Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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plus ca change
- W R Harris (22 July 2001)
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Fix the person and their job (as recommended by Chambers and Maxwell)
- Chris Manning (23 July 2001)
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vocational rehabilitation, the way forward.
- Pradeep Deshpande (24 July 2001)
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Proposed National Vocational Rehabiliation Institute
- Jonathan Leach (25 July 2001)
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Groundwork on Retention in the UK
- Gillian Paschkes-Bell (25 July 2001)
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Download address for citation 9
- Nerida Wallace (26 July 2001)
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Setting occupational standards in vocational rehabilitation
- Philippa Simkiss (7 August 2001)
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Vocational Rehabilitation in the Armed Services
- Ian McCurdie (14 August 2001)
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W R Harris, Retired Home
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It seems to me that nothing has changed since the late Plewes established his vocational rehabilition programme at Luton and Dunstable in the 1950s |
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Chris Manning, Chair Depression Alliance and CEO PriMHE (Primary care Mental Health and Education) Twickenham, Middlesex
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Dear Sir Disler and Pallant highlight Britain's continuing woeful tendency to overmedicalise and dehabilitate. There are also continuing disincentives for people wishing to return to work, especially after having or continuing to have mental health problems, where work may or not be therapeutic and many environments are "psychotoxic" to the brain and CNS. Standard One of the NSF for Mental Health gives a clear imperative for joined up thinking and working by all stakeholders, focussing not just on diagnoses, but service user's issues and needs. For example, DH, DSS and Benefits Agency working together to iron out Benefits anomalies which specifically inhibit those who have had a longer term problem from returning to work via the voluntary sector, because their payments are penalised if they declare such activity. As a GP I was also constantly frustrated in my attempts to send people back to work through a gradual re-exposure and by the varying interpretations of the term "therapeutic work" by different offices and agencies, including employers (especially the NHS). Further, if it costs the taxpayer money and GPs (especially) a lot of consultations - why should this subject solely be within the state's purview? Work is emphatically not a blessedness for many, where perspiration has replaced aspiration and performance management our own self-imposed goals for achievement . All large employers [and perhaps the NHS could "lead by example"?] should now be regarded as sharing the duty of care. Why should the NHS have to sort everyone out - fix the person AND their job [if demonstrated to be contributive] should now become the rallying cry for those who realise both the contribution of work towards ill health and who wish to develop the models for the future that place the responsibilty for resolution where it really lies. As the HSE announced recently, the cost of work-related mental health problems alone(such as depression and anxiety) to the country is £3.75bn and to employers £375mn. PriMHE proposes that it is now time for a British Quality Standard for Mental Wealth (the value placed on the mental health of an individual) to address mental health in the workplace and for the adequate funding for necessary training, rehabilitation and job "psychotoxicity reduction" to come from responsible and ethical Corporates and employers also, not just the increasingly stretched NHS and state budgets. Yours Faithfully Dr Chris Manning MRCGP |
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Pradeep Deshpande, specialist registrar kings college hospital, london.
