By Sarah Holt, Occupational Therapist
Vocational Rehabilitation, London Road Community Hospital Derby
In Group Rehabilitation Occupational Therapists have been providing work focused rehabilitation in some form for over 20 years. Our work brings us into contact with many local employers on a daily basis. We were already offering workplace assessments, functional capacity assessments and work focused rehabilitation as part of our NHS package of care. We generally treat a wide variety of musculoskeletal patients and some neurological conditions.
Rolls Royce is a large employer in our local area with a variety of physically demanding job roles. We recognised that we were treating a high number of Rolls Royce employees but had little direct contact with the company and their occupational health department. This was mainly due to the fact that they sub contracted their occupational health services and utilised a private company to complete their workplace assessments.
Having had the opportunity to meet with their lead nurse and doctor, to explain the assessment and treatment options we already used; I discussed with them the possibility of assessing their employees in the workplace. They were very happy for us to complete workplace assessments for their employees that we were already treating in an NHS capacity.
They expressed interest in the range of OT assessment and treatment options we were able to offer; therefore I took the opportunity to discuss with them the possibility of providing our interventions to their staff not referred to us in a NHS capacity. This would require them to pay for the interventions and would therefore generate income for the department and for the Trust.
Although private providers are able to offer workplace and functional capacity assessments they are less likely to offer supervised, work focused rehabilitation for employees who are struggling with their work tasks. Having the BTE PrimusRS allowed us to offer a more thorough, objective assessment process and improved the quality of the assessments and reports we were able to provide.
Workplace assessment involves the OT visiting the employee’s place of work and assessing them undertaking the tasks required of them. The therapist may consider how the employee could perform the task more effectively but also how the environment, use of the equipment and nature of the task could be adjusted to meet the employee’s needs.
A workplace assessment report will be sent to Occupational Health within 5 working days. The report will include the therapist’s observations, opinions and recommendations as well as the employee and manager’s comments.
FUNCTIONAL CAPACITY ASSESSMENTS
We complete an assessment which will inform the business of the employee’s capacity to complete their job or to advise regarding their potential for redeployment into an alternative role. The assessment uses an activity based approach that focuses on their ability and identifies if the worker is able to match the demands of their job. The assessment may address their ability to carry out activities of daily living, their mobility, fitness, stamina, strength and dexterity. The assessor will establish the employee’s perception of their ability and any barriers they perceive to have regarding work. The assessor will then observe the employee carrying out a variety of selected activities. The assessor will utilise the BTE PrimusRS in order to simulate specific activities and objectively measure their strength and stamina.
After the assessment a comprehensive report will be provided. The report will provide details of the assessment, the therapist’s observations and subsequent recommendations. The report will endeavour to relate findings to their specific job role where appropriate and where possible.
This can be recommended during a workplace assessment or functional capacity assessment in order to improve their ability to complete particular tasks that they currently struggle with and that cannot easily be amended. It can also be recommended as a stand-alone intervention where an Occupational Health Practitioner and/or a manager feels that an employee needs to work on their strength, stamina or fitness to complete aspects of their work role. This type of rehabilitation focuses on the physical requirements of their job and seeks to replicate this in the treatment environment as well as working on the employee’s general strength, stamina and where appropriate their joint range of movement. The BTE PrimusRS is used as part of many of the patients’ treatment programmes and to evaluate their progress throughout the rehabilitation process. Data from the BTE PrimusRS is used in many of the reports we provide.
Each patient undergoes an initial assessment to determine the requirements of their role and their current capacity, unless a workplace or functional capacity assessment has already been completed. The assessment also acknowledges the psychological effect of being off work or struggling with work. Following assessment we will predict a realistic time frame for their rehabilitation and will provide progress updates during this time. A discharge report will also be provided.
The work focused rehabilitation has seen the biggest increase in activity since the relationship began. It contributes significantly to the income that we make. It is approximately 70% of our monthly income.
SETTING UP AND CHALLENGES
The biggest challenges were to come up with an appropriate cost and to consider capacity and how to ensure that NHS work was maintained and not sacrificed.
I contacted the finance department and discussed with the accountant how to come up with an appropriate price. Their advice will usually focus on covering cost of staff time, overheads and the depreciation of any equipment used. I soon realised that the price we set at the beginning of the project was too low as it is difficult to predict the time required for none patient related admin tasks. I then worked with one of the Trust’s business managers to come up with a new cost and I negotiated this with occupational health providers at Rolls Royce. At this time we also developed a service level agreement to outline more formally what we were able to offer.
At present I am working with finance and representatives of Rolls Royce to ensure that our price doesn’t just cover costs but recognises the quality of the service we provide and to be closer to the prices charged by private providers. It is likely that this cost will rise by 30%.
Throughout the project this has been the biggest challenge. We already run a busy outpatient occupational therapy service. We have been able to have Rolls Royce staff in for the rehabilitation sessions alongside NHS patients however; workplace assessments and functional capacity assessments take more consideration; one to one interventions and the potential to be off site. As a team we discussed the best times to ensure that we could maintain our current NHS service and minimise disruption. We agreed that off-site assessments should be completed at the beginning and end of our working day to minimise disruption to the day. This also ensured that we were able to offer assessments to either morning or afternoon shifts at Rolls Royce.
Working with Occupational Health
I have worked with admin and clinical staff at Rolls Royce to improve the process, develop paperwork, respond to feedback from managers and employees, and identify patterns in referrals/difficulties.
Very little money was required to set up the service. A small amount was required for safety boots and glasses for staff to wear on the “shop floor”. Otherwise it was the cost of staff time to work on the required paperwork and to negotiate terms with Rolls Royce.
Based on the original price we were able to generate approximately £20,000 in the first year. In the second year this increased to £36,000. As a result of proven income and activity we have been able to employ an additional Band 6. We now have an income target of £4,000 a month and we now generate between £4,000 and £7,000 per month. The additional income is able to be used to contribute to the cost improvement plan.
Due to the success of the project there is a high demand for the services that we offer. To date we have completed just over 2000 interventions. We recognise that the model could be sold to other local companies but I am mindful of our capacity and at present the work with Rolls Royce alone generates more income than our target requires.
Sarah is very willing to speak with anyone interested in learning more about this service and the BTE PrimusRS. Please contact firstname.lastname@example.org for more information.