Kathryn:       Hi everyone, this is episode 12 of season three and I have Chrissy Clark with me, from Health Claims Bureau.  Hi Chrissy.

Chrissy:       Hi Kathryn, good morning.

Kathryn:       Good morning.  Today we’re going to be focussing upon how rehabilitation services work, sort of like when it comes to insurances.  We’ve all heard of them and we know what they are, but do we really understand them?  This is the Practical Protection Podcast.  So, Chrissy, how are you doing?  I know we’ve just sort of like said you’ve a little bit of hay fever starting today, is that right?

Chrissy:       Yes, I feel today that I am the embodiment of what I always say that just because I’m not feeling 100%, I can still be a useful member of society and a member of your podcast for today, but yes, apologies if I sound a little bit congested, shall we say.

Kathryn:       You sound absolutely fine and any sneezing will just – it will just add to the atmosphere and that’s fine and we can always put a little bit into the transcript as well.  I’m looking forward to Lindsay having like a little kind of you know, thing saying ‘sneeze’ [laughs] and we can go forward from there. Well, I think possibly people listening, they might be a little bit confused if they listened to the last one, because I said, after the last episode, that I was going to have a masterclass with Alan about critical illness, but we have a puppy and we got a puppy three days ago and I’m sure everybody can understand that we are now, just as you would do with a new born, we are alternating things at the moment, so us both taking part in a podcast doesn’t really work and also, we’re kind of just all over him, we’re just smushing him so much, he’s so gorgeous, so trying to tear Alan away from him is not happening and it’s lovely that we’re going to be able to, in a sense, bring this episode forward a bit and have a chat through things.

I think that what would be quite good is sort of like to start off, because we’ve got a complete mixture of people listening to this, we’ve got advisors, we’ve got insurers, we’ve got underwriters, administrators and we’ve also got businesses as well and I think that this is a really good episode to sort of showcase what actually happens, you know, if we have something like group income protection in place with a company, what that benefit can really be to the person and also to the employer.  So, a little bit of a background on me, Chrissy, I know we’ve spoken before, but just to give a bit of a recap obviously, so Chrissy, I know we’ve had a little bit of a chat before, but just a little bit of a recap on what I do.  So I advise on insurances like income protection and part of what I do is explain to people when they are wanting to arrange it, that if they are ill, the insurer’s going to step in help with their rehabilitation.  What they’re also going to do is try and step in before a claim has even started.  So it’s kind of a proactive intervention rather than it having to be reactive.

So you know, hopefully before a claim has even started, people like yourself have come in, you’ve provided support, the person’s better, they’ve not even had to reach the stage of making a claim even, so it’s kind of a – it’s a win-win for everybody.  And I know all that, but it’s also quite hard to know how that actually works, so if somebody is involved in supporting policy holders this way, where does it all start and when do you tend to step in and get involved?

Chrissy:       Yeah, it’s a really, really good question, Kathryn and I really love the fact that the word proactive was kind of thrown in right in at the beginning of the whole podcast.  Obviously, we do work for different insurers and different employers directly so it’s not always the same path for everyone, but in general, particularly on the group income protection products we support with, the employer will notify the insurance provider that someone has become absent from the workplace or is at risk of becoming absent from the workplace and I’ll kind of come onto that in a minute.  But normally, they will notify the insurer and the insurers that we work with have spent quite a lot of time and effort really encouraging employers to let them know as soon as possible once that person has become absent and certainly in the four years that I’ve been working in the industry, we have noticed notifications coming in two weeks, three weeks after someone’s become absent, whereas I believe historically, three or four years ago, we were seeing people at 16 weeks or 20 weeks.  Particularly if it’s a 26-week deferred period, it was giving less wiggle room, so I can definitely see there’s been an improvement in that early notification.

But yes, we will be informed as soon as the insurer’s aware that someone has become absent from the workplace and the referral that we’ll get from the insurer will really have as much information as the employer or the individual has provided to them.  So, in some cases, we actually have a very expansive idea of what’s going on for someone, when we first receive a referral.  In other cases, it a very small amount.  And that doesn’t really matter because the initial conversations that our team will have with the person who’s absent from the workplace, is really wanting to understanding in their own words where they’re at with their health and what they perceive the difficulties are.  I did mention a little bit earlier on about in some cases supporting people before they’ve even become absent and we are starting to see this a little bit more with employers and insurers that we’ve worked with for a long time. They can see that there’s actually benefit to them or there’s benefit to the insurer, there’s benefit to the employer, but there’s a huge benefit to the employee if they can be supported to stay in the workplace, maybe with some short-term adaptations or kind of, yeah, short-term amended duties so that they never get to the point where they have to identify themselves as kind of an unwell person or someone who’s absent from the workplace.  So I think we all know that is a huge knock to someone’s confidence if they find that their health circumstances or their social circumstances have led them to not be able to continue in the workplace even for a short amount of time.

