When you first meet someone, you will probably have disclosed, directly or indirectly, what work you do before the end of the conversation. It is equally likely that you will ask yourself what job the other person undertakes. Work, or more accurately the productive activities we undertake and our roles, defines us and is an essential part of our being. When illness limits our ability to work or prevents work, the psychological effects are as significant as the physical effects. Vocational rehabilitation is a vital part of rehabilitation, not well provided in the NHS. Tow organisations are covered on this page. The Vocational Rehabilitation Association is a provider of rehabilitation services (here). The Shaw Trust is a social purpose organisation focussed on supporting disabled people back into work (here). On 20th December 2021, the British Society of Rehabilitation Medicine published revised guidance on Vocational Rehabilitation. Although referred to as Brief Guidance, it is in fact a 24-page, excellent guide to all aspects of vocational rehabilitation, written in conjunction with the Vocational Rehabilitation Association. (here)
Vocational Rehabilitation refers to rehabilitation that, as its primary goal, aims to establish a person who has a disabling disorder in a sustainable work role. Work is often assumed to equate to paid employment. However, some people cannot sustain full-time work. Some people with a disabling illness cannot deliver work of the economic value expected in the role. Some people cannot undertake paid employment at all. For these individuals, vocational rehabilitation may have a part to play in identifying a sustainable, productive but unpaid role for the person. These might range from being a volunteer in a charity shop or other charitable organisation to being a hospital or care home visitor through undertaking productive hobbies such as pottery or painting.
Vocational Rehabilitation in the UK
It is said, without evidence, that “vocational rehabilitation providers have been practicing since the early 1900s”. (Tim Dawson, Previous Chair VRA) This statement probably referred to ensuring a person had medical treatment for any disease or trauma. A focus on returning to work, usually as a soldier, has also probably existed even from Roman times for people injured in war. Rehabilitation after war injuries during and after World War I had employment, including sheltered and supported work as a goal.
The second World War precipitated change. The word rehabilitation was first used in 1940 to describe the process of returning wounded soldiers to active work. For example, Queen Mary’s hospital in Roehampton specialised in rehabilitating people who had lost a limb during the war. By 1945, there was a network of convalescent and rehabilitation centres around the UK for disabled servicemen and women. (here) The first UK rehabilitation centre – the Egham Industrial Rehabilitation Centre – was opened in 1946. The National Health Service started in 1948 and, by 1951, it was responsible for most of the vocational rehabilitation services. Organisations such as Remploy provided sheltered employment.
Vocational Rehabilitation was fully integrated within the NHS until about 1980 when reforms gradually led to the loss of almost all specialist centres. As someone researching into stroke, in 1983, I was asked to provide a review of Garston Manor Rehabilitation Centre, near Watford. It offered vocational rehabilitation with a separate, small rehabilitation service in a large house. It closed within about five years. I am not sure that my report had any actual influence!
The Department of Employment took over vocational rehabilitation, but it had no relevant expertise. During the 1990s, the number of people receiving support for unemployment due to disability grew considerably. Association does not prove causation, but it is a reasonable hypothesis that there was a causal relationship. (here)
The British Society of Rehabilitation Medicine (BSRM) published its first report on Vocational Rehabilitation in 2000. It published a second edition in 2003, and a report focused on rehabilitation after traumatic brain injury n 2004. A further report, Vocational Assessment and Rehabilitation for People with Long-Term Neurological Conditions: Recommendations for Best Practice, was published in 2010. The BSRM has just published a new report on vocational rehabilitation.
Last, politicians and the NHS acknowledge that vocational rehabilitation is vital for patients after trauma and Covid-19.
The Vocational Rehabilitation Association
The Vocational Rehabilitation Association (VRA, here) aims to “support practitioners to develop their professional knowledge and skills and increase awareness of the role and benefits of vocational rehabilitation and return to work support for employers, commissioning services, human resources, occupational health and other others within the world of health, work and wellbeing.“. It was registered as a charitable organisation in 1996. Its objects, as registered with the UK charity commission, were:
- To promote the professional knowledge, attitudes and skills of people practising in the field of vocational rehabilitation.
- To contribute towards the development of quality standards and training in vocational rehabilitation practice.
- To promote equal opportunities within the field of vocational rehabilitation.
- To increase awareness and recognition of vocational rehabilitation.
- (added later) To provide a vehicle for the exchange of ideas and experience across the UK
The Association has both individual members and organisational members. The individual class of membership depends upon the extent of a person’s experience in vocational rehabilitation and their qualifications. The Association supports professional development and learning in various ways: webinars, courses, conferences and free online Continuing Professional Development modules.
The Vocational Rehabilitation Association has advice for people who have a disability (here), including an extensive list of agencies and organisations that can help. It provides support and training for practitioners.
The Shaw Trust
Another last voluntary-sector organisation promoting employment for people who have a disability is the Saw Trust (here). Its history is summed up in a single sentence, “Having grown from humble beginnings in 1982 in the village of Shaw in Wiltshire, finding jobs for disabled people, today we are a complex and diverse charity committed to employment as the core pathway to a better life. “
It is heavily committed to helping people obtain or return to work, or to remain in work. It has a range of services, shown here. These services include providing education for children. This seems to be in keeping with a less health-oriented approach. The approach seems, from the website, to be educational, supportive, and aimed at facilitating the person to achieve.
Contribution to the rehabilitation community.
Having one or more productive roles, undertaking activities that increase the richness of society in some way will undoubtedly be beneficial for a person’s well-being, general health, and self-esteem. Equally certainly, rehabilitation services in the UK do not provide vocational rehabilitation to meet the population’s needs. Although most rehabilitation professionals are aware of the importance of a person having a vocation, they do not have the expertise needed, nor are there adequate resources.
Many organisations need to work together to achieve success: employers, employees, occupational health services, the department of work and pensions, and health services. Educational services will also often have a role. Moreover, the rules around financial support (e.g. Universal Credit) often adversely affect success, making success much more difficult.
Organisations such as the Vocational Rehabilitation Association and the Shaw Trust bring a wealth of expertise and experience in negotiating this quagmire. A second major contribution will be a different approach with a greater emphasis on education, training, and social skills. The Shaw Trust in particular probably works within a different cultural setting, one that would expand rehabilitation practice.