Vocational rehabilitation
BMJ 2001; 323 doi: https://doi.org/10.1136/bmj.323.7305.121 (Published 21 July 2001) Cite this as: BMJ 2001;323:121
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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
NVRA Accreditation Committee and RNIB Policy and Development Officer
RCEVH, School of Education, University of Birmingham, Edgbaston,
Birmingham. B15 2TT
p.simkiss@bham.ac.uk
Competing interests: No competing interests
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
Competing interests: No competing interests
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.
Competing interests: No competing interests
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
Competing interests: No competing interests
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.
Competing interests: No competing interests
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
Competing interests: No competing interests
It seems to me that nothing has changed since the late Plewes
established his vocational rehabilition programme at Luton and Dunstable
in the 1950s
Competing interests: No competing interests
Vocational Rehabilitation in the Armed Services
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
Consultant in Rheumatology & Rehabilitation Medicine
Sqn Ldr Nick CARTER, RAF
Consultant in Rheumatology & Rehabilitation Medicine
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,
Consultant in Rheumatology & Rehabilitation Medicine,
Defence Services Medical Rehabilitation Centre,
Headley Court,
Epsom,
Surrey KT18 6JN
e-mail: ianmccu@dsca.gov.uk
Competing interests: No competing interests