Kathryn:       I think that’s absolutely true as well, you know, we have somebody, I’ll chat a little bit about it, we have somebody that works for us who’s been on – needed to make a claim on our group income protection.  And just being clear, this isn’t something that’s linked to yourselves at all, it’s somewhere separate and the confidence is a big thing of them coming back and sort of like I think as well, the longer you’re away, you’re kind of – the more nervous you become about your own health and what that actually means going forward and then as you try and sort of like put things in place, it’s a case of – well it kinds of keeps living it as well, you know.  In a sense it prolongs it even more so, even when you’re trying to reintegrate, which is quite interesting.  We’ll chat about that a bit more later.  So, I think, you know, once you’ve been told, you know, you’ve got somebody there that you know has, is needing your support, so what happens in a sense, once you start getting involved?  I’m guessing there is some specific kind of case handlers, that there’s assessments done, like a co-ordination of therapies and things like that.  How does it work?

Chrissy:       Absolutely.  So, at the moment, thanks to the wonder of the pandemic, I will try to keep my comments on that subject to the bare minimum for now.  I think everyone’s probably a bit tired of talking about it.  But a lot of our work is done virtually rather than in person, face-to-face assessment, but in some ways that does enable us to really look out what the main reason for absence is and match the best case manager based on their experience and their expertise to that person’s needs.  So, we have a very expansive – I’m lucky, a very good, diverse team of clinical case managers who are made up of adult general nurses, mental health nurses, physiotherapists and occupational therapists and they’re spread all over the country, as our clients are spread all over the country.

Kathryn:       Okay.

Chrissy:       So when an initial referral comes in, we’ll look at the main reason for absence and sometimes it’s kind of a bit generic, but in other cases, we’ve had some really, really specific ones and knowing the backgrounds of all of our case managers, we can then pick who is going to have the most insight, or maybe most experience with working within that environment.  So, we will engage that case manager to make an initial conversation with the employer before we speak to the employee.  That’s really to understand the background from the employer’s perspective.  Obviously from the beginning, we’re going to be starting to think about the ultimate goal being return to work, so we will always want to understand from the employer what they are comfortable with and what they are able to facilitate in terms of maybe amended duties or a phased return to work but also in some cases there may be more than meets the eye.  There may be a health issue but there may also be a workplace issue as well.

We would really want to understand that before we enter into a conversation with the employee, because I think if we don’t have those conversations at the beginning, we can be working with a certain perspective and we’re missing half of the pieces of the puzzle which can delay conversations that need to be had or referrals that need to go in to really address all of the needs in that situation.  It’s also really good for the employer to feel that they are a partner in the whole process because they absolutely are.  There is no point us working with the employee to get them ready to go back into the workplace to then find that the employer may not feel confident in supporting that person, particularly if it’s a more complex physical health condition or in some cases some complex mental health situations, sometimes that people have become very unwell in the workplace and have had to kind of be rushed off to hospital directly from the workplace.

So sometimes there can be a real fear around, “How are we going to support this person when they come back?”  So we always want to make sure the employer is happy, a) from a designing a return to work that meets their needs, as much as the employee’s needs but also supporting the people within their team and within the HR department that everyone feels confident that this is going to be a successful return to work.  That would always be the first place we’d start.

Kathryn:       Yeah.  I think it’s really important as well from like an employment point of view.  I’m not saying this is necessarily where you guys would step in, but obviously as an employer, it’s making sure that, it’s that fine balance of, you know, you need to be able to support your team to be rehabilitated, because there is actually a legal requirement and potentially, a disability – sort of like, when we talk about the legal side of things, the Disability Act and the Equality Act in terms of making sure that you do reasonable adjustments and whilst that can be a little bit grey, the same point is always, you know, you’re probably going to need to take some kind of legal counsel at some point on it.  But then having you guys there to step in and really say, “Well actually, these are tried and tested things that have happened before, for people in these, you know, these health situations. This is what we’re assessing everything at, this is how you can help this person going forward.”  It kind of feels like it’s not just the case of, “Right, we’re going to get somebody back to you as quick as possible in rehabilitation.”  It’s actually probably taking away and helping the company against a certain level of risk that they might actually be seeing, if they don’t fully take control and don’t fully support that person back into the role.

I mean, there are certain things and certain job roles and duties that obviously, depending upon somebody’s health, it would be a case of, “You know what, this is probably going to be much more of a long-term claim type situation.”  Which is – like you say, is perfect when you’re going in there and you’re speaking to the employer first, to sort of like really establish, “Right, what is going on here, what do they need to do, what are the responsibilities, what are the duties?  And we’re going to try and figure out if that’s still possible at the moment.”  And I think that sounds exactly how it should be working.  I know you mentioned a little bit before but, you know, we’ve all heard about, you know, I think the words ‘presenteeism’ and ‘long-term absenteeism’ are words that are being bounded about, especially the last couple of years or so and it can really affect somebody’s ability to work.  So I suppose, what is the benefit of accessing the support services as soon as possible, from in a sense the client’s point of view and also from an employer who is offering this out to their team?

