1. MakeWorkHealthy to ensure Retention, Rehabilitation and Reintegration
Main findings from the ´Rehabilitation and return to work: Analysis report on EU and MSs policies, strategies and programmes´
Boglárka Bóla
Project Manager, EU-OSHA

2. Background of the EP project
Financed by the European Parliament, implemented by EU-OSHA
Objectives:
Improving knowledge of existing policies and initiatives addressing the ageing of the workforce and how they have been implemented in the MSs and EFTA countries
Providing reliable information and analysis for policy development in the area of OSH, including rehabilitation and return-to work policies
Supporting the exchange of good practice at company level
Official Journal Pilot project — Health and safety at work of older workers

3. Setting the scene: the European demographic challenge

4. Setting the scene: the European demographic challenge

5. Rehabilitation and return-to-work systems
Elements of a successful system
Rehabilitation and return-to-work systems integrated into broader policy frameworks for sustainable working lives
Integrated legal and policy framework
Return to work system inscribed in legislation and based on coordination across relevant policy areas.
Inclusive systems
Rehabilitation services and return-to-work programmes target all employees.
Early intervention
Avoiding sickness absence. Early workability assessment. Maintaining a link with the workplace during the sickness absence.
Tailored approach
Individual support plan. Workplace adaptations. Vocational and social rehabilitation. Reintegration into the workplace.
Coordination mechanisms
Enhanced role of employer Case management. Coordination at all stages. Interdisciplinary teams.
A number of elements explain why certain national systems for rehabilitation and return-to-work are more successful than others:
Countries that have put in place integrated systems for rehabilitation and return-to-work have generally inscribed it into a broader policy framework which tackles the sustainability of work and the need to retain people longer at work in good and healthy conditions. In Austria, Denmark, Germany and Sweden, the policy discourse has, since the early 2000s, focused on maintaining employability and ensuring the sustainability of social security systems. This has supported the creation of integrated systems or programmes for rehabilitation and return-to-work, such as fit2work in Austria, or the large Return-to-Work programme in Denmark.
Early intervention in the return-to-work process is another critical success factor. The longer a person stays off work because of a health problem, the lower are their chances of returning to work. Interventions are therefore more efficient at the stage of sickness absence. There is strong evidence in the research that structured vocational rehabilitation interventions are effective between the first six months of sickness absence. In countries with integrated systems, the return-to-work procedure indeed starts between four weeks and three months after the beginning of the sickness absence, with contacts between the worker on sickness absence and the employer or the coordinating body for return-to-work. The new Fit for Work advice services implemented in the UK for instance proposes assessment of working capacity four weeks after the person has been placed on temporary work incapacity.
If timing of the intervention is important, rehabilitation and support for return-to-work must also be tailored to the worker’s needs and abilities. A tailored approach allows information about the worker’s occupational and personal history to be taken into account, in order to create an individual plan with adapted measures for rehabilitation/return to work. Most of the countries with integrated return-to-work systems require employers to draw up individual action plans. Tailored interventions support a stepped-care approach, which differentiates the services provided to each worker in relation to the seriousness of their conditions and the duration of their sickness absence.
The reintegration process is a complex one. There is strong evidence that multidisciplinary interventions addressing health, personal determinants, such as motivation and skills, and workplace factors, are effective in facilitating return-to-work. Many roles and responsibilities are involved in the process therefore coordination is crucial:
Interdisciplinary teams, including medical and paramedical experts (general medicine, specialist medicine, psychiatry, physiotherapy and other types of therapy) and non-medical professions (such as employment and labour market experts, ergonomists, psychologists, vocational rehabilitation experts, coaches and trainers and social and administrative officers), should work together to determine the appropriate pathway for the worker’s reintegration into the workplace or labour market.
Coordination with the workplace is also important, the employer must be involved in the definition of appropriate measures to accommodate the worker.
Finally, interdisciplinary cannot work without leadership. The case management approach is becoming increasingly common. The case manager helps the worker and the employer to navigate through the different steps of the rehabilitation process and facilitates their interactions with other stakeholders.

6. Success factors for return to work
Inclusive systems to target all workers with health problems
Broader scope than disability management
Intervention already at an early stage
Interventions tailored to the workers’ needs
Case manager
Assessment of work capacity, individual support plan
Targeted workplace interventions
Obligations and responsibilities for employers and workers
Coordination at policy level (cross policy), system level and workplace level (GPs, OSH specialists, rehabilitation service providers, case manager, employer…)
Financial, technical support to SMEs
Economic drivers before receiving disability or early retirement benefit
Raising awareness about the benefits of RTW
Return-to-work:
All procedures and initiatives aiming at facilitating the workplace reintegration of persons who experience a reduction in work capacity or capability, whether due to invalidity, illness or ageing.
Mismanaged return-to-work leads to unemployment, disability pensions or early retirement.
Success factors:
1. scope of systems, holistic approach
2. timing of intervention
3. tailored intervention /case management
4. obligations of employers and workers
5. coordination of stakeholders
6. Level of external support
7. access to vocational rehabilitation
8. economic drivers
9. raising awareness on all levels
Early intervention increases the chances for quick return.
RTW is a complex process requiring combined action of many professions not used working together (GPs OSH doctors, specialists, rehab. providers and companies…).
Economic drivers before receiving disability, early retirement benefits et cetera can be drivers for return to work processes (also part-time sickness)
Also economic drivers for companies exist (e.g. how long they pay for sickleave, or which compensation they pay, or if they receive benefits when providing rtw)
!! No reforms in social security systems should be made, such as cutting or tightening compensation and benefits without developing return to work programmes!! (Irene Kloimuller)

7. ‘Safer and healthier work at any age’/ some conclusions
Policy level:
Legal framework, policies to support good OSH practices in the context of an ageing workforce (Framework Directive, Anti-discrimination Directive)
Integrated policies: economic, employment, education, health, social, OSH
Coordinated actions
Social dialogue
Workplace level
Life course approach, addressing different needs of young and old, intergenerational interaction
Holistic approach, taking into account factors beyond OSH that have an impact on OSH (e.g. based on work ability concept)
Workplace Health Promotion
Age/diversity sensitive risk assessment, gender issues
HR policies supporting OSH management (working time, training)
Leadership
Social dialogue / workers participation

8. Thank you