Workplace Health Connections

The Department for Work and Pensions today published a survey to mark the first anniversary of the "fit note", introduced to try to stop people sliding into long term sick leave by giving GPs the option of saying a patient may be able to return to work with certain adjustments.

Employers like to blame GPs for the fit note's failure to transform sickness absence but the new survey suggests most of them understand the aims of the fit note and support them. 
The survey shows 70% of GPs agree that the fit note has helped their patients make a phased return to work,  just under half (48 per cent) agreed that it had increased the frequency with which they recommend return to work as an aid to patient recovery;  70 per cent of GPs agreed that the fit note had helped their patients make a phased return to work. 

The survey also shows that fit note cannot solve the problem on its own. Only one in five (19 per cent) reported that there are good services locally to which they can refer patients who need support in returning to work. In both instances, 17 per cent of GPs reported that they did not know if services were available locally.

But speakers at a recent roundtable event (organised by occupational health provider AXA PPP   and XpertHR's sister publications Personnel Today  and Occupational Health)   pointed out employers too lacked capability to support a gradual return to work after sickness. You can read a report on Personnel Today next week but here is a flavour of the debate from the Work Foundation's director Steven Bevan: 

"One of the big issues I haven't really seen addressed is how employers are going to be supported in helping to accommodate people back into work once they're judged fit for work and when they're given a pathway back into work - either through case management or through other mechanisms. I still think there's a big capability problem in many organisations - not just small ones."  

Continue reading "GP surveys sign the Fit Note fit for purpose a year on " »

Seventy-two per cent of staff soldier on at work when they could legitimately take sick leave so as not to let down their colleagues, according to a survey by health insurance provider Axa PPP. How do these findings relate to Axa's other survey - the  annual survey they do with the Confederation of British Industry  (CBI) - which shows that sickness absence is costing the UK economy about £13 billion a year?  It seems to me that while staff throwing sickies are costing employers, their colleagues are saving them a fortune by coming in and no doubt spreading their infections to everyone else.

How do you tackle this phenomenon? Well the survey gives a hint in showing that some staff are worried that their sickness absence record could be used against them by managers or that they cannot afford to take any time off for fear of not getting their job done. These are issues for managers to tackle. HR might want to consider training or some other way to change management culture.

What about OH practitioners? Some will no doubt take the view that they should just ignore it - it's a management problem. It's a response I see quite a lot on the profession's chat forum. I'm not sure if this attitude will be viable in future though. Could it be that if OH is to remain relevant it will have to extend its responsibility towards advising on the causes of sick leave or low morale?

Recent events are making some of us uneasy about the government's appetite to put energy and funding behind the recommendations in Dame Carol Black's report for reform of occupational health. And that's leaving aside the fact that Gordon Brown and his cabinet are likely to be putting more effort into stopping the government from imploding than on reforming sick notes or launching fit for work teams.

This week we are all reeling from the latest chapter of the financial crisis with 5,000 jobs likely to go at Lehman Brothers and tens of thousands threatened elsewhere in that sector. We can only hope that business leaders do not take the attitude that health and work are too much of a luxury when all hands are needed on deck to try and stop the ship going down. The point is though that at times of change and uncertainty such as these mental health at work should be rising up managers' agendas, not dropping off.  If the new word for managing 'stress' is 'resilience' then we are going to need a lot of resilience over the next few months to see us through the uncertain and threatening times ahead. .  

As for the government's response to Dame Carol Black's recommendations, I bumped into her last week and the smart money is on early November for an announcement.   

Research launched earlier this month suggested a connection between lack of co-ordiantion and sporting ability among children and obesity in later life - an interesting topic given the backdrop of the Olympics. One interpretation was that children who weren't good at sports didn't exercise enough and set themselves on the slippery slope to obesity later in life. Those of us with adolescent couch potatoes among our offspring will know that persuading a teenager to take any exercise can be a bit of a challenge. The sensible response however to these findings is to point out that obesity has a complex range of causes and lack of sporting flair is only one of many.

