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Return to work (RTW) after the COVID-19 lockdown

Posted by Ann Caluori | Mon, 18/05/2020 - 09:50


Guest blog by Professor Kim Burton OBE, Lorraine Anderson-Cole and Jennifer Remnant


Supporting people back to work is not just about the economy - there are substantial personal and social benefits. These benefits though come from good jobs, jobs that are safe and supportive. COVID-19 is going to reshape the nature of work, and it is crucial that we ensure that altered jobs are good jobs in order to maintain work ability as well as safety.


Return to work (RTW) has three meanings in the coronavirus context:

  • For those working at home, the challenge is return to the workplace.
  • For those who have been not-working, the challenge is returning to work.
  • For those who have continued working, the challenge is maintaining work ability.

* Return to Workplace requires actions to support groups of workers. * Return to Work involves actions to support individual workers.

* Maintaining work ability is essential for all.


Effective support in this changed context must be flexible, imaginative, responsive, and adaptive. Workers who do not have the benefit of formal occupational health (OH) services will be reliant on their line managers having the right understanding, skills, and tools.


General principles

Helping workers return safely and productively will be a considerable challenge. Employers need to prepare a written plan for how to manage the situation both at the group level and the individual level. It must be agreed through collaboration between all relevant players: managers, HR, OH, workers, unions. The complexity of the plan will reflect the size of the organisation: it may be a bullet list of actions or a wider ranging document informed by departmental priorities – importantly, all actions must have a responsible person/department allocated.


It is important to acknowledge that some workers will return to work with common physical and mental health problems. And they will have additional concerns and uncertainties related to COVID-19. Reducing uncertainty and fostering resilience will help workers engage with the new ways of working: acknowledge struggling and support problem-solving.


While coronavirus-specific actions are covered in SOM's new toolkit Returning to the workplace after the COVID-19 lockdown, the generic OH Support approach to RTW is:

  • Identify needs
  • Develop plans
  • Implement actions
  • Review and revise

(all the above both at group and individual levels)


Core actions

Focus on ensuring the workplace is safe and minimises the risk of spreading the coronavirus. There will be a measure of conflict between the needs of the business and the safety of workers. Employers will need to reconcile this through collaborative actions to minimise risks and maintain work ability. (There is special guidance in the toolkit on necessary risk assessments related to COVID-19).


Generic actions are simple in principle - and effective if actioned:

  • Provide accurate advice about COVID-19 to reduce uncertainty and encourage compliance
  • Assess risks - come up with controls
  • Stay home in case of COVID-19 symptoms or suspected transmission of virus
  • Regularly wash hands with soap and water or clean with alcohol solutions (70%)
  • Maintain physical distance (2m) between people
  • Sanitise communal surfaces and objects; reduce sharing of objects; wash clothing regularly
  • Ensure good workplace ventilation
  • Develop and deploy smart working solutions
  • Do not recommend unnecessary PPE
  • Support safe transport

(adapted from Belinghiri et al. Occup Med 2020;70:82-83)


Good jobs

Newly altered jobs must be as good, satisfying, and comfortable as they can be. Good jobs help resilience - the way jobs are organised can help people deal with unavoidable discomfort and irritation.


The principles of good jobs, with tools for how to provide them, are available in the evidence-informed Health-Work Toolbox. password = goodwork2020. [Presently hosted by University of Huddersfield, the Health-Work Toolbox is being made freely available as part of this SOM guidance. The Toolbox stems from an HSE commissioned research project (RR1035)][1].


The characteristics of good jobs are:

  • Balanced demands and a safe work environment
  • Effective and supportive line management
  • Feeling valued and a respected member of a team
  • Opportunities to use and develop skills
  • Support and opportunity for workers to solve their own problems
  • Support to make improvements to the job
  • Opportunities for social interaction

* Senior Management sets the approach. * Line Managers make it happen. * Workers contribute to the process.


Supporting individuals

Workers will still struggle at work with common health problems, irrespective of the pandemic. They may be problems that emerged since leaving work, or pre-existing long-term conditions, or difficulties in recovering from COVID-19. They all need OH Support to make a sustained RTW and to maintain work ability. (There is special guidance in the toolkit on how to manage workers who become symptomatic with COVID-19 while at work).


A first step in supporting work ability is to recognise struggling workers. Line managers are key to identification and to making things happen. A lot can be done in the workplace to maintain work ability in the face of illness.


Workers need to know how to report work-relevant symptoms, and to whom - it may be OH or their line manager - this should be part of the written plan discussed in General Principles above. Individuals’ difficulties then need to be accommodated through specific job modifications that form part of an agreed RTW Plan.


Line managers and OH Support providers need to be able to:

  • Adopt a biopsychosocial approach
  • Recognise when a colleague is struggling to cope with symptoms or injury
  • Respond to anyone who reports symptoms or is off work
  • Evaluate their work ability (i.e. how they are coping with work and health)
  • Identify any obstacles to staying at work or getting back to work
  • Agree an individual RTW Plan that sets out job modifications to overcome the obstacles
  • Help people build up gradually as they recover
  • Review progress

A wide range of tools to action each of these steps, along with explanations and examples for small as well as large organisations, is provided in the Health-Work Toolbox. In particular, there is extensive information and advice on workplace accommodation to help maintain work ability for workers experiencing work-relevant health problems.


[1] The Health-Work Toolbox contains a variety of tools to help you manage health at work. The framework has three key areas - Knowledge; Good Jobs; Supportive Workplaces - each with three sections - Overview; Detail; To Do - with links to more detail about the ideas, actions, and Resources. While the Toolbox is a primarily for line managers, it also will be useful resource for OH Support providers, helping to promote a consistent approach to workplace health.