Vocational Rehabilitation
Vocational rehabilitation can be defined as “whatever helps someone with a health problem to stay at, return to and remain in work”. In their review (Vocational Rehabilitation What Works, For Whom, and When?) Waddell, Burton and Kendall concluded that there is strong evidence that return to work assists recovery from many health conditions, that healthcare professionals should play a key role in advising and supporting patients in their return to work, and recognise return to work as an important clinical outcome.
The Scottish Government’s Co-ordinated, integrated and fit for purpose - A Delivery Framework for Adult Rehabilitation identifies the importance of vocational rehabilitation and sets out a model for service delivery. Importantly, the rehabilitation framework recognises that rehabilitation cannot be delivered by health services alone and that an integrated approach across services is required. A network of Rehabilitation Coordinators have been appointed jointly between NHS Boards and local authorities.
The model for vocational rehabilitation outlines the support structures that should be available to individuals in workplaces to promote health and wellbeing at work. It identifies a rapid access referral process through which individuals should be able to secure support and specialist advice from a dedicated vocational rehabilitation team consisting of a range of professionals (case manager (any discipline), counsellor, manual handling trainer, occupational health adviser, occupational health physician, occupational therapist, physiotherapist, psychologist) using case management approaches.
The Scottish Governments Health Works strategy recommends that the case management approach to working with clients must be more widely adopted. It is important to de-medicalise the client’s situation and take a whole person approach, considering wider issues around personal circumstances, housing, money issues, etc.
Three vocational rehabilitation service pilots in Dundee, Lothians and the Borders have been established to trial models of integrated service delivery, allowing rapid access to treatment for employees of small and medium sized enterprises who do not have access to in-house occupational health services.
These pilots are being fully evaluated to establish if the approach provides a cost effective way of helping people to recover from ill-health and return to and retain their employment. The learning from the evaluation will inform further development of vocational rehabilitation based services. The objective will be for every NHS Board area to develop access to relevant health services within their existing resources by adopting the good approaches and practices highlighted by the evaluations of the vocational rehabilitation and Fit for Work Service pilots.