Greater Manchester Neurorehabilitation Conference 16 Dec 2019

Dr Emer McGilloway

King’s College Hospital, London

emermcgilloway@nhs.net

Vocational rehabilitation: Models, policy and guidelines to support the development of a service

Overview

• What is vocational rehabilitation (VR)?

• Why does it matter?

• Principles of VR

• Links with Occupational Health

• Military VR model

• Government Policy

• Vocational Guidance- practical applications- Sarah

Definition

‘Whatever helps someone with a health problem to stay at

return to and remain in work1

‘A process whereby those disadvantaged by illness or disability

can be enabled to access, maintain or return to employment, or

other useful occupation’2

QR6 of NSF for LTC3: • Support to enter training or work opportunities • Support remain in/return to existing job • Support to identify and prepare for alternative employ • Support to plan withdrawal from work • Support to access alternative educational or leisure opportunities

• Waddell et al 20081

• BSRM 20032

• Mapping VR Services for LTC Playford, Radford et al3

Importance of work [Dame Carol Black, 2008]

• Identity and purpose

• Confers status and financial benefit

• Provides structure and social contact

• Work is a health outcome

• “Work is Nature’s physician” (Galen)

• “Work is one of the great social determinants of health along with food, addiction, early life, social support (Michael Marmot)

• Lack of work is associated with: • Loss of physical and mental fitness (Viner and Cole 2005)

• Obesity, low mood, greater risk of IHD (Waddell and Aylwood 2005)

• Increased suicide risk in young men (Bartley et al 2005)

Is there a difference between Rehabilitation medicine and Occupational health medicine?

• Occupational Medicine focuses on ‘the health and wellbeing of the work

force, minimising the adverse effects of work on health and mitigating the

effects of ill health on work’ [Ford et al, 2008]

• Vocational Rehabilitation focuses on preparing those with disability for the

world of work, supporting and maintaining those currently in work, and

facilitating new work.

Results

• 91 TBI patients

• 85 male : 6 female

• Median age 27 years

• Median duration of admission 63 days

• 79 patients with MPAI-4 T score on admission and discharge, and 4mo f/u clinic

• Mild: 19

• Moderate: 32

• Severe: 28

MPAI-4 change with rehabilitation

33.0 38.5

43.5

32.0 29.5 32.0

0

10

20

30

40

50

60

Mildn=19

Moderaten=32

Severen=28

T sc

ore

TBI Severity

Admission

Discharge

p = 0.0020 p < 0.0001

p < 0.0001

Employment status at 4 months

0

5

10

15

20

25

30

35

40

45

Unemployed Sheltered Supported Transitional Competitive

Vocational Independence Scale

30 1

4

112

0

4

10

16

0

1

4

7

16

N

Severe

Moderate

Mild

VIS 3-5 = community-based employment: 92%

Employment Summary

• Community-based employment VIS 3-5: 73 (92%)

• Transitional or Competitive VIS 4-5: 64 (81%)

• Unemployed or sheltered work VIS 1-2: 6 (8%)

• 5 unemployed – 3 mild TBI, 2 moderate, 0 severe

• All suffered from MH disorders e.g. depression, PTSD

Improving Lives: the future of work health and disability - a ten year programme of change

• Less than half of disabled people in employment (48%) compared to 80% of non disabled population

• 1 in 3 working age people in the UK have a long term health condition putting participation in work at risk

• 1 in 5 of the working age population has a mental health condition

• 54% of all disabled people out of work have mental health or MSK condition as the main health condition

AIMS:

• To ensure equal access to work opportunities and support in work

• Help employers to take action using an employer framework for voluntary reporting on disability and mental health

• Ensure access to the right employment and health services

• Integrate health and social care and welfare systems to help disabled people move into and remain in sustainable employment

Improving lives-the future of work health and disability https://www.gov.uk/government/publications/improving-lives-the-future-of-work-health-and-disability

Thriving at work review

Set clear standards for all employers to support mental health at work:

• All employers should produce, implement and communicate a mental health at work plan

• Develop mental health awareness among employees

• Encourage open conversations about mental health and the support available

• Provide employees with good working conditions

• Promote effective people management

• Routinely monitor employee mental health and wellbeing

Matthew Taylor Review of Modern working practices

• Supports ‘Improving Lives’ in viewing work as a health outcome

• Highlights Access to Work, Fit for Work and the low awareness of these schemes

• Importance of promoting health and wellbeing at work- the need for joined up working between employers, JobCentre Plus the NHS and local authorities

• Recommendations for relevant government departments to incentivise local authorities, particularly City Regions and combined authorities to develop integrated approaches to improving health and wellbeing at work

Health is Everyone’s business

• A 2019 consultation on measures to reduce ill health-related job loss

• Proposed strengthened statutory guidance to support employers to take early, sustained and proportionate steps to support a sick employee to return to work, before that employee can be fairly dismissed on the grounds of ill health.

• Government to provide more help for employers, recognising the differences in employers’ capacity and capability to act

• Proposal for government to cofund Occupational Health for smaller companies

• Improving the provision of advice and information to support management of health in the workplace and encourage better-informed purchasing of expert-led advice.

• Preventative approach that will help people to stay in work if they develop a health condition or disability

Long term plan Percentage of the population who are employed, by disability status,

England, 2016 to 2017

Source: Public Health England. Health profile for England: 2018. September 2018.

The Long Term Plan- health and employment

• For people in work, fast and convenient access to health services plays an important role in maintaining employment

• Stable employment is a major factor in maintaining good mental health, and is an important outcome for recovery for people with a mental health problem

• The NHS will support up to 20,000 people with severe mental illness to find and retain employment by 2020/21

• The NHS will offer supported internships for people with autism and LD

• Employers have a key role to play in supporting their staff to stay well and in work

• Government will provide support to Trusts to access fast track OH services and a line management development programme complementing the NHS Health and Wellbeing Framework