Rehab Roundtable: Coping with Long Covid in the workforce

mental-health
Symptoms of Long Covid can include fatigue and memory loss

As the government and health practitioners get to grips with the symptoms and effects of Long Covid, insurers have been urged to work with employers to raise awareness of early intervention and services available to claimants.

In the four-week period ending 6 March, an estimated 1.1 million people in private households in the UK reported experiencing Long Covid, with symptoms adversely affecting the day-to-day life of 647,000 people and 196,000 of them reporting a limited ability to undertake their day-to-day activities, according to the latest available data from Office for National Statistics. 

Identifying Long Covid as a significant risk, both to the health and wealth of the UK has been at the forefront for the All-Party Parliamentary Group on Coronavirus.

Speaking at the recent Vocational Rehab Association roundtable on Long Covid, Tom Brufatto from the secretariat of the APPG on Coronavirus said: “We have been investigating, researching, building coalitions and working with parliamentarians for the specific purpose of providing recommendations and solutions to the government to help people, whether in the private or the public sector, and employers deal with the long term impacts of the pandemic.”

Bruffato highlighted that there are “growing significant issues” with employment as a result of the pandemic and the group is working to define and categorise long Covid.

He said: “There is more that we don’t know than there is that we do know. The majority of the data on Long Covid is currently based on self-reporting. It is an umbrella term that we think encapsulates various different conditions that will require separate categorisation and management in the long term, and that is the complication.

“Our number one recommendation to the government is to count Long Covid with a proper definition of various symptoms that it has, capturing the relapsing nature of it and the various grades of severity that it may have.

“We have also been pushing for the guidelines for general practitioners to be able to help people that are living with Long Covid at the moment. At the same time, we have been pushing for recommendations for employers, particularly since the lockdown is coming to an end. We recognise that when it comes to the impact of Long Covid on the workforce that has not happened to the standard that we expect and this causes some problems.”

Bruffato added that the party work had begun looking at categorising long Covid as an occupational disease.

Bruffato was joined by 22 other participants working for insurance companies, rehabilitation providers, and academics.

Symptoms

According to Diane Playford, professor at Warwick Medical School, the difficulty with “post-Covid-19 syndrome” is that it consists of a “cluster of symptoms which often overlap, fluctuate and change over time”.

Playford said: “It’s probably immediately apparent that there are some problems with that as a definition because it leaves patients in a limbo waiting for this formal diagnosis of the post-Covid syndrome.

“What patients are frustrated by is it being treated as a series of individual symptoms and not having these managed in coherent and multidisciplinary way and not recognising how individual symptoms impact each other.”

Julie Denning, chartered health psychologist at Working 2 Wellbeing, pointed out that there is a “lot of data that’s washing around within the insurance sector”.

Denning said: “There isn’t a national Covid register of patients, but the insurance companies have it because they have all their claimants. They have a register of sorts.”

Long Covid

According to the NHS, for some people coronavirus can cause symptoms that last weeks or months after the infection has gone, which is sometimes called post-Covid syndrome or Long Covid. 

There are lots of symptoms that can be associated with Long Covid, however according to the NHS the most common symptoms include: 

  • extreme tiredness (fatigue)
  • shortness of breath
  • chest pain or tightness
  • problems with memory and concentration (“brain fog”)
  • difficulty sleeping (insomnia)
  • heart palpitations
  • dizziness
  • pins and needles
  • joint pain
  • depression and anxiety
  • tinnitus, earaches
  • feeling sick, diarrhoea, stomach aches, loss of appetite
  • a high temperature, cough, headaches, sore throat, changes to sense of smell or taste
  • rashes

“For me, it’s about how the role that insurers play fits into it and how insurers can shout louder about it because they have got a lot of data, a lot of information and are doing an early intervention, rehabilitation, vocational work, how can this body of information get out there?”

Denning added that insurers can communicate with employers and helm them with “upskilling and educating them”.

She said: “They are already doing so much, how can we make the best use of that?”

Early intervention

The biggest concern for Paula Coffey, head of claims, rehabilitation and medical services at Unum, is that claimants are not receiving access to rehab services early on.

Coffey: “Insurers have a huge amount of value-added services – access to counselling, vocational rehabilitation, physiotherapy, there are many things available through our policies.

“The concern is we are notified much further on and that has a negative impact on the duration of claims and complexity of those cases.”

She added that employers know there are services available through the NHS but insurers are trying to reinforce the importance of “we can still add value in those early stages” even though it might not be clear what is driving their symptoms.

Coffey continued: “For a lot of insurers out there there is a focus – and I am hearing it from brokers as well – they are trying to bang that drum because we’ve been on this journey over a number of years, pushing the importance of rehabilitation and the early intervention aspect. We know the success rates are much better from an early intervention perspective.”

Employers are fearful of doing something wrong and pushing their employees with Long Covid syndromes too much, according to Stuart Lewis, head of claims at Met Life.

He said: “It just creates a challenge for us as insurers in order to try and help. We have to talk to our clients or employees about services we have available.”

Claims

Lewis added that it is also important for insurers to consider how they are looking at claims and how they talk to people.

He said: “If we start trying to get claimants to continuously prove they’re still ill with post-Covid syndrome, we’re going to find it really difficult. We’re talking to our claim assessors about bringing out all their soft skills. So your empathy, your active listening, engagement and understanding. If we start late, if we start leading with phones and information and challenge all the time, then people are likely to retreat from us and not engage with the services, which then is counter to the messages that we’re trying to get across to people.

“Claims aren’t black and white, we might need to be a little flexible and where those shades of grey live with Long Covid to get the best outcome, in the long run, is definitely a challenge for us.”

Insurers are already “supporting employers who are reporting employees with Long Covid or Long Covid-related symptoms”, according to Charlotte Bray, rehabilitation clinical lead at Legal & General.

She said: “Our approach is to treat them the same way that we treat all customer who might have needs that are not included in their claim.

“The support we provide is free to those customers, this support is not Covid related, it could be anything at all including free access to psychological support and financial support. The financial impact on out of work claimants can be catastrophic on that individual and their family, so our approach is to support them.”

Time for change

While prior to Covid getting employers to understand the needs of employees dealing with “persistent pain and fatigue” required a “difficult conversation” things changed in the last year according to Beverly Knops, executive manager and specialist occupational therapist at Vitality 360. 

She said: “I am asking for very similar things for people with Long Covid that I may have asked for people with other post-viral conditions. Suddenly employers and HR departments are saying ‘tell us what to do and we’ll try and implement it.

“Now is the moment not just for people with Long Covid but all other health conditions where this whole concept of working with health conditions, going back to work, is going to become possible.

“Things like working from home, even in industries where previously it was not possible, overnight everything can be done at home and there is no going back from that.

“This is our time to actually make really good code changes for the future for everybody.”

 

Vocational Rehabilitation Association

Vocational Rehabilitation - also known as Occupational Rehabilitation - is an umbrella term for a wide range of services. VR helps people who are facing workplace obstacles to stay at work, return to work, recover in work or reach for work. VR practitioners support individuals experiencing difficulty with their health and its impact on their ability to work.

While it recognises that the chances of recovery are higher if practitioners are able to help early on, they can actually help at any stage - whether the client is struggling at work, is at risk of being off work due to a health condition, if they have just fallen out of work, or have been absent for a long time.

While recognising the condition that has brought them to this point, they focus on the future to help the client and their employer identify and remove the workplace obstacles which remain in the way of a return to work.

The Vocational Rehabilitation Association is the membership charity supporting VR practitioners to practice competently and safely within its standards of practice. It also provides continuing education in VR,  curate VR research updates for its members, and provides a community for networking with like-minded practitioners.

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