examination, and it would be appropriate to include a disabled person in this process. It is not appropriate for an employer to insist on a medical check for a disabled person and not for others without justification. The crucial question is not simply whether this person is fit for the job but often whether he or she would be fit for the job if a reasonable adjustment was made. In recent research, good practice was found where the selection process was separated from the health screening. Confidential health questionnaires or medical examinations would only be triggered after a preferred candidate had been identified, and these would be dealt with by an occupational health specialist."

Source: Department for Education and Employment.

Figure 3.7: Back pain management at work

Back pain is the single biggest cause of disability and, according to the CBI, costs businesses the equivalent of £208 a year for every employee in the labour force. The Faculty of Occupational Medicine has carried out a major review of the scientific evidence on back pain and has produced detailed recommendations for its management in relation to work. Some of the key recommendations are summarised here.

-        "a belief that back pain is harmful or potentially severely disabling";

-        "fear-avoidance behaviour (avoiding a movement or activity due to misplaced anticipation of pain) and reduced activity levels";

-        "tendency to low mood and withdrawal from social interaction"; and

-        "expectation of passive treatment(s) rather than a belief that active participation will help."

Source: Faculty of Occupational Medicine (2000). "Occupational health guidelines for the management of low back pain at work: evidence review and recommendations". ISBN 1 86016 131 6, Available from the Faculty of Occupational Medicine of the Royal College of Physicians, 6 St Andrew's Place, London NW1 4LB, price £15.

Figure 3.9: TUC wants greater efforts on rehabilitation

According to the Trades Union Congress (TUC), Britain has a "lamentable record" on rehabilitation for injured workers. Employees who suffer a serious work-related injury, or whose health is made worse by their job, stand no more than a one in 10 chance of returning to work, it says.

Speaking at a conference in London on 11 May to launch the TUC's consultation paper Getting better at getting back, TUC general secretary John Monks said that employers should be required by law to adopt a rehabilitation policy in addition to a basic health and safety policy.^14,31 According to Monks, a change in the law would "revolutionise" employer approaches to rehabilitation, although he recognised that a new duty would have wide implications for government, insurers and the NHS.

The TUC highlights a number of key points in its consultation paper:

The paper proposes:

-        early intervention: a key to successful rehabilitation, with prolonged absences (of more than six weeks) leading to a loss of confidence and affecting willingness to return; and

-        case management: the TUC believes that the Australian case manager system (see chapter six) is well worth importing. The case manager's primary duty is to develop a return-to-work plan with the injured person. They should have "sufficient control over resources to ensure that the rehabilitation process is effective." In Australia, case managers are usually employees of larger companies, or are contracted to the state itself for smaller employers (and for federal employees).

¹     Department for Education and Employment (1999), Employing disabled people: a good practice guide for managers and employers, ISBN 1 84185 101 9, DfEE, London, free.

²     IRS (1997), "Implementing the DDA: an EOR survey of employers", Equal Opportunities Review, 71, 20-25.

³     IRS (1997), "Implementing the DDA: an EOR survey part 2", Equal Opportunities Review, 72, 18-25.

⁴     Dench S, Meager N and Morris S (1996), The recruitment and retention of people with disabilities, Institute of Employment Studies report 301, ISBN 1 85184 227 6, IES, Brighton.

⁵     Floyd M (1998), "Vocational rehabilitation services and the DDA", Occupational Health Review, 71, 29-32.

⁶     Hansard 13 April 2000.

⁷     Stafford B (2000), Long-term illness and impairment: who needs help with job retention, paper presented at the Joseph Rowntree Foundation seminar on job retention in the context of long-term illness, 1 March 2000.

⁸     Thornton P and Howard M (2000), Possible interventions for job retention, paper presented at Joseph Rowntree Foundation, see note 7.

⁹     James P and Bruyère S (1995), "Handling disability - implications of the new law", Occupational Health Review, 58, 21-24.

¹⁰    Cunningham I (1997), "Managing disability in the workplace", Occupational Health Review, 70, 14-18.

¹¹    Department for Education and Employment (1996), Disability Discrimination Act 1995: Code of Practice for the elimination of discrimination in the field of employment against disabled persons or persons who have had a disability, ISBN 0 11 270954 0, HMSO, London.

¹²    James P, Dibben P and Cunningham I (2000), Employers and the management of long-term sickness, paper presented at Joseph Rowntree Foundation seminar, see note 7.

¹³    Ford F (2000), Job retention: the health perspective, paper presented at Joseph Rowntree Foundation seminar, see note 7.

¹⁴    Getting people back to work, TUC Conference, London, 11 May 2000.

¹⁵    Industrial Society (1997), "Maximising attendance", Managing Best Practice 32, Industrial Society, London.

¹⁶    Faculty of Occupational Medicine (2000), Occupational health guidelines for the management of low back pain at work: evidence review and recommendations, ISBN 1 86016 131 6, FOM of the Royal College of Physicians, 6 St Andrew's Place, London NW1 4LB, 84 pp, price £15.

¹⁷    Ballard J (1993), "Workers' compensation: a case study of America's largest insurer", Occupational Health Review, 43, 17-21.

¹⁸    Pratt J, Mcfadyan A, Hall G, Campbell M And Mclay D (1997), "A review of the initial outcomes of a return to work programme for police officers following injury or illness", British Journal of Occupational Therapy, 60, 6, 253-258.

¹⁹    Meadowcroft R (1995), "Visual impairment and employment", Occupational Health Review, 57, 15-46.

²⁰    Royal National Institute for the Blind (1992), Adapting to change when an employee becomes disabled, RNIB, London.

²¹    Paschkes-Bell G (1996), "Visible improvement", People Management, 5 December 1996.

²²    Occupational Health Advisory Committee (in print), Report and recommendations on improving access to occupational health support, Health and Safety Commission Occupational Health Advisory Committee, London.

²³    Bruyère S M (1996), "Disability discrimination and the OH nurse", Occupational Health Review, 64, 11-16.

²⁴    Ballard J (1999), "Who's looking at you? A survey of OH clients", Occupational Health Review, 81, 17-26.

²⁵    Kogan H (1997), "Income generation in the NHS", Occupational Health Review, 67, 11-14.

²⁶    Milburn A (2000), A healthier nation and a healthy economy: the contribution of a modern NHS (London School of Economics annual health lecture), Department of Health website: www.doh.gov.uk/speeches/index.htm

²⁷    Anon (2000), "Taking an age - why cold economics will force ministers to be more radical", The Times, no.66,810 (25 April 2000).

²⁸    Department of Social Security figures for August 1999 reveal that of 3,839,000 unemployed or economically inactive people aged 50 to 65 years, 1,286,000 were on sickness or disability benefits. Personal communication.

²⁹    Sherman J (2000), "Ban on early retirement for under-55s", The Times, no.66,810 (25 April 2000).

³⁰    Cuelenaere B (2000), Work resumption and the use of interventions: experiences from the Netherlands and other countries, paper presented at Joseph Rowntree Foundation seminar, see note 7.

³¹    Trades Union Congress (2000), Getting better at getting back, TUC consultation document on rehabilitation, available from the TUC, tel: 020 7453 5499, free.

³²    The Workwell project coordinator can be contacted at Business Link, Black Country House, Rounds Green Road, Oldbury, West Midlands B69 2DG, tel: 0121 543 4490.

³³    Source: "Implementing the DDA: an EOR survey of employers", Equal Opportunities Review, 71, 20-25.

³⁴    Source: Management Review Survey, March 2000.

³⁵    Equal Opportunities Review survey, October 1996²

³⁶    IRS Management Review survey, March 2000.