Health reforms special report: Fit for Work pilots

In October 2009, in a joint announcement from the Department of Health and Department for Work and Pensions, the government revealed the 10 sites that will be pilot testing various delivery models of national director for health and work Dame Carol Black’s proposed Fit for Work Service.

Most are expected to start properly early this year or in spring and run until “at least” March 2011, the government has said, with £13m of central funding set aside to “pump-prime” the process.

So, what do we know about them? While there is less detail available on some than others, what is clear is that the primary focus of the pilots will be to reach out to small and medium-sized companies (SMEs) that do not already have access to specialist occupational health (OH) support.

The pilots also have a clear remit to look at models of support designed to help ­people who are out of work and on sickness benefits (primarily the government’s new Employment Support Allowance). Many are looking at models of intervention designed to support people hanging on in work by their fingertips and at risk of losing their jobs because of ill-health or sickness, as well as the problem of ‘presenteeism’ – how to help workers who are struggling into work despite ill-health. Many are looking, too, at ways of improving GP sickness certification and referral in this area.

How the pilot sites were chosen

The process of choosing the Fit for Work service pilotprojets kicked off in March, when the government published a memorandum of information, followed by a succession of information workshops held in Edinburgh, Birmingham and Cardiff.

At the time, ministers made it clear that the principal focus of any future pilot needed to be to “provide personalised back-to-work support to sickness absentees – people off sick from work on health grounds – to assist them in their recovery and support them to return to sustained work more quickly than they otherwise would”.

The pilots needed to have two key aims:

  • To reduce the amount of time users of the service took to return to work and, ideally, to return them to work sooner than they would have done otherwise
  • To reduce the flow of people losing their jobs as a result of ill-health or going on to welfare benefits for that reason.

Following the workshops, interested parties were required to go through a three-stage application and selection process, which included the organisations involved forming into so-called Eligible Partnerships.

These could be combinations of bodies and had to include within them a mix of primary care trusts, local authorities and other public sector commissioners. Organisations also had to go through the rigours of a panel interview.

With the government pledging £13m to the pilot programme, a key element of any application was to include an outline of the projected costs of running the pilot and the funding it would require.

The government made clear the £13m was to be used either to meet the cost of re-configuring existing services or to cover to cost of procuring new services.

Built from scratch

Finally, there has been a focus on placing some pilots in areas of deprivation, particularly in coastal areas, as well as, in the case of Wakefield, examining how a Fit for Work Service might be built up from scratch.

Focusing on three of the pilots – Notting­hamshire, Leicester City and Leicestershire and North Staffordshire/Stoke on Trent – what comes through loud and clear is the desire to not reinvent the wheel, but build on what is already there locally.

Expand into the country

In Nottinghamshire, for example, the intention is to expand an already fairly well-­established health employment programme set up for Nottingham City out into the county, explains David Kirkham, employability and skills manager for Nottingham Employment and Skills Board, which is leading the City Strategy Partnership behind the pilot.

Individuals will be referred to the pilot by their employers, their GPs or through organisations such as JobcentrePlus, or they will also be able to self-refer. From there, they will be referred on to teams of specialist occupational therapists and clinical support workers.

There will be a particular emphasis on picking up and tackling common mental health problems and musculoskeletal disorders, and there will be an option to provide vocational rehabilitation for individuals in a group environment.

“It will be a mixture of occupational therapists, mental health nurses and physiotherapist support, along with case management support for individuals who are both in and out of work,” Kirkham explains.

“The priority will be around those off sick from work, but there will also be support for people in work and support around presenteeism,” he adds.

The pilot will be based at, and delivered through, the support-at-work team at Nottingham City NHS.

Accessing support

The pilot will provide phone, online and paper-based support for employers, especially SMEs, workplace assessments and a brokerage service to help firms access the right sort of support. “To be honest, it is probably not a complete fit with OH teams. It is more geared to employees and employers that do not have that support in the first place,” concedes Kirkham.

“But it will expand the role of the NHS to deliver multi-caseworker support and it will help develop closer links with GPs.”

The Leicester City and Leicestershire ­pilot is a partnership of NHS Leicestershire County and Rutland PCT and Leicester City Council, and will receive £1.2m of the Fit for Work funding to develop a pilot that it is hoped will run from March and help about 2,000 people. Other partners include NHS Leicester City, Leicestershire County Council, Jobcentre Plus, Leicester City Employment and Skills Board and Leicestershire and Leicester City Learning Partnership.

The pilot will focus on improving how GPs sign people off work, in particular encouraging GPs to refer sickness absentees to a case-managed pilot service.

“Our model works on the basis that many people have contact with their GP for a sicknote when they first fall ill. Through this scheme, we will be able to help these people from a very early stage to avoid the long-term health problems associated with being off work for an extended period of time,” explains Dr Rob Hampton – a member of the NHS Leicestershire County and Rutland professional executive committee as well as a GP in Wigston – who led the bid application.

“Case managers will co-ordinate access to a wide range of services, including physiotherapy, psychological therapies, education or re-training, workplace interventions and home and personal interventions, such as housing and debt advice, to help people to get back to work quickly and stay in their jobs, where appropriate,” he adds.

The pilot is lining up a number of GP practices across the county to take part in the pilot, with the central casework team being based at the Leicester Adult Education Centre in the city.

The North Staffordshire/Stoke-on-Trent pilot is being run by an ‘Eligible Partnership’ consisting of Jobcentre Plus, Staffordshire County Council, Stoke-on-Trent City Council, NHS Stoke-on-Trent PCT and NHS North Staffordshire.

The other pilots

Dame Carol Black’s Health, Work and Wellbeing now has a webpage dedicated to the Fit for Work Service. It provides links to Black’s Working For A Healthier Tomorrow review, as well as the government’s response, plus a brief outline of each of the 10 pilots.

Apart from Nottinghamshire, Leicester City and Leicestershire and North Staffordshire/Stoke-on-Trent, the other pilots are:


OH provider Salus will be delivering a large-scale, Scotland-wide Fit for Work Service through a freephone national advice line. The intention is for telephone advisers to ‘triage’ calls to determine the support required. Callers will be offered direct advice, pointed in the direction of self-help resources, or referred on to one of 14 local Fit for Work services – one for each health board in Scotland. Three of these local services are already up and running, with one being Dundee (see below), and resources are now being set aside to establish the other 11. The primary focus will be on SMEs that do not already have OH support and on workers in low-paid employment.


This pilot will build on an existing health and employability service for SMEs that has been running for the past year through Working Health Services Dundee. It will have a remit to develop a model looking at options for earlier intervention to prevent presenteeism. Already, workers with ill-health who continue to work but are at risk of sickness absence and loss of employment form 72% of the service’s caseload, so the intention is to build on that.

Central West Midlands

This Fit for Work Service will operate across Birmingham, Coventry, Sandwell and Solihull. Its primary focus will be to provide support to sickness absentees, but it will also reach out to unemployed people receiving Jobseeker’s Allowance who have specific needs that would benefit from the specialist Fit for Work expertise. It will be case management-led, with this aspect of the pilot being provided by a private sector supplier.

Rhyl (Wales)

Led by Rhyl City Strategy Partnership, this Fit for Work Service is to focus on how support can be best provided to a deprived coastal areas. Its principal focus, much as with the other pilots, will be to provide personalised back-to-work support. In this instance case managers will be based in GP practices to provide scope for what the government has termed “co-location” with physiotherapy, psychological therapies and other support services. The intention, therefore, is to provide, and assess the wider feasibility of, a ‘one-stop shop’ approach within a primary care setting.

Eastern and Coastal Kent (Margate)

This Fit for Work Service is intