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Aims: To measure changes in health related quality of life and employment status of NHS staff one year after early retirement because of ill health, and to identify predictors of re-employment. Methods: A national cohort of 1317 NHS staff taking early retirement because of ill health in 1998 was recruited. Postal questionnaires were used to assess their quality of life (SF-36) and employment status 12 months after retirement. Results: A total of 1143 (87%) ill health retirees responded; 152 (13%) retirees were working at one year, mostly part-time, and 22% of them were re-employed by the NHS. Independent predictors of reemployment were: living in England rather than Wales and occupation of doctor. There was an increased likelihood of re-employment with reducing age and increasing quality of life at baseline. Retirees' quality of life improved from baseline to one year after ill health retirement, but at one year still remained lower than the general population. Improvements in physical and mental component scores were greater in those working at one year compared with those not working. Conclusion: Reducing ill health retirement is likely to be of benefit to the individual, the NHS, and the economy. Results suggest that such a reduction may be possible and the identified predictors of reemployment may help in this process.T he National Health Service (NHS) is the largest UK employer, with over one million staff.1 2 Every year approximately 0.5% of the NHS workforce is retired early because of ill health.3 While the criterion for ill health retirement is illness which will prevent staff from doing their normal work until retirement age, once retired the pension scheme does allow an individual to seek alternative work. No adjustments are made to their pension unless they return to work in the NHS and their new earnings plus pension exceed their old NHS salary. 4 In a previous paper we described a sample of two thousand NHS staff at the time of their ill health retirement in 1998. 5To address the lack of information on health and employment status following ill health retirement, we followed up our cohort one year later. We compared their quality of life at retirement with that of the general population, looked for predictors of re-employment at one year, and measured the change in quality of life over the year.We aimed to identify staff for whom job modification or redeployment could be an alternative to ill health retirement. METHODS SampleWe wrote to the first 2000 of 5469 NHS staff awarded ill health retirement in 1998 (April-August) in England and Wales. Of these, 1317 (66%) agreed to participate one year later in our follow up study; they received a postal questionnaire and up to two reminders. MeasuresStaff were allocated to occupational groups according to their job title at time of retirement. Social class was coded as nonmanual (classes I, II, and IIInm), for example, doctors, nurses, and administrators, or manual (classes IIIm, IV, and V), 6 for example, healthcare assistants and ambulance workers. We as...