Chrissy:       Yeah, absolutely.  So presenteeism, absenteeism, what’s interesting is that the data still shows that presenteeism has more of an impact for an employer and kind of across the employment sector in the UK costs billions more pounds a year than absenteeism does and we’ve had experience in the past where we’re working with one member of a team, particularly around a mental health situation, there may be some workplace stress in there, that person works in quite a small team and there is very much that sense that the feeling that that person has starts to seep out, if you will, to the rest of the team.  So there is a risk from an employer’s perspective that if you just think, “Well, everyone’s in the workplace, they’re present from nine to five, I don’t have a problem.”.  But what can be going on behind the scenes is a growing sense of disconnect, a perceived lack of support from your employer.

I think support from an employer is a huge factor in whether you’re going to be able to sustainably return someone to work.  So if the perception is that if you’re not supported to address your health and wellbeing needs in the workplace, that is a big risk factor to someone, or more than one person within a team, to become absent and we have seen that in the past – suddenly, a flurry of referrals have come through, all from one company and when you look at it, it’s all from one department within one company, so I think that presenteeism is a risk in terms of mental health.  Obviously, what we’ve seen in the last year or so, with everyone working from home, the risks of presenteeism around physical health, so going into the workplace when you’ve got a really bad cold, probably the flu, or going in when you’ve been unwell the night before and the general advice is if you have had a gastrointestinal bug – I’m going to use the technical terms – I realise it’s before midday, but if you’ve had a bug along those lines, we know that you should be absent from work for 24 to 48 hours.

Kathryn:       Yeah.

Chrissy:       In a lot of cases, people don’t follow that and so suddenly you see a whole spate of people becoming absent and obviously these are short-term absences, but that will have an impact on the productivity of an employer, if suddenly half of your kind of call centre staff are all off at the same time with norovirus – obviously that’s going to have a huge impact.  But really, looking at the – really the absenteeism or the presenteeism that goes on for a longer time, the risk that we see in people who have been absent for a long time before we have been able to get in and to support them is quite significant.  We know that the data suggests that once someone’s been absent from the workplace for more than 26 weeks, the chances of them going – getting sustainably back to work long-term drops by more than 50%, which is a significant hurdle for us.  And we also know that conversely, those who are referred to us in the first four weeks of absence, we can – through the data that we’ve seen over thousands of cases that we’ve worked on, we can get more than 90% of people back to work within four weeks providing they are – the notification that they’ve become absent is received really as close to kind of day one of absence as possible.

Kathryn:       Absolutely.  I think I saw something – I know that you were talking there about how long it can be, I think I saw something in one of your materials or something, where it said something like, “If somebody’s more than 26 weeks, that it’s less than 5% of people are able to get back into the workplace,” and that’s something that really stands out for me because, as I say, we have a member of our team who’s been on long-term sick and we have, you know, insurances in place and it was six months.  I think, because obviously with everything that happened last year as well, I don’t think that helped the situation.  It was six months before the rehabilitation team were notified to give us support and to give that person support and that was despite obviously being where we are and knowing what we do, we contacted very early on and to try and get that all in place.

And obviously, touch wood, we feel very lucky that this person is now getting the opportunity to reintegrate back and I think, most important with that and for me just to say with anybody else who’s in a similar situation is, is in a sense, not to give up, because for our employee there has been a very big kind of disconnect between the support services that can be provided by a company such as yourself, but then there are certain things for their situation that’s required very specific support from NHS services as well.  And it’s until sort of like, that side of thing is kind of restarted in the NHS and sort of like made available again, there’s always going to be for this person sort of like a bit of a barrier to be able to like fully start to integrate.

So I mean at the moment, they are on a phased return with us and that’s kind of like, you know, when we were chatting earlier, I was saying about how it can really knock their confidence.  You know, for this person it has really, really knocked their confidence, because they’re almost sat there just like, “I’m absolutely fine,” you know, and they feel absolutely fine, they just want get back into things, but there’s still so much that still needs to go on in terms of support, to try and make sure that everything’s okay from everyone’s point of view and that there isn’t that – we don’t inadvertently go into kind of presenteeism without realising it and sort of like doing that at quite a – a phased pace.  And I imagine maybe for a lot of small firms who I know – a lot of small firms are the ones that tend to have the group insurances, I think, you know, in the grand scheme of things, I think it’s probably in some ways quite tempting to go, “Well actually, they’re coming back now, so we’re okay, let’s get them back in, let’s get them back in.”  Because small firms, you know, someone who are really dependent upon your staff and it’s, you know, somebody that’s gone, it’s a big shock to the system in many ways.

