Getting People Back
to Productive Work
HEALTH POLICIES
01. Proactive Health Policy
02. Internal Health Relationships
03. Health Surveillance and Screening
04. Mental Health and Stress
05. Getting People Back to Productive Work
06. Employee Wellness and Engagement
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Getting People Back To Productive Work
Contents
Extended periods away from work
is not good for employee or employer . . . . . 3
Pathway for managing long-term or recurring
short - or long-term sickness absence . . . . .4
What does vocational rehabilitation look like? . 5
Some of the best rehabilitation
ideas available . . . . . . . . . . . . . . . . . 7
Improve the skills of line managers
so that they can help achieve your goals . . . 9
Learning from those that have
made a change . . . . . . . . . . . . . . . . 11
Further information . . . . . . . . . . . . . . 13
Notes . . . . . . . . . . . . . . . . . . . . . 14
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About the Proactive
Health Policies booklet
series
Management of employee health and
wellbeing is an important challenge
for all organisations. Becoming
proactive in health management can
assist corporate responsibility, reduce
company costs, increase productivity
and, most importantly, improve
people’s lives.
involved engage with a similar set of
ideas. These ideas will enable a flow
of information and understanding that
can push the health agenda forward.
They highlight:
This nest of six health policy booklets
is designed to support organisations
in becoming proactive in health
management. They are a starting
point to help the different disciplines
• Good practice
• Key focus areas
• Important concepts
• Useful tools and links
Booklet 5 - Getting People
Back to Productive Work
Getting people back to productive
work provides benefits to the
employer, the employee and the
economy. There is an increasing
view that intervention at the early
stages of ill-health can prevent
and reduce the length of employee
sickness absences and the mantra of
‘work is good for you1’ is also being
recognised as an important part of
the recovery process after illness in
promoting a return to work.
This document aims to provide
information for getting people back
to productive work, and outlines
the management approach that
organisations can use to provide
benefit to both employer and
employee.
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Getting People Back To Productive Work
Extended periods away
from work is not good for
employee or employer
Employee ill health has a cost for the employee and employer.
A solution to assist both is vocational rehabilitation.
The CBI/Pfizer Absence and Workplace
Health Survey 20102 estimated that
employee absence cost the UK economy
£16.8bn in 2009, with long term sickness
absence accounting for 22% of all
working time lost, at cost of £3.7bn.
It is clear that reducing the length of
employee absence and the consequential
loss of duties is of key importance to an
organisation.
Research also shows that getting back to
work is in the employee’s best interest.
Someone who has been off sick for six
months or longer has an 80% chance of
being off work for five years. There is also
‘strong evidence that work is generally
good for mental health and the benefits
usually outweigh the risks’ (Lelliott et al.
2008; Waddell & Burton 2006).
Dame Carol Black’s report on working for
a healthier tomorrow defines vocational
rehabilitation as:
‘A process to overcome the barriers
an individual faces in returning to
employment which result from injury,
illness or disability. It encompasses the
support an individual (and the employer)
needs to ensure the individual remains in
or returns to work, or access employment
for the first time.3’
The National Institute for Health and
Care Excellence (NICE) in its report
on managing long-term sickness and
incapacity for work4 defines rehabilitation
as:
‘Helping those who are ill, injured or who
have a disability to access, maintain
or return to employment or another
useful occupation. It may involve
liaison between occupational health,
management, human resources and
other in-house or external facilitators.
It may result in transitional working
arrangements, training, social support
and modifications to the usual tasks.’
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Pathway for managing long-term or recurring short - or longterm sickness absence
Health Problems
Assess and record occupation type and main duties; fitness to undertake duties; relationship
between work, health and sickness; any relevant advice or workplace support; the need for sickness absence
Absence from work
Usual care
and treatment
(see NICE
guidelines section 7)
No further
action
required
Certified absence from work (e.g. via GP)
or self-reported sickness absence
Initial enquiries
Triggered by employer ideally at 2-6 weeks
Explore reasons for sickness absence, barriers and options for returning to
work and determine whether a deatiled assessnebt is required
(Recommendation 1)
Deatiled assessment
Explore reasons for sickness absence and barriers and options
for returning to work identify required interventions and
services
(Recommendation 2)
Case worker
appointed
(if needed)
Coordination and delivery of agreed
intervention and services
(Recommendation 3)
Example: intensive interventions
Example: light/less intense
interventions
• Tailored advice
• Encouragement to be physically active
• Specialist referral (if needed)
(Recommendation 3)
•
•
•
•
Coping stratergies
Psychological therapies
Workplace modifications
Referral to specialist services or vocational
rehabilitation
(Recommendation 3)
Return to work
National Institute for Health and Care Excellence (2009) PH 19 Managing long-term sickness
and incapacity for work. London: NICE. Available from http://guidance.nice.org.uk/PH19
Reproduced with permission.
You can find further guidance on the pathway, on managing long
term sickness absence or recurring short term sickness absence and
helping employees to return to work on the NICE website at:
http://guidance.nice.org.uk
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Getting People Back To Productive Work
What does vocational
rehabilitation look like?
An organisation is likely to have some elements of
rehabilitation within it. But is this the same as a coordinated
programme of proactive health management?
Organisations are likely to have elements
of sickness absence management
and intervention, but if these are
not coordinated, can they really be
considered part of a proactive health
policy?
Proactive management of sickness
absences takes the form of early
intervention, where early signs of ill health
are identified and the necessary support
is provided. It also includes encouraging
an employee’s early return to work
through workplace adjustments and
where necessary, case management.
An important starting point is for
employers to accept that people do not
need to be 100% fit to work. In many
cases, an early return to work with
appropriate adjustment is beneficial to
the employee. The Health and Safety
Executive (HSE) recommends that
employers put in place, or review their
existing policy and procedures on
managing sickness absence and return to
work. The HSE provides guidance on how
to develop a policy along with an example
of a return to work policy.5
Dame Carol Black’s review highlighted
the importance of three key principles for
effective early intervention6:
• Holistic care in line with the
‘biopsychosocial’ model: This
simultaneously considers the
biological, the psychological and the
social factors and the links between
the three.
• Multidisciplinary teams providing
a range of services tailored to the
individual’s needs: This encompasses
exercise, cognitive behavioural
therapy, organisational elements such
as workplace adjustment, educational
elements and broader factors
affecting poor health such as financial
concerns.
• Case managers or support workers:
They aim to help the individual
navigate the system and facilitate
communication between the
individual, their employer, their GP
and other clinicians.
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Does your organisation bring together the elements of the biopsychosocial?
Health
and
wellbeing
Is your organisation prepared for early intervention as described by
Dame Carol Black? http://www.dwp.gov.uk/docs/hwwb-workingfor-a-healthier-tomorrow.pdf
Review your policies following the guidance on the HSE website:
http://www.hse.gov.uk/sicknessabsence/
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Getting People Back To Productive Work
Some of the best
rehabilitation ideas
available
Whether you are starting from scratch or improving your early
intervention activities, the leading health organisations have
guidance that can help you.
NICE has published guidance for
employers on the management of longterm sickness absence and incapacity
for work, particularly for employees with
Musculoskeletal disorders (MSD) or
mental health problems. The guidance
outlines three key recommendations for
supporting the quick return to work of
someone on sickness absence leave7:
• Identify someone who is suitably
trained and impartial to undertake
initial enquiries with an employee who
is experiencing long-term sickness
absence or recurring short-term or
long-term sickness absence.
• If necessary, arrange for a more
detailed assessment by relevant
specialists. This could be coordinated
by a suitably trained case workers.
• Coordinate and support any health,
occupational or rehabilitation
interventions or services and any
return-to-work plan agreed with the
employee.
NICE has also developed a checklist to
help employers put the recommendations
into practice, in conjunction with
employees, line managers, supervisors
and case workers such as occupational
health specialists8.
CIPD, in association with HSE and Acas,
have launched a free online toolkit to help
organisations to manage absence9. This
toolkit is split into four parts:
• Identify an absence problem
• Develop an absence strategy
• Deal with short-term absence
• Deal with long-term absence
The HSE has identified six key elements
involved in the effective management of
sickness absence and return to work10:
1. Recording sickness absence: identify
trends and patterns that will support
better management.
2. Keeping in contact: provide regular
and sensitive contact with absent
employee to aid return to work.
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3. Planning and undertaking workplace
adjustments: work with employees
and professionals, if required, to
provide suitable adjustments and
if necessary amend existing risk
assessment to protect employees.
