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Vanessa Sallows, Group Protection Claims & Governance Director, Legal & General Retail, chats with Charlotte about her experience of supporting employees to return to work; the impact of sickness absence on mental health and the benefits of early intervention.
Vanessa: Please tell us what your role at Legal & General involves?
Charlotte: I’m part of the clinical team. We’re a collection of Nurses, Occupational Therapists and Physiotherapists. So, a wealth of experience between us. I’m a nurse; qualified for over 20 years. Prior to Legal & General, I worked for the Department for Work and Pensions doing functional assessments for Universal Credit. Before that, I worked in NHS acute care.
The clinical team support everyone at the workplace in the Group Income Protection (GIP) journey when an employee is unable to work long-term. We speak directly to the employee we’re covering about their current circumstances and their medical conditions that are affecting their ability to work. Then I put all that into a report for the claims team which is considered when a decision on the income protection claim is made. That report will also factor in what’s needed to support them back into the workplace, whether planning a return to work, with a structured plan and reasonable workplace adjustments, for instance, or providing focused rehabilitation to support recovery to a stage where resumption of work is feasible.
Vanessa: Can you provide some examples of the type of short- and long-term absences you support?
Charlotte: This varies hugely. A common absence though is back pain, especially for those in a manual role. The NHS waiting list for physiotherapy can be considerable, with national variation. We can arrange some consistent physiotherapy for the individual, perhaps for 4 – 5 weeks, then they’re often fit to return to work, and we support them on that journey. That’s an example of a short absence.
Or an absence might be more complex and for a longer duration. For example, if someone has had a stroke. In such cases, we may consider a referral to a third-party partner provider with expertise in neurological rehabilitation. We work with the provider and have regular reviews, building up a therapeutic relationship with the employee. It can take up to a year sometimes to support an individual back to work, but we set return to work as a long-term goal where appropriate and hope that will be the outcome for that person.
Vanessa: And how do you manage and prevent relapse?
Charlotte: We work very closely with the claims team to case manage from beginning to end; that includes regular reviews after the individual has returned to work, as required, during the phased return to work programme. It’s not a once-and-done job.
For some people, a return to work is very straightforward. So, we monitor their progress and ensure they know to contact us if there are any problems. The door is always open.
Then, on the opposite end of the scale, people do relapse, often those with chronic conditions. They’ve typically had a long absence and, when they return, they might have a dip in their function, due to pain perhaps. So, we try to manage that the best we can, whether that’s putting a pause on a return-to-work plan or getting an ad hoc session with a specialist partner provider. We’ll talk with the employee about what’s caused the relapse. Reviews are a big part of what we do, helping us anticipate potential problems and put in place solutions without there being too much damage, either to the individual’s health or to the employer’s business continuity.
When a relapse happens, we would usually refer the individual back to the vocational clinical specialist they spoke with previously. We want to ensure they don’t have to start from scratch, explaining their whole case again. Plus, they’ll already have that trust and rapport built up.
Vanessa: At the heart of our claims and clinical proposition – our Be Well. Get Better. Be Supported. framework – is the philosophy that good work is beneficial for health. It’s part of the recovery journey, with the potential to also bring with it a sense of inclusion or belonging. To what extent do you get a sense of that in the work you do with the employees you support?
Charlotte: It’s well documented that work can be a pivotal part of recovery from illness. We know that work provides a ‘why’ for individuals: why do I get up in the morning; why should I shower, get dressed and look after myself.
So, we know that work has a big role in self-motivation. It also provides stability and social contact for people. I’ve supported individuals who’d be socially isolated if they hadn’t returned to work. Work can be a big driving force for them to get better.
I recently worked with an individual who, despite having a cancer diagnosis, found work to be her outlet and a place where she could go to be “normal”. At work, she’s no longer the lady with breast cancer, who’s got no hair. She can be herself and use her talents and experience and just be seen for who she is, a highly talented individual.
Being away from work on an ongoing basis was detrimental to her. It was affecting her mental health. We arranged rehabilitation for her, and she’s been able to return to work, with adjustments and tools, so she can manage any long-term health problems from the hormonal treatment. She told me that having this support was invaluable.
So, I think that vocational rehabilitation encompasses the philosophy of Be Well. Get Better. Be Supported. It takes people on a recovery journey, back to the things that bring them health and happiness.
Vanessa: Absence from work can lead to feelings of exclusion, lack of hope and loneliness, because people get trapped in a downward spiral. Even if they have a physical condition, you often get a psychological overlay. Has this come through in your experience?
Charlotte: We look at people through the biopsychosocial (whole person) model, so we might know they’ve got a physical condition, but we also need to find out what’s going on elsewhere; in their life and family circumstances, also emotionally. This gives us a full view of how we can best support that person.
Work can provide us with a social network. A lot of people, especially young people, use work as their peer support.
I’ve been working with an individual recently who’s been off work with severe mental illness. She’s having that treated, but not being in the workplace is making her feel worse. Being young and away from family and friends, with her mental ill health, she didn’t have the enthusiasm to get up in the morning She wasn’t speaking to people, her family live in a different country. And her friends were mostly at work; she usually works long hours.
She was just at home on her own, overthinking things, becoming anxious about her career. All this can be a big driver for anxiety. So, we got everyone involved – Occupational Health and her social networks within the organisation – to help get her back, in a supportive environment with reasonable adjustments in place. If we hadn’t supported her back to work, it would have been to the detriment of her health.
Vanessa: How do you support the employer in this whole process? I imagine you’re having to manage their expectations, just as much as you are the vulnerable employee.
Charlotte: It all comes down to communication. Sometimes it involves having a conversation with the employer, the employee and us in the middle. Often this is to inform the employer about a condition their employee is experiencing; what to expect.
We have the Be Well helpline, a direct line for employers (HR professionals and line managers) to our team, to help with early intervention. We can help employers nip problems in the bud early, supporting employees to stay in work if they are showing early signs of struggling with health issues that might be affecting their work.
As well as return to work plans, we can help with bespoke support for the employer such as carrying out stress risk assessments.
For mental health, we’d always advocate a Wellness Action Plan as a kind of relapse prevention tool. This is a document from Mind, for the employee to write down information on their mental health, their triggers, what to watch out for, what works for them, how they prefer to be managed. Our team can help employers and employees with these too.
Vanessa: In situations where an employee feels their condition has been caused or exacerbated by work, what can the vocational clinical team do to provide support to the employer and help with the cultural aspects?
Charlotte: It’s difficult because, ultimately, we can’t sweep in and change environments. So, it’s a case of thinking about what’s realistic. And what’s realistic is opening communication doors, helping employees communicate effectively with their employer. I think it’s valuable that we can support the employee in having honest, open, and transparent conversations with their employer. We’ll have the conversation with the employer that the employee didn’t want to have; but they’re happy to give us consent to share that conversation with their employer.
The important thing is to identify what the underlying issues are. And, ultimately, it’s about whatever works to pull everyone together.
We also have the Employee Assistance Programme (EAP) and always suggest people download this app. It provides a whole repository of tools and guidance to help people stay well, from recipes and exercise plans to financial matters and dealing with work-related stress.
Where suitable, we can also refer people to the structured counselling offered by our EAP service, regardless of a claim outcome. This is useful, especially where work-related stress is concerned. Obviously, employees can refer themselves, but they often won’t always take this step without support and encouragement. The EAP is a valuable tool, because it’s completely confidential and it takes the conversation out of the work environment.
Download the second edition of the Legal & General Group Protection Chief Medical Officer Report, to find out more about how Group Income Protection can help break down some of the barriers to equity and inclusion.
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