Summary of case studies

Injury	Rehabilitation provided	Start of intervention	Outcome	Lessons learned	Cost of treatment v. savings
1. Spine injuries and concussion resulting from slip and fall from back of lorry	Occupational Health Adviser (OHA) arranged for medical treatment to be carried out privately saving 3 months for a neurosurgeon appointment and 12 months for an MRI scan. MRI scan revealed best treatment was physiotherapy and graduated return to work in less demanding role.	3 months	Employee was working at normal capacity 13 months after accident.	Early medical treatment can speed up return to work. OHA intervention can improve motivation to return to work.	Costs: medical treatment £1034. Savings: Employee was off work for 10 months instead of an estimated absence of > 2 years
2. Severe post traumatic stress disorder (PTSD) following severe burns to hands trapped in machine	OHA liaised with injured person’s GP and representative to provide psychological input. Severe PTSD was diagnosed and treatment continued for 12 months (alongside NHS treatment for the burns).	1 month	18 months after the accident the employee was ready to return to work on a gradual basis. OHA persuaded HR not to dismiss him and he returned to work the following month.	The employee’s PTSD was so severe that without OHA input it is unlikely he would have been able to resume any form of employment.	Costs: £5,170 for non-NHS cognitive therapy. Other costs £16,675. Savings: Employee returned to work after 19 months instead of possibly never returning to work.
3. Knee injury following 7.7m fall from height through trap door	OHA arranged physiotherapy for back, knee and ankle pains. Knee was slow to respond so OHA arranged for a private orthopaedic consultation, MRI scan and the further physiotherapy required.	Immediate	Employee returned to his normal job at work 12 weeks after accident.	Early involvement of OHA and early medical treatment can speed up return to work.	Costs: £1,226 for physiotherapy, orthopaedic consultation and MRI scan. Savings: Employee returned to work after 12 weeks instead of an estimated absence of 15-17 months.
4. Knee injury following slip on wet floor	OHA arranged physiotherapy for knee injury. Knee was slow to respond so OHA arranged for a private orthopaedic consultation, MRI scan and the further physiotherapy required.	Immediate	Employee returned to his normal job at work 4 months after accident.	Early involvement of OHA and early medical treatment can speed up return to work.	Costs: £2,995 for physiotherapy, orthopaedic consultation and MRI scan. Savings: Employee returned to work after 4 months instead of an estimated absence of 15 months.
5. Knee injury following trip over waste material on floor	OHA arranged physiotherapy for knee injury. Employee returned to work during treatment and resumed her normal work following completion of treatment.	1 month	Employee returned to her normal job at work 1 month after accident.	Physiotherapy can significantly speed up return to work.	Costs: £164 for physiotherapy. Savings: Employee returned to work after 1 month instead of an estimated absence of 2-3 months.
6. Lower back injury following slip/trip on uneven tile	OHA arranged physiotherapy for back injury that was slow to respond. OHA arranged for a private orthopaedic consultation and MRI scan that revealed surgery was required. Postoperative physiotherapy and hydrotherapy were then provided.	2 months	Employee returned to his normal job 8 months after the accident	Early medical treatment, physiotherapy and hydrotherapy can significantly speed up return to work.	Costs: £8,630 for physiotherapy, investigations, surgery and consultant fees. Savings: Employee returned to work after 8 months instead of an estimated absence of 23 months.
7. Groin injury (hernia) while moving heavy machinery	OHA arranged for hernia repair to be carried out privately saving 10 months on NHS waiting time. This brought forward rehab. treatment by 10 months.	1 month	Hernia repair operation carried out just 2 months after accident and employee returned to work 2 months later.	Early medical treatment can speed up return to work.	Cost: medical treatment £1,700 Savings: £13,700 (ie £14,400 sick pay less treatment costs)
8. Amputation of right arm and leg resulting from serious road accident	After 6 months of medical treatment for his injuries, the employee (an engineering craftsman) was offered a full rehabilitation package comprising advice, support, different job, adapted work equipment, mobility/access needs etc.	Immediate	Employee returned to full-time desk-based work within 12 months of the accident and continues to lead a normal life.	A full rehabilitation package allowed the retention of a skilled and valued worker	90% of cost of specialist equipment was paid through access-to-work scheme. Reduced cost to company through reduced long-term absence and no ill health retirement cost.
9. Back pain caused by slipped discs	Company provided private physiotherapy until NHS physiotherapy was available. Company corresponded with consultant leading to an operation to free a trapped nerve being brought forward. Risk assessments set out appropriate work regimes both pre- and post-operation to ensure rapid return to normal work.	Immediate	Employee (cold store operative) has returned to full duties and is pain-free. Instead of being off work for 10 months, he returned to work (on graduated hours and restricted activity) after just 6 weeks.	A full rehabilitation package allowed a valued worker to return to work more than 8 months earlier than would otherwise have been the case.	Reduced cost to company through reduced long-term absence.