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Dear Editor, I agree with the authors perspective about the future of vocational rehabilitation in u.k. There are some issues however that need to be stressed- one is that it is difficult to find an agency which is flexible and specialised to accomodate the complex needs of brain injury people in terms of reemployment or retraining of work in most of the parts of England and Wales. These people form a substantial part of the young disabled workforce in the community.The organisations like Headway, Rehab uk are doing this hard work but need to be closely attached to rehabilitation units or coordinated with them. Similarly as a single, if heterogenuos client group are the self employed people who struggle to go back to work. They find it very difficult to find help which will result in atleast in some cases to regain their previous skills. Perhaps the vocational training culture in the NHS will in some way address these problems in future. I am currently conducting a survey to find out the experience of professionals in the country regarding their approach to this rather complicated aspect of rehabilitation in the community. |
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Jonathan Leach, Chair National Vocational Rehabilitation Association Oxford Brookes University
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Dear Sir I would like to endorse Disler and Pallant's proposal for a national vocational rehabilitation institute for the UK. The National Vocational Rehabilitation Association (NVRA) has provided a forum for practitioners working in the field of disability and employment since 1992. Many of the issues they raise are close to our hearts. The timing for such an initiative is good. In July of 2000 the NVRA arranged a meeting at Whitehall to look at the establishment of National Occuptional Standards for those who work in this area. Chaired by the Right Honourable Magaret Hodge MP and attended by representives of disability organisations and the Employment Service. The result of this has been funding from the Qualifications and Curricual Authority for research into the needs for and scope of such qualifications. This work, carried out under the auspices of the Employment National Training Organisation is underway and details can be found on their web-site http://www.empnto.co.uk/projects/campag/index.htm Information about the NVRA can be found at http://nvra.org.uk/ The NVRA is a voluntary body and can only do so much. A national institute for vocational rehabiliation could do much to address the 'hit and miss' approach to disabled peoples's employment situation that exists now. Whilst agreeing with the need to create a body of dedicated professionals within the existing healthcare and social work professions, I would make a plea not to forget all those who are working in this field in the volunatary and private sectors. The National Occupational Standards which we hope will result from the current review, will be designed to cover those working across all sectors and indeed to improve the collaboration between all concerned parties. Yours faithfully Jonathan Leach |
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Gillian Paschkes-Bell, research & development at RNIB Royal National Institute for the Blind, London, UK
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Since the publication of 'Blind and Partially Sighted People in Britain: the RNIB survey,' (HMSO, 1991), the Royal National Institute for the Blind has been concerned about the lack of employment-retention support in the UK. This publication raised awareness of the incidence of visually impaired people who gave up work following the onset of sight difficulties, and remained unemployed. In the early '90s, RNIB funded a research and development project called 'Disability Leave' which drew on the experience of eighteen employers who piloted 'best-practice' retention polcies developed during the life of the project. The final report of the Disability Leave project, 'Adapting to Change when an employee becomes disabled,' (Paschkes-Bell, Da Cunha, Hurry) was published by RNIB in 1995. It recommended that, where no employment solutions are found by employer and employee, a specialist 'employment adviser' should be asked to carry out an initial assessment. If the employee needs a work-break for the purpose of making adjustments to work- practices, this should be offered as 'Disability Leave', using the analogy of maternity leave. The Disability Leave research was available to influence government at the time of drafting the UK Disability Discrimination Act, 1995. Further development work carried out by RNIB and Rehab UK resulted in publication of the 'Get Back' series in 1999/2000. This is a series of checklists and guides developed to help employer, employee and employment adviser work together on the assessment process. It includes specialist guides, for example, on working with people with brain injuries or visual impairment. The series can be viewed over the Internet. Visit: http://www.rnib.org.uk/ew/getback.htm During the period in which this work has been carried out, it has been possible to detect an increase in awareness of the importance of good practice in employment retention at government level and amongst some large employers here in the UK. However, the next big step has to be to develop training to a nationally recognised standard for those who work in the rehabilitation field, and to develop funding strategies that encourage retention in preference to early retirement. The National Vocational Rehabilitation Association (NVRA) is lobbying government to this effect. |
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Nerida Wallace, Principal Transformation Management Services
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The report referred to in this article - Deterring Reconsiderations - may be downloaded in adobe format from http://www.transformation.com.au/tms/Publications/reports.html |
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Philippa Simkiss, Policy and Development Officer University of Birmingham
