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matter is obviously one for review. With the help of a detailed report on

all factors relating to the patient’sability to return to work – this couldnot only be on their physical function,but on their family/socialcircumstances, ability to drive to andfrom work, attitude to their employerand an outline of the specified jobwith that employer following a worksite assessment – an OH physician orcase manager may assist in a GP inreaching a more informed decision.

There is a clear argument here for amore active role among OH physiciansto assist and educate GPs in gettingemployees back to work, and isperhaps a way for the UK to begin toimprove its rate of return to theworkforce of its sick and injured – arate which currently stands at 14 percent.

An age old problem?As Tim Ablett, chief executive of FirstAssist Group, succinctly puts it: “Weare living longer but we’re fatter anduglier”. The UK’s ageing workforcehas enormous implications for the well-being of both individuals andorganisations. Jo Jenkins, occupationalhealth lead at Campbell’s, points toresearch that shows that by 2008, thenumber of people aged 45 andupwards in the workforce will increasefrom 33 per cent to 44 per cent.

The current pensions crisis alsomeans that more people hoping toretire at 65 or earlier will have to stayin employment, and by December2006 the EU directive outlawing agediscrimination will come into force.

OH professionals will need to fullyembrace a huge array of medicalconditions associated with age such asdegenerative musculo-skeletaldisorders, eyesight deterioration,cardiovascular disease, malignantdisease and diabetes. An awareness ofan individual’s decline in mentalability to process information,particularly, in the more skilled workareas, also needs to be considered.Shift working and the ability to donight work significantly decrease. Thechallenges facing modern OH

services, will be, as Jo Jenkins pointsout, to adapt services to offer well-being clinics with extended specialistservices such as chiropody anddisability provision.

The news is not all bad, however.Unlike its younger colleagues,research shows that the ageingworkforce is more dependable, lessprone to absenteeism and brings awealth of experience to anorganisation. The factors which makeadvancing age a handicap are mostlyconcerned with the constraints inworking conditions and types of workorganisation. As the EuropeanFoundation for the Improvement ofLiving and Working Conditions states:

“Age-friendly job design shouldinclude: adapting the workplace,premises, equipment, working hoursand processes to the employee’schanged capacities; taking thechanged capacities of older workersinto consideration by selectiveorganisation of trainingopportunities…”

All in a day’s workFor employers seeking to managethese risks, earlyintervention (fromday one of anabsence or injury) isimportant. Accuratesickness andabsencemanagement andbespoke OHprovision which isspecific to anorganisation’s risks isproving a successfulmodel in reducingabsence rates. Largerorganisations are ahead in thisfield – greater awareness andtraining to SMEs needs to takeplace for the effect to beconsistent.

Case management tosupplement all theseservices and toimplement, co-ordinate andmonitor rehabilitationprogrammes is another means

to assist employers in returning sickand injured employees back to work.Whether this is providedindependently or under the employer’sliability insurance policy, the overallaim is for the case manager to co-ordinate the medical and vocationalinterventions and to ensure a publicand private sector partnership occursto restore an individual and theorganisation to maximum health andwell-being.

Rosie Corless, BSc RGN DN, isrehabilitation manager at QBEInsurance, and directorand chair of CMSUK

QBE endorses case management and by utilisingthe skills of their in-house rehabilitation experts,are assisting many organisations to return injuredemployees back to the workplace in a costeffective way.

As founder members of CMSUK, QBE Insurancehave supported this new organisation in itsinnovative work – the recent publication of theCMSUK Standards of Best Practice is recognisedas breakthrough in their work to establish casemanagement as a profession in its own right.

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n ageing working population,rapidly advancingtechnological innovations with

associated new risks and overload,globalisation and the downsizing oforganisations are just the tip of theiceberg of challenges facing UKorganisations today in all sectors andacross all industries – not to mentiona poor return to work history and notleast the questions surrounding GPsissuing sick notes.

Successful organisations evolvewith their surroundings andorganisations that choose torecognise the importance of abiopsychosocial approach to thehealth and well-being of theiremployees as opposed to just thebiomedical model will have a farbetter chance of survival in a workingand living environment that is rapidlyevolving and changing.

Understanding the importance ofwork in relation to an employee’smental, physical and social well-being is central to the role of amodern occupational health (OH)service and physician.

By ensuring innovative practice,challenging the culture andperception of illness and disease andmoving away from the focus ofabsenteeism towards presenteeism,disability to residual capacity, and

utilising case management, thesignificant value of the OH role willbe revealed. The recommendation toa GP for an employee to return to theworkplace as soon as possible inorder to prevent disability beliefsfrom arising was noted as one of thekey roles of the modern OHphysician at last month’s QBE AnnualEmployers Liability Conference.

The bottom lineUnderstanding how OH can directlyimpact on an organisations’ bottomline is one starting point towardsunderstanding how to manage thatorganisation’s overall risk exposure.

Gaining an understanding of the‘well-being landscape’ of theorganisation can reveal the natureand extent of employee well-beingand appropriate well-being servicesput in place to address to reflect thislandscape. Dr Les Smith, medicaldirector, Premier OccupationalHealth, advises a thoroughassessment of the parts of a businesswhich reveal high accident andinactivity rates and stress relatedabsences with clear indicators as tothe percentage related to work.

This, he says, is whereoccupational health can subsequentlyenergise individuals, encouragingthem to achieve a good work/lifestyle

balance towards realistic goals inhealth – described uniquely as “aused pair of trainers, an emptymedicine cabinet and not knowingthe name of your GP”.

Considered as one of thefundamental roles of a modern OHdepartment is the assessment ofmusculo-skeletal problems and theimpact of a work accident on anemployee. By basing a return to workprogramme on objective information,assessing capability and havingspecific fitness for work criteria (asopposed to the use of ‘light duties’crtieria, for example), practitionerscan expect to see greater success inreturn to work programmes.

Through her work as groupoccupational health adviser at PSAPeugeot Citroën, Dr Barbara Knealehas implemented a functional muscleevaluation tool into the workplacewhich allows accurate, objective andunderstandable baselinemeasurements of an employeesfunctional capacity. The tool enablesher organisation to match thesecapabilities to specific jobs andhighlight areas for treatment tomonitor the progress of an employeeagainst a particular timeframe. Inaddition to the obvious benefits,motivation during a long and complexrehabilitation programme can bemaintained through the use ofobjective data on muscle strengthand production of progress charts.Its value in pre-employment screeningto secure a suitable and safeplacement for an employee is afurther key feature and an obviousone in helping reduce risk.

Such objective measurements canhelp OH professionals to bettercommunicate with GPs on a patient’sability to return to employment. TheGP medical certification scheme is acurrent issue on the Government’sagenda and debates are occurring onwhether employers should take on theresponsibility for sick notes. And withGPs themselves claiming that 20 percent of all medical certificates areinvalid, and that they receive minimaltraining on return to work issues, the

Rosie Corless examinesthe changed value ofmodern occupationalhealth, and describeshow employers canimplement innovativeand appropriate policiesto ensure a productiveand healthy workforce

WorkologyA