1 R e H a b NetWork Number 67 November 2004 The National Vocational Rehabilitation Association The National Vocational Rehabilitation Association The National Vocational Rehabilitation Association The National Vocational Rehabilitation Association The National Vocational Rehabilitation Association The National Vocational Rehabilitation Association The National Vocational Rehabilitation Association The National Vocational Rehabilitation Association The National Vocational Rehabilitation Association The National Vocational Rehabilitation Association The National Vocational Rehabilitation Association The National Vocational Rehabilitation Association The National Vocational Rehabilitation Association The National Vocational Rehabilitation Association The National Vocational Rehabilitation Association The National Vocational Rehabilitation Association The National Vocational Rehabilitation Association The National Vocational Rehabilitation Association The National Vocational Rehabilitation Association The National Vocational Rehabilitation Association The National Vocational Rehabilitation Association The National Vocational Rehabilitation Association The National Vocational Rehabilitation Association The National Vocational Rehabilitation Association The National Vocational Rehabilitation Association The National Vocational Rehabilitation Association The National Vocational Rehabilitation Association The National Vocational Rehabilitation Association The National Vocational Rehabilitation Association The National Vocational Rehabilitation Association The National Vocational Rehabilitation Association The National Vocational Rehabilitation Association The National Vocational Rehabilitation Association The National Vocational Rehabilitation Association The National Vocational The Magazine Of The National Vocational Rehabilitation Association
2 2 R e H a b NetWork Production/Design Ian Martin Contents 2 Advertising Sarah Gatenby Tel Published by NVRA Contact Ian Martin Tel Ian Martin A view from the chair by Tim Dawson 3 Rehabilitation and job retention: the role of employers by Philip James, Ian Cunningham and Pauline Dibben 5 Book review by Mike Floyd 10 New case management training by Linda Hoskinson 13 New UnumProvident centre by Jean Brading 14 The NVRA - Minutes from the trustees meetings News & Who Does What? 15 The Data Protection Act requires that we inform you that your name & address are kept on our computer files.
3 3 A View From The Chair. Welcome to the November edition of ReHab NetWork The house journal of the NVRA. Much activity has taken place since our last edition, both internally and externally, reflected by the précis of the minutes of Trustee meetings held in August and October, contained in this edition. I have as you know been suggesting through this column that our current structure and remit is unsustainable given the resources currently available to us. The letter you should received in August informed you that Trustees took stock of our current role and remit, and considered the options open to us to link with sister organisations, when we met to conduct a visioning exercise at Caledonian University, Glasgow in June. I have therefore included a précis of the visioning exercise to inform you of the background to negotiations we are conducting on your behalf. We are currently involved in dialogue with CARP (Canadian Association of Rehabilitation Professionals) to consider how our respective organisations might work together to the benefit of our members. The results of our discussions will be announced as soon as possible and will feature largely at the AGM scheduled for 3rd February at SwissRe. As in previous years the AGM will be linked with a National Interest Day, and further details will follow shortly. We will be seeking expressions of interest from members who wish to help us develop and expand our current role and I will write separately to members before Christmas to explain the process. Externally the main development impacting on the NVRA s current and no doubt its future role and remit was the announcement by Jane Kennedy, Minister of State, Department of Work and Pensions of the proposed Framework for Vocational Rehabilitation at the Health conference in Manchester on 27 TH October. For those of you who have not yet had sight of the Governments proposals, please log on to I personally was encouraged with the DWP s attempt to pull together a coherent strategy with an overdue emphasis being placed on accreditation. The spirit of HOST may not be dead after all. You should by now have received a copy of the PowerPoint presentation on the Framework, given by Jim Neilson of the DWP, at City University s Rehabilitation Resource Centre on 10 th November. At that meeting it was announced that workshops are to be held to look at various facets of the implementation of the Framework, and that the NVRA will be invited to attend those appropriate to its current role and remit. No doubt publication of the vocational rehabilitation framework will fuel considerable debate across the sector. It is important that we do not become bystanders in its development and implementation. Therefore Trustees and I are working on your behalf to ensure the NVRA continues in dialogue with other key players in the sector and the DWP to ensure the development of a meaningful and coherent framework, I will be pleased to keep you informed of progress.
4 4 Turning again to internal matters I regret to inform you that Jenny Chapman, Membership Secretary and Trustee, and John Brooks, Trustee, have resigned from the Board of Trustees. Jenny did much to promote membership of the NVRA, and John was always available to give sound advice based on his considerable knowledge of the vocational rehabilitation sector. Trustees and I are very appreciative of their contribution. Finally may I take this opportunity to welcome the following members who have joined us since our April 2004 edition. Kimberly Beckett - Momentum Scotland Ltd - Brain Injury Services Manager Karen Clarke - St Loye's Foundation - Operations Planning Manager James Anthony Ford - Wellwork Ltd - Occupational Health Physician James Foster - Jacqueline Webb & Co - Rehab Logic - Lead Therapist Sharon Hammond - St.James's House - Project Manager Margo Lloyd - Business For People - Managing Director Doria Pilling - City University - Visiting Senior Research Fellow Joy Reymond - Unum Provident - Head Of Rehabilitation Services Barry Williams - Alphacare (Rehab) Ltd - Chief Executive Thank you for your continuing support. Tim Dawson Chair NVRA
5 5 Rehabilitation and job retention: the role of employers Philip James (Middlesex University), Ian Cunningham (University of Strathclyde) and Pauline Dibben (Middlesex University) As Robert Walker highlighted in a recent article in this journal, the Labour governments since 1997 have introduced, and are in the process of exploring, a variety of initiatives to assist disabled people to return to employment. A striking feature of these is that they, primarily, focus attention, either by design or by operation, on the provision of assistance to those who are not currently in employment. The present government is undoubtedly correct in seeing a need to provide such support. It is, nevertheless, noteworthy that the actions it has taken have, in large part, involved shutting the stable door after the horse has bolted insofar as they have primarily embodied an emphasis on helping people after they have become detached from work. One important consequence of this has been that little concrete action, with the notable exception of a number of pilot projects currently being run by the Department of Work, has been undertaken to improve the job retention of those who become ill and disabled while in employment. team went on to conduct a review of the available evidence concerning (a) the validity of the framework document and (b) the extent to which employers do currently undertake the types of activities detailed in it. In 2002 the authors were commissioned by the Health and Safety Executive (HSE) to carry out a project aimed at identifying the issues which employers needed to address in order to facilitate the continued employment (and return to work) of ill, injured and disabled workers via the provision of vocational rehabilitation (James et al, 2003). This project consisted of two phases of work. Phase 1 consisted of two sub-stages. First, the development of a relatively brief framework document that sought to identify the processes and practices central to the successful job retention of such workers. Secondly, the presentation of this framework to a conference of stakeholders at which delegates were given an opportunity to discuss the appropriateness of its content. Subsequently, in Phase 2, the research team went on to conduct a review of the available evidence concerning (a) the validity of the framework document and (b) the extent to which employers do currently undertake the types of activities detailed in it. In what follows, the main features of this framework document are, initially, reviewed. Following this, attention is paid to the issue of how far the available evidence supports the validity of this framework and suggests that British employers do currently undertake the types of activities detailed in it. Finally, some observations are made about the implications that the preceding analysis has for future government policy. The framework document In the framework document seven processes and practices were identified as being central to the provision of effective support to ill, injured and disabled workers. In summary, these were: Speedy identification of workers whose attendance or more general job performance is being adversely affected by their conditions; to aid the job retention of workers by (a) making provision for workers to have access to medical treatment and (b) providing other forms of support, including any necessary retraining and adjustments to work processes and environments; Putting in place of adequate mechanisms to facilitate communication, discussion and co-ordination between the individual worker and the various organisational actors, for example, human resource specialists, safety practitioners, occupational health personnel, and trade union representatives, who can contribute to the rehabilitation process; Provision of access to worker representation as a means of ensuring that rehabilitation occurs in an atmosphere of openness and trust;
6 6 Establishment of policy frameworks which clearly detail not only what can and should be done, but also make clear who is responsible and accountable for implementing their requirements; Systematic actions to ensure that the laid down policy frameworks are implemented properly and hence do, in practice, influence how particular cases are handled; and Creation of mechanisms to monitor the operation and effectiveness of established rehabilitation procedures with a view to identifying and addressing any weaknesses in them. In the addition, the framework went on to identify a range of internal and external variables that could potentially serve to facilitate or hinder the nature and impact of the rehabilitative processes and practices of employers. These included the size and resources of employers and the nature of the product and labour markets within which they operate. They also included the following: Organisational commitment and culture, including the attitudes and values of senior management; Availability of specialist advice, required financial resources and line management, as well as general workforce awareness and support of organisational policies and objectives; Nature of work tasks and processes, as well as surrounding pay and grading systems; Extent to which workers have access to systems of worker representation that provide them with an independent and meaningful voice in discussions over rehabilitation issues; External guidance, support and financial incentives provided to employers; Nature of surrounding legal frameworks, including those relating to unfair dismissal, disability discrimination, health and safety at work and personal injury litigation; Employer access to external health care and specialist rehabilitative expertise; and Worker access to various forms of external support, such as public transport, social security benefits, relevant training and educational opportunities and medical care and rehabilitative support. The validity of the framework document Overall, the evidence reviewed via the literature review lent some support to the various propositions put forward in the Framework document with regard to the employer processes and practices that contribute to the development and operation of effective workplace rehabilitation. For example, it did point to the value of having in place arrangements to enable the speedy identification of vulnerable workers who are in need of help (Habeck et al, 1991; Faculty of Occupational Medicine, 2000), indicated that the provision of timely and appropriate rehabilitative support can support the job retention of ill, injured and disabled workers and suggested that the provision of such support is facilitated by the presence of adequate mechanisms for the coordination of discussions and actions between relevant organisational actors and between them and outside medical and rehabilitation personnel (Kenny, 1995; Schmel et al, 2000). In addition, the evidence suggested that access to worker representation, at least if it is trade union based, can have a beneficial impact (Butler et al, 1995) and that it is desirable for appropriate and mutually supporting policy frameworks to be established (Bruyere, 1999; Labour Research Department, 2002; Industrial Relations Services, 2001) and for the implementation of these to be adequately supported and monitored (Watson et al, 1987). In a similar vein, the evidence reviewed supported the relevance of the various internal factors that the framework document identified as potentially influencing the nature and operation of employer rehabilitative activities. It pointed, for example, to the fact that senior management commitment and a supportive organisational culture do act to facilitate the establishment of return to work policies and practices and that, linked to this, the operation of these policies and practices is influenced by such factors as the attitudes of line managers and coworkers and the skills and knowledge of such managers, as well as their access to relevant specialist support (Hunt and Habeck, 1993; Shoemaker et al, 1992). It also indicated that the perceived scope for and ease of, workplace adjustments can be influenced by the nature of work tasks and processes (Kenny, 1999). Furthermore, substantial evidence was found to show that a range of psychosocial factors, including age and educational levels, the nature of family support, worker fears and views concerning their prospects to both recover and re-commence work, and levels of job satisfaction, can influence the likelihood of workers returning to work (British Society of Rehabilitation Medicine, 2000; Faculty of Occupational Medicine, 2000; Ford, 2000). As regards the various external influences identified, the evidence enabled little to be firmly said about
7 7 how the rehabilitative activities are influenced positively or negatively by the presence of external guidance, support and incentives. However, the fact that such guidance and support is utilised by many employers and that there seems some enthusiasm for the use of financial incentives, was felt to suggest that the roles of these sources of influence should not be discounted. In contrast, evidence was found to show how the actions of employers could be influenced by surrounding legal frameworks (Purse, 2000; Cunningham and James, 1998) and the important way in which return to work activities can be hindered by long NHS treatment waiting lists and also, potentially, through the absence of adequate channels of communication and coordination between workplace personnel and outside medical staff and other specialists (Anema et al, 2002; Hiscock and Ritchie, 2001; Industrial Relations Services, 2001; Labour Research Department, 2002). It must, nevertheless, be acknowledged that this broad support for the framework document came from a research base that was problematic, both in terms of scope and quality, and whose support for the framework document was therefore often rather tentative, speculative and indirect. In particular, three specific weaknesses in this base were apparent. First, it contained relatively few studies which had sought to explore the links between job retention and vocational rehabilitation at the level of the employing organisation and hence within the context of on-going employment relationships a weakness that has also been noted elsewhere (Habeck et al, 1991). Secondly, insofar as such studies had been conducted, they were found to often embody an emphasis on the analysis of quantitative survey data and a corresponding lack of focus on the in-depth exploration of the organisational dynamics that surround the management of workplace rehabilitation processes. Thirdly, in some areas of interest, due to a lack of relevant British evidence, it was found necessary to place heavy reliance on the findings of studies conducted in other countries, notably North America, Australia and Scandinavia, whose applicability to the British context is therefore inevitably open to question given the differing nature of their legal, healthcare and social security systems. Assessment of current employer practice The assessment of how far British employers currently do utilise the types of practices and processes identified in the framework document proved problematic given the evidence at present available. It did, however, appear that most employers are likely to have formal procedural provisions relating to the handling of employees who become ill, injured or disabled. It also indicated that these provisions can be found in a number of different types of policy, including disciplinary, absence, equal opportunities, disability and rehabilitation/return to work ones and that, as a result, employers not infrequently possess a number of different, but relevant, policy frameworks. At the same time, it seemed that only a minority of employers have formal disability policies and that the use of standalone rehabilitation ones is very rare (Stuart et al, 2002; Goldstone, 2002; Labour Research Department, 2002). Consequently, there appeared good grounds for believing that disciplinary and absence management procedures constitute those that are most commonly used in relation to cases where an employee is unable to attend work or otherwise fulfil fully their work duties. Unfortunately, some survey evidence was found to suggest that many such policies pay only a lip service to the issue of return to work (Industrial Relations Services, 2001). How far these current policy arrangements do effectively provide for the speedy identification of potential problems arising from illness, injury and disability also seemed questionable given that absence policies by their very nature are in large part of a reactionary nature since they, for the most part, only come into play once a condition has resulted in an employee being unable to attend work. Furthermore, this doubt was reinforced by the fact that only a small proportion of employers were found to make regular health checks available to employees (Pilkington et al, 2000), although the further finding that, at least in the case of workplaces employing 10 or more people, performance appraisal systems are relatively widely used means that many employers do, at least in theory, have a means through which problematic health conditions can be identified at an early stage (Cully et al, 1999). On a more positive note, it would seem that many absence policies, at least within larger organisations, do tend to require line managers to keep in contact with absent employees, although it is likely that compliance with such requirements is highly variable (Buchanan and Secombe, 1995; Bevan and Hayday, 1998; Industrial Relations Services, 1998 and 2000). It would also seem that many employers do collect absence data, circulate it to line managers and
8 8 utilise trigger points to identify potential problem cases. These trigger points, it appears, sometimes encompass an action threshold of so many consecutive days of absence (James et al, 2002). However, organisations were found to vary considerably in terms of how longterm absence is defined and the length of absence that occurs before an employee is referred to occupational health staff or a company doctor (Audit Commission, 1990). Indeed, it was clear that in some organisations these thresholds could be measured in months rather than weeks. With regard to the provision of rehabilitative support, the available evidence was found to clearly demonstrate that only a relatively small minority of employers provide private medical cover to all employees (Pilkington et al, 2000; Cully et al, 1999) and it also rare for them to provide in house rehabilitation via internal or external occupational health services (Bunt, 1993). On the other hand, it also revealed a relatively widespread willingness on the part of employers to make workplace adjustments to accommodate the needs of ill, injured and disabled workers, although it also seems that the translation of this willingness into actual practice is not always perfect (Goldstone, 2002). Some of the likely reasons for this imperfect translation of willingness into practice were noted to include such factors as the lack of skills and knowledge of line managers, and their hesitancy to accept the redeployment or return to work of workers over whom doubts existed concerning the level of work performance that they could achieve (Floyd, 1998; Bruyere, 1999; James et al, 2002). They were also noted to encompass the lack of access that line managers, particularly in the private sector, frequently have to specialist support from human resource and occupational health specialists and the patchy way in which the implementation of policies intended to facilitate the job retention of workers are monitored and supported via training. Policy implications Overall, the research evidence reviewed in the HSE study did, then, lend a reasonable amount of support to the propositions put forward in the project team s framework document as to the employer processes and practices that are central to the development of effective workplace rehabilitation programmes. However, it also strongly suggested that relatively few British employers are likely to possess arrangements that comprehensively accord with them. It would consequently seem that there is a good deal of scope for encouraging employers to do far more to support the continued employment of ill, injured and disabled workers, particular in smaller organisations, through the adoption of the types of processes and practices detailed in the framework document. This, turn, raises the question of whether this encouragement is best provided by the provision of additional guidance, the introduction of new legal requirements, or a combination of the two. No definitive answer can be given to this question. However, this does mean that the possible value of legal intervention should be discounted. As a result, there would seem a strong case for the government to investigate experiences in those countries that have introduced relevant legal provisions. Such investigation could extend to encompass, for example, the impact of those that exist in Sweden, the Netherlands and a number of Australian State jurisdictions such as New South Wales and South Australia. Philip James Ian Cunningham Pauline Dibben References Anema, J., van der Giezen, A., Buijs, P., van Mechelen, W. (2002). Ineffective Disability Management by Doctors is an Obstacle for Return-to-work: A Cohort Study on Low Back Pain Patients Sicklisted for 3-4 Months. Occupational Environment Medicine, 59, 0-4. Audit Commission. (1990). Managing Sickness Absence in London. Audit Commission for Local Authorities and the National Health Service: London. Bevan, S. and Hayday, S.(1998). Attendance Management: A Review of Good Practice. Institute of Employment Studies: Sussex. British Society of Rehabilitation Medicine Vocational Rehabilitation: The Way Forward. BSRM: London Bruyere, S. (1999). A Comparison of the Implementation of the Employment Provisions of the Americans with Disabilities Act (ADA) in the United States and the Disability Discrimination Act (DDA) in the United Kingdom. Cornell University: Ithaca.
9 9 Buchan, J., and Seccombe, I. (1995) Managing Nurse Absence, Health Manpower Management, 21, 2, Bunt, K. (1993). Occupational Health Provision at Work. Health and Safety Executive: London. Butler, R., Johnson, W. and Baldwin, M. (1995). Managing Work Disability: Why First Return to Work is not a Measure of Success. Industrial and Labor Review, 48, 3, Cunningham, I. and James, P. (1998). The Disability Discrimination Act An Early Response of Employers, Industrial Relations Journal, 29, 4, Cully, M., Woodland, S., O Reilly, A., and Dix, G. (1999). Britain at Work, as depicted by the Workplace Employee Relations Survey. Routlesge: London. Faculty of Occupational Medicine. (2000).Occupational Health Guidelines for the Management of Back Pain. FOCM: London. Floyd, M. (1998). Vocational Rehabilitation Services and the DDA. Occupational Health Review, Ford, F. (2000). The Health Perspective. In Lewis, J. Ed. Job Retention in the Context of Long-term illness DfEE: Nottingham. Goldstone, C. (2002). Barriers to Employment for Disabled People. Department of Work and Pensions: London. Habeck, R.V., Leahy, M, J., Hunt, H.A., Chan, F., and Welch, E.M. (1991). Economic Factors Related to Workers Compensation Claims and Disability Management. Rehabilitation Counselling Bulletin, 34, 3, Hiscock, J., Ritchie, J. (2001). The Role of GPs in Sickness Certification. Department for Work Pensions: London. Hunt, A. and Habeck, R.(1993). The Michigan Disability Prevention Study: Research Highlights. W.E. Upjohn Institute for Employment Research. Kalamazoo: Michigan. Industrial Relations Services. (1998). Sickness Absence: A Survey of 182 Employers. Employee Health Bulletin, 5, October, Industrial Relations Services. (2000). Managing Long-Term Absence. Employee Health Bulletin, 16, Industrial Relations Services. (2001). Return-to-Work Policies and Practices. IRS Employment Review, 741, James, P, Cunningham, I. and Dibben, P. (2002). Absence Management and the Issues of Job Retention and Return to Work, Human Resource Management Journal, 12, 2, James, P., Dibben, P. and Cunningham, I. (2003). Job Retention and Vocational Rehabilitation: The Development and Evaluation of a Conceptual Framework. Sudbury: HSE Books. Kenny, D. (1995). Failures in Occupational Rehabilitation: A Case Study Analysis. The Australian Journal of Rehabilitation Counselling Kenny, D. (1999). Employers Perspectives on the Provision of Suitable Duties in Occupational Rehabilitation. Journal of Occupational Rehabilitation, 9, 4, Labour Research Department. (2002). Rehabilitation The Workplace View. LRD: London. Pilkington, A., Graham, M.K., Cowie, H.A., Mulholland, R.E., Dempsey, S., Melrose, A.S and Hutchinson, P.A. (2002). Survey of Use of Occupational Health Support. HSE Books: Norwich. Purse, K. (2000). The Dismissal of Injured Workers and Workers Compensation Arrangements in Australia. Occupational Health Policy, International Journal of Health Services, 30, 4, Schmal, A., Niehaus, M., Heinrich, T. (2001). Betriblicher Umgang mit der Gruppe Leistungsgewandelter und Behinderter Mitarbeiter/innen: Befragungsergebnisse aus der Sicht Unterschiedlicher Funktionstrager. Rehabilitation, 40, Shoemaker, P., Robin, S., Robin, H. (1992). Reaction to Disability Through Organisation Policy: Early Return to Work Policy. Journal of Rehabilitation, 3, Stuart, N., Watson, A., Williams, J., Meager, N., Lain, D. (2002). How Employers and Service Providers are responding to the Disability Discrimination Act Department of Work and Pensions: London. Watson, A., Owen, G., Aubrey, J., Ellis, B. (1997). Integrating Disabled Employee: Case Studies of 40 Employers. Research Briefs. Research Report No.56.
10 10 Book Review David Stapleton and Richard Burkhauser. The Decline in Employment of People with Disabilities: A Policy Puzzle. Published by the W.E. Upjohn Institute for Employment Research The ADA was passed in 1990 so it is now over ten years since its employment provisions have been influencing the employment circumstances of disabled people. The ADA continues to be the most comprehensive and far-reaching legislation of its kind. No other country has legislation covering such a wide range of areas in which discrimination can affect disabled people. It covers not only employment but also education, transport and access to goods and services. The UK s DDA fell some way short of this and, to begin with, was confined to employment and goods and services and did not cover educational provision. Initially there was no body, such as the Equal Opportunities Commission in the U.S., to ensure that the legislation was enforced properly, although a council, with very limited powers, was set up. Some years later a Disability Rights Commission was established. It is therefore rather astonishing to find, on reading this book, that the employment circumstances of disabled Americans appears to have worsened during the 1990 s. Thus, in 1989, the employment rate for men with disabilities, aged 25-61, was 44.0%. That is to say 44.0% of all disabled men, aged 25-61, were in some form of employment in The rest, 56% of all men aged 25-61, were either registered as unemployed or were in receipt of social security benefits. By 2000 the proportion of disabled men of working age in employment had fallen to only 33.1%. In the case of disabled women the decline in employment rates was not quite so dramatic, from 37.5% to 32.6%, but still marked. One possible explanation for these changes could, of course, be that the labour market situation of all Americans deteriorated during this period and the ADA had not protected disabled people from suffering a similar fate to other, nondisabled Americans. It turns out though that the proportion of nondisabled men, aged 25-61, who were in employment changed very little during the same period, declining only slightly from 96.1% in 1989 to 95.2% in And, in the case of non-disabled women, there was, in fact, a significant increase in the employment rate, from 77.1% to 81.3%. These analyses of employment trends have led to a questioning, in the U.S., of the value of the ADA This has, in turn, resulted in supporters of the ADA questioning the validity of the data. Burkhauser and his colleagues have however shown that while the level of the employment rate is sensitive to the survey and measure used, trends in the employment rate are much less sensitive. The book goes on to consider whether the overall employment rate is an appropriate measure of the effectiveness of the ADA Drawing on the work of other researchers, brought together in this book, they point out that all of the authors contributing to the book agree that, although the overall employment rate of working age disabled people declined during the 1990 s, the employment rate of working age people with disabilities, who say they are available or able to work, actually increased. The overall rate declined though because the proportion of working age people with disabilities, who say they are unable to work at all, or are unavailable for work, increased. The various chapters in the book then examine other possible reasons for the overall decline in employment rates. First of all it examines whether this can be attributed to a shift in the demographic composition of the population (such as ) older workers, who are less likely to undertake retraining after the onset of a disability, or less educated workers. Two researchers, who have investigated this, find no credible evidence to indicate that composition changes of this sort or the dramatic decline in employment of a specific subpopulation artificially caused the decline.
11 11 Another possible explanation of the decline, that has been proposed, is that the job market has changed. Once again however an analysis of the Current Population Survey (CPS) data shows that, while changes in the composition of jobs might have contributed to a long-term decline in the employment of people with work limitations, such changes are too small to explain the dramatic decline in their employment found in these data. It is also noted that although the literature provides some evidence that job security has declined.... the decline has been very gradual and began well before the decline in employment rate for people with disabilities. The next chapter considers whether the decline might be due to the way in which rising health care costs have made it more expensive for employers to employ people with disabilities. An analysis of data from the National Medical Expenditure Survey and the Medical Expenditure Panel Survey indicate that there is some evidence for this being a factor in the case of women but not for men. Furthermore, even in the case of women, the size (of the effect) is small relative to changes in employment rates over the period of the study. The next explanation to be considered is that there has been an increase in the proportion of very severe work-limiting impairments and chronic conditions within the population of disabled people. The work of one researcher, Kaye, points to this being a significant factor. He demonstrates that it is the increase in the share of chronic conditions that have low able to work rates..... that is driving the overall decline in (those).... able to work at all and that the rapid growth in the prevalence of conditions with low able to work at all rates musculoskeletal, respiratory, nervous system and mental health conditions (is) due to the obesity epidemic and stress-related disorders caused by the 1991 recession. Another contributor to the book, DeLeire, concludes that the ADA is indeed responsible for the decline in economic activity of disabled people. He argues furthermore that the reason that the ADA failed in this regard in contrast to the 1964 Civil Rights legislation was the burden that accommodation costs place on employers. Some other researchers however, while replicating DeLeire s results, demonstrate that the employment rate of the work-limited population who report being able to work at all rises following the passage of the ADA. Another group of researchers come to a similar conclusion and argue that, because the ADA was intended to focus on only a small subset of the population with chronic conditions or work limitations, empirical analysis of its consequences should focus solely on the outcomes in its intended protected class. Perhaps the most plausible explanation for the decline in disabled peoples employment rates lies in the changes in social security benefits. As in the UK eligibility for disability benefits require the individual to be deemed incapable of any kind of work. Thus, it is argued, changes in the benefit rules might have induced a greater proportion of those with work limitations to leave the labour force. This proposition is examined by Goodman and Waidman, who conclude that changes in DI (disability insurance) eligibility and benefits are primarily responsible for the decline in the employment of working age people with disabilities....they show that increases in the DI rolls account for the entire rise in the fraction of the population that both report that they have a work limitation and are not employed. Burkhauser and Stapleton go on to weigh these arguments and their implications for policy. They conclude that the employment rates declined for all major demographic and educational groups. They note that though the decline is particularly marked amongst young adults and that the most notable declines... were amongst white men and women aged with more than a high school education 27.6 and 20.0 percentage points respectively. They also conclude that there is no evidence of an acceleration of change that could account for the sharp decline in the proportion of workers with limitations after the mid-1990s. They point out though that a gradual increase in educational and skill requirements, and a gradual decline in job security, are making it more difficult for disabled people to obtain employment. Their analysis of the effect of health care costs leads to less clear-cut conclusions. They note that people with disabilities frequently cite access to health insurance as a main reason for not working and find that growth in the prevalence of high-cost chronic conditions....has depressed the employment rate for people with work limitations. The size of this effect.... was small. The reason, for this, they suggest, is that a growth in health care costs only affected those with high-cost chronic conditions. They go on to examine the work of Kaye, who asserts that the changes in the type and severity of underlying health conditions can explain the
12 12 decline in the proportion of people with disabilities, who say they are able to work at all and Kaye s claim that this explains the decline in activity rates. Burkhauser and Stapleton acknowledge that the data does support the claim that the activity rate of the disabled people, who say they are able to work at all, has increased. They point out however that the decline in the numbers of such disabled people may well be due to changes in the social environment that all workers with disabilities face. One very significant change is, of course, the ADA. The other is the change in the social security benefits. Beginning in 1984 there was a period of liberalisation in eligibility criteria.... and a gradual increase in programme generosity for lowwage workers. The consideration of these two possible causes of decline raises more questions than answers but they conclude that the real and substantial decline in the employment rate... was caused by a change in public policy. They also conclude that the weight of evidence favours the (social security) explanation over the ADA explanation but admit that our comfort level with that conclusion is not as high as we would like it to be. They go on to say that although we are not convinced that the ADA had a significantly negative effect.... we are not convinced that it had a significantly positive effect. At best, it may have increased the employment of the decreasing share of that population who report being able to work at all.... What the findings in this book lead us to recognise is that attempts to improve insurance protection against work loss owing to disability or reduce discrimination in employment can have the unintended consequence of reducing employment. They conclude by spelling out two ways in which these unintended consequences can be ameliorated. Both involve clarification: First of all with regard to whom the ADA protects (and) under what circumstances; Secondly with regard to what constitutes reasonable accommodation. Both of these, it is argued, will reduce ADA compliance costs and increase the employment of people with disabilities who are determined to be protected under the law especially through new hires. Unfortunately no one has attempted such a systematic and comprehensive evaluation of the DDA. The good news is that, in contrast to the situation in the USA, the proportion of disabled people in the UK who are economically active has increased slightly. The bad news is that it looks as though this may be more due to the changes in the benefits regime than a consequence of changes brought about by the DDA. Thus the recommendations, outlined above, regarding clarification of the way in which disability is defined and what is meant by reasonable accommodation, may be just as significant in the UK as in the USA. Mike Floyd
13 13 NEW CASE MANAGEMENT TRAINING ON OFFER FOR 2005 Certificate And Diploma Level, Training Provided Through E - Learning And Workshop Participation It has been established that professional Case Management of people with mental health and related issues increases the chances of them remaining in productive employment and assists those prematurely absent or retired back into the workplace, depending on their personal needs. As NVRA members know, it ensures that individual situations are assessed accurately and holistically and that a range of co-ordinated interventions and professional services can then be made available to produce a prompt resolution. New training in Case Management is planned for 2005 which will bring together for the first time in the UK a range of professional interventions, commonplace in other parts of Europe, the USA and Australia. The course will include models of work assessment and adjustment, legislation, professional responsibilities, codes of best practice in rehabilitation, business risk and absence management, job retention, return to work plans, working with Human Resources specialists, Occupational Health, Welfare and employee assistance programmes (EAPs), referrals to and from the health service, specialist and private community resources, job matching, and overall co-ordination and project management skills. The training be delivered by a recognised university, to Certificate and Diploma level initially, and will particularly benefit those in the professions of job retention, NHS, occupational health and therapy, job centres, rehabilitation, counselling, welfare and EAPs. Delegates will receive training, at the same time as continuing with their jobs; approximately 24 days over a period of a year to 18 months. This would include information, private study, skills development, tutorials, exams and certification. This course is sponsored by Work Life Partnerships Limited (WLP), a not for profit company in a Public Private Partnership with a number of NHS Trusts, including the Avon and Wiltshire Mental Health Partnership. WLP brings together and delivers Job Retention Services - based on effective Case Management to employers from the public and private sectors. WLP is addressing the clear need to create capacity in the UK and ultimately offer a national service. It is working in association with a range of existing bodies that have experience of mental health, disability, job retention, rehabilitation and the workplace, including NVRA. If you are interested in this training, either for yourself or a team member, and wish to be kept informed, please contact Linda Hoskinson or Roger Butterworth on Get the latest version of the Acrobat Reader Free of charge from
14 14 New UnumProvident Centre for Psychosocial and Disability Research, Cardiff University On 1 July, an important new initiative was launched ready for the start of the academic year this autumn. The new centre, based in the world-renowned School of Psychology at Cardiff University, sets out to achieve the highest level of research and teaching excellence in psychosocial and disability matters. It is a new partnership between the university and UnumProvident, the UK s leading provider of group income protection insurance, and is to be headed up by Professor Mansel Aylward. The partnership is significant in that it illustrates how income protection insurers and the state social security systems are facing the same challenge: that of the increasing numbers of people with mental health problems and subjective health complaints, many of which are poorly understood in terms of conventional biomedical models of illness and disease. The new centre will focus on understanding the psychosocial, social, economic and cultural factors that influence health, illness, disease, recovery, rehabilitation and reintegration into rewarding work. Research in this area is critical for understanding the growing problem of sickness absence and long-term work incapacity. It is hoped that out of the ambitious programme that has been set out will come ideas of better ways of providing vocational rehabilitation and early intervention strategies. Jean Brading
15 15 Précis of Outcomes from Trustee Event Held On 4 th and 5 th June 2004 at Caledonian University Glasgow: Part One PRESENT Tim Dawson Sarah Gatenby Stewart Gould Gail Kovacs Ian Martin Sally Young Chair and Trustee Vice Chair and Trustee Trustee Member Administrator Trustee APOLOGIES Jean Brading Jenny Chapman Trustee Membership Secretary and Trustee PURPOSE OF THE EVENT Tim welcomed all present and outlined the programme for the two days and referred to the previously circulated copies of the proposed programme and the copies of the PowerPoint presentation He briefly stated the purpose of the event, which he suggested would focus on the following key issues for the NVRA: WHERE WE ARE TODAY: OVERVIEW Aims objectives. Structure. Constitution. Membership. WHERE DO WE WANT TO BE? Aims & objectives. Structure. Constitution and modus operandi. Membership. HOW DO WE GET THERE? NVRA STRUCTURE Trustees how many roles responsibilities. Full / part time officials roles responsibilities. Secondees career development opportunities. Structure national regional local. Permanent premises.
16 16 WHAT RESOURCES DO WE NEED TO GET THERE? Funding. Expertise. Links with external organisations. HOW DO WE SECURE THE RESOURCES WE NEED? Fundraising consultancies. Write our own bids. Approach external sources. Word of mouth. Promote NVRA. WHERE WE ARE TODAY: OVERVIEW In commencing the main business of the day, Tim gave a brief resume of where the NVRA is today in terms of; Aims objectives. Structure. Constitution. Membership. He suggested that key to the future development of the NVRA is resources, and therefore had invited a number of Fundraising consultancies to submit their ideas for developing and implementing a fundraising campaign. Of the agencies approached, three have responded, including Craigmyle Consultancy, who agreed to attend this event to present their ideas for consideration. WHERE DO WE WANT TO BE? NVRA AIMS AND OBJECTIVES Tim suggested that the current objectives are not achievable in the short term and that what is needed are a revised set of short term objectives that are achievable and time bound and fit SMART criteria. In discussion the following Short term objectives were agreed in principle subject to absent Trustees and members endorsement. NVRA Trustees and delegated members to be fully involved in the development of training and national standards relating to vocational rehabilitation. Provide a forum and network for members. Provide educational / training opportunities in current vocational rehabilitation practice. At this point, Gail Kovacs led a discussion on members needs. Beneath each identified need where appropriate is a brief description of what is already provided for through current NVRA membership. A comfort level that NVRA will be invited to the table for all sector related consultations, (ongoing work that needs to increase to increase profile and PR/Lobbying of NVRA s position and potential).
17 17 Access to every professional business opportunity, (job opportunities communicated to members need to attract business opportunities). Representation in the development of the vocational rehabilitation sector, (on going PR / Lobbying). Access to peers, (via membership /ReHab NetWork). Ongoing education awareness raising, (National Interest days / AGM). In the loop for relevant information. To encourage personal professional maintenance. Value for money. Financial benefits. Catalyst to recognition of professional practice. NVRA STRUCTURE It was agreed that the whilst the structure will need further review in the advent of the expansion of the NVRA involving developing closer working relationships with sister organisations and links with external bodies, the governing body for the foreseeable future remains the Board of Trustee to incorporate the following roles and responsibilities, (current office holders shown in parenthesis).! Chair (Tim Dawson)! Vice Chair (Sarah Gatenby)! Treasurer (Sarah Gatenby)! Company Secretary (Sarah Gatenby)! Membership Secretary (Jenny Chapman)! Trustees without portfolio (Jean Brading & Stewart Gould) CONSTITUTION Tim reiterated the views agreed at the last Trustee meeting in March that a new constitution needs to be designed to reflect current developments. Should the NVRA progress towards closer working relationships with the Canadian Association of Rehabilitation Professionals (CARP), it would be appropriate to incorporate rules that reflect CARP s protocols and vision. MODUS OPERANDI / COMMUNICATION BETWEEN TRUSTEES Tim suggested that the communications process within the NVRA could be improved to enhance efficiency and professionalism. NVRA NAME Following a discussion it was agreed in principle to consider shortening name of NVRA to (UK Vocational Rehabilitation Association (UKVRA), particularly as the organisation is seeking to become more global, potentially encompassing Europe. MEMBERSHIP Agreed by all Trustees present that a concerted effort is required to expand the NVRA s membership base through past, existing and network contacts.