But I liked what you were saying then about not going into the offices and into work if you’ve got the stomach bugs – and I’ll just say stomach bugs, I’m not going to go into the fancy terms that you use, because it made me think of my children at nursery and obviously if the children are sick or have a stomach bug, that’s it, you are absolutely, you are not going anywhere near that place for two days, whereas as adults, we can’t really say that to each other, can we?  It’s not really a done thing that if someone tells you, “Ooh I’ve got a bit of a dodgy tummy,” you can’t just go, “Get out,’ you know, “Go home and you’re not here for two days.”

Chrissy:       Absolutely.

Kathryn:       I’m going to say it, with some of my team, in all fairness the way that we talk to each other, maybe it’s our Northern lingo, we would probably just say that to each other, it’s just a case of, “Just go home,” and they’ll probably be like, “Oh my word, thank you, I’d love to go home,” kind of thing.  I don’t think it’s nice for anybody to be in an office situation like that.

Chrissy:       Yeah.  No, absolutely and I, I have told my colleagues in the past to go home.  It’s interesting – if you work within the NHS, they’re actually – they are – they follow the nursery model.

Kathryn:       Okay.

Chrissy:       Coming out of the NHS into the private sector, that was quite interesting when I started working and there was almost – I think there’s almost the perception it’s kind of a badge of honour that despite the fact you’re, you’ve got a sick bucket under one arm, or your leg’s hanging off in he workplace and that used to be, “Yes, well done you!”  And you’re like, “No, that’s –”

Kathryn:       Absolutely.

Chrissy:       “Madness.  What are we doing?  We don’t want staff to – we shouldn’t be flogging staff half to death and then for them to become absent for a significant amount of time, whereas if we just put that kind of short-term support in place for them in the first place –

Kathryn:       Yeah.

Chrissy:       Maybe they’re absent for a couple of weeks, or in the case of your stomach bug, a couple of days, but that short-term impact is more than made up for by the fact that yeah, a) you’re not losing other members of the team to an infection but the perception from the employee that they are truly supported –

Kathryn:       Yeah.

Chrissy:       Holistically, not just in whether they can meet their targets but whether they’re able to be healthy and happy in the workplace and we see time and time again the gratitude of employees when they are supported effectively by their employer and it needs to be very little things, maybe engaging in a return to work kind of keep in touch couple of sessions with someone, again going back to that confidence, or even kind of speaking to the employer about, “Right, I’m coming back into work, I don’t really want to have the same conversation 20 times about why I’ve been absent, so can we just agree something that can be shared with everyone before I come back in?”

Kathryn:       Yeah.

Chrissy:       Seem like really little kind of common sense things but so often, I think because people think they’re little and they’re common sense, they can get overlooked.  And in so many situations when we’ve supported someone kind of clinically through the medical reason for their absence, the barrier to return to work isn’t the medical condition, it is the concern about those water cooler moments, the social aspects of going back into the workplace and in some cases physically, “How am I going to get into the workplace?”

Kathryn:       Yeah.

Chrissy:       And so, yeah, I think we do need to make sure that we’re seeing that person as a whole when it comes to their absenteeism or their presenteeism behaviour and more often than not, it’s not the medical reason that’s really disruptive to their productivity in the workplace.

Kathryn:       Absolutely and I think that, sort of like just before I go onto the next bit, I think it’s like a little extra sort of extension to that as well, is the fact to sort of say, “We’ve proven for well over a year – the majority of people have proven that they can remote work and so if, for some reason, somebody has developed a medical condition which is making it hard for them to get in the office, but they can still be very productive at home, just let them carry on as before.”  You know, there’s, you know, if they’ve been productive all this time, they’ve still been able to do their job duties, then there’s no reason to in a sense force that person into the office or, like we were saying there, with a stomach bug or something.  “You’ve had those remote working practices in place for such a long time, don’t lose all that positivity that you have sort of like inbuilt into the culture and everything, by supporting people to be at home, by just suddenly going, ‘Oh, well everything’s –’” I was going to say everything’s coming back to normal but obviously I’m touching wood, but we all know it’s still hanging there a bit.

Chrissy:       Yeah.

Kathryn:       But I suppose a big part of this role that the insurer takes in getting – so we’ve got – obviously we’ve talked about the clients, so the clients making people involved.  Sorry, clients, I say sort of like the policy holders, so the people who actually come and buy the insurances, it’s making people aware, “I’m not well.”  And then we know that the employer has then got to really quickly remember and hopefully, remembers very quickly that they’ve got these insurances in place and the main thing then is for the insurer then to obviously step in as quickly as possible.  I know I’ve just mentioned obviously a situation where it’s took a long time with us and I know you were saying a few different ones, but what kind of turnaround times – I know you say that you work on a number of different insurers and companies, but say like for yourselves at Health Claims Bureau, what would be the kind of turnaround?  So say like, somebody has come to you and said, whether or not it’s the insurer or an employer, they’ve come and they’ve contacted you and they’ve said, “Right, we’ve got a member, they’re not well, we need you.”  How long does it take for you to step in and how long would you say on average you would usually see an insurer or a company getting in contact with you?

