INTRODUCCIÓN

This section looks at how people’s health developed between going off sick and going back to work and the influences on this. It then examines how people thought about their fitness for work and the influences on this.

4.4.1 Developments in health

There was much variation in how physical health conditions had developed among those who had gone back to work. In both the control group and the panel study samples there were instances of people who described a near or full recovery from back pain and other musculoskeletal conditions, infections, a broken limb and mental health conditions. Whilst some improvements in health conditions, typically a reduction in pain, were reported among the remainder of the sample, there were also cases of people having returned to work where there had been little improvement in conditions. Some people, especially those with long term conditions with little hope for improvement, said they had learned to live with a certain level of pain or limitation.

4.4.2 What led to developments in health

Chapters 2 and 3 described the range of health care services received by panel and control group respondents. The focus of this section is the impact that NHS and private health care services and those provided through JRRP had on the health developments described above.

People in the control group and panel study respondents who went back to work described their health as having been significantly improved through NHS or private health care encompassing: surgery, physiotherapy, the use of a TENS machine, psychological therapies and medication (particularly pain relief and anti-depressants). People also said they had experienced pain relief and improvements in conditions through rest and being away from work duties that had caused or aggravated their condition. Improvements in health were reported as the main reason why these people had been able to return to work.

In other cases, though, people had experienced little or no improvement in their condition, and had not received any effective treatment. This arose in a number of ways:

• Incurable conditions. Some people said they had been told their conditions were incurable or that any potential cures, such as surgery, carried other health risks. • Treatment held back by lack of diagnosis. Pain relief was often the only treatment

available to those awaiting a diagnosis.

• Delays in treatment. Some people had not received treatment because of NHS waiting lists (particularly for operations, counselling and physiotherapy), or, in one case, because of a delay in an insurance company agreeing the necessary funding for private treatment.

• Treatment not offered. There were instances of people who felt they would have benefited from treatments, such as counselling or physiotherapy, sometimes while they were waiting for other treatment, but were not offered them. • Ineffective treatments. Finally, others had received treatment but not found it

Role of JRRP in health developments

The impact of JRRP health services varied among people in the health and combined intervention groups19 _{who went back to work. In some cases, JRRP had had a clear}

impact: individuals with back problems, depression and chronic fatigue syndrome said that they did not feel they would have been able to return to work if it were not for health care services provided by JRRP. The services described here were cognitive behavioural therapy, physiotherapy, a personal trainer and a combination of pilates and occupational therapy.

In other cases, people in the health and combined intervention groups had returned to work, but did not feel that JRRP had had an impact on their health. In some cases, no health services had been received, where people had already returned to work shortly after their assessment, where no services were seen as necessary in addition to those being provided privately or on the NHS or, in one case, where no contact was maintained after the initial assessment. As Section 3.6 described, there were also cases where people appeared not to have been offered services which might have been helpful, and which were offered to other participants with similar conditions. In other cases, people had received health services from JRRP but did not think they had been effective or significant in the health improvements that allowed them to return to work, although they did sometimes feel they had helped them remain in work, as discussed in Section 4.7.2.

4.4.3 Fitness for work

It was clear from the experiences of those who went back to work in the two studies that people did not have to have fully recovered from a health problem to consider themselves ready to return to work. People who had experienced some improvement in health often felt fit enough to do some work even if it was not their normal duties. However, for some, the return to work had happened too soon and made it difficult for them to remain in work over the longer term, as discussed in Section 4.7.4. In general, people made their own assessments of whether they were fit for work However, others were influenced by GPs, other medical professionals and JRRP service provider staff.

Where GPs had been involved, people generally talked about their GP having agreed withtheir own view that they were ready to return to work, rather than having advised themthat they were now well enough to return. There were few reports of GPs having had a more active role in people’s decisions to return to work, but where they did it tended to be considered unhelpful. One person, for example, who felt she was too ill to work had returned to work on a number of occasions before she was ready because she said her GP had refused to renew her sick notes. Another said her confidence about returning to work had been damaged by her

19_{Of the 19 panel study participants who went back to work, 15 of them were}

GP’s suggestion that she consider early retirement. People who returned to work for financial reasons or because of job security concerns sometimes talked about having ‘convinced’ their GPs to agree to them returning to work. Some people described their GPs agreeing only on condition that they ask their employers for light duties or phased returns or at least try to ’take things easy’. Others said their GPs had said they did not agree with them going back to work or had advised a return could be detrimental to their health. However, as already discussed in Chapter 2, people did not follow this advice if they felt they were fit enough to go back to work or if they faced significant financial or job security pressures, although they sometimes regretted this later. Others described how their GPs had supported their decisions to return to work or how they had been encouraged to decide for themselves on whether they were ready to return to work or not.

As reported in Chapter 2, people did not always feel that it was their GP’s role to decide when they were ready to go back to work, and so the GP’s input was sometimes only sought where it was needed to secure a return to work, such as where employers required a GP’s letter before allowing someone to come back to work. In contrast, where people were receiving specialist treatments or had been in hospital, they generally did seek the advice of their consultant about whether they were ready to return to work. However, here again advice was not always followed where it went against returning to work.

Employer occupational health staff were also sometimes involved in helping people decide when they were ready to go back to work. However, again, this was typically described in terms of seeking their consent to the return to work rather than their advice, and was often linked to arranging phased returns or light duties.

Role of JRRP in establishing fitness for work

People who received JRRP services did sometimes describe discussing whether and when to return to work with JRRP staff. However, in both the panel study and the control group study, it was largely people’s own assessments which drove their decisions, and in both samples people returned to work before they were fully fit. People in the panel study did not talk in terms of JRRP providers influencing their own assessments of their fitness for work, or helping them to recognise that they could return before they had fully recovered. The only example of any direct influence was the case of a man contemplating his employer’s offer of a return to light duties who was reassured by a JRRP provided workability assessment that he was fit enough to work.