18 18 As a key aim of the NVRA is to be a lead body, it is suggested that in the interim we offer Associate Rehabilitation Professional Membership. This will give an immediate benefit and status to members. This will be particularly relevant if in the longer term the NVRA goes through a credential process similar to that experienced in the USA and Canada in terms of a grand fathering process leading towards Registered Rehabilitation Professional Status. CARP: A ROLE MODEL: GAIL KOVACS Gail gave Trustees an overview by PowerPoint presentation of how CARP started and how it developed to its present day position of being a major Vocational Rehabilitation Association, seeking to develop its services in the UK. She stressed how close the NVRA are in terms of aims and objectives and how the development of CARP in its formative years mirrored what the NVRA is currently experiencing. She read out a welcome message from CARP president stating that they would be welcome to assist the NVRA and open the door for communication about potentially having opportunity to be in the UK. Opening up the discussion, Tim suggested he would very much like to accept the offer from CARP s President to explore ways of working together, which he felt would considerably assist the NVRA to achieve its aims of becoming a lead body to the sector, and at the same time to support those practitioners who are currently not able to access recognised qualifications. However Tim stressed his views are subject to Trustees and member s approval. In discussion, Trustees present agreed that CARP would be an ideal model for NVRA to mirror, and potentially to be affiliated with, particularly in the format of the subset groups already in existence, including the crucial area of research. Gail informed Trustees she would feedback the wishes of Trustees to the CARP president who would get in touch with Tim as a first step to developing a future working relationship. LINKS WITH OTHER REHAB /DISABILITY ORGANISATIONS In addition to exploring potential links with CARP, it was agreed that Trustees need to consider other options for expansion i.e. affiliation with CMS UK as a delivery vehicle. However it was generally felt that due to the focus of CMSUK on medical case management and requiring degree/professional association to be case manager many current and potential VR practitioners would be out of scope. WEBSITE DEVELOPMENT It was agreed that the website offers considerable scope for further development to the benefit of existing and potential members. THE NEW NVRA: HOW DO WE GET THERE? Trustees present agreed Tim s suggestion that to implement the developments discussed under Structure the NVRA needs to develop a Time-bound Strategic Plan following the GANT chart principle to enable Trustees and members to be aware of progress made to achieving ALL agreed aims and objectives, resources both human and financial required and timescales. The plan concept will enable Trustees and members to be aware of progress made to achieving ALL agreed aims and objectives, resources both human and financial required and timescales. On completion of the Plan template, Trustees to meet to amend as appropriate and approve the final version, and agree how the Plan is presented for members endorsement prior to opening negotiations with CARP or and sister organisations.
19 19 PART TWO: AGREED RECOMMENDATIONS AND PROPOSED ACTIONS NVRA STRUCTURE It was agreed that we need to ensure public sector representation and that places should be ring fenced to ensure equal representation of the public / private sectors It was also agreed following that given the outcome of the discussions on member needs that a number of small working groups should be set up to focus on the following activities to ensure those needs are met 1. Public Relations / Lobbying. 2. Communications. 3. Membership. 4. Education. 5. Credentialing. It was agreed that the remit of those working groups should include: 1. Public Relations / Lobbying To identify all key stakeholders in the industry. To educate the key stakeholders in the role and importance of the NVRA and the Rehabilitation Sector. To identify current relevant issues and determine how to make an impact. To liaise with key rehabilitation partners. 2. Communications To develop an introductory brochure - Who the (N) VRA / UKARP are - Define vocational rehabilitation. To post all new / upcoming intranet events and external events on the website. To create a monthly update sheet for members. To create a quarterly journal / newsletter. 3. Membership Committee To actively recruit new members. To develop membership materials / application processes. To upgrade the membership database. To review membership categories. To identify member s needs. CONSTITUTION Need to look at eligibility criteria both for members and for potential Trustees. A revised draft constitution is to be considered by Trustees. Prior to adoption, the proposed changes will require the endorsement of Trustees and members.
20 20 MODUS OPERANDI / COMMUNICATION BETWEEN TRUSTEES It was agreed that any general enquires to NVRA (Ian) should be forwarded to Tim and Sarah only to restrict unnecessary traffic flow. Exceptions being notification by Ian of Job / Business opportunities that would continue to be forwarded to all members. Communication from any trustee should specify that the response should be to the entire group or to the sender of message only, again to restrict traffic flow. As Chair, Tim should be copied in to any NVRA correspondence so he is up to speed with events. As previously agreed at the Trustee s meeting held in March 2004, all agreed points to be processed within 10 working days, unless by prior agreement with the Chair. Where the 10-day rule cannot be met, the Chair to notified with a revised timescale or reasons for delay in completion of the outstanding actions. NVRA NAME This proposal to shorten the name of the NVRA to Vocational Rehabilitation Association (VRA) will be discussed at the next Trustee meeting and if agreed, be put to members for ratification. MEMBERSHIP Agreed a working group of 2/3 members be formed to look into how membership can be increased and side issues such as appropriate incentives Realistic targets and timescales to be agreed by all Trustees at the next Trustee meeting. CARP: A ROLE MODEL: GAIL KOVACS It was agreed that Tim would commence dialogue, with key officials with a view to agreeing further steps towards a closer working relationship with CARP. However before we do this, and to inform the discussions he and Trustees will require a summary document required of what Vocational Rehabilitation is in place in UK, Ireland and Europe. It was agreed that this stage would take place over the next six to eight weeks with next steps being the following actions, to draw together a summary document of the current situation on the following issues, (now to include the Governments proposed Framework for Vocational Rehabilitation). Leonardo Bid. European Platform for Rehab: Donal McAnaney. Public Sector. Legal implications of possible affiliation with CARP. To seek the endorsement of NVRA members for the proposed development of a working partnership with CARP. FOLLOW UP ON RECENT INITIATIVES Further contact with CSMUK to identify how far the issues discussed at the meeting with Deborah Edwards could be actioned. Further contact to agree links between the respective, or given impending merger, the new umbrella organisation for Supported Employment. Further contact with UNUM and Norwich Union respectively to identify how working relationships could be further developed further to recent discussions.
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