Chrissy:       Really good questions.  We’re fortunate with one of our biggest clients that they have worked – our biggest insurance clients, they have worked really, really well and really closely with their employers to really kind of hammer home that message that kind of, “Let us know straight away.”   So normally we would see for them a referral coming in within kind of the first one or two weeks since the person’s become absent from the workplace and when the referral comes through to us we will – as long as the employer is happy and occasionally employers do not want to speak to us and that’s absolutely fine, but if they’re happy for us to contact them, we will allocate that out to the case manager the same day, or obviously if it’s two minutes to five the next day, we have to look at this realistically, and then our case manager will immediately try to make contact with the employer to start that kind of process and that understanding of the perspective from them.  And once we’ve heard from the employer, we will follow the same time frame to speak to the employee as well.

So, in the best case scenario, we will refer a case to our case manager in the morning.  Hopefully they’ll be able to get hold of the employer by lunchtime and then can be speaking to that employee by kind of the afternoon.  What we would never do, we would never kind of cold call, I guess is the best term for it.  We will make a phone call just to introduce ourselves.  In a lot of cases, the employer has done a brilliant job of making the employee aware of exactly what our support service is for them, but there are occasions when there might a kind of a bit of a disconnect there, so our initial conversation is always just to introduce the nurse or the physio and to explain what the process is, make sure the person is still happy, because it is a voluntary service, make sure they’re happy to engage and then we will make an appointment for a time that is going to be right for them.

In some people’s cases, particularly if they’ve got cognitive issues, mornings might be a much better time of day for them than afternoons.  In other cases, someone may want to have an advocate or a family member or a friend present, so we will always do our best to accommodate exactly what that person needs to feel comfortable in undertaking the initial assessment.

Kathryn:       That sounds a brilliant turnaround time from yourselves, in terms of, you know, sort of like you know, I get that, completely understand the two minutes to five thing.  I think, you know, we all have to understand that sometimes it may not be necessarily the same day [laughs].  We have to make sure that everybody takes care of ourselves.

Chrissy:       Absolutely.

Kathryn:       And make sure that we obviously are having our time to be able to shut the computers off as well, but no, that’s an incredible turnaround.  I think, if I’m right, that you possibly have some case studies for us, where you’re going to be able to explain where you guys have been able to step in, in different situations and just how important these rehabilitation services can be.

Chrissy:       Yes, absolutely.  So I’ve got a couple of case studies for you.  But I did just want to touch back on something that you mentioned earlier, with employees who are really motivated to get to work and it really kind of rang true with a case I’ve worked on previously.  A chap who had suffered a significant car accident and had broken pretty much every bone on one side of his body.

Kathryn:       Oh wow.

Chrissy:       And he was, he was recovering, he absolutely was recovering and he was desperate to go back to work and he worked in a very highly specialised industry in a very key role, where concentration and focus was crucial to the impact on everyone else really kind of within the business.  And when I met him first off, I thought this was going to be a relatively straight forward referral.  This, you know, this chap’s been off for X number of months and he’s really motivated to go back to work.  Fab!  When I spoke to him, he was still taking quite a significant amount of opiate medication, so he could really turbo charge, in his mind, his physiotherapy.  So he was taking a lot of pain relief to really kind of do – like three times what the physio was expecting him to do every day, because he thought that was what he needed to do and could do to kind of almost cheat his way to recovering more quickly than the specialists had told him.  Obviously, that wasn’t going to be in the best interests of the employer and it wasn’t going to be in the best interests of the employee as well because he had – if we’d supported him to go back to work at that point in time, it was highly likely he would have made a significant error, which would have been absolutely devastating to him and his sense of his role within the company.

And so, in that case, we had to have a conversation around how we could maximise recovery and how the way he was doing it wasn’t the way to achieve that.  But we did speak to the employer and found some aspects of his role that were not the, not the kind of, crucial, crucial side of things, so he could start to reconnect, so kind of clearing his old emails.  That might normally be something I’d suggest to an employer before someone comes back, but in his case he really wanted to do something so it was just kind of doing that kind of tidying – tidying up of bits and bobs, maybe sitting in the background listening into meetings, so he wasn’t contributing and no tasks were being assigned to him, but he was able to safely do a little bit whilst we got his recovery back on track.  So, sorry to jump another case study in there.

Kathryn:       No, it’s brilliant.

Chrissy:       Sometimes the motivated employee, I mean, they’re wonderful, but they can almost be harder to work with than people who are kind of feeling resistant at that point in time.

Kathryn        Yeah.

