Return2Health

SAVE ITEM
case-study

03 / 11 / 2011

 

The organisation

What we did and why

How we did it

Results and next steps

Contact details

Return2Health (R2H) is an innovative programme that optimised joint working between Occupational Health (OH) and Human Resources to minimise both adverse health and well-being effects and the costs of long-term absence. R2H comprised the following key elements:

  • a focus on reducing sickness absence longer than four weeks
  • a high intensity case management approach
  • provision and signposting of multidisciplinary treatment, advice and support, including on-line cognitive behavioural therapy (CBT), exercise and activity management and physiotherapy
  • close liaison with HR business partners and line managers.

The organisation

University Hospitals Southampton NHS Foundation Trust provides services to 1.3 million people living in south Hampshire, plus specialist services including neurosciences, cardiac services and children's intensive care to more than three million people in central southern England and the Channel Islands. The trust is also a major centre for teaching and research in association with the University of Southampton and partners including the Medical Research Council and Wellcome Trust. 

What we did and why

The design and format of the R2H programme was based on previous work undertaken with benefit claimants and the long-term unemployed by the Dept for Work and Pensions (Fit for Work pilots) and SALUS (an NHS occupational health provider in Scotland) . Evidence exists which demonstrates that these programmes improve well-being outcomes, but sickness absence reduction was not evaluated against a control group. We designed our approach to case management to meet the needs of our organisation and we built in a scientifically robust evaluation against a control group.  The threshold for R2H inclusion was a long-term absence event of four weeks duration. The organisational drivers were twofold – improving employee experience and well-being and reducing sickness absence from the previous level of 4.14 per cent to the national target level of 3.5 per cent. 

How we did it

The service was radically different from the previous OH services which were made up of traditional fitness for work assessments, fast track physiotherapy treatment, counselling and passive reports to managers about adjustments to work.

The fundamental change was a highly active case management approach that enabled employees to access specific treatments, to identify their own return to work barriers and high intensity follow-up to support them in personal goal setting. Thus employees were empowered to overcome hurdles to achieve earlier rehabilitation. A key aspect was the early recognition of psychological distress and use of positive techniques (including CBT) to minimise impairment of mental well-being.

OH physicians were involved early in the management of complex cases and in conducting case reviews. The link with managers was very active, with practical input into planning adjustments to work. Regular meetings with divisional HR business partners intervened with cases of absence that crossed the eight week threshold.

Project management was driven by an R2H steering group, comprising key implementers, users and other stakeholders. The group was chaired by the head of OH, and included the OH nurse manager, a consultant liaison psychiatrist, a clinical psychologist, a chronic pain consultant and representatives from case managers, physiotherapists, human resources, communications, divisional managers and employees. The group met monthly initially, with reducing frequency of meetings during the one-year set-up.

Results and next steps

The principle analysis used sickness absence data from the Electronic Staff Record (ESR) from both the trust (UHSFT) which adopted the intervention and the control trust. The control trust had a broadly similar OH service, but did not introduce the R2H intervention. The key outcome of this project is the change in proportion of four week absences that progress to cross the eight week absence threshold. UHSFT saved 10.3 per cent of eight week absences, 26 per cent of agency costs and 26 per cent of ill health retirements compared to the control trust. The overall absence rate in UHSFT has now reduced to 3.1 per cent, well below the strategic target of 3.5 per cent. There has been a year on year improvement in the indices of staff satisfaction in UHSFT and employees rated the occupational health service highly. The R2H service was cost effective and has been deemed a highly successful part of our well-being and absence management strategies.

Contact details

Dr Julia Smedley
  • Occupational health lead consultant and Head of service
  • julia.smedley@uhs.nhs.uk
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