Vocational rehabilitation, case management and occupational health.

Vocational rehabilitation is the restoration to health and capability to work of individuals incapacitated by mental or physical disease, or by injury. It is high on the national agenda. Securing Health Together [1], the Health & Safety Executive's (HSE) long-term occupational health strategy for England, Scotland and Wales, has made availability for rehabilitation for all who require it as one of its key 2010 targets. Further, the Partnership Board of Securing Health Together has a stated aim of developing a nationwide vocational rehabilitation service. The Support Programme Action Group, as part of a model for delivery of nationwide occupational health services, includes rehabilitation services as one of its priorities. There have been calls for greater emphasis on rehabilitation both from employers and from employees' representatives. Each acknowledges the central role that occupational health must play. We, in turn, as occupational health professionals, need to be aware of the emphasis being placed on vocational rehabilitation. We must decide what steps we need to take so that we can answer the challenges ahead, hopefully with evidence-based best practice such as that in the Faculty's guidelines for the management of low back pain at work [2]. Provoked by the targets set out in Securing Health Together, some of the principal stakeholders have been voicing their opinions on vocational rehabilitation. Many of these echo the sentiments long held and proclaimed by 'jobbing' occupational health professionals. Until now, this has only been acknowledged by a few enlightened employers or employee representatives. In December 2001, the CBI (formerly the Confederation of British Industry) produced a report [3] entitled 'Business and Healthcare for the 21 st Century'. In this report, they sought to highlight the direct cost to UK business of sickness absence of nearly £11 billion a year, with an overall cost to society of nearer £23 billion a year. They suggested three ways of tackling and reducing these costs: by businesses taking greater ownership and responsibility for the management of sickness absence; improving the delivery of publicly funded health care; and innovative thinking on the longer-term funding of health care. The CBI point out that some businesses are better than others at managing workplace absence and employee health care, and that best practice needs to be shared and encouraged. This includes policies to address long-term sickness absence. It also includes the provision of rehabilitation to prevent the progression of long-term sickness absence leading to early …