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Setting occupational standards in vocational rehabilitation Editor- Disler and Pallant 1, practitioners in Australia, were among the first to respond to the report published by the British Society of Rehabilitation Medicine 2 and we support their efforts to draw attention to the lack of resources directed to vocational rehabilitation (VR) in the UK. Although we are aware of several local networks of multi-disciplinary practitioners from the public, private and voluntary sectors we have long recognised the need for a more co-ordinated approach to supporting disabled people to gain or retain employment 3 . No one knows how many people work in vocational rehabilitation or where they all are and there has been no national forum to consult, exchange ideas or share information. We still have little insight into the impact that the application of medical and vocational interventions have upon labour force participation 4 and the extent to which they facilitate sustained employment. The National Vocational Rehabilitation Association (NVRA) was established in 1992, as a professional body for those working in the field of disability and employment, to address these issues. Its aim is to advance education in matters related to VR and in particular to promote the development of professional skills, knowledge and resources for VR practitioners. The Association is committed to developing national standards of practice and training for practice and a competence framework with quality standards by which people using VR services can evaluate their support. This will ensure the long overdue recognition of the skills and knowledge of existing practitioners. For more information see the NVRA web site at www.nvra.org.uk. NVRA is working with the Employment National Training Organisation to undertake occupational and functional mapping exercises of the disability and employment sector. We are currently seeking the views of practitioners on the draft maps, which will be posted to a web site (see www. Empnto.co.uk/projects/campag/index.htm). There will also be a series of consultation workshops around the UK to elicit comment. NVRA sees this work as the first step towards developing national occupational standards. Our vision for the future of VR in the UK includes a national centre of excellence for research, training and information provision; professional accreditation which takes into account prior learning; accredited training at all levels (technician to post-graduate) to encourage new recruits to the profession; and ongoing dialogue between medical and non-medical practitioners as we work towards a seamless vocational rehabilitation service. 1.Disler PB, Pallant JF. Vocational rehabilitaiton. BMJ 2001; 323:121 -123. 2. British Society of Rehabilitation medicine. Vocational rehabilitation: the way forward. London,2001. 3. Simkiss PA. The use of occupational information to improve vocational opportunities for disabled people. [PhD thesis]. City Univ. London; 2000. 4. Cuelenaere B, Prins R. Factors Influencing Work Resumption: A Summary of Major Findings. In: Bloch FS, Prins R, editors. Who returns to work and Why? London, Transaction Publishers. 2001. P. 273. Philippa Simkiss BSc PhD
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Ian McCurdie, Consultant in Rheumatology & Rehabilitation Medicine Defence Services Medical Rehabilitation Centre, Headley Court
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Vocational Rehabilitation in the Armed Services Sir, We read with interest Disler & Pallant’s comments on the dearth of vocational rehabilitation in the UK [1]. Readers may be interested to learn of the well-established system of vocational rehabilitation that exists within the British Armed Services. Many of the 200,000 Service personnel follow physically demanding careers, which can be associated with a high incidence of injury. As a result, the Defence Medical Services have gained extensive experience in returning patients to a high functional level through vocational rehabilitation. The Defence Services Medical Rehabilitation Centre (DSMRC), Headley Court celebrates its 50th anniversary this year. We are the last remaining Tri-Service rehabilitation unit and provide intensive, residential rehabilitation for up to 180 patients. Approximately 2,000 Service personnel attend annually, most of whom have complex musculoskeletal injuries sustained during sport & military training. Each patient follows an individualised exercise rehabilitation program, performed in groups, with physiotherapy, occupational therapy or other input as needed. Chronic low back pain (LBP) accounts for 40% of all admissions. Rehabilitation programs vary, ranging from a five day initial assessment, with education and a home exercise program, through a progression of three week courses of exercise rehabilitation at different functional levels, the highest of which culminates in an eight mile forced march carrying 55 lbs. These courses provide the intensity of multidisciplinary rehabilitation that has been shown to be effective [2]. Furthermore, this takes place in a military environment, with a positive approach, peer support and a degree of social rehabilitation. Military patients are also generally motivated to recover, as their career prospects often depend upon a return to full fitness, and are encouraged to comply with their rehabilitation program. These factors are likely to further improve their outcome. Of 807 such patients undergoing rehabilitation at DSMRC for chronic LBP, only 5.2% were recommended for medical retirement. Military medicine also has extensive experience in the grading of disability and has used the ‘PULHHEEMS’ system of medical classification since 1946. This allocates all Service personnel with a grade that reflects their functional ability and capacity for work. Service medical officers, who understand the demands of life in a military environment and work closely with their patients’ employers, are able to directly influence an individual’s employability and recommend modifications and restrictions to their work until such time as they are fit to resume to full duties. There is, as Disler and Pallant report, a pressing need for better provision of vocational rehabilitation in the UK. Perhaps the military model could help industry, the insurance companies and the NHS to achieve this. Lt Col Ian McCURDIE, RAMC
Sqn Ldr Nick CARTER, RAF
References: 1. Disler PB, Pallant JF. Vocational Rehabilitation. BMJ 2001;323:121-3 2. Guzman J, Esmail R, Karjalainen K, et al. Multidisciplinary rehabilitation for chronic low back pain: systemic review. BMJ 2001;322:1511-6 Corresponding Author: Lt Col Ian McCURDIE, RAMC,
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