Improving Access to Vocational Rehabilitation: Scaling Up

The Case for Vocational Rehabilitation

9 in 10 people return to work when they have access to Vocational Rehabilitation.

That single statistic, noted in Sir Charlie Mayfield’s Keep Britain Working Review published last November, should stop us in our tracks. We have a model that works. We have the evidence. And yet the majority of working people in the UK cannot access it. Not because vocational rehabilitation is unproven, but because it has never been built to scale. 

Right now, vocational rehabilitation remains largely a one-to-one service: effective but rationed by circumstance. Whether you benefit depends not on clinical need, but on whether you happen to work for the right employer, hold the right insurance policy, or find yourself on the right health pathway. For everyone else the system simply isn’t there or they are not aware which insurance policies may offer it. 

The Keep Britain Working Review estimates that economic inactivity costs the UK economy £150 billion in lost productive capacity. Those out of work for less than a year are nearly five times more likely to return than those who remain inactive for longer. Every week without early, structured support is a week closer to a much harder journey back. 

So, the question is not whether vocational rehabilitation works. It’s why we’re still leaving so many people without it and what it would actually take to change that.  We asked Dr Julie Denning what she thought…

 

Vocational Rehabilitation – Scaling up 

Written By Dr Julie Denning AFBPsS, Founder and CEO, Working To Wellbeing

Vocational rehabilitation is one of the best kept secrets in the work and health ecosystem.  Most people have heard of occupational health, but when vocational rehabilitation (VR) is mentioned, faces go blank.  So for clarity, here is what the Vocational Rehabilitation Association defines VR as:  

Vocational rehabilitation is the biopsychosocial process of enabling people who have disabilities and/or health conditions (including illness and/or injury) to remain in, return to, or gain employment or vocation. (VRA 2025). 

It has been referred to as an approach as much as an intervention by Waddell, Burton and Kendall (2008) in their seminal work; Vocational Rehabilitation: what works, for whom and when?  The VRA extended this thinking to consider how practitioners work in the ‘spirit’ of VR, namely to:  

• work in an inter and multidisciplinary way.  

• include all stakeholders to smooth the pathway back into work.   

• be action orientated and ‘do the doing’.   

• have a ‘can do’ approach, focusing on strengths and capabilities to build on.  

• flexible, creative and adaptive.  

• focus on the whole individual. 

It is important to understand this backdrop of VR to see that it can be as much a way of thinking and as a ‘thing’ as Jeremy Clarkson would say. It can be operated in the clinical and non-clinical space and enables people to remain in, recover in and return to work as well as reach for work.  Knowing this scope of VR helps to understand the challenges of scaling up this very powerful ‘thing’ to ensure there is access for all.  

 

How can VR be scaled for greater reach? 

There are several factors to take into account when scaling up to reach a wider population.  

Firstly, work needs to be considered a health outcome.  If this were the case, then every clinician would include work as part of their clinical dialogue and goals for those of working age.  Work would immediately be ‘on the table’ and open for discussion.  

Secondly, work needs to be considered as part of the recovery process and the myth that someone needs to be 100% fit (lets face it who is ever?) before they return to work, be debunked.  This is something that employers can really embrace, and VR practitioners are ideally placed to support them.  

Thirdly, a robust biopsychosocial triage process carried out by a VR practitioner needs to happen to ensure that people get the support that they need, when they need it.  Currently there is a tendency to either be too light touch or too heavy-handed which means that interventions aiming to support people with their work needs miss the mark and are costly.  

 

VR as prevention 

Scaling up can be considered from a prevention perspective. In the space of VR, early intervention can be interpreted as prevention; namely to prevent people from falling out of work in the first place.  The literature has consistently stated that in order to help people remain in work, intervention must happen as early as possible.  The moment someone falls out of work, the clock starts ticking and the likelihood of them returning without support decreases every month. Indeed, at 12 months the chance of someone returning without assistance is around 3-8 % (The Health Foundation 2025). Increasing access to VR earlier, results in numerous efficiencies and usually for all stakeholders involved in the process.  Insurers and employers in particular have much to gain from such an approach, including preventing claims and enabling employee productivity through improved wellbeing.  

 

The role of technology 

Technology can also be used to facilitate increased access to VR support.  Telemedicine enables clinical conversations to be delivered remotely thus facilitating smoother healthcare transaction. It can avoid unnecessary and time-consuming trips to clinical outposts, and potentially avoid flare ups of symptoms due to the effort of face to face contact. If at work, employees can avoid taking time off work, thus preserving financial stability.  There is plenty of evidence pertaining to the efficacy of telemedicine and telehealth care as modes of delivery bringing clinical and financial efficiencies.   

A lesser consideration of the benefits of telehealth in a work context is the ability to join the employer into the conversation.  It strips back barriers to engagement and brings work much more directly into the conversation.  Gone are the days of sending letters to advise line managers of return-to-work plans.  Those plans can be co-developed within a meeting and shared so that regular updating can be easily managed, even when VR intervention has ceased.   

AI within VR can also facilitate scaling up, creating efficiencies of time and resource.   For example, less time laboriously report writing (albeit always checked by a human) and more time to meet with more people to discuss their work needs and goals.   

 

Improving reach and avoid the pitfalls 

In summary, VR in its essence is something that can be scaled up and more people can gain access to it.  For those insurers, employers and government personnel who are keen to develop VR that is clinically effective and fiscally sustainable, bear the following in mind: 

Often 1:1 support is seen as labour intensive and costly and there is a drive to establish group working, engagement in apps, pre-recorded training or signposting to community and other resources, as way of reducing costs and being able to reach a wider audience.  However, human beings are complex.  They don’t learn through information alone and engaging in behaviour change in a work context is challenging and hard to do without human support.  In the drive to create efficiencies and improve reach, a cautionary note must be struck.  Identikit methodologies won’t cut it.  One size won’t fit all.  Resist the human tendency to oversimplify and reduce to a single part.  People are complex, workplaces are complex, to ignore this will be to the cost to all.   

The key takeaway, scale Vocational Rehabilitation wisely and it will definitely pay everyone dividends. 

 

Industry comment 

Written By Jo Throp BSc (Hons) OT, CEO, Krysalis 

‘Scaling vocational rehabilitation provision is about prioritising timely access to the right support, recognising the opportunity to improve work outcomes and the claims experience. For neurological conditions and neurodivergence, this requires specialist expertise to define need and use clinical insight to illuminate real‑world work demands and potential. Early intervention and collaborative working, enables more sustainable functional outcomes and more appropriate allocation of resources.’ 

‘Effective vocational rehabilitation is rarely delivered in isolation. The greatest impact comes from genuine partnership between rehab professionals, claims teams and employers – supporting better outcomes while fostering shared learning and a culture where work potential is actively explored rather than limited by assumptions.’