Good practice in rehabilitation

Your organisation should have a clear and up-to-date policy on rehabilitation. This should be part of an overall strategy for managing sickness absence. The policy should clearly define roles, responsibilities and expectations, and be effectively communicated. This will help create a fair and consistent approach, and build trust between employees, managers and the employer.  
    
Managing day-to-day sickness absence and return to work should be a line manager’s responsibility. For complex issues, managers need to draw on advice from human resources, occupational health or health and safety specialists.
    
Early intervention is important, particularly in the case of musculoskeletal disorders, stress and mental health, which can become chronic. Some employers refer all cases of stress and musculoskeletal disorders to their occupational health adviser on the first day of absence. Generally, intervention should take place within weeks rather than months.
    
Managers should stay in regular contact with employees from the start of their absence. Contact should be weekly. If the illness is prolonged, then less frequent contact may be agreed, but it should be at least once a month.

Beginning rehabilitation
Rehabilitation should begin at an appropriate stage. In some cases, such as musculoskeletal disorders, this could be very early. In other cases, say nervous breakdown or where the employee is too ill, early contact should mainly be for welfare purposes – to see how the employee is and whether there’s anything the employer can do to help. The decision on when it’s appropriate to discuss rehabilitation should be based on the manager’s conversations with the employee.
    
Rehabilitation should be considered once it’s clear that absence could be lengthy, say after the employee has sent in a second medical certificate or has been off work for a month.
    
A co-ordinated case management approach is best, beginning with an informal discussion at an early stage – between the manager, employee and human resources specialist – to start looking at rehabilitation options. The manager should assess what the organisation can do to help the employee return to work. The manager should also try to find out if anything is preventing the employee from coming back, as this will help to identify any adjustments that need to be made at work.

Occupational health adviser
After the initial meeting, the employer may have to arrange for the employee to see an occupational health adviser or occupational safety and health practitioner, or ask the employee’s GP or specialist for more information. Here, the employee would need to give the employer their consent. The employer should ask the GP about the employee’s ability to do specific work tasks, and their views on the suitability of the rehabilitation measures that have been proposed. The employer needs to ask about what the employee can and can’t do and, if appropriate, how long their disability or medical condition might last.
    
Once the manager has medical advice about what the employee can and can’t do, they can plan a programme of rehabilitation.
    
The manager may need to make adjustments to the workplace or buy specialist equipment. If these are likely to be expensive, and the employee has a disability, the employer may be able to get funding through Access to Work. The manager should also assess how long it will take to make adjustments, as this may delay the rehabilitation process.
    
At this stage, the manager will need to start thinking about any health and safety issues, and may need to contact their occupational safety and health practitioner for advice.
    
The employer and employee should then agree the arrangements for rehabilitation – these should be recorded.
    
The employee’s progress should be monitored regularly, normally by their line manager. Their manager should keep notes (making sure confidentiality isn’t breached) and agree any significant changes to the employee’s role with the occupational health adviser or employee’s GP or specialist.

Asking an employee’s GP or specialist for information
Employers should get their employee’s consent if they want information from their GP or specialist. The employer should then ask the GP or specialist for the information in writing. If it’s convenient, the employee can hand over a letter from the employer, but usually the employer sends the letter direct to the GP or specialist.
    
The employer should:

• explain that they would like to help the employee get back to work as soon as possible
• summarise the employee’s duties, paying attention to things such as job demands, the work environment, working time, travel, and whether the employee is a lone worker
• ask the GP questions about the employee’s fitness to do their current job. For instance, they should ask about the possible side effects of medication, the employee’s stamina and motivation and, if relevant, whether the employee can lift or move heavy objects. It’s important to ask questions about what the employee can do, not just what they can’t do
• suggest a range of rehabilitation measures – such as a phased return to work, altering the work or adapting the work environment – to find out if these could help the employee come back to work.

GPs and specialists don’t have to give employers their views on an employee’s fitness for work or rehabilitation. If they don’t, the employer may have to make decisions without this information. If they do agree, they may charge a fee. Unless an occupational health adviser makes the request, the report won’t necessarily give clinical information about things such as the diagnosis, or the medication the employee is taking.

Examples of reasonable adjustments for an employee
Working arrangements

• Encourage employees to visit the workplace so that they stay in touch
• Offer them a phased return to build up their strength, gradually increasing their hours of work
• Change their working hours so they don’t have to travel at busy times, or offer them flexible working to support their work–life balance
• Provide them with help travelling to and from work, or let them park nearer workplace entrances
• Allow them to work from home
• Give them time off work for medical treatment and assessments

Working environment

• Move their workstation so that it’s more accessible, or closer to washing and toilet facilities
• Alter the work premises, for example install ramps or improve lighting

Work adjustments

• Give them specialist equipment or modify existing equipment
• Modify their workstation or furniture
• Change or simplify their work pattern, such as no shift or night work
• Give them extra or refresher training
• Modify instruction manuals and standards to suit their abilities
• Modify their work tasks, such as reducing the need for face-to-face meetings or travel if they cause anxiety
• Modify management systems to give them more control
• Reduce their pace of work – give them less difficult targets or deadlines, longer breaks and so on
• Modify procedures for testing and assessing competence or ability to do a job
• Give them a ‘companion’, mentor or more supervision
• Give some of their tasks to other employees, give them different work, or re-deploy them
• Give them training and information, for example on back care

This material is taken from the IOSH guide A healthy return – good practice guide to rehabilitating people at work, October 2008, available for free download via www.iosh.co.uk (select IOSH Guidance on the information centre menu).

Notes
1. Adapted from the EEF guide, Fit for work

IOSH is Europe's leading body for health and safety professionals, with over 34,000 members worldwide, including 13,000 Chartered Safety and Health Practitioners. The Institution was founded in 1945 and is an independent, not-for-profit organisation that sets professional standards, supports and develops members and provides authoritative advice and guidance on health and safety issues. IOSH is formally recognised by the ILO as an international non-governmental organisation.