“Broken” fit note and fit for work scheme face overhaul

The Government has announced plans to overhaul the GP fit note and statutory sick pay, as well as reform the way that disabled people on sick leave are assessed for fitness for work.

The Department for Work and Pensions has published a “Work, health and disability” green paper asking for views from disabled people, employers and health professionals on how to reform statutory sick pay, GP fit notes and the Work Capability Assessment so that people on long-term sick leave are helped back to work.

The Government aims to stop people with long-term conditions falling out of work, which costs the NHS about £7 billion per year. Work and pensions secretary Damian Green told Parliament: “In 2010 we inherited a broken system”.

Ministers said statutory sick pay will be reviewed to encourage supportive conversations between employers and employees, and support phased returns to work.

The green paper proposes that employees earning less than the statutory sick pay rate of £88.45 per week who returned to work on reduced hours would be able to top up their wages to the statutory sick pay level.

The consultation will also consider allowing other health professionals than GPs to sign fit notes. Ministers say this will help ensure people receive more tailored support.

Both the fit note, which replaced the sick note, and the assessment of fitness for work on long term incapacity benefits were introduced after the publication of Dame Carol Black’s review of health and work in 2008. Since the fit note was introduced in 2010, surveys have shown employer frustration at GPs’ reluctance to adopt the principle of the phased return to work.

The decision by the previous Government to link the aim of supporting disabled people on incapacity benefits into work with welfare benefits cuts led to criticism and the premature exit of the Atos Healthcare from contract in 2015. This overshadowed the aim of demonstrating the value of work as a health outcome, the key aim of Black’s recommendations. The consultation launched this week aims to ensure the system is better targeted and works for everyone.

Green said: “This green paper marks the start of our action to confront the attitudes, prejudices and misunderstandings that, after many years, have become ingrained within the welfare state, within the minds of employers and across wider society.”

Health secretary Jeremy Hunt said: “With all the evidence showing that work is a major driver of health, this is a big opportunity – to make sure that people get the support they need, improve their health and benefit the NHS all at the same time.”

He added: “The gap between the employment rates of disabled people and non-disabled people sits at 32 percentage points – a gap the Government is determined to start closing.

“Despite a record-breaking labour market, 4.6 million disabled people and people with long-term health conditions are out of work.”

Green reiterated a commitment that no new welfare savings are being sought. Specific proposals in the consultation include:

• Creating a Disability Confident Business Leaders Group to work with ministers and officials to increase employer engagement around disabled employment, starting with FTSE 250 companies.
• Consulting on the Work Capability Assessment, to put an end to “put an end to the binary ‘can work/can’t work’ groups”.
• Developing large-scale trials on how health-led services and support can help get disabled people and those with long-term conditions back into work – with a specific focus on mental health and musculoskeletal conditions. The first trial areas are expected to be the West Midlands Combined Authority and Sheffield City Region. Trials could begin in spring 2017.
• Working with Health Education England and Public Health England to make the benefits of work part of the training of the health workforce.