Rehabilitation

Hand holding a recording microphone

Managing rehabilitation successfully relies on good occupational health advice

Rehabilitation aims

Risk assessment

Supporting the worker

Making workplace adjustments

Recommendations for employer

Further guidance

Long-term absence isn’t costly just for workers – employers and society pay a high price too. The longer a worker is off work due to poor health, the less likely they are to return to work. It’s important to begin the process of rehabilitation early, so that worker can:

  • return to work in a suitable role
  • regain confidence and motivation
  • maintain good relationships with their managers and colleagues
  • avoid financial hardship
  • avoid having to retire from work because of their ill health.

Research has highlighted the benefits of work in providing the economic support, social inclusion and self-esteem that are important for individuals’ physical and mental wellbeing. However, an early return to work is not always the right approach in every case. There are times when rest is the best treatment.

The type and severity of a worker’s ill health will determine whether they can remain at work while continuing treatment. If the worker is fit to work, it is essential that they are not exposed to noisy tasks that could adversely affect their treatment or recovery until a proper risk assessment has been made. In some cases, a worker may decide not to disclose any medical information about their illness to the employer. However, relevant information, including the treatment schedule and any restrictions on work or work tasks, could help the employer make any reasonable adjustments needed.

Rehabilitation aims

The aim of the rehabilitation is to help workers who are absent as a result of noise-induced illness or disability to return to work or allow those with chronic health conditions to remain in work. It involves a range of measures from medical intervention to workplace adjustments (see below).

A suitable rehabilitation programme has two main objectives:

  • to help an individual return to work after an illness or disability
  • to help an individual with chronic health conditions stay in work.

Good rehabilitation practice involves managers, workers and a range of other professionals working together to find solutions to achieve these aims. It requires a co-ordinated approach, with the focus on producing the best outcome for the individual.

In a large organisation, rehabilitation is usually dealt with mainly by line managers, supported by occupational health teams, occupational safety and health and human resources professionals. In a smaller organisation, the employer may look to the occupational safety and health professional alone to give them advice in this area.

Generally, the decision about whether a worker on long-term sick leave should return to work is made by the worker and their line manager, and they need sound medical advice so they can decide on what the worker is capable of doing. Here, it’s worth noting that automatically treating someone who has a hearing impairment or other related medical condition as a health and safety ‘issue’ or ‘problem’ could be regarded as bad practice or discriminatory.

It is also essential to consult the worker on what work they may be capable of, especially those who are involved in safety-critical work. Medical advice should be sought from either the worker’s physician or through the occupational health team.

Risk assessment

Where the hearing impairment of an individual may compromise their ability to undertake a safety-critical task, thereby posing a significant risk to their safety and health and that of others, a suitable risk assessment should be carried out in order to assess any risk posed by the worker's health or any medical treatment. The requirement for an assessment of fitness for safety-critical work should only be applied where it is necessary and not used as a form of medical selection and potential disability discrimination.

Whether carrying out an individualised risk assessment, or reviewing existing risk assessments, the following factors, although not exhaustive, should be considered:

  • ergonomic factors
  • individuals capabilities to perform the task
  • risks of infection/further exposures
  • use of personal protective equipment
  • the psychological and psychosocial demands of the work
  • communication barriers
  • inclusion of emergency planning if necessary.

Supporting the worker

If a worker is absent as a result of a noise-induced illness or accident, they might be reluctant to agree to rehabilitation. This could be because they’re:

  • concerned that the source of harm hasn’t been removed or aren’t confident that what’s been done to remove or control it has been successful
  • thinking about claiming compensation and feel it may have a negative impact on their claim
  • not aware of organisation’s ability and willingness to be sufficiently flexible to meet their needs.

Here, management should play a role in helping the worker get the confidence to return to work, by making sure that a proper investigation has been carried out and measures have been put in place to prevent a recurrence. The manager may need to identify, with the worker, any health and safety or refresher training and development the worker might need.

It’s important to consult the worker (and their physician if possible) on what work they might be capable of and to review this continually as treatment progresses. There may be occasions where worker symptoms are so bad that they have to take time off work to recover. If a period of absence has been necessary, it’s important for the employer to work with the worker to manage their return to work.

Making workplace adjustments

Hearing loss can make individuals feel isolated at work. If a worker leaves the employment because of hearing difficulties, they will take all of their knowledge, skills and experience with them. However, with the appropriate adjustments and management support, hearing loss does not present a barrier in the workplace. Adjustments may include:

  • providing equipment – such as an induction loop or text phone
  • adjusting physical features – for example, changing the layout of the workplace
  • changing a provision – reviewing the way things are done.

Offering support and making some small changes to the working environment not only benefits worker but also is good for the business. If hearing impairment does not cause risks to the health and safety of the individual or others, there is no need to exclude the person from any work activity. A simple way to find out what support a worker with hearing impairment might need is to carry out a work-based assessment. This involves assessing the work environment and asking the worker how their hearing impairment may affect them in the workplace.

In A Healthy Return: Good Practice Guide to Rehabilitating People at Work, IOSH provides a useful work adjustment assessment form and guidance.

Recommendations for the employer

It is good practice to introduce a rehabilitation policy covering serious illness, including noise-induced ill health. Such a policy might include the following:

At the point of diagnosis

Consider the following issues when a worker is diagnosed with noise-induced ill health:

  • who needs to be informed and what information needs to be disclosed
  • what covering arrangements are to be put in place
  • what is the best way of keeping contact between an off-sick worker and the workplace
  • what information needs to be provided to the worker – such as sick pay

Maintaining contact with the worker while away from work

  • maintain informal contact with the individual – with their consent
  • keep the individual informed about workplace events and changes
  • liaise with all the personnel who will be involved in the return-to-work process.

Planning return to work process

  • introduce a return-to-work plan – this should be reviewed on a regular basis
  • involve all stakeholders – worker, occupational health team, occupational safety and health and human resources professionals
  • consider workplace adjustments – working pattern, redesigning or adjusting workspace, provision of special equipment and so on
  • assess the worker’s capabilities
  • assess all physical and psychological issues
  • discuss and explain the return-to-work process to the worker in good time.

Organising the return-to-work process

  • consider a phased return – with modified duties, home working, reduced hours, frequent breaks and so on
  • consider travelling arrangements to and from work
  • consider working patterns, follow-up appointments, workplace arrangements.
  • consider the impact of treatment and resulting adverse effects – safety-critical, complex or stressful tasks.

Meetings

  • hold regular meetings with the individual to review the return-to-work process
  • establish on-going informal conversations.

Further guidance

The UK’s Health and Safety Executive has developed some tools and documentation to help with absence management and rehabilitation. These include: