By Tracey Ward, Head of Business Development & Marketing at Generali UK Employee Benefits
It’s increasingly understood that illness cannot simply be categorised as either physical or emotional. Usually, it’s a mixture of both. And the social aspect – an individual’s environment – also represents a crucial ingredient in this mix. On that note, momentum is also building on the notion that work has a really important role to play in recovery and ongoing condition management, in terms of giving hope and ensuring people feel valued, supported and equipped. In other words, appropriate support needs to be provided at the point of suspected long term absence, not just at the point when the employee deems themselves ready to return to work (which is commonly the case).
So, while the UK government is consulting on tax incentives to encourage greater employer provision of occupational health (OH) services – with the ultimate goal of improving return to work for those with long-term illness – we take a look at the important role of vocational rehabilitation (VR). We specifically focus on the work ability model (and its biopsychosocial underpinning). What is it? In what situations is it relevant? And what benefits does it bring to the employer and employee?
We posed these questions, as part of a recent podcast, to Kay Needle, Generali UK’s Early Intervention and Rehabilitation Expert. Also to Dr Julie Denning, Chartered Health Psychologist, Managing Director of Working To Wellbeing, and Chair of the Vocational Rehabilitation Association.*
Here, we share a few highlights from that discussion.
Tracey: What is work ability? And what benefits does it bring to both the employer and employee?
Kay: Firstly, I think there’s a lot of confusion outside VR circles about what work ability is. It isn’t just a phrase, it’s something that we can measure and benchmark as part of the work ability index. It provides the basis for many of our assessments and bespoke support that we provide to employees as a group income protection provider in partnership with VR experts such as Working To Wellbeing
Julie: Yes, it’s a model that was originally designed by the Finnish Institute of Occupational Health. They wanted to understand what would lead someone to retire at a certain age. As part of that, it unpicks the factors that contribute to an individual’s ability to be in work, thriving and feeling well. It’s coming at it from the approach of self-management. But also looking at how workplaces can enable people to be healthy from both a psychological and physical
The model uses the metaphor of a house to explain this, with work ability as the roof. In order for the roof to be strong and to keep out the bad weather, various structures are needed; work, work community and leadership.
It also considers people’s values, attitudes and beliefs; for example, about their competency. Health and functional capacities underpin all of this. This latter level is about physical and psychological health and the relationship between the two. It considers the kind of work and leisure activities the individual engages in to help understand their functional capability; what they are able to do. Alongside all of this is family and community; the individual’s social infrastructure.
All these phenomena need to be considered together to understand work ability. Each element is measured, either through self-reporting or via questionnaire. VR professionals will then use this insight to help the individuals improve their work ability.
Kay: It’s typical for all these things to be considered in isolation, but they’re all dependent on each other. For example, we know through our experience of speaking to people with long term conditions that their confidence can be negatively impacted. That can have a knock-on effect on their beliefs about their competency. And that, in turn, starts to impact their work ability.
Tracey: What is the biopsychosocial model? What are its benefits and limitations?
Kay: The work ability model is informed by biopsychosocial philosophy. This is about ‘whole person’ thinking; the notion that the physical, emotional and social aspects need to be considered together. It’s still seen as a ‘modern’ way of approaching wellbeing, but VR professionals have been doing this for years.
Julie: To completely align the two models though, I’d argue the biopsychosocial model needs to be updated to include work. The inference is there, but it’s not explicitly discussed as part of recovery in most traditional healthcare settings where the goal is to get the individual well. VR also has this same goal, of course, but it’s about getting them well and back at work, where appropriate. It’s about seeing work as a health outcome.
Another area where the biopsychosocial approach needs an update is on the ‘psych’ aspect – the mental health aspect. The work ability model arguably takes a broader approach by factoring in values, attitudes and beliefs. So, for example, an individual might be experiencing certain emotions about a return to work. They might be worried about how their team are going to respond to their return, for instance. But that’s not a mental health issue. It is, however, something that a skilled VR professional will help the individual unpick, communicate and overcome.
Overcoming such issues is an iterative process, with various solutions being tried and tested until the individual feels they have the tools and techniques they need. This includes support to enable conversations with their line manager so that, ultimately, the VR professional can be removed from the equation. Such support should only really be considered short-term, leaving the employee and line manager equipped to take it from there; perhaps with a wellbeing action plan in place to help facilitate longer term conversations about staying happy and healthy in work.
Kay: Yes, this is about workplace culture and, as a layer of the work ability ‘house’, culture represents a simple, no-cost aspect that deserves more attention. On the subject of lin manager conversations, calling in sick is another key thing. It’s something we’re not always very good at in the UK. But with an open and empathetic line manager, such conversations are made easier. The ability to completely switch off and recover also becomes easier, as opposed to still remaining open to contact when you’re supposed to be off sick. This is typical for many!
Tracey: OH has traditionally represented the ‘go to’ for employers. What benefits does all of this bring to OH?
Kay: In my experience of working with both OH and VR professionals, I think there’s room for both to work alongside each other. Occupational Health from an ongoing risk assessment basis and VR brought in to assist in individual cases of suspected long term absence to help support early in the process, with in-depth ‘whole person’ fact finding and relationship building as part of that. It’s about considering work as part of the recovery journey, where appropriate, as this early stage.
Julie: I think it’s really important that we collaborate. For example, if OH has created a return to work plan, then VR practitioners need to work with that plan. They also need to feedback to OH if the plan needs to be adjusted and adapted to suit the individual’s changing workability. This can, at times, mean lengthening a plan from, say, six weeks, to significantly longer if need be. The focus for both professions should be having a flexible plan that enables a sustained return to work for the individual.
*To download the podcast, please go to episode 9: How return to work is evolving’ here.