CPD: OH and HR working together to support long Covid

Many people are still experiencing the debilitating effects of long Covid. This presents an opportunity for OH and HR to work together to facilitate a successful return to work, utilising their different skillsets, writes Lesley Macniven.

The significant rise in ‘economically inactive’ people since the start of the pandemic, to over 20% of working-age adults, according to the Office for National Statistics (ONS), has prompted concern. With vacancies running at record levels and hampering economic recovery, we must take action.

Understanding the cause and impact of this requires a multiple-perspective analysis, not just an economic one. A colleague and I, from the multi-disciplinary consultancy ‘Long Covid Work’, have spoken to various newspapers about this, adding the perspective of those now ‘inactive’ as a result of the substantial, long-term adverse effects of Covid-19.

Looking at the experiences of people with long Covid, many of whom are now economically inactive as a consequence, allows examination of the role of occupational health and HR, and how the professions should be open to collaboration, and to understand where their expertise ends and when to take advice from others.

I have been analysing the impacts of the Covid-19 pandemic from a strategic HR perspective. However, I did not anticipate the huge numbers who would not fully recover until I found myself in that situation. I met many others suffering with long Covid online. These connections became a patient-led Long Covid Support Facebook group, which now has approximately 60,000 members worldwide.

Few saw this coming; Covid-19 has been the single largest disabling event since the Spanish flu epidemic. Therefore, over the past three years, individual patients have often had to advocate for themselves.

How many have long Covid?

Studies have found that more women than men experience long Covid. The monthly ONS statistics consistently suggest around two million people have been experiencing ongoing symptoms for at least four weeks following infection. At the time of writing, more than half of that number had been ill for at least one year, while 30% had experienced long Covid over two years.

With over one million people effectively disabled and incapacitated for over a year, it is accepted that this group contributes significantly towards this spike in the economically inactive, though accurate data is not available. What will prevent the other million people, ill for less than a year, suffering a similar fate? I posed the question in an article in the Guardian:  “What percentage of our working population has to become disabled by this before we realise that [long Covid] is a chronic problem? We have this massive cohort of half a million people who have been ill for over two years.”

Rethink how we manage illness

Living with Covid requires a rethink of how we manage illness, retain staff who become ill, and fully recognise this as a strategic challenge for the economy, employers and workers.

Individual patients, line managers or GPs cannot solve this problem. While the National Institute for Health and Care Excellence (NICE) recognised the condition in 2020, there are still no recommended treatments. The best outcomes tend to come through excluding or identifying other conditions, providing some symptom relief, supported self-management and the hope the body can heal, to an extent at least, over time.

Many long Covid patients have said HR processes and procedures for sickness absence did not provide the necessary support for recuperation from this illness. The phased return period did not work well. As Kirsty Stanley recently commented in the New York Times: “They basically expect people to go from potentially zero to 100… What happens is people crash.”

Managing these new challenges requires problem-solving approaches on a case-by-case basis, taking into account the individual, their role, the availability of flexible accommodations or an alternative hire.

Role for both HR and OH

Navigating complex negotiations with employers while ill, fatigued and with cognitive issues, often exacerbated by stress, is far from easy. HR staff are not medically trained and thus ill-equipped to appreciate how to proceed.

I have learnt what a key role occupational health can play in creating the opportunity for a rounded, solution-focused but realistic dialogue between all parties – patients, HR and line managers – backed up with objective medical opinion. Where collaborative approaches are done well, a staff member can be saved from becoming ‘economically inactive’.

The ONS data shows different ‘cohorts’ of people with long Covid. Those, like me, who became infected at the outset, pre-Alpha and pre-vaccines, have been ill for over three years. Chances are a majority are no longer working as they were pre-infection and are less optimistic about making a full recovery in the near future. Some are seeking ill-health retirement, but some of these requests are being rejected on the basis that the illness is too new to know if recovery is possible.

The prognosis for those infected more recently, following vaccination and benefiting from advice to rest and recover, is more open-ended. We have an opportunity to stop them falling out of work and adding to these concerning inactivity figures.

Considering interventions

I’m a founding member of Long Covid Support, a charity formed by a group of ill volunteers that evolved from the peer support Facebook group. An appreciation of the lived experience of those affected is at the heart of all we do.

The first principle of any intervention is to acknowledge that the patient knows more about their illness, capability and personal limits than any ‘expert’. The National Institute for Health Research (NIHR) recognised this need to become ‘experts by experience’ until clinicians and researchers catch up. What none of us have is a crystal ball predicting if or when we will recover; we can however use the general trajectory we are on as a guide.

The second principle builds on the first: listen to the patient and look for ways to add to their knowledge and understanding when analysing the situation. Operational HR staff in the UK tend to rely on a standard sickness policy and procedures for long Covid or ‘Post Covid Syndrome’ (defined as having been ill for 12 week or longer), but the condition is unpredictable. Standard policies and procedures were not written with this type of illness in mind. Line managers should maintain constructive, ongoing communication whilst supported by HR and OH to take a problem-solving approach and be able to explore win/win solutions based on each case.

Whilst taking this individualised approach, each organisation should look at this as a strategic workforce challenge. The pandemic has only made it more difficult for most sectors to recruit and retain talent, and we are seeing people with long Covid losing jobs then being rehired by other employers prepared to support their recovery. Talent retention is usually significantly easier and more cost-effective than going to the market for a replacement, so canny employers will invest in rehabilitation.

Recognise where to get help

The third principle is to recognise where to get help, starting with OH support. As this is a relatively new condition, it’s important for employers to seek advice from OH practitioners who stay abreast of ongoing research and who espouse patient-centred values. The assessment of a patient with long Covid may not be definitive, however, they can have a valuable role in mediating and considering the needs of the organisation and the worker’s capability. Can the person undertake some aspects of their role? How easily could the worker be replaced? Given the current depleted workforce, this will be more difficult than pre-pandemic, especially among key workers in health and social care, education and childcare.

We have also found value in consultations with occupational therapists (OTs) who can focus on adjustments to remove barriers in relation to the time, place or pace of work. A focus on what can still be done is essential to wellbeing but also needs to be realistic. In 2021 several members of Long Covid Support, including two OTs, an occupational physician, a journalist, a former trade union representative and myself (a strategic HR and change management practitioner), formed an offshoot called Long Covid Work. Our key focus is emphasising the multi-disciplinary approaches we embody within our advocacy and consulting work.

Patients often overestimate their abilities, often provoking symptoms to flare-up, and hampering their progress. Over-ambition is generally harshly penalised with this condition, as a majority of those report having to manage post-exertional symptom exacerbation (PESE) through careful pacing. OTs and physiotherapists are upskilling in how to best support patients to understand how PESE works and in pacing activities to promote recovery. Thanks to the work of many advocacy groups, including Long Covid Physio, this support may now be available in certain GP surgeries and NHS England clinics.

The fourth principle relates to how an employer’s actions will be viewed by others; legal requirements and managing reputational risk. People with a physical or mental impairment having a ‘substantial’ and ‘long-term’ negative effect on their ability to undertake normal daily activities are covered by the Equality Act 2010. The Equality and Human Rights Commission states that long Covid will count as a disability if their condition meets the Equality Act disability definition.

The TUC and Long Covid Work surveyed members of Long Covid Support in 2021 and produced a report outlining the issues. In respect of disability, they argued that the government could specify that long Covid should automatically be considered as a disability, taking the onus off an individual having to argue their case, possibly requiring an employment tribunal. In the absence of this provision, the TUC and Long Covid Work both strongly recommend that employers act as if workers “already have the full range of protections afforded by this Act, including making reasonable adjustments”.

Support staff with long Covid

To support staff with long Covid, OH and HR teams should work together to:

1. Review existing policies

Workplace policies should be reviewed in consultation with workers who have long Covid, trade unions and disabled workers to ensure they are fit for purpose, and take the needs of workers with long Covid seriously.

Revisions may be required in relation to longer and more flexible phased returns to work and the impact of energy impairment. Policies must include different scenarios, including the fact that workers might recover after a protracted period while others may never recover fully or return to their previous ways of working.

2.  Consider how to address inequality and discrimination

Consult with unions and staff with long Covid about the best way to remove workplace barriers, determining appropriate solutions, including OH referrals.

3. Review flexible work arrangement

During the pandemic many aspects of work became more accessible. This progression was recognised when the right to request flexible working was recently extended to employees from their first day of employment. It is therefore important to review existing policies with the aim of enabling flexible working for all staff, including those with health challenges.

4. Consider reasonable adjustments

OH professionals can help workers, line managers, HR and union representatives to consider adjustments to a worker’s time, place and pace of work, and any other aids.

5. Record long Covid-related leave separately from sick leave

Employers should record sick leave taken by workers connected to long Covid separately from other sick leave. The TUC guidance on recording sick leave taken by disabled workers recognises that some workers with long Covid may have a higher rate of sickness absence.

6. Plan a return to work, including risk assessments

Planning a return to work should be done well in advance, allowing the best possible chance of success. This should include individualised risk assessments for any activities requiring adjustment on account of symptoms such as fatigue and cognitive debility, helping to prevent the risk of injury to the worker or others. The return for workers in safety-critical functions may be inappropriate until the individual has had the opportunity to test their abilities in a lower-risk context.

 Will this enable us to maintain a healthy workforce?

There is an argument for putting measures in place to limit the spread of Covid at work. However, whilst we live with Covid there are strong economic, organisational and ethical reasons to ensure that, if the worst happens, workers are given every opportunity to recover, remain in work and continue with their careers.

We can work together as professionals towards this common goal.