4. Using professional or other advice
and treatment advice: advice and
access to support and treatment may
be required before an employee can
return to work.
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5. Agreeing and reviewing a return to
work plan: tailor return to work plan to
individual employee and review once
back at work to ensure still effective.
6. Coordinating the return to work
process: ensure everyone is working
towards a common goal and use case
management where beneficial.
NICE advice: Management of long-term sickness and incapacity for
work: http://guidance.nice.org.uk/PH19
CIPD advice: How do you deal with short-term recurrent absence?
http://www.cipd.co.uk/binaries/3862Absencemanagement3.pdf
HSE advice: Managing sickness absence and return to work
– An employers’ and managers’ guide:
http://www.hse.gov.uk/sicknessabsence/
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Getting People Back To Productive Work
Improve the skills of line
managers so that they
can help achieve your
goals
Line managers may need training and support to play their part
in helping people back to productive work.
Successful implementation of sickness
absence management comes from
appropriate training for line managers.
With training and support, line managers
can feel equipped and confident in
supporting their staff and ensuring the
appropriate action is taken.
A survey by the Chartered Institute of
Personnel and Development (CIPD)
showed that just 62% of organisations
train their line managers in the skills
needed to do this effectively, and only
30% provide tailored support for line
managers.
The CIPD has developed a tool which
provides practical support to help HR
practitioners and operational managers
to respond effectively to problems with
absences11. The kit helps to answer the
questions:
• How do you help managers to deal
with short-term recurrent absence?
• How should managers investigate
short-term absence?
• What practical steps can be taken to
address short-term absence?
While HR managers may be aware of
the CIPD guidance, it must be passed
on to line managers, who can use it to
inform the support and advice which they
provide.
The CIPD present practical support for developing an absence
strategy and response to long term and short term absence issues:
http://www.cipd.co.uk/hr-resources/practical-tools/absencemanagement.aspx
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DO...
Keep a
note of
contacts
made
Create a climate of
trust by agreeing
with line managers,
HR, and employee
representatives, the
methods, frequency and
reasons for maintaining
contact with the
employee
Give employees
the opportunity to
discuss their health
or other concerns
that are affecting
their performance
or attendance in
private
Welcome the
employee
back to work
after their
absence.
Encourage discussion,
particularly with trade
union or other employee
representatives, about
overcoming barriers to a
return to work
DON’T...
Talk to other
people about
the employee’s
circumstances
without that
person’s knowledge
and consent
Consider training
for yourself, your
managers and your
employees on a
sensitive approach
to helping each other
get the most out of
contact
Carry out
returnto-work
interviews
Take advice from
the employee’s
colleagues, HR
manager or trade union
and other employee
representatives if you’re
unsure how to make
contact
Treat
each case
individually,
but on a fair
and consistent
basis
Wait until
someone goes on
long-term absence
to consider your
contact strategy
Take the time
to know your
employees
and the things
that affect their
health
Consider the
timing and type
of contact, and
who makes it.
If the employee
is able to travel,
suggest they come in
to see colleagues at
lunchtime or during
coffee breaks
Put pressure on the
employee to discuss
their return before they’re
ready, or suggest that
colleagues or teammates
are under pressure or
that work is piling up
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Put off making
contact or pass
responsibility to
someone else
unless there are
sound reasons for
doing so
Make assumptions
about the
employee’s situation
or their medical
circumstances
Forget that recovery
times for the same
condition can vary
significantly from
person to person
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Getting People Back To Productive Work
Learning from those that
have made a change
Organisations are benefitting from early intervention activities.
It is good to see the gains made.
Case study
Royal Mail
The Royal Mail have experienced
issues of long-term absence, especially
related to musculoskeletal health, for
many years12. In 2003 their sickness
absence levels were 7%, equating to
an average of 16 days per employee
per year, and with a daily cost of £1m.
Customer service standards were also
being affected.
Royal Mail introduced a range of
integrated measures:
• Health screening
• Health clinics at 90 sites
• Fast access to occupational health
services
• Employee assistance programme
(EAP)
• Incentive scheme
• Rehabilitation centres focusing on
improving back, neck and shoulder
injuries
• Phased and partial return to work
(RTW)
• Case management
After four years, sickness absence
levels had fallen to 4%, an average
of 10 days per employee, and saved
Royal Mail almost £230m. Up to 3,600
more staff were available to work each
day as a result of these measures.
