The longer an employee is off sick with back pain or stress, the less likely they are to return to work. We find out about a system that enables them to return to work sooner, with added benefits for the employer and its patients
Rapid access is a system for providing rehabilitation and occupational health treatment for NHS employees to enable them to return to work more quickly, or to stay in work rather than taking sick leave.
“The whole premise is to try and speed up the process of somebody coming back into work when they have been off sick by providing an intervention,” says Ruth Warden, deputy head of employment services at NHS Employers.
Rapid access physiotherapy services are one example, given that musculoskeletal problems are one of the highest reasons for sickness absence in the NHS. Stress and mental health issues are the other highest cause of sickness absence in the NHS, and rapid access services for counselling and talking therapies are another area that can have a big impact.
The benefits of rapid access services extend beyond the employee to the organisation and ultimately patients. Organisations can reduce their levels of sickness absence and make significant financial savings through reduced sickness costs and use of agency and bank staff – one trust significantly reduced its incidence of musculoskeletal absence and as a consequence made significant savings through reduced use of agency staff.
Research shows that the longer an employee is off sick with back pain for instance, the less likely they are to return to work. And long periods of absence can lead to depression and anxiety, which extends the absence further.
Keeping staff in work or helping them to return to work earlier through a rapid access service ensures that trained and competent staff who are familiar with a trust’s processes and procedures are at work and caring for patients. That leads to a higher quality service and improved continuity of care. It also helps minimise pressure on colleagues, with benefits to staff morale.
Rapid access services are operating in a number of trusts across the UK, either formally or informally. NHS Employers has published guidance to help boards formally agree a policy on rapid access and help human resources and occupational health teams design and implement a service. The guidance supports the core services set out in the NHS health and wellbeing improvement framework published in 2011. The framework emphasised the importance of providing easy and early treatment for the main causes of sickness absence in the NHS and of rehabilitation to help staff stay in work during illness or return to work afterwards.
The guidance describes how rapid access services can be implemented alongside interventions recommended in the NHS staff handbook for avoiding premature and unnecessary ill health retirement. These are rehabilitation, phased return to work, and redeployment.
Three common models for implementing rapid access are outlined in the guidance and include GP referral to the trust’s services or purchasing dedicated rehabilitation services for staff. Boards need to agree on a model and develop a trust policy around it, with input from staff representatives, line managers, occupational health, human resources and GPs.
“One of the keys to rapid access [and] any intervention around health and wellbeing of staff is that it’s an approach that involves a number of people,” says Ms Warden. “As a group, almost like a multidisciplinary team, they look to what can we do to support this person to keep them in employment in a way that’s safe for them.”
Employees can refer themselves to rapid access services, or they may be referred by their line manager or GP. A healthcare professional receiving the referrals then decides whether rapid access is clinically appropriate for the staff member. Employees who use the rapid access service will not always receive immediate access to services, but they will help to create their own care plan aimed at speeding up their return to work. Line managers should be involved early on in the process and may be required to make adjustments to working patterns or the job itself to enable the employee to return to work as soon as it is clinically appropriate.
Confidence to recover
As a professional body and trade union, the Chartered Society of Physiotherapy has supported rapid access for a number of years. It believes the facility for staff to self-refer to clinicians such as physiotherapists is particularly important. Department of Health piloting of self-referrals by patients to physiotherapy revealed a number of benefits which would apply equally to rapid access services for staff. Patients with a musculoskeletal problem get access to advice and treatment if they need it, get better quicker and in some cases can avoid sickness absence. It also reduces the likelihood of being prescribed drugs like anti-inflammatory medication and pain killers.
Natalie Beswetherick, director of practice and development at the society, adds: “Once people take the decision to self-refer they then have the confidence to do what is needed to help their own recovery.”
Rapid access interventions may include rehabilitation or redeployment. Phased rehabilitation with a change of duties can get staff back in work and according to research speeds up their recovery. Redeployment can be used in the short term while an employee is recovering or long term for staff unlikely to return to their original role. It is an important way of retaining skilled and experienced staff. Some staff may need retraining for their new role.
NHS Employers director Dean Royles sums up the rationale driving the publication of the guidance: “This is straightforward, helping sick NHS staff to get well and return to work quickly is important for delivering high quality patient care. Getting better quickly benefits the individual and our patients and reduces the cost of providing temporary cover, which can be expensive.”
Rapid access schemes are welcomed by employers, unions and staff because they offer good value and lead to healthier, more productive workplaces.”
While the business case for implementing a rapid access service is clear, trusts are encouraged to collect data to show the effectiveness of their strategy. Information should be collected about patients, sickness absence, reductions in costs and reductions in length of absence. Baseline data collected before the service is launched will allow progress to be monitored. The evidence can be used to present reports to the trust board and make a case for expanding the service.
Case study: Fast Physio
Musculoskeletal disorders are one of the biggest reasons for sickness absence in the NHS. In 2010, East Lancashire Hospitals Trust saw that these disorders were consistently reported as the number one reason for sickness absence in the trust. Human resources and therapies teamed up to find a solution and created Fast Physio, a dedicated in house service for staff delivered by physiotherapists.
Common problems addressed by the service are back pain, shoulder pain and neck pain. Staff may receive one to one treatment such as mobilisations, manipulations, or advice on exercises. Physiotherapists can also recommend how to modify duties for a phased return to work. Prevention of musculoskeletal injuries through correct posture and moving/handling of patients is promoted through the trust’s health and wellbeing champions.
Employees can self-refer via a dedicated webpage or over the phone, or they can be referred by a manager. Urgent cases are seen within three working days and routine cases within 10 working days. “The uptake has been very high because it offers timely access,” says Lee Barnes, clinical lead physiotherapist for the service. “We know that with musculoskeletal disorders the sooner you resolve it, people tend to recover a lot quicker.”
Staff say the service has helped them to stay in work or get back to work quicker, and has reduced their pain. In the first four months musculoskeletal sickness and absence significantly reduced and spending on agency staff reduced as a consequence.
The key to making the service work has been a partnership approach which includes human resources, therapies and unions. Ms Barnes says: “We’ve sustained [the service] because it feels like the trust owns Fast Physio and it is seen as a real employee benefit.”