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:
]]> A GP at the roundtable, Dr John Chisholm, pointed out that hospital doctors also need to be on board:"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."
"It's been a frustration... that hospital doctors could issue [Fit Note] certificates and don't. If hospital doctors are seeing patients and are in a position to give advice about returning to work, they should do so because otherwise it triggers unnecessary consultations in primary care."
On a positive note, Dr Steve Boorman, chief medical adviser at Royal Mail (and author of a major report on sickness absence in the NHS) stressed the chief benefit of the fit note, which is to encourage a discussion between the person off sick and their line manager. Talking about direct experience of the fit note at Royal Mail, Boorman said:
"Interestingly, in over half of the cases where the Fit Note has recommended an adjustment, just simply having the dialogue with the manager is enough for the individual to return to unmodified work. And it's just setting up that dialogue and opportunity that's the most important thing."
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?
]]>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.
]]>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.
]]>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.
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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.
]]>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.
]]>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.
]]>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.
]]>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.
For the time being it is safe to assume that employers will be footing the bill for OH for some time to come.
Can someone more used to selling baked beans boost the health of staff in the NHS? Clare Chapman, former HR boss at Tesco, and now NHS workforce director general is about to introduce some private sector style health promotion which might ruffle the feathers of die hard occupational health traditionalists in the NHS ranks.
Chapman has hired wellbeing consultancy Vielife to deliver two-year pilots in 10 NHS trusts. The link of health and wellbeing with productivity will raise some OH eyebrows. The NHS OH group are often seen as quite different culturally from their business-minded peers in the private sector, even by their own colleagues. Observers of the Jiscmail forum will have noticed that infection control and health assessment questionnaires tend to get more airplay than pedometers and healthy eating. They might ask if a NHS stuggling to keep hospitals free from bugs like MRSA should be focusing on dispensing healthy eating pamplets.
Chapman has the government's backing though. Dame Carol Black, in her recommendations on work and health earlier this year, called for the public sector to lead by example in improving the health of the workforce. And it is difficult to argue against an intervention which could cut NHS absence rates. Provided that Chapman's pilots do not take funds from basic risk management they should be welcomed.
]]>The campaign is organised by Business in the Community, an employer-led organisation which aims to make employers fairer and more responsible. BITC aims to get employers to invest in health at work by emphasising the impact on the employer brand and employee engagement. Research BITC launched today by YouGov involving 1,347 adults in the UK has found that three out of five workers would consider quitting employers who fail to address workplace health and safety and four out of five say this would influence whether they took a job.
The problem with getting commitment from senior managers though is trying to get them listening in the first place, when they have a lot of other priorities. Absence costs are a blunt weapon but may be the best way to get boardroom attention, suggested Peter MacDonald, HR director of Parcelforce, at the meeting.
At Parcelforce, which as part of Royal Mail is not able to compete on cost, the company's performance depends on making deliveries on time. The case for good absence management is clear. And you can produce key performance indicators for it which might look good in a company report.
Once you've whetted their appetite with some cost savings in cutting absence, the trick then will be to get managers to look at the business case for health and wellbeing interventions in the round.
]]>I came across the information this week when I was chairing an IRS conference on managing stress. Here is a round-up of the hot ideas that came up for anyone interested in managing their own stress or responsible for stress management in an organisation:
There - I bet you feel better already.
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For years, HR and occupational health specialists have had an uneasy feeling about home-working and health and safety. The increasing use of mobile technology such as laptop computers, blackberrys and mobile phones with or without internet access means that risk management and health surveillance may have to extend beyond the home office into the car, the train and even the local Starbucks.
Microsoft want to publicise this to sell their ergonomically designed hardware but this issue goes beyond this into work design and practices, including working hours. Maybe now is the moment to dust off the policy on home-working and make sure your organisation is covered against absence costs or a potential costly tribunal claim. If you're old enough to remember the early days of RSI then you'll know that the condition does seem to be catching too (if one person in a department gets it, others will follow) and it is notoriously difficult to get an accurate diagnosis of the cause.
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The latest opportunity is a new category in the Personnel Today Awards, the Award for Health at Work. If you’ve been to this event before you’ll know it is quite a bash, so well worth getting on the shortlist. You’ve only got a month left to enter so get to work on your entries now. I know for a fact that there are lots of you doing innovative things who can demonstrate the benefits for staff and the organisation alike.
Better still, there is no rule that bars you from entering both awards, doubling your chance of coming away with a trophy.
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