Rehabilitation blues

Poor rehabilitation strategies can put a serious dent in a company\'s bottom line. Stephanie Spicer weighs up whether forking out for insured solutions to deal with the problem really stacks up

Whether an employer is implicated or not in the reason for an employee’s absence it is incumbent on them to ensure staff off sick get back to work as soon as possible – simply paying people to watch daytime TV is not a cost-effective use of human resources.

At the top of the list of problems for employers addressing rehabilitation of sick employees is not acting early enough, and the magic figure of four weeks is recognised as the right amount of time to leave an employee without offering some intervention. Some insurers even argue intervention should in some cases take place before an employee goes off sick.

“We know delay in treatment will increase the length of absence and reduce the likelihood of a successful return to work,” says Jill Pollock, head of corporate solutions at Bupa, “If musculo-skeletal conditions are addressed before someone actually goes off work the chances are they are potentially going to need simple and straightforward treatment and potentially adjustment in the workplace before it becomes more complicated. But as in often the case people will struggle on and the condition become more complicated and expensive to treat.”

The trick of course is to know how to assess when an employee might be struggling. Good sickness absence management allied with a rehabilitation strategy is essential. But neither is any good unless employers know how to use them effectively and train key managers to do the same.

“One of the advantages of sickness absence management systems is you spot people very early when they are potentially going to be off for long periods of time,” says Dudley Lusted, head of corporate healthcare at Axa PPP healthcare. “There is a lot of good policy out there but not very good training of managers as to what all that means. Take the ubiquitous back to work interview. Managers are told to do it, but not necessarily trained very well in how to do it. More importantly when you start to see people with a psychological problem or a physical problem, call in the support services immediately so they can help deal with it.”

For many employers the dilemma concerns how they should view rehabilitation, their definition of it and attitude towards it. Should they feel responsible if an employee is sick because of work or because they have suffered an accident at work but not if their illness is not because of their work?

For some, rehabilitation is getting people back to work as quickly as possible through treatments such as physiotherapy, counselling and private medical treatment. For others it is rehabilitating someone who has suffered a serious accident and enabling them back into the workplace with a role suited to their condition, post accident or illness, making sure the ergonomics of their work station are right or offering them flexible or part-time working hours.

“What employers are doing wrong in the main is looking at rehab in terms of external expenditure and provision of treatment and from the point of view as to who is liable?” says Lusted, “So if there is a potential employer’s liability claim then they will tend to pay for the treatment because it will mitigate their loss and in many cases the insurance company will provide that facility. The problem is that only deals with a relatively small proportion of people who will be off work because the vast majority do so for problems not caused by work. If a person is going to be absent for quite long periods of time and the cost of that absence is going to be significant, the cost of the treatment in getting them back to work quicker is probably going to be less than the cost of the absence. There are opportunities to better help people back to work but people are ignoring that unless it is caused by work.”

Joy Reymond, head of rehabilitation services at Unum agrees: “Once you are into a legal arena there are a lot of other agendas and motivation drivers other than let’s just get this person better and back to work,” she says.

“The value of having rehab tied to sickness absence is, irrespective of what drove the sickness or injury, we are going to try to help you get back to work. So employers don’t have to get into the fight about whose fault it is.”

Corporate clients who want to see bottom line cost savings to justify implementing rehabilitation strategies will find it is not as straightforward as simply putting a rehab process in place and getting £x amount knocked off the premium.

That said, Legal & General, under its group income protection policy offers employers an early notification bonus of 5 per cent of the annual premium for companies with over 500 insured staff provided employer clients notify them of at least 80 per cent of long-term absences by the sixth week of absence. L&G claims to reduce absence rates by 21 per cent through early intervention during weeks four to six.

Legal & General’s group income protection product, Progressive, includes re-integration programmes over stages as appropriate up to four years, for employees offering career counselling, stress management and physical evaluations, to assess the employee’s abilities and disabilities and find the best way to get them back into work.

Another example of an insurer solution is Unum which offers to larger companies a full account management service called Premier, of which rehab is part.

“Within that we formalise a process of early intervention,” says Reymond. “We sit down with the client at outset and go through how they manage their sickness and see how we can fit in our services at the early stage that will fit with their message. It means we get to know the client and how they work so when there is an absence longer than four weeks we know what it is they need from us. So it is not a sporadic thing when they phone us – it is all part of the claims management process.”

Smaller Unum employer clients can access a network of vocational rehab consultants. “As soon as they have a case they feel could become long term absence they contact us and we can help them with setting up a claim and once we are into that claim process we bring our rehab people into place. We can advise over the phone or give them the tools to keep managing it themselves if that is what they want,” says Reymond.

Reymond cites the case of a financial company which saw a 15 per cent decrease in premiums under the Premier initiative, equating to a £1m saving; a legal firm which saw a 33 per cent rate decrease, equating to over £100,000 savings and a technology firm which saw premiums fall by 40 per cent over 4 years saving about £500,000.

Most insurers offer absence management tools for employers to assess their risk. Bupa offers Absence Management from day one so employers measure absence across the client’s business from the contact, identifying potential problem areas and, where appropriate, enabling clinical experts to discuss return to work with employees.

Its 360° Health Risk Management is an end-to-end case management service that covers health risk management issues and provides an integration of healthcare provision including medical and vocational expertise.

“It is that combination of people that can ensure the best co-ordination of treatment and case to make sure people are getting back to work as quickly as they can,” says Pollock.

Corporate clients have to consider the costs of poor rehabilitation strategies – or non existent ones, not just in terms of litigation from disgruntled employees, replacement costs and productivity costs but savings that can be made by making fewer claims on their insurance. Insurers keen to help corporate advisers should ensure their clients are exploring all the tools available to them.

focus – Dudley Lusted, Head of corporate healthcare development, Axa PPP healthcare

According to the CBI/Axa absence and labour turnover survey 2008 At work and working well?, 81 per cent of employers operate some form of rehabilitation policy to get staff back to work. In the main activity is concentrated in the largest companies. with 94 per cent active in the area, while just 36 per cent of smaller companies take such action.

Yet despite this, absence still cost UK employers £13.2 bn last year with the average employee taking an average of 6.7 days off sick.

What should be of most concern to employers is long-term absence. Only 5 per cent of absences became long-term, defined as 20 days or more, but this accounted for 40 per cent of all time lost, costing employers £5.3bn. While the report calculates the direct cost of absence at £517 per employee or 3.1 per cent of payroll, indirect costs such as reduced customer satisfaction add a further £263 per employee each year.

This is a cost employers could obviously do without and crucially one they can do something about. Dudley Lusted, head of corporate healthcare development at Axa PPP healthcare says the tools to deal effectively with the key reasons for long term absence, stress, depression and musculo-skeletal problems, are well established and readily to hand. “It’s no accident employers who provide access to these tools have lower absence rates than those who don’t,” says Lusted.