Return to work

Module created June 2012 - Reviewed May 2020

The industries of Great Britain have a long association with health and safety legislation which spans over 150 years1. The Health and Safety at Work Act 1974, provided the foundations of our existing system2. The result is one of the best health and safety records in the world2, which is illustrated by a 70% reduction in work-related injuries since the introduction of the Act3. Whilst this is in part due to the decline of heavy industry and manufacturing, the significant factor is that of increased recognition and management of risks3. It was recognised at least as early as 2004, that whilst safety in the workplace has improved, health needs much greater recognition2. The HSC (2004)2 said that the:

“HSC, HSE and LAs have done a great job on safety but there is still a huge job to do on health”.

This was echoed by Black3 (2008):

“Although there is widespread understanding of the risks of damaging someone’s health through the workplace, the role it can have in promoting employee’s health and well-being is less understood”.

Until recently, rehabilitation was based on the ‘Biomedical Approach’4 which resulted in many experiencing long-term incapacity. The expectations of health professionals, employers and society in general, as well as those presenting with common health problems resulted in many adopting the sick role4. Waddell and Burton4 argued for a fundamental change in culture towards rehabilitation based on the ‘Biopsychosocial Model’. This was because many who experienced severe medical conditions were working, whilst those with more subjective conditions, known as common health problems, were incapacitated4.   Waddell and Burton4 argued that psychological and social factors had a more significant role than biological for those with common health problems. They4 also highlighted that modern approaches to clinical management stress the importance of continuation of normal daily activities. The expanding evidence base on the relationship between work and health, both for the general population and for those with common health problems, is summarised by Freud5:

“Work fulfils psychological is central to identity and social roles and status, which in turn drives better physical and mental health. The converse is also true: worklessness is strongly associated with poor health, including higher mortality, poorer mental health and higher usage of medical services”.

In 2008, Black3 reviewed the health of the working-age population and made important recommendations on achieving this change in culture. As a result, in 2010, General Practitioners (GPs) saw the introduction of the new Statement of Fitness for Work, the ‘Fitnote’6. Public Health Wales’ GP Healthy Working Wales team has found that on the whole, this has been positively accepted by Welsh GPs. However, despite the optimism, the ‘Fitnote’6 has generated questions from GPs, employers and individuals. One such question is procedures to follow/ length of time before a patient should return to work, following surgical procedures.


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