The Government has published a report assessing several pilot schemes that it launched in 2010 aimed at improving sickness absence management in small and medium-sized enterprises. Nic Paton discusses the key findings.
Lessons learned from the pilot have fed into design of the continuing service (an extension of the pilot to March 2013) to further develop understanding of how to engage.
Will the Fit for Work Service eventually become a nationally rolled out “National Health at Work Service”? Not on the results of the first evaluation of the 11 pilots that have been testing various different models since March 2010.
Even Jim Hillage, the co-author of the Evaluation of the Fit for Work Service pilots: first year report and director of research at the Institute for Employment Studies, is pessimistic that a Fit for Work Service will be “scaleable” in the current economic and financial climate.
“My expectation is that it is unlikely to become a national service. It is probably too expensive and too narrow to fund nationally, so it may also be a question of whether mainstream support can be provided through GPs or some other organisations,” he tells Occupational Health magazine.
“I think we are likely to see more work being done with GPs to help encourage them to work more closely with employers to get people back to work more quickly. So that could be a Fit for Work Service, just in another guise.”
Initial reactions
Hillage adds: “What the pilots have shown is that there is a group of people off work who could be helped back into work if they had access to the right level of support.”
The evaluation report, published in March, found that both the volume and profile of those using the service was generally not what was originally expected, with some 6,700 users logged, about 40% less than anticipated. This was despite one pilot, in Leicester, separately reporting its 1,000th referral in March.
However, those who did use the service, both employers and employees, generally found it useful (see box 1). Scepticism and a distrust of the service from GPs remains a significant barrier, the report also found.
OH advice lines report
The evaluation was published alongside an assessment of the free occupational health telephone advice lines for small and medium-sized enterprises (SMEs) piloted by the Government between late 2009 and March 2011. That report, Occupational health advice lines evaluation: final report, revealed high levels of satisfaction, but, again, a lower than expected take-up (see box 2).
Nevertheless, the lessons able to be drawn from both pilots could prove valuable to OH practitioners, argues Dr Sayeed Khan, chief medical adviser to the manufacturers’ organisation EEF.
Positive thinking
First, on the Fit for Work Service, the take-up sample, in fact, should not be considered too poor in the scheme of things, Khan contends.
“Time and time again with pilots people over-estimate how many clients or sample respondents they are going to get. But I would argue 6,700 is a good base sample and it does seem to be something that has worked well,” says Khan.
Jim Hillage |
“Another good thing is that it is using the biopsychosocial approach rather than any single model. In terms of illness or people under-performing at work, the actual illness will probably be just one of a number of factors,” he adds.
Another positive finding was that two-thirds of the 6,700 users had still been at work (fewer than 30% of users having been the original prime target group of those already off work for between four and 12 weeks) suggesting that early intervention and support were possibly making a difference in terms of keeping people in the workplace, Khan argues.
Concerns for OH
One area of concern, however, was the issue of liaison between the service and OH practitioners.
“I have heard OH people privately complain that what they were saying was being contradicted by the Fit for Work Service. In some cases, Fit for Work [services] do not know a person has already gone to see OH, so there can be an issue of conflict between their own employer service provision and the Fit for Work Service, and that is something that needs to be looked at. Care needs to be taken to ensure there is contact between the Fit for Work Service and the OH service provider,” says Khan.
Good call?
Second, on the occupational health advice lines, the fact that more than 90% of employers found it useful and would recommend it was a “powerful” conclusion, Khan suggests.
“But one thing that was not clear was the qualifications and experience of the call handlers. Are the right people handling the calls? Are they giving the right advice? That does not come out of the report,” he says.
“They need to be much cleverer about marketing and raising awareness of the service. Perhaps, for example, they should be talking to banks or accountants, because every small business will have those.
“I think in future it will develop into a premium line type of thing. The other issue with it is that at the moment it is very reactive; it is just responding to problems.”
Moving forward
The lack of engagement from GPs with the Fit for Work Service does make it hard to gauge its long-term effectiveness and future, concedes Dr Steve Iley, head of medical services at AXA ICAS.
“But the concept is good, especially around things such as case management and vocational rehabilitation, plus the fact it focuses on the biopsychosocial model.
“What will be nice to see is what happens when it gets a few more people. As a commercial provider, obviously, at one level this could be seen as a threat. But, in reality, I think it will just become another provider in the market.
“In fact, it may even lead to more work for OH because once employers know what OH can do, they may be more encouraged to use it in the future,” Iley adds.