• Access to physiotherapy
Royal Mail generated improved savings from early intervention.
7% was a high starting point for absence but organisational
averages should be viewed with caution, as they may hide individual
departments with high absence rates.
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Case study
York Teaching Hospital NHS Foundation Trust
– Reducing sickness absences
A primer for this initiative was that the
trust needed to find a saving of £33
million over three years, with £12.2
million required in the financial year
2010/11. This equated to approximately
£30 per employee per week. A primary
investment of £100K was made
in new posts in human resources
and occupational health, to act as
champions on sickness absences. The
intention was to:
• Identify and target areas with high
levels of sickness
• Assist line managers in proactively
managing sickness absence
• Provide increased capacity in OH to
facilitate fast-tracking for referrals,
a staff counselling service, clinical
psychology support for staff, and
physiotherapy fast-track referrals.
Over the three years that the project
has been running, the trust has
achieved a proportionate reduction in
sickness absence of 32%. This equates
to having approximately 57 more staff
at work - nearly enough to cover two
wards.
At the start of the project, the trust was
losing approximately 52,717 days per
year. This has now reduced to around
36,000 days, a reduction of £2.71m and
a saving of approximately £5.58m over
the last three years (24/05/12).
York Teaching Hospital’s approach to reducing sickness absence
highlights how guided investment and appropriate planning can
generate significant savings.
http://www.nhsemployers.org/HealthyWorkplaces/
ToolsAndResources/Pages/Featuretrust-York.aspx
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Getting People Back To Productive Work
Further Information
The Health and Safety Executive (HSE) website offers examples of written policies,
resources for managers and advice for employees on sickness absence issues and
return to work: http://www.hse.gov.uk/sicknessabsence/index.htm
The Chartered Institute of Personnel and Development (CIPD) has produced online
toolkit on absence measurement and management:
http://www.cipd.co.uk/hr-resources/practical-tools/absence-management.aspx
The National Institute for Health and Care Excellence (NICE) has published guidance
for employers on the management of long-term sickness absence and incapacity for
work and it offers other resources to support implementation of the guidance:
http://www.nice.org.uk/nicemedia/live/11779/43545/43545.pdf
The Case Management Society UK (CMSUK), is committed to the delivery of quality
case management through standards of best practice while promoting the individual and
collective development of case management: http://www.cmsuk.org/
Health for work advice line provides information on managing back pain and workplace
adjustments for back pain: http://www.health4work.nhs.uk/
Institution of Occupational Safety and Health provides Information and factsheets on
musculoskeletal disorders.
NHS choices provides information on symptoms, causes, diagnosis, treatment and
prevention for back pain: http://www.nhs.uk/Pages/HomePage.aspx
Worklife is a website for people with chronic fluctuating health conditions such as
multiple sclerosis, diabetes, arthritis, cancer, HIV and AIDS, parkinsons, ME/CFS,
migraine and epilepsy. This site aims to focus on, and provide solutions for any and
every issue or question that someone who is trying to stay in work, or find work would
need to know. It also covers all of the information that health care professionals,
employment professionals, and employers need to know to enable work retention:
http://www.yourworkhealth.com/
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Notes
1
Is work good for your health and well-being? Waddell and Burton, 2006
2
The CBI/Pfizer Absence and Workplace Health Survey 2010
Dame Carol Black’s review of the health of Britain’s, working age population: Working for
a healthier tomorrow, Health, Work and Wellbeing Programme, 2008
3
National Institute for Health and Care Excellence (NICE) - Managing long-term sickness
absence and incapacity for work
4
5
http://www.hse.gov.uk/sicknessabsence/gettingstarted.htm
Dame Carol Black’s review of the health of Britain’s, working age population: Working for
a healthier tomorrow, Health, Work and Wellbeing Programme, 2008
6
7
http://guidance.nice.org.uk/PH19
8
http://guidance.nice.org.uk/PH19/CheckList/doc/English
9
http://www.cipd.co.uk/hr-resources/practical-tools/absence-management.aspx
10
http://www.hse.gov.uk/sicknessabsence/
11
http://www.cipd.co.uk/binaries/3862Absencemanagement3.pdf
12
The value of rude health, London School of Economics, Marsden and Moriconi, 2008
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