Workplace interventions

Much of the help given in respect of the workplace was felt to have been of value to both employees and employers. Not only were both thought to have benefited financially from employees’ returns to their workplaces, but both learnt from the experience of being off work and about methods to aid rehabilitation. There was hope from some JRRP staff that successful use of gradual returns and workplace adaptations would encourage employers to use such methods in the future. Chapter 3 reports that some clients in the workplace interventions group did not receive any services and were asked to come back when they were well enough to return to work. In the staff discussions, people said that they found it difficult to help clients in the workplace interventions group who needed expensive surgery because they were not able to provide health care support. They also felt they could not help these clients focus on their future employment prospects because they did not know what their capabilities would be after receiving treatment (see Chapter 6 for further discussion). However, some staff working with clients in the workplace interventions

group said they had used mediation with employers for people who had unresolved health problems (see below). They said some clients had returned to work before they were fully fit because suitable working conditions had been provided for through mediation. There was some recognition that the return to work process had sometimes taken a long time because they were waiting for medical intervention, but that clients had been supported throughout.

Mediation

Some staff at all organisations providing workplace interventions gave strong support for the use of mediation with employers. For staff who did not have recourse to health interventions, meeting and negotiating with employers was considered to be their key intervention. Contact with the workplace was felt to be crucial to workplace rehabilitation, in order to obtain an appreciation of the workplace cultures and processes, and thus, to make it work in the client’s favour. Although it was believed to be potentially beneficial to all clients, it was felt particularly useful for clients who had stress and anxiety related to the workplace. Its importance lay chiefly in what was produced from liaising with personnel from employing organisations, such as the contents of return to work plans.

According to staff, some clients said they valued having someone come with them, particularly if they were nervous about meeting with their employer. Indeed, people who had been reassured by the prospect of having a JRRP staff member as a ‘buffer’ between themselves and their employer had felt able to visit the employer and open communication channels again. Some staff thought that clients did not only appreciate having someone to represent their interests, but also welcomed their expertise in making suggestions, such as a phased return, that they would not have known to pursue otherwise. One helpful outcome was breaking down barriers and changing employees’negative perceptions of their employer.

Some people spoke about building ‘partnerships’ with employers, to aid clients’ returns to work. Such partnerships were fostered more easily and successfully when staff had a clear point of contact, such as one line manager, or when occupational health professionals were involved. Partnerships with large private sector companies were given as examples. One opinion was that some employers might have dedicated more time and support to individual employees when they knew JRRP was involved. Having established a ‘positive’ partnership, some JRRP staff felt they were in a better position to make enquiries about the workplace and suggestions for rehabilitation plans. Good working relationships also facilitated access to other types of help on occasions, such as arranging for a car parking permit nearby. Where employers were not experienced in managing people back to work, or perhaps initially hesitant or unwilling to take the employee back, JRRP staff were able, in some cases, to persuade them to give the employee another opportunity and to be willing to make concessions, such as taking someone back when not fully fit and making reasonable adjustments. It was felt to have been important in some cases to have educated employers and changed their perceptions, for example,

improving their understanding of individual clients’ health conditions and capabilities, the therapeutic qualities of working, and their options, such as offering a phased return, lighter duties, and working from home.

Government responsibility for the pilot was considered by some to have aided their work with employers. They felt it had helped to make an impression on employers, and to give reassurance to employers that their employees would continue to be supported and their progress monitored.

Assessments and providing equipment

One provider specialised in conducting functional capacity assessments using a purposely built suite of mock workplace environments. Staff at this organisation felt it was suitable for a wide range of clients and produced ‘scientific’ results in which employers had confidence. In this way, assessments conducted by JRRP staff had helped to inform discussions with employers.

Likewise, ergonomic assessments conducted in the actual workplace had helped to inform negotiations with employers, by identifying equipment needs. Although it was suggested that larger employers were better able to purchase necessary equipment, many employers were said to have welcomed JRRP staff’s site visits and advice and felt more confident in ensuring clients returned to the right conditions as a result. One case manager said that in some cases, purchasing equipment for work had removed the single barrier keeping people from returning to their workplace. Some staff identified Access to Work as an effective scheme for meeting clients’ equipment needs. Provider organisations were not always able to meet the cost themselves and Access to Work made a ‘crucial contribution’ by funding the cost of travelling to work for some clients. Staff from one provider organisation described how they filled gaps in Access to Work provision by providing equipment quicker than it would otherwise have arrived, and to people who did not qualify for Access to Work help.

Gradual returns to work

Some people stressed gradual or phased returns to work as something clients perceive as the most important aid to their return to work. It was considered effective for clients with physical problems and physical jobs. People who had numerous and complex health conditions needed additional interventions to make a successful return to work. Some frontline staff said that increasing numbers of employers were willing to take employees back on a gradual basis. This was considered to be due, in part, to the actions of employers’ legal representatives in reminding employers of their duties under the Disability Discrimination Act to make reasonable adjustments. The work done by JRRP staff in communicating with employers about individuals was also described as having informed employers about graduated returns and reminded them of their legal responsibilities.

Plans for gradual returns were described as emerging through mediation with employers. According to some staff, JRRP staff helped employers and employees break jobs down into their component parts and gave advice on how employees could modify their work and break patterns, the time of day that they worked, the tasks they did and the equipment they used. For example, one client who had suffered a stroke worked his way back to his original job, after JRRP staff liaised with the workplace and conducted a risk assessment, and having spent six weeks doing tasks below his level of competence. In some cases, a supportive occupational health department was thought to be useful in convincing employers to try a phased return, as was stressing the long-term, if not immediate, benefits of having an employee back in the workplace. Once embarked upon, phased returns were considered successful when clients followed the programme set out for them and felt financially supported throughout. Several members of staff stressed the importance of paying employees full pay whilst on phased returns, not only in influencing their initial decision to return to work, but in helping them finish the phase-in period. As discussed in Chapter 4, there was some disquiet amongst clients about being asked to use annual leave to cover days not worked during phase-in periods.

Advising and supporting clients

In addition to what has been set out above, staff variously mentioned mentoring, group work, occupational therapy and forms of financial advice, as important in achieving desirable outcomes for clients. The interventions mentioned depended on which ones the organisation made available and reflected the expertise amongst frontline staff, some of whom delivered such services themselves. Important, and seemingly common, elements of these forms of help were described as having had the opportunity to talk to someone or engage with a group of people, to have received help to make lifestyle changes, and to have built confidence. In the view of some staff, such support helped resolve problems that were exacerbating people’s main health conditions and which had taken the focus of their attention away from work. For example, talking through financial problems with a mentor, debt counsellor or welfare rights adviser helped some people consolidate debt and learn about their rights and options with regard to employment and benefits. The staff discussions support the client data reported in Section 2.6.3, about clients having little knowledge about claiming state benefits. Having received financial and welfare advice, staff said people had felt able to focus on their health and make informed decisions about work without feeling under pressure. Examples were given of how people had credit debts written off, made successful appeals for Disability Living Allowance (DLA) and obtained grants from charitable trusts.