Process for returning to work

The previously mentioned occupational health assessment should identify the ongoing physical, cognitive and emotional difficulties that a brain-injured employee has, and these will need to be taken into consideration when planning the return to work. Specifically, in planning the return to work, employers and employees will need to discuss:

Both sides may be assisted in this discussion if the employee is supported by a colleague, trade union representative, friend or family member of their choosing. It is also usually helpful to take notes of the meeting and allow the employee time to consider and comment upon the notes (with the help of a companion if necessary), to make sure that everyone has understood what has been discussed and decided upon. Timeframes for next steps can help to alleviate an employee’s concerns about what is going to happen, and these should be recorded in any notes. If the timeframes cannot be met, then the employee (or employer) should be informed about this, the reason for the delay and what the new anticipated timeframe is.

It is important to consider the particular employee’s needs when assessing whether they can return to their previous role. Even someone with a relatively minor brain injury may need to move to a different role if it’s not possible, with reasonable adjustments, for them to continue in their previous role.

For example, an accountant who has suffered a stroke resulting in ongoing physical disability, but with their pre-injury intellect intact, may well be able to return to their pre-injury role provided they have the correct assistive equipment and support.

Conversely, a plumber suffering a similar injury may not be able to return to the same role because of the physical demands of the job. A truck driver who suffers from epilepsy following a brain injury won’t be able to continue in the same role, given the restrictions on driving for epilepsy sufferers.

Employers are under a duty to consider alternative employment for employees who are unable to continue in their previous role and if suitable employment is available, to offer it to the employee. For example, if the truck driver in the above example works for a distributor that also runs warehouses, they may be able to work in an administrative role in the warehouse instead.

Employees who have been offered a different role by their employer should seek specialist advice on their options if they have concerns. Employers need to remain aware of their legal obligations, and should seek advice from a specialist in employment law if they are unsure about the process of offering an alternative role to an employee.

An employee who has a brain injury may need to gradually increase their working days/ hours to ease their transition back into working life. For most, their workload will need to be reduced, even if this is just in the short term. This is known as a phased return to work.

A phased return to work can also include a mix of working from home and working from an office/on site, if that is required by the job. This can allow the employee time to get used to working again, without the added pressure of having to travel. Whether this will help the employee will depend on their individual circumstances, including the views of the employee.

An employee with a brain injury may need their working hours to be reduced on a permanent basis. There are many reasons why an employee’s working hours may need to change following a brain injury. It may be a reasonable adjustment to arrange for the employee to job share with another employee or to recruit someone for this purpose.

As another example, if an employee suffers from mental fatigue as a consequence of their brain injury, they may not be able to work a full day, and may need to work half-days or another working hours arrangement suited to their needs.

As another example, if an employee has to take medication following a brain injury they may need their working hours altered to take account of this or to take account of any side effects of the medication.

An employee may also require more flexibility or a reduction in their working hours to allow them to attend medical appointments or deal with ongoing symptoms.

Employers will need to consider whether it is reasonable and possible to make such changes in line with the needs of the business.

If an employee has returned to work part-time/on reduced hours and feels they have the stamina and ability to increase their hours, this can happen, so long as both employer and employee are in agreement, and it is safe for the employee to do this. Sometimes employees returning to work after brain injury work excessively to try and prove their worth, without appreciating that the approach is likely to be unsustainable. The employer should be mindful that the employee might not recognise their limitations.

If it is the employer that would like to increase the employee’s hours, they should be careful to ensure that the employee is ready and happy for their hours/workload to increase.

It might be appropriate to get updated occupational health advice if an increase in hours is being considered.

It is a good idea for employers and employees to meet regularly, especially around the period of re-adjustment to work, so that they can keep up to date on how the employee is doing and how they are feeling about their hours/workload. Working practices and hours should be reviewed and may need adjusting a few times before the right balance is reached.

Employers may observe that an employee finds it hard to accept that they cannot work at the same pace as before. If there seems to be a mismatch between what an employee wants to do and what they appear to be capable of doing (i.e. a lack of awareness about their changed level of ability), this will need to be handled very carefully. A further independent occupational health assessment may help to achieve the clarity that is needed.

Fatigue is a common difficulty following a brain injury. Tasks are likely to require more mental energy than they did prior to the injury and trying to fit too much into too short a period of time might leave a brain injured employee exhausted.

Regular breaks can help to split up a working day and help an employee to manage their fatigue and assist their performance at work.  The frequency and length of breaks required will depend upon the employee’s injury. When breaks are taken may depend upon work requirements as well as the needs of the employee. Giving the employee some autonomy can often be helpful, but it is important that both parties understand the parameters for breaks that have been agreed, so the employee feels able to take the breaks and the employer does not become frustrated if breaks are or are not taken. It may be necessary to inform not only the employee’s direct manager, but other colleagues, of the arrangements for breaks, as depending on the workplace, this adjustment could cause friction; this should only be done with the employee’s consent and no more information than is necessary and agreed by the employee should be disclosed.

An employee may need to work shorter working days, or split the working day into sections with longer breaks for rest.

The employer may need to consider whether a flexible system of working that incorporates breaks and means that the employee can work from home some, or all of the time, is possible. This has become easier in many industries over recent years and what is reasonable in terms of working from home has expanded.

It is important that the employee’s working pattern is kept under regular review to ensure that this works for both employee and employer. Again, keeping open lines of communication where both employee and employer can speak honestly about how things are going, is often the most helpful approach. It can be helpful to schedule meetings, so both parties know when the discussion is due to take place, but also keep open lines of communication between any meetings in case issues arise in the meantime.

It can take a long time to reach ‘peak’ recovery after a brain injury and many people continue to make progress over a number of years. For some, rehabilitation and recovery is a life-long process.

Planning an employee’s return to work following a brain injury should include consideration of whether they will need time off for medical appointments, treatment and/or rehabilitation, and if so, what that is likely to look like in terms of time and frequency.

They may still need to attend regular appointments. If these appointments are during their usual working hours, employers should try to accommodate them as much as possible. If appointments/rehabilitation sessions are on a regular basis and are for hours a week, it might make sense to plan an employee’s working hours around these sessions, or reduce working hours to accommodate the sessions if that would avoid putting the employee under pressure to fit too much into their day. It may be reasonable to continue to pay the employee for this time off.

Section 20 of the Equality Act 2010 places a duty on employees to make reasonable adjustments for employees who have a disability. ‘Disability’ is a wide definition and can include physical, cognitive and psychological disability.

The size and resources of the employer are taken into account when establishing what’s reasonable. Reasonable adjustments for an independent village bakery will be different to those considered reasonable for a multi-national corporate bank. However, a lot of potential adjustments don’t involve much expense. A formal assessment and guidance from an occupational therapist can often be beneficial to help both of you understand what will be required.

Under section 20(4) of the Equality Act 2010, an employer may need to adapt the employee’s physical working environment to enable them to carry out tasks independently. Ongoing physical injury could be anything from a slight weakness in one limb, to an inability to walk or to use one or more limbs at all. Specialist equipment may be required, or existing arrangements may need to be adapted.

Example 1 – Imagine an employee who has suffered a stroke and has ongoing weakness in the left side of their body, mainly in their left leg. They are able to walk, but struggle with stairs and need to use a walking stick for stability.

In this case, in a warehouse environment, an employer would need to ensure that there is sufficient space for the employee to navigate safely in their working environment. This could involve ensuring that walkways are wide enough and free of anything that could create a risk of them falling.

It may also be necessary to ensure that all stairs have banisters on both sides and that there are grab rails in appropriate places, such as in an accessible toilet. The type of aid required will depend upon the needs of the employee – if an employee has more severe mobility restrictions, a lift may need to be installed.

If they have a workstation, frequently used items could be stored within the employee’s reach to minimise the amount of moving around they have to do.

Consideration may also need to be given to them working remotely and conducting assessments/inspections via a video link, if appropriate.

Example 2 – Imagine an employee who works in retail and has been left with sight problems. They may require a larger monitor at the payment point, or for their display screen settings to be adapted to increase the size of writing on the screen. It may also be important to ensure that their workspace and floor area are kept clear of obstacles to reduce their risk of falling.

Example 3 – Imagine an office worker who has lost function in one of their hands following a stroke, and is suffering from neuropathic pain in their back and legs. They may benefit from a single-handed use keyboard for typing, a suitably adapted chair and desk set-up and regular breaks to allow them to move and change position.

There is a wide range of technology available to assist physically disabled employees in the workplace – occupational therapists will be able to recommend equipment if the employer and/or employee need some guidance on this.