10. Acute knee pain and associated disability affecting mobility and car driving	Company assessed the situation and provided funding for an MRI scan. Six weeks of physiotherapy was provided following a knee operation.	Immediate	Employee (a manager) was absent from work for only 2 weeks, during which time he worked from home. He no longer has pain or a knee disability.	Quick intervention by the company prevented the manager working below full efficiency and in pain for an extra 3-6 months.	Cost of MRI scan and physiotherapy was offset by not paying long-term sickness and not having disruption to the manager’s department.
11. Recovery from heart attack	Company occupational health department monitored the case allowing employee to return to work on reduced hours and with limited physical activity both prior to his heart artery bypass operation and following surgery. However there were difficulties in making the rehabilitation fully effective.	Immediate	Employee returned to work 4 months post-operation and within a further 3 months was on full-time hours and performing well.	Employee suffered unnecessary anxiety during rehabilitation due to poor support from his line manager. Teamwork is essential to overcome such issues.	Total disability cost was higher than necessary as employee was absent from work longer than was necessary post-operatively due to anxiety/concerns about returning to work.
12. Rehabilitation from type 2 diabetes	Employee attended a routine medical check-up provided by the company’s occupational health department. Symptoms caused concern and subsequent investigation revealed type 2 diabetes. The company put in place a full rehabilitation package to protect the employee’s health and allow him to work normally.	Immediate	A medical condition was detected that would have gone untreated for years resulting in sickness absence, reduced productivity and serious medical complications. He now works full shifts and is coping well.	Routine medical surveillance can pick up serious illnesses early, to the financial benefit of both the company and employee.	Intervention by in-house occupational health department at no additional cost. Without intervention employee would have had increasing sickness absences and his ability to work would have deteriorated.
13. Low back injury caused by lifting, exacerbated by a trip	The employee was visited at home by an OHA and advice given. Following 6 weeks absence he returned to work with a full rehab. package in place offering reduced hours, easier work, manual handling training and physiotherapy.	Immediate	8 weeks after returning to work the employee was back at his usual work having made a full recovery.	A carefully thought out return-to-work rehabilitation package ensures less chance of the injury repeating itself.	Employee was only off work for 6 weeks following rehabilitation intervention, reducing an extended sickness absence considerably.
14. Back pain caused by lifting	Company occupational health department (OHD) provided advice and guidance at a home visit prior to arranging physiotherapy and light duties on return to work.	Immediate	Employee was absent from work for only 6 days (despite a GP's sick note for 4 weeks)	Early intervention and physiotherapy is beneficial.	Reduced, and possibly extended, sickness absence was avoided.
15. Back pain resulting in long-term absence (30 weeks)	Company OHD obtained specialist advice and provided treatment comprising advice, physiotherapy and acupuncture.	6 months	Following a return-to-work risk assessment it was judged that the employee could not safely return to her previous job, and no others were suitable.	Early intervention is very important for treating back injuries. Physiotherapists dealing with such cases should be trained in workplace occupational health.	This case was very expensive for the company, resulting in an experienced worker being absent on sick pay for 30 weeks before being discharged on medical grounds.
16. Lower back pain in ‘shunter’ driver	Driver was assessed by the company’s OHD, followed by an extended course of physiotherapy and acupuncture and easier driving duties. A further absence due to back pain led to reassessment and light office duties.	Immediate	This case has been ongoing for a year and is continuing. The driver wishes to return to driving duties and should do so soon.	Earlier restriction on driving would have been beneficial and may have reduced sickness absence. Physiotherapists concerns that physio was not working effectively should have highlighted the OHD to a more serious complaint.	Intervention by in-house occupational health department at no additional cost. Sickness absence costs could have been reduced had the OH team not been so new and not fully aware of the situation.
17. Back injury caused by lifting trays from a machine	Employee was given immediate advice by the company’s OHD on how best to treat the injury. He returned to work a week later and under the company’s rehabilitation programme was put on light duties and restricted hours for 1 week. The OHD provided physiotherapy and further advice.	Immediate	Within 3 weeks of the injury the employee was back to normal duties and hours.	Intervention by OHD immediately after the injury was beneficial. The rehabilitation programme ensured the employee could return to work early without risk of further injury.	Intervention by in-house occupational health department at no additional cost. Sickness absence costs were minimised by the rehabilitation procedures in place.