Introduction

Vocational rehabilitation (VR) is an umbrella term used to describe the wide range of processes and interventions that enable people with a health condition, injury or disability to enter, return to, or remain in work. As such, the current state of VR services is critical to the wellbeing-at-work agenda and the expected need, with an ageing population, for an even greater emphasis on enabling people with health conditions to remain in employment. This chapter examines VR interventions and the contexts in which services are delivered. Contemporary approaches to VR are discussed, including traditional condition-focused and newer occupation-focused perspectives. The discussions place a particular emphasis on how contextual factors influence practice within this field. The chapter goes on to explore how advancements in VR services have been hampered by significant challenges, not least terminological inconsistencies, shifting socio-political agendas and a traditionally reductionist approach to interventions. It then touches on the impact of historical trends on the sustained development of these types of services, together with tensions posed by factors such as a lack of professional regulation within the sector. Finally, the chapter explores the shift in focus towards early intervention and the likely impact of planned welfare reforms.

A lack of shared understanding: evidence, terminology and frameworks

Within healthcare, the ability to demonstrate the effectiveness of a particular intervention has long been highly prized. Within VR, there is the added requirement to make a business case that demonstrates the cost-effectiveness of the intervention (Joss, 2002). However, there remains a lack of consensus as to what VR means, or what it entails. This lack of clarity has negatively affected researchers’ ability to generate the substantive evidence needed to drive practice forwards in a consistent manner. This problem is coupled with the difficulties inherent in evaluating complex healthcare interventions of this kind (Campbell et al, 2000).

As a result, the literature fails to reflect an accurate understanding of the multidimensional nature of the role of return-to-work facilitators and the VR process (Shaw and Polatajko, 2002). For many years, useful descriptive accounts of well-established programmes designed to assist people into, and back to, work have been published within the international literature (Floyd, 1996; Pratt and Jacobs, 1997; O’Halloran, 2002; Koch and Rumrill, 2003; Curtis, 2003).