Published: 15/01/2004, Volume II4, No. 5888 Page 34 35

Getting people back to work quickly after long periods of illness keeps them off the benefits bill. Jane Feinmann reports on a scheme to help those who would have fallen through the healthcare net

A visit to a bold experiment in healthcare is a lesson in how things are not always as they seem.

The airy third-floor unit just behind Orpington's main shopping street looks more like an upmarket commercial property - with its suite of conference rooms and a well-equipped gym - than a clinic designed to reduce the incidence of long-term chronic illness and disability. The halfdozen members of staff seem too relaxed to be running one of six pilots of a scheme that could cut the country's sickness bill by millions of pounds every year.

The Orpington centre in Kent, opened in June 2002, and fellow pilots, are searching for the most efficient and cost-effective ways in which the NHS can help patients quickly return to their jobs. The two-year job retention and rehabilitation project (JRRP) is funded equally by the Department for Works and Pensions and the Department of Health and is run by a Dutch private healthcare company.

Every week, nearly 3,000 people enter long-term incapacity due to ill-health. The majority - most frequently suffering from musculoskeletal pain problems, cardiovascular complaints or stress or depression - are out of work and on benefits for years.

People fall through the net for reasons such as missing out on physiotherapy appointments because of travel problems or poor communication with their employer. As a result, there are around 2.7 million people in the UK not working due to ill-health.

Providing early rehabilitation assistance to those who are off work due to sickness dramatically increases their chances of returning to work, according to evidence collected by the DWP.

However, rather than rush into general rehabilitation service delivery, the JRRP is carrying out an unprecedented randomised controlled trial, with a caseload of 7,500, to test the impact of various 'boosts' to existing healthcare and occupational health services.

Full funding from the DWP means that all the schemes are free to the patient, employer and GP. At its most comprehensive, the support can be substantial. In Orpington, potential clients, normally referred by their GP, are being assigned to one of four groups. Alongside a control, one group will receive extra help with problems in the workplace, while a second will be given extra rehabilitation healthcare services.

The third and potentially most effective will provide participants with a combination of healthcare and work-based support in an intensive, five-day-a-week, sixweek programme. The centre has its own practitioners, including a cognitive behavioural therapist, a physiotherapist and an occupational therapist, along with access to a consultant orthopaedic surgeon and a cardiologist who are available on a part-time basis.

The individually tailored support is likely to involve counselling, physiotherapy and development of frank communication between clients and their doctors and employers.

The therapists involved say this work is more satisfying than normal NHS practice because of its holistic approach. Clinical psychologist Henry Prempeh explains: 'Someone with depression is likely to reduce their activity and consequently develop all kinds of physical health problems, ' he says. 'At the same time, problems with workload and relationships with colleagues may have contributed to the depression, just as the depression may exacerbate these very problems, ' he says.

In his former role in a Scottish hospital providing support and counselling for people with mental health problems, Mr Prempeh was able to refer his clients for physio or occupational therapy. But such referrals could take months to organise, and effective communication between different therapists working in separate departments is patchy at best.

'Here the barriers are very much reduced, ' he explains. 'We all meet and discuss our caseload at the end of each day.An insight from one therapy can lead to an immediate development in the way another therapist provides treatment.'

The project recognises that patients can benefit from a holistic approach, because 'both the mind and body may be damaged, regardless of whether the original health problem is depression or a broken limb'.

Specialist rehabilitation physiotherapist Audrey KivellWang says one key task is to help clients pace their recovery. '[JRRP is] about helping people change their approach to life. Training the body through physiotherapy in a gym is one of the best ways of bringing about permanent changes.Many physiotherapists would like to do far more of this holistic work - but it can really only happen with the support of an inter-disciplinary team.'

Occupational healthcare, currently very limited within the NHS, is the third strand of provision, providing an opportunity to investigate problems at work and regular meetings with the employer to help resolve them.

With similar schemes also underway in Greater Glasgow, Teesside, Tyneside, Sheffield and the West Midlands, the project is endorsed by the TUC and is gaining admirers within the NHS.

North Birmingham primary care trust commissioning manager Chris Lewis says that although providing a comprehensive therapeutic support system may seem costly, it is money well spent: 'It is not expensive compared to the cost of keeping people permanently on invalidity benefit.'

Orpington GP and Labour MP for Dartford Dr Howard Stoate says he regularly sees people in both his professional roles who have been written off to a lifetime on benefits because of ill-health.

'Many people who are absent from work for long periods would like to return, but are frustrated by delays in receiving treatment or simply by their own lack of confidence, ' he says.

Back in Orpington, the therapists admit there are teething problems in getting their ideas across. 'People are very suspicious and anxious when they first come to the centre, ' says Ms Kivell-Wang.

'But the feedback from those who have completed the six weeks is phenomenal.One lady wanted to get her sister on the programme.Another said it was worth being 'on the sick' to be given an opportunity to turn round his life.'

Further information lHuman Focus Return To Work, 020-8255 8182