Work, disability and rehabilitation: making the best job of it

The relationship between a person's health and their work was recognised as central to the good practice of medicine by Charles Turner Thackrah (1795-1833) in his seminal work, The effects of arts, trades and professions on health and longevity (1823). The connection is largely forgotten in current clinical practice; the UK has a high level of dependence on benefits mainly in those with non-severe disabilities. Recognition of the value of preventing this by access to early, usually multidisciplinary, rehabilitation and prevocational rehabilitation via a general practitioner and in hospital practice is needed as a priority. This requires that all NHS staff adopt a biopsychosocial approach to illness and are taught about the workplace needs of patients and the value of early rehabilitation. Communications within the NHS and with other agencies have to be improved by the development of better pathways with dedicated staff time for this activity. The creation of the Director of Health and Work position and the refocusing of occupational medicine present an unrivalled opportunity to improve our practice.