If a brain-injured employee works ‘off-site’ their employer will need to ensure that the places they visit during the course of their work are also accessible and suitable for them.

Cognitive difficulties after brain injury are very common and present in a unique way for each individual that has a brain injury. These can include:

These issues will be considered further below:

Communication difficulties – An employee with a brain injury may find it difficult to speak because of their injuries, and/or they may find it hard to understand and mentally process what people are saying. They may also have trouble with written communication. Thankfully, there are lots of communication aids that may assist the injured employee in achieving effective communication at their place of work. For example:

Difficulties relating to attention span/concentration – A brain injury can affect an employee’s ability to focus on tasks – they may be very easily distracted. It is possible to reduce these difficulties by managing cognitive fatigue and minimising the level of distraction in the workplace.

Depending on the needs of the employee and the nature of the work, this could be achieved by:

It is, however, important to ensure that the employee does not feel isolated or excluded as a result of any measures taken to help improve their concentration. This can be a difficult balancing act and employers should discuss this openly with the employee to see how they feel about any proposed changes and whether they have any suggestions that they feel might work for them.

Problems with memory – Brain injuries can affect the way the brain organises and stores information which can cause memory problems. Memory problems can cause embarrassment for employees, who may feel anxious about relying on colleagues for help.

There are ways that employers can help employees work around any memory difficulties.  One of the most useful aids for memory loss is a smartphone. There are many downloadable software applications, such as planners, voice recorders, dictaphones etc. that can help an employee to remember information. The use of alarms and a consistent daily routine can also be helpful, as it provides structure and certainty. Repetition can also assist a brain-injured employee to relearn lost skills or learn new skills after their injury. It may be reasonable for the employer to provide a smartphone to the employee, or to pay for helpful app subscriptions.

Providing tasks in writing (with a list of steps needed to complete the task) instead of orally may assist, as may creating written reference user guides for equipment, so that they can follow this instead of asking how to use something a number of times. It is best to discuss options with the employee as to what they think will work best and if necessary, try different options before deciding which is the best approach. Any timeframes and other parameters for review should be agreed, so the employee knows when and how to give feedback and what other options are available if something is not working for them.

Difficulties with planning ahead and time-keeping – Similar to memory problems, planning difficulties may be assisted through software and smartphone apps. Making good use of a calendar and having a good routine can also help with planning and timekeeping as the employee has a set structure to work within. This reduces the number of decisions they have to make each day, hopefully reducing any cognitive fatigue and allowing them to focus on their work. The employee’s manager, and potentially (with the employee’s consent) their colleagues, should be clear as to what these requirements are, to make sure that they are able to support and not hinder any structures that are needed.

It is important for employers to be realistic about what the employee can achieve. This is likely to involve carefully planning longer projects together, setting realistic timelines and checking in regularly to see if they are making progress and are not feeling overwhelmed.

Rigid thinking/difficulties with problem-solving – A brain injury can make the brain less flexible in how it functions. This can result in rigid thinking and difficulties with thinking of creative solutions to problems. This can be very frustrating for an employee who was previously creative and good at problem-solving. Practising problem-solving can increase mental agility although an employee with a brain injury may require more time for tasks that involve an element of problem-solving.

Reduced processing speed – A brain injury can make completing tasks at an average speed very difficult. As above, a brain injured employee may need extra time to complete some tasks. A brain injury can also make it difficult for someone to switch between different tasks, or multi-task (which is, in fact, switching between different tasks very quickly). If an employee’s role is unpredictable with tasks that can change at short notice, employers should try and make this as easy as possible for them, by trying to ensure they work on one task at a time wherever possible.

Lack of Insight/self-awareness – A brain injured employee’s self-awareness is often linked to the severity of their injury, with employees who have suffered more severe injuries being less likely to have insight into the changes in their abilities. An employee who lacks self-awareness may attempt to carry out tasks that are beyond their capability, which in some situations could put them at risk. This may need to be discussed with the employee, sensitively, to agree how to deal with this situation if it arises or to deal with it as soon as possible once it has arisen.

Brain injury can commonly cause psychological and psychiatric symptoms, which will vary depending on the nature and severity of the brain injury. The emotional and psychological consequences of brain-injury can be life-long and may require long-term support.

Common psychological and psychiatric symptoms after brain injury include:

Upon returning to work, a brain-injured employee may already have some support in place for any psychological or psychiatric consequences of their injury. This can be pharmacological support, meaning they take medication to reduce their symptoms. Alternatively (or in addition) they may also receive psychological support from counsellors or medical professionals (usually a psychologist or psychiatrist).

Sometimes, it becomes apparent that an employee might need some psychological support after they have returned to work. It might be someone who works closely with the employee that notices issues first, and if there is an open and supportive workplace culture, they will hopefully feel able to say something so that the employee who is struggling can be supported. Talking to the employee about how they are feeling so that the appropriate adjustments can be made /support accessed is of high importance. Supporting the employee and providing positive encouragement about their achievements and contribution may also be helpful.

If an employee is not receiving psychological support but it seems that this might be useful in assisting them in their adjustment back to work, and perhaps even throughout their employment, the employer may encourage the employee to seek medical advice or refer the employee to an occupational health practitioner. The occupational health practitioner may recommend treatment and will consider if the employee is well enough to work, as well as suggesting what adjustments may be needed to enable the employee to continue or return to work. If treatment is recommended an employer may want to consider funding this.

In addition to treatment, some simple adjustments to the work environment may assist an employee who is struggling emotionally. These overlap with adjustments that might be needed for cognitive disability and include things like:

Employers do, of course, have to strike a balance between supporting the employee who is struggling emotionally and taking appropriate action if their behaviour causes a safety risk to others. If an employee is, for example, abusing alcohol/other substances or having emotional outbursts at work that are affecting others, further action may need to be taken. Employers owe a duty to all of their employees to provide them with a safe working environment.

Employers may need to adapt policies for dealing with situations like these to ensure that the employee is not placed at a substantial disadvantage when the policy or procedure is applied to them, compared to someone who has not suffered a brain injury (section 20 and 21 of the Equality Act 2010) or treated unfavourably because of something arising in consequence of their disability, without that treatment being objectively justified (section 15 of the Equality Act 2010). In situations like these specialist advice from an employment lawyer or HR specialist may need to be sought by the employer.

If employers or employees are not sure about their legal obligations/rights, advice should be sought from a specialist in employment law.

The first few weeks back at work is likely to be an intense period of adjustment for a brain-injured employee.  They will be working out how to adapt to do the job and may feel particularly anxious and overwhelmed. Employers should try and create an open work environment so that the employee feels comfortable sharing how they are feeling. This will allow the employer to manage their business appropriately whilst ensuring the employee receives the support they need.

Anyone who has been away from work for an extended period of time due to a career break, illness or parental leave will know that there can be a lot to catch up with on their return. Employers should have a ‘back to work’ action plan in place to help make the employee’s return to work as easy as possible. They should discuss the content of this with the employee to identify any other areas/matters that the employee would find it helpful to be caught-up/refreshed on; involving the employee and listening to their views is one of the best ways to develop a positive return to work. Catching up with changes in the workplace is likely to be more challenging for an employee who has suffered a brain injury. Prior to the return to work the employer should think about what refresher training the employee will need, and whether there have been any changes to processes, technology, or anything else while the employee has been off work. Update training may need to take into account reasonable adjustments to the new processes/technology. It may be difficult to assess exactly what extra training the employee will require, so this should be kept under close review when an employee returns to work, in consultation with the employee. Where a need is identified, training should be provided as soon as possible. The ‘back to work’ plan may also include a staged return, with flexibility to alter the plan depending on how things go.

The buddy can act as the main point of contact for the employee which may help them access any support they need. The employee may feel less worried about asking questions to their buddy or raising any issues they are having with them. The buddy should have clear guidance as to what their role involves and should ideally be positive about accepting this important position.

In terms of choice of buddy, it is often best to select someone from the same team as the employee and at a similar level where possible. It may be useful for the buddy to be trained on the effect of brain injuries and on how it has affected this colleague of theirs, in particular.

It is probably a good idea to have more regular management meetings while the employee is re-adjusting to work.

Regular management meetings will help both employer and employee to identify any issues early on and to make any changes required. They will also provide an opportunity to review any arrangements or adaptations that have been made, to see what is working and what is not. Either party may also have new ideas about further changes that could help them day-to-day.

Regular and open communication can really help both employees and employers to feel supported and achieve their best.

The reason for these meetings should be explained to the employee, so they do not feel that they are being micro-managed or put under unnecessary pressure.