Impetus for rehabilitation

Issues of rehabilitation and the speedy return to work of absent employees were much to the fore at the recent ALARM annual conference in Manchester. Figures published by the Health & Safety Executive, the CBI and others present a worrying picture of the state of the working nation's health and the case for robust, proactive rehabilitation risk management is clear.

Speaking at the conference, Neil Fraser (Zurich Municipal) described ways in which specific types of injury, such as whiplash, could be addressed, stressing the importance of early notification of accidents and appropriate physiotherapy, while Simon Hills (Praxis Partners) and Pam Bailey (AIG Medical and Rehabilitation) outlined a range of benefits to be gained from early intervention. They described a case in which a male council worker aged 35, who was a Scarab driver, suffered an ankle injury. His employers admitted liability, and the occupational health doctor considered him unfit for work. However, medical evidence suggested that he could continue to work if some adaptations were made to the Scarab. Working in close liaison, occupational health, personnel, legal services and the individual's department head were able to make suitable arrangements, which persuaded the OH doctor to change his mind and allowed the employee to be reinstated. Not only was this a satisfactory solution for the employee, but there were significant savings to both the council and its insurer.

It is worth noting at this point that this radical approach was supported and funded under the employer's liability insurance and risk funding arrangements, and the advice and business case of the insurers indicated a significant saving over the potential settlement costs of the claim.

But should rehabilitation extend beyond workplace accidents? In short yes. It is accepted that a robust process to manage absence and use rehabilitation schemes is advantageous. And the employees of a public sector entity are a significant asset. They provide specialist and specific services - without the people, the service fails. Given this, we need to consider why the public sector is not grasping the nettle.

Traditionally, statistical analysis of lost work days show the public sector as significantly worse than the private sector. This in itself has resulted in national 'best value' performance indicators for public sector organisations. In essence they are required to provide performance data to the Audit Commission as part of regular returns. This requirement originally caused a flurry of activity, as many public sector organisations had not invested in IT systems capable of capturing the required statistics, and did not have absence management policies which ensured consistent reporting of absence.

Such policies were quickly established, and the fact that early intervention and welfare visits are the key to countering persistent absence was noted and investigated. However, many organisations went no further. And, while a referral to an occupational health unit has been used as a reactive measure to long-term ill health, the public sector did not grasp the opportunity to embrace a rehabilitation policy.

Why was this? Much rehabilitation care can only be sourced from private medical providers, and so expenditure of this nature was frowned upon. How would it be perceived if public money was used to provide private medical care? Private medical schemes were seen to be a private sector perk, rather than a sound practice of business management.

Some responded by providing an in-house resource, providing rehabilitation and proactive health checks where needed. While such initiatives have been a proven success, they are rare in the budget challenged public sector.

So will the dual challenges of accountability and scarce resources prevent the public sector from seizing the opportunity to effectively manage their business? Not if a risk management approach is adopted.

Instead of perceiving such initiatives as a luxury, public sector organisations need to ensure that meaningful and proactive rehabilitation schemes become the risk control for the risk that features on all corporate risk registers - loss of key personnel. Detailed analysis of the cost that lost days have, not just in terms of monetary value, but in terms of service impact, should be the driving factor to establish easy acceptance of a rehabilitation policy that benefits both the individuals and the organisation.

Health and safety capacity exists in all public sector bodies to meet the statutory requirements of such legislation, the emphasis being on safety to protect the health of employees. It does not take a huge leap of faith to focus some of the activity on health - for health's sake.

With a new UK government framework for vocational rehabilitation in place and issues of social responsibility gaining increasing attention, there is greater pressure on employers to address this problem and to demonstrate to employees that they have their best interests at heart, helping them recover from illness or injury, and return to play their full part in both the workplace and the community.

ALARM will be supporting their membership on this topic with the publication of a research document identifying good practice and, where available, statistical information.

The future of public sector people management should clearly include a risk-managed approach to the use of rehabilitation schemes as a control measure.

- Carolyn Halpin is vice chair and national secretary, ALARM, the National Forum for Risk Management in the Public Sector, www.alarm-uk.com