A view on absence – HCML’s CEO shares his perspectives on rehabilitation & absence management after being hit by a bus in Spain

When Keith Bushnell was knocked down by a bus in Madrid it sharpened priorities for the friends who were with him.

Bushnell, CEO of rehabilitation case management company HCML and a passionate Chelsea fan, was in the city last season for his team’s Champion’s League clash with Atletico Madrid.

‘I was lying on the pavement being tended by medics when one of my group told them, “Can you make your mind up quick if he’s got to go to hospital, because we don’t want to miss the kick-off.”

‘Luckily I wasn’t badly hurt and made the game, but though it was partly in fun – I think! – it certainly confirmed to me that people are strongly driven by their own priorities.’

Currently Bushnell, who took over at the helm of HCML in 2010, is busy creating strategies that will persuade employers to give greater priority to the health and wellbeing of their greatest asset – their staff.

HCML has always delivered independent medical needs assessments and subsequent case management services for solicitors and insurers acting for injured clients in employer, public liability or road traffic accident cases, returning clients to their pre-injury state quickly and cost effectively through a stepped care, evidence based approach to recovery.

But now it has begun expanding into employee wellbeing, preventative and absence management services by talking directly to firms concerned by the amount of costly absenteeism arising from physical and mental health problems, and the importance of wellbeing in preventing future absence and making employees feel better about themselves and their employer.

Bushnell, who has seen HCML go from loss to profit and almost double its turnover in five years, wants the Croydon-based company to not only help get people back to work as soon as possible but prevent them going off in the first place.

‘Staff should be given in-workplace guidance on how to self-monitor and self-manage.

‘Fortunately I think managements are now recognising they need to be more proactive in encouraging staff to take care of themselves, whether it be about diet or sleep patterns or exercise or lifestyle in general.’

Much of that recognition stems from what he calls the unacceptable £25-billion cost to the nation of absenteeism and from the fact that increased stress in the workplace has led to a marked increase in absence due to mental health issues.

‘Our work with solicitors and insurers  means assessment of both physical injury and consequent mental health issues, and expanding into the employer field will involve a good deal of stress-related problems – think call-centres and pressure on all managers to deliver business objectives ’ he says.

‘Though it should have eased along with the easing of the recession we are not seeing the reduction and there is still much more anxiety at work than there ever was.

‘It is now as great a cause of absenteeism as physical problems, but mental health remains a subject no one wants to talk about. There needs to be a more mature approach by employers, who can be reluctant to go beyond traditional HR routes to seek solutions.’

Bushnell, who has established a record of increasing revenues and expanding market share throughout his career, stresses the importance of prevention and early intervention rather than allowing people to be off long-term before acting.

‘What’s often overlooked or ignored is that people off work for weeks and months can become very depressed,’ he says.

‘The result is the physical issues that might have caused them to go off in the first place might get sorted but they are then left with problems affecting their state of mind, where the very thought of going back fills them with dread.’

Encouragingly, he feels employers are becoming more acutely aware of the effects of mental health issues and absenteeism on morale and bottom-lines, with the result more of them are taking advantage of an HCML service called It’s The Time to Talk.

Staff are directed to the company’s health professionals for confidential discussion and assessment and then the appropriate pathway, ranging from self-help to phone based or face-to-face treatment sessions, with any action required initiated within 24 hours and all parties kept updated with progress.

In another early-intervention scheme attracting support companies can pay £15 a year to secure appropriate physio or mental health treatment for workers who have been absent for more than three successive working days.

‘Employers often have private medical schemes for senior management, so why not for the troops?’ he says. ‘It’s a view I’m happy to say more and more companies are coming round to.’

What it all comes down to, he adds, is that HCML’s emphasis on wellbeing and absence management is going to become a strong field for development.

‘There is a big market out there and in 12 to 18 months we shall have in place total integration of self-prevention and early intervention. I call it absenteeism and presenteeism - keeping people both in work and productive, and then getting them back to work as soon as possible where necessary.’

From taking the capabilities HCML has developed for the legal and insurance sectors into employers he also wants to build on links being established with the NHS, especially at primary care level.

‘It’s a delicate area, especially as it would involve the private sector, but with the great pressures on funding facing the NHS being intensified by the demographics of an ageing population such measures need to be looked at.

‘Clinical Commissioning Groups are already looking at the private sector to see what services can be delivered more effectively. In five to 10 years’ time there will be greatly enhanced private involvement in the NHS and we propose to be at the forefront of any area where we can offer high value services.’

That is a policy, he points out, that will be strongly underpinned by the recent appointment of two senior medical professionals with strong track records in innovation and service design and strong knowledge and extensive experience in NHS service delivery.

Meanwhile, Bushnell confesses to a ‘mental health problem’ of his own.

‘It’s called OCD – for Obsessive Chelsea Disorder,’ he says. He has not missed a single game, home or away – places like Madrid and Japan included – for almost six years, a dedication so impressive it was justly recognised in a recent match programme.