Chrissy:       But yeah, one of the case studies I wanted to share with you was a situation where someone was still in the workplace.  We spoke about that at the beginning, so this was a gentleman who had quite a significant mental health condition.  He was schizophrenic.  He had been known to our service before, so he’d been absent for quite a long while, but it was a couple of years earlier, but the case manager he’d worked with then was still working within the company.  So, we had a referral we received from his income protection employer – insurer, sorry – to say the employer is worried, they’re starting to see some of the behaviours that they saw last time, which suggested kind of a ramp-up in his mental health condition.  They’re starting to see that again now and they want to see if there’s anything we can do to support him to stay in the workplace, but to seek early treatment so that he didn’t become as unwell again.

Which was wonderful, it was so positive to hear that and for the insurer to see that it was far better to do a kind of that short, sharp intervention at the beginning, than for him to become absent because he was absent for a significant period of time previously and had been on claim for a short amount of time.  So thankfully yes, the case manager who he developed a really good rapport with and he still remembered her name, which was wonderful and we were able to reallocate the case to her and it was supportive for him that he didn’t have to go through everything he’d been through in the past and give a kind of – an expansive history, but they could also look at some of the plans and safety netting that had been put in place the first time round and they were able to use that almost as a framework to discuss where he thought he was at with his mental health at that point in time.

Because I think perception of where you’re at with your health as opposed to where other people might see you with your mental health, there can be a bit of a disconnection there.  But because they already had that positive relationship, they were able to have some of those more frank and, shall I say, open discussions from the beginning about the concerns that people in the workplace were having about certain behaviours that he was doing.  And I think, by being a service that is led by clinicians, so kind of the nurse, physio, OT’s, we are afforded – and I’m sorry insurers who are listening to this podcast, we are afforded, I think, a little bit more leeway to ask some of those uncomfortable or difficult questions, in our initial interactions with people that, that can really get to kind of what the root issue is.  But in his situation, we got the feeling that he wasn’t saying anything to anyone, but he was worried about his mental health but didn’t really know where to start with addressing it again.

So, being able to speak to the same person and look at everything that had been put in place the previous time and we’d supported the design of something called ‘A Wellness Recovery Action Plan’, which is very much a kind of roadmap of if we see these certain symptoms, these are the sort of things we’re going to think about doing.  So, he felt listened to and supported and we weren’t really telling him anything he didn’t already know, but he just needed that person to be a guide and to be a support for him, while he went through that.  And he did – he was able to sustain remaining in the workplace, the employer thankfully facilitated him having time off for kind of appointments that he needed to have.  And some short-term amendments to his day, giving him a place to go and kind of decompress when he needed it, reducing the targets that were expected from him in the workplace, just gave him that breathing space to focus on what he needed to.

And the case manager, I think she only needed to spend about four weeks supporting him, so it was a really short, sharp intervention just to get him back on that even keel and get him engaging in the services that were available to him.  And then she was able to step back and thankfully, we’ve not heard anything again, which is always good news in our industry.

Kathryn:       Absolutely.  That sounds like a brilliant one to have been so proactive and I think, I imagine for him as well, I suppose some people would maybe be a bit nervous if their employer was sort of like saying, “Hang on a minute,” you know, sort of like, “I’m thinking you’re maybe being a bit symptomatic,” you know, but really good that they took that step and had that confidence to reach out to yourselves and to sort of like restart everything.  That’s a really lovely one.  There’s another one as well, I think you were going to go through.  Is that right?

Chrissy:       Yes, there is and I will try and keep the medical lingo down to a bare minimum.  I apologise, we do like silly terms in medicine, I think.

Kathryn:       It’s alright.

Chrissy:       But this gentleman, it was a really interesting case.  He initially presented with what seemed like a very straightforward appendicitis.  He then became very unwell very, very quickly and actually spent a significant period of time in intensive care, which is unusual for an appendicitis, particularly in this chap, who was a relatively young gentleman, with a younger family.  He didn’t have any comorbid conditions and he’d actually been very physically active.  So there was nothing to indicate that he would have such a significant reaction that, yeah, he developed a significant infection and ended up in ITU.  He was ventilated for quite a long time.  So, when the case was eventually referred to our team, obviously he had recovered from that initial infection phase but he had been left with quite a significant respiratory problem, which comes along quite often if someone has been ventilated for a longer amount of time.

He’d also developed a neurological condition and he had various symptoms related to the initial infection that had impacted his spine and his bladder.  So, there was a lot going on there for him.  Unsurprisingly, and we see it quite often when someone has been admitted to intensive care, there are mental health issues that come along with that for people, particularly if you’ve not been an unwell person before.  He suffered with post-traumatic stress and a longer-term depression and he was also reporting cognitive difficulties, kind of – we hear this term quite a lot now, but if someone’s been ventilated, obviously they’re under heavy sedation and it does have an impact on their kind of cognitive abilities.  They report something called brain fog, it can have longer term fatigue impact to it.  So, there was a lot going on for this gentleman and he was having a lot of support from NHS services at that point in time to understand and to go through a lot of the symptoms that needed addressing, particularly kind of the bladder issues and the neurological issues.

He was receiving some physiotherapy and NHS physiotherapy is very, very good at doing kind of the basics to get you back up and functioning at home.  But what they don’t have the capacity to do is really that kind of vocational focus to the rehab.  So really looking at what that person wants and needs to be able to do to get back into the workplace.  So, once we’d made our initial assessment, it was clear that there could be some dovetailing of – we have a partner service, a partner physiotherapy service, that we were able to refer him into to really help him with his musculoskeletal and his respiratory function.  They are still very much a work in progress but he is seeing some improvements from that perspective.  We also, thankfully, had a very supportive employer, and so they were happy to facilitate an advanced workstation assessment to really look at all the wonderful ergonomic kit that is available.  Obviously, this was a very specialist assessment because of his needs.  And we were also looking at adaptive software that could be put in place in the workplace.  So, pulling all of those things together, we have managed to achieve – he is working three days a week.  So, he is currently on a proportional benefit.  He is doing three days a week but spread over five days and in his case, some of the adaptations are – mornings are very much his best time of day, so he is doing the majority of his work in the morning, but he is really – we’ve helped him design a pacing process throughout his day so that he can have breaks and then be able to concentrate again and then have another little break.  So, he’s really optimising the best times of his day but without completely exhausting him.

Kathryn:       Yeah.

Chrissy:       Yeah.  We’re lucky the employer and the insurer have both been incredibly supportive of this and although he is still on the proportional benefit, he’s not fully on claim at this point in time, so it’s a bonus for the insurer.  The employer is getting a very well-loved employee back.  The employee is, bless him – if either the insurer or the employer ever needs a – kind of a, positive statement, he is the gentleman to give them kind of a little soundbite.  He is absolutely thrilled by the support he’s received from both the insurance side and the employer side.  And I can’t say whether we’re fully going to get him back to work, but I thought he was just a really, really good example of someone with, on paper, a significant amount of barriers to return to work.

Kathryn:       Yeah.

Chrissy:       But these people absolutely shouldn’t be written off.  We know the data shows that someone who is out of work long-term will be at a much higher risk of contracting some of the more chronic conditions that can actually lead to a – kind of a shortening of lifespan.  So, you’re at much higher risk of Type II diabetes, high blood pressure, other cardiovascular conditions if you’re out of work.  Much as we might not all feel like going to work on Monday morning, it’s good for our health and that’s just on the physical side.  It’s absolutely good for our mental health as well to have that structure and have that routine to our day.  And for this chap, it was his kind of – his number one goal was he wanted to be able to see himself back in the workplace and doing something productive.  So, his was kind of another good news story that, yeah, let’s not write these guys off.  Yes, it’s hard work and our case manager is still supporting him quite a long way down the line, so he’s very different from our short, sharp example in the previous one, but it’s absolutely the right thing to be doing.

I’m just so thankful for him, he has the right insurer and the right employer supporting him and enabling him to do that.  So yeah, he’s my little positive, bless him.

Kathryn:       Absolutely.  I think what’s, like you say, a stand-out from that, is that I mean, just generally, from a human side of things, you know, we shouldn’t write people off in that kind of a situation.  I don’t think, well I hope, that there’s not many people that would look at that and just go, “Right, that’s it, you know, not going to have this person back.”  But as well, from like an employer’s point of view, you’ve got somebody there who is highly skilled, highly trained, yes they need to work a lower amount of hours but, you know, do you do it sort of like – do you do something where you try and retain that person and maybe bring in another person part-time to work alongside them, that they can learn from that skillset, learn from that knowledge and everything?  Or do you start from scratch with somebody brand new?  And, you know, the loyalty that he must feel towards his employer as well must be absolutely phenomenal.

So, I think there’s so many different ways of looking at this and looking as to why it’s the right thing to do.  We’re coming towards the end of the episode now, I think it’s been really, really good to sort of like bring home and hit home how this works and how it actually has practically worked for those case studies.  So, I know you’re with Health Claims Bureau, so obviously I’ll just give you maybe a few minutes to just chat a little bit about Health Claims Bureau and there’s also, I remember us chatting about sort of like options about coming into organisations as well, that you’ve got something that’s been in place and something new that’s maybe coming along?  So if you can tell us all about that, that would be amazing.

Chrissy:       Yeah, no, absolutely.  So yes, obviously at HCB early intervention is very much our kind of bread and butter work and whether that’s as we’ve talked about today, with the support of your income protection insurer or whether it’s direct from the employer, that’s very much where our work starts.  Having – sorry, can you hear that?

Kathryn:       I can hear your dog, that’s fine [laughs].

Chrissy:       Stop!  Apologies.

Kathryn:       No, no, no.  I want the dog in the podcast, I love it.  Just carry on [laughs].

Chrissy:       There we go.  He has been good and quiet for a while now, so –

Kathryn:       Brilliant, yeah [laughs].

Chrissy:       [Laughs] But yes, outside of the early intervention work that we do, we do have a service that is called ‘Health in Hand’, that was really starting to gain traction in 2019 and the very beginning of 2020 and then unfortunately the wonder of Covid came along and it’s been paused.  But the Health in Hand is very much kind of a menu, we like to call it, of proactive kind of health and wellbeing interventions that we can put in place for an employer based on whatever – either something the employer has identified in the workplace as a common theme or something that they really want to focus on with their health and wellbeing during that year.  Or they can be tied in with the kind of NHS public health campaigns.  So, in the past we have done blood pressure clinics for clients around the ‘Know Your Numbers’ campaign.  We’ve done – our physios have done some musculoskeletal sessions, we’ve done stress management in the workplace.  Obviously during Covid we’ve done quite a lot around remote working and kind of maintaining work/life balance.  But we can do things along the lines of checking blood sugars during kind of diabetes, for diabetes sessions, really the list kind of goes on and on.

So the Health In Hand gives you a kind of a pick list that you can choose from to kind of design what support you might want during the coming year, but what I would say is that anything that’s not on there, it isn’t a ‘no’, it would just be maybe having a conversation with us and seeing if it’s something that we could do or it might be something that the partner services that we work with might be able to deliver.  So, the early intervention is very much kind of our day-to-day work, but I think if you’re interested as an employer in kind of nipping things in the bud before they get to the point that we’re having to support people going back into the workplace, that can be really, really crucial.  And in some of the cases that we’ve worked on, someone might have become physically unwell in the workplace with, say, a kind of epilepsy or we have had some cardiac issues in the workplace for some of our employers and really to support the employees in understanding what they’ve seen their colleague go through, particularly around things like kind of epilepsy, or someone with Type I diabetes, who’s had a hypo in the workplace.  Supporting the staff to understand what’s happened there and to be able to support them – help them support their colleague in the future is really useful.

But also, in those kind of sudden life events that we can see around cardiac conditions, kind of the conditions that can come along if we’re not prioritising our health – our physical health or our mental health.  Putting something in place as early on as possible, I think is really, really key and interestingly, in one of the blood pressure sessions that we’ve delivered in the past, we did identify two members of staff with eye-wateringly high blood pressures who were able to go and see their GP that afternoon and were yeah, speedily encouraged to access medication and referral to specialist services to prevent a catastrophic illness coming along for them.

Kathryn:       Yeah.  So potentially, in many ways kind of life-saving in some ways, you know, for people in the insurance world listening to this, it’s kind of like, in some ways, you know, sort of like doing a pick and mix of potentially the free kind of medicals, or health MOT’s that we see that are offered with some insurance policies.  And for my insurance every year, I can access, sort of like a mini medical.  I get my cholesterol checked, my blood pressure, what – other things, I get plenty of things checked all in one go and I think it’s always that kind of thing that it’s so much better to be preventative, rather than reactive.  So that’s brilliant.  So how do people – obviously insurances wise, insurers can come to you, set up relationships with you.  Organisations, so employers, what do they do, do they just – in sense, do they just look for you on the internet, see whereabouts you are and get in contact?

Chrissy:       Yeah, absolutely.  We have – obviously we have our website, we’re on LinkedIn, we’re very, very lucky, we have a super marketing support, so we are on Twitter as well, but yes, insurer, employee, employer – if you can find us under hcbgroup.co.uk – there’s a contact form and there’s our phone number, there’s the email address for our enquiries inbox, so you would be able to start that conversation and we will come  back to you.  We do also have quite an extensive suite of technical services, which one of my colleagues is far more skilled in and so once you’ve had that initial conversation with us, if that looks like something that could be of benefit to you, particularly for insurance clients, we will always make sure that you are put either to the right person, so whether it be a clinical issue, you might come to me, if you’re looking more at that kind of – those technical services, then I can direct you to my colleague, but yes contact us through the website and we’ll see what we can do.

Kathryn:       Fantastic.  Thank you so much for your time today, Chrissy, it’s been absolutely lovely to chat to you.

Chrissy:       Thank you so much Kathryn.  I’ve really enjoyed it and appreciated having the forum to talk about what we do.

Kathryn:       Absolutely.  I think it’s incredibly important.  So, next time, I’m going to be back soon and I’m going to be speaking with Peter Maynard about how underwriting manuals are developed, how these are used by insurers and the role of the manual and automatic underwriting.  If you would like a reminder of the next episode, please drop me a message on social media or visit the website practical-protection.co.uk and don’t forget, that we are now sponsored by Octo Members and you can now get an accredited CPD certificate for listening to this episode and again, please just contact us through the website to get that.  So thank you again, Chrissy, it was lovely speaking to you.

Chrissy:       Thank you Kathryn.

Kathryn:       Bye.

Chrissy:       Bye bye.