However, a thought has crossed my mind in recent years, once again in response to my own children's development. My son was fanatical about football in his junior school but when he went to secondary school and didn't make it into the football team he became disillusioned and lost all interest. It seems to me that if schools are going to encourage more children to take part in sport they need to balance the competitive element by offering chances for kids of all ability to play in a team. As we all know, playing sport is not just a way of developing athleticism but also of developing team skills and self esteem - attributes that you need in spades in the world of grown up employment.

The Olympics is great for encouraging people to strive for world class sporting skills, but we should also look for ways to encourage those of us with more modest sporting ability to join in - especially teenagers.

Government documents and research have come thick and fast in recent weeks laying out the changes to the welfare system and building up the evidence base to support these reforms and the long awaited pilots for a range of other proposals, including Dame Carol Black's recommendations for health and work the government's promise of funding for health promotion pilots in the workplace .

A report from the University of York looks at the evidence that return to work interventions for mental health problems can cut the numbers on sick leave, while the government's Vocational Rehabilitation Taskforce has launched evidence showing that nine out of 10 people can be moved back into employment given the right basic healthcare and management.

Business has given its blessing to the welfare reforms, no doubt encouraged by promises to double the amount of funding available for employers who make adjustments to get incapacitated people back to work. 

It is almost three years since the Health Work and Wellbeing strategy was launched in October 2005 and the pieces of the jigsaw puzzle are still falling into place.

Of course it is ultimately down to individual people to take responsibility for their health and once again the evidence is there to show that given education and encouragement most of us are prepared to do so.

A report out this week finds the government is under  fire again for failing to address the tax barriers to employers investing in health promotion and return to work interventions. Now that Dame Carol Black's recommendations demand early intervention to get people off sick and back to work and keep them there there, the government has run out of excuses not to change a system that is unfair and riddled with contradictions.

For example, if employees are exempt from tax when their employers provide an Employee Assistance Programme (EAP) (which allows staff to discuss health issues not related to their work), then why should an employee be taxed when their employer pays for them to join a private gym? Currently there is tax relief when a big employer provides a gym or sports facilities but employees in smaller firms are penalised if their employer pays for private gym membership. This is a barrier to smaller employers investing in the health of their staff. How can this tax regime be justified when the Black review points out that the vast majority of employees without access to occupational health are working for small and medium sized companies.

Then there is the issue of tax on employers who spend to get sick staff back to work. Even if the government baulks at introducing tax incentives for employer spending that promotes health among people who are not incapacitated, surely it should provide tax exemptions for all spending on vocational rehabilitation, regardless of whether the illness or injuries are solely work-related or not. Currently if an employer pays for an employee's treatment to get them back to work for reasons which are not solely work-related the employee has to pay tax on it. Yet there are often long waiting lists on the NHS meaning treatment is provided too late to stop the employee swelling the ranks of those on incapacity benefits. Taxing the employee completely contradicts the aims of Dame Carol Black's recommendations. 

Realistically, employers may prove reluctant to help fund  a national OH service  without any financial support.The government should consider reinvesting some of the money it plans to save by cutting the numbers on incapacity benefits to support employers who are expected to foot the bill for getting sick employees back to work. This may have to be done through private medical insurance (PMI). However, up until now the government has had a very Old Labour suspicion of PMI despite its aim introduce more private sector investment into the NHS. The solution is to introduce tax exemptions on PMI and the use of private medical services only when they are used for the purposes of vocational rehabilitation. Surely that would be a more joined up way to achieve the government's objectives for the health of working age people. 

The government is due to respond to the Black review in the autumn and if it fails to address the non-sensical tax system it will be failing employers, employees and itself.  

So a dyslexic medical student is to launch a legal claim against the General Medical Council to try and get the GMC to stop using multiple choice tests. The 21-year old student, Naomi Gadian claims that the test is discriminatory and inappriopriate as it is unlikely she would be presented with four options when making a diagnosis or selecting a therapy in a real job situation. The student has good A-levels so obviously hasn't been held back so far in her medical education by her dyslexia.

This issue worries me. Maybe I'm making too light of a serious issue but isn't it the case that medical terminology is particularly hard to spell and being good at recognising one condition or treatment from another is a required skill for the job?

Conceptually the whole idea of 'disability' as covered by the Disability Discrimination Act  is problemmatic as far as I'm concerned. The law should be there to protect people from discrimination which is not relevant to the job or profession. Therefore, discrimination on the grounds of ability that is relevant to the job is surely reasonable? For some professions, dyslexia is going to make someone less able to do the job than another person without the 'disability'.  It doesn't seem unreasonable in medicine to require students to be able to distinguish between technical terms reasonably quickly and accurately. But this is an issue where feelings tend to run high so I expect others may disagree. 

If, like me, you like to start the weekend with a take-away and general blow-out slumped infront of the TV, then maybe you should know about some new research showing a link watching TV  crime shows and obesity. The research study has found that people who are thinking about their own deaths want to eat and shop more. Or at least if you've got low self-esteem. Research involving 746 people in Europe and the US found that death-related news can also make people more patriotic about what brands they buy. This shows that death is good for business, or retail at least. 

Obviously there is a big opportunity for cookie manufacturers to book advertising space during TV programmes involving lots of death, but the implication for people with responsibilities for workplace health are more obscure. Perhaps, as well as advising staff to give up smoking and join a gym, we should be warning them about the danger of watching too much of CSI: Crime Scene Investigation or The Bill .
 

The research, "The Sweet Escape: Effects of Mortality Salience on Consumption Quantities for High- and Low-Self-Esteem Consumers", appears in the Journal of Consumer Research, . For more information email natherton@noirsurblanc.com.  

This month's annual meeting of the Society of Occupational Medicine brought out a rash of announcements from government people to try and push forward the health and work strategy. First off, Bill Gunnyeon, director, health, work and wellbeing and chief medical adviser, Department for Work and Pensions.. er where was I? Oh yes, he gave us a sneak preview of a GP survey due out later this month which is a repeat of the one carried out last year, and it shows, at long last, that GPs are finally getting the message that work is good for people's health.  

Meanwhile Lord McKenzie announced that on 17 July the Vocational Rehabilitation Taskforce  will be publishing an evidence review of the cost effectiveness of interventions on musculoskeletal disorders, mental health, cardiovascular respiratory conditions. He added that Dame Carol Black is going to be 'supporting' the government's first ever do-ordinated strategy for mental health at work. This starts on 10 July with a meeting of eminent experts from business and academic medicine.

Finally,  if you don't know already the government has produced a tool for employers to help them assess the cost benefit of interventions in occupational health, based on consultancy PWC's report earlier this year. If you want to volunteer your company as a pilot just click here and you can download the tool for free.  

Today is the Society of Occupational Medicine's annual conference and president Dr Gordon Parker has stated that occupational health services  should be free at the point of delivery in the NHS. The call comes in the week the NHS celebrates its 60^th birthday and the day after Lord Darzi announced his proposals for the future of the NHS. I would like to support the SOM's aims but  they do raise a few complicated questions.

There is the question of who is going to provide these OH services. The SOM seems to be fixated on OH doctors and nurses doing it but in reality there are never going to be enough available and a lot of the services are not of a primarily clinical nature in any case, for example "benefits advisers and others associated with workplace wellbeing" to quote the SOM.  There are also case managers, disability assessors and a range of other services which are unlikely to be provided by doctors or nurses. 

 Will NHS Trusts be willing to use NHS funding to provide services which are not 'clinical'? It all boils down to the cost benefit case. In an apparently under-funded service where rationing is the norm, could we, to give one example, demonstrate that return to work through psychological therapies would save a fortune on anti-depression prescription drugs? If we save millions on incapacity benefit can that then be reinvested in improving NHS services? Over to you, Lord Darzi.  

For the time being it is safe to assume that employers will be footing the bill for OH for some time to come.