NHS Health Scotland
  Outcome Indicators

3.1, 3.4, 3.5, 3.6

Deliver a range of services to support individuals with health issues to return to/remain in work and well.


Delivery of a range of services should be available to support individuals of working age with health issues to return to/remain in work and well, and these will contribute to improved consistency of approaches, holistic and integrated support, and timely appropriate referrals that ensure individuals are fully supported.


Policy Note



Where a range of relevant services are delivered in a consistent way to appropriate professional standards this will contribute to individuals with work-related health issues receiving holistic, integrated and appropriate support when needed, and more timely referrals between services through improved linkages between relevant partners and services, and through simplified pathways and processes.

Case management approaches, Fit for Work services and the use of guidance and assessment tools and processes for individuals aim to support increased consistency of approaches to supporting individuals. This might include the new Fit Note introduced in 2010, although evaluation and monitoring will be necessary to assess any related impact. There is review level evidence that personal advice and support, incorporating case management approaches, is an effective method of delivering employment services to clients with a disability or chronic illness.[1]

Current evidence highlights a need to improve vocational rehabilitation in the UK.1 Vocational rehabilitation has been defined as “whatever helps someone with a health problem to stay at, return to and remain in work” 1 (p10), as this includes routine healthcare and workplace management in addition to more structured vocational rehabilitation interventions. Evidence shows that many people have common health problems and injuries (mild/moderate musculoskeletal, mental health and cardio-respiratory conditions) whose conditions should be manageable and are therefore a prime target for vocational rehabilitation in the UK.1 Informed by reviews of effectiveness evidence, Waddell, Burton and Kendall 1 set out a series of evidence statements relating to common health problems, highlighting evidence to inform practice including, for instance, the importance of coordinated action, clear communication between all players, and early intervention. This review highlights:

  • a strong scientific evidence base for many aspects of vocational rehabilitation.[1] For instance, effective return to work and vocational rehabilitation intervention depend on healthcare that includes a focus on work and workplaces that are accommodating; both are necessary and inter-dependent.

  • that improved communication between all players leads to faster return to work and less sickness absence overall, and is cost-effective; and that the duration of sickness absence is significantly reduced by contact between healthcare provider and the workplace.[1]

  • there are good epidemiological and clinical reasons and widespread acceptance throughout the literature that early return to work and stay at work approaches are appropriate and beneficial for most people with most musculoskeletal disorders.[1]


A more recent study proposes that there remains mixed evidence in relation to the impact of return to work rehabilitation for low back pain. It was noted in this study that few studies have return to work as an outcome, but found evidence for a clinically relevant effect of multidisciplinary interventions on return to work.[2]

Informed by reviews of effectiveness evidence, NICE public health guidance 19 Managing long-term sickness absence and incapacity for work sets out a set of generic principles and recommended actions to guide primary care services and employers.[3] This includes a recommendation that organisations commissioning services for individuals who are unemployed and claiming incapacity benefit or employment and support allowance should commission integrated programmes to help claimants enter or return to work (paid or unpaid).

Small and Medium Sized Enterprises (SMEs) are known to have low awareness of occupational health risks and also have specific needs based on their size and potential lack of resources to support staff health and wellbeing. However, there is currently a lack of evidence on effective occupational health and vocational rehabilitation models in SMEs.[1]


Scottish policy note:
The Scottish Government supports an increase in the use of case management approaches. The National Programme Lead for the Delivery Framework for Adult Rehabilitation, together with regional Rehabilitation Co-ordinators will ensure that all NHS vocational rehabilitation services adopt case management approaches.

In Health Works and the Framework for Adult Rehabilitation the Scottish Government set out a clear commitment to developing coordinated vocational rehabilitation and return to work services. Those in work who acquire an illness or injury that compromises their ability to work are at an increased risk of losing or regaining employment.  Three Working Health Services Pilots will provide evidence on the efficacy of a dedicated, case managed vocational approachS. The Scottish Government will build on learning and evidence from these. The DWP’s Fit for Work service pilots will provide further evidence of early intervention models that can support a return to work. 

The Scottish Centre for Healthy Working Lives provides a range of information and advice for employers and employees through a comprehensive website, free and confidential telephone advice line, and a network of advisers. The Centre has been tasked to improve and develop its reach to SMEs with accessible and easy to use advice on workplace health and wellbeing. The Centre is working to broker services for clients with Occupational Health providers, assisting them to ensure limited resources are positioned in the most appropriate place.

Territorial NHS Boards are to work with local employability service providers to define the local pathways for providing support to those for whom health is a barrier to retaining or returning to work.


  1. Waddell G, Burton AK, Kendall N (2008). Vocational Rehabilitation: What works, for whom, and when? A report for the Vocational Rehabilitation Task Group. The Stationary Office: London.

  2. Norlund A, Ropponen A, Alexanderson K (2009). Multidisciplinary Interventions: Review of Studies of Return to Work after Rehabilitation for Low Back Pain. Journal of Rehabilitation Medicine 41: 115-121.

  3. NICE (2009). NICE public health guidance 19 Managing long-term sickness absence and incapacity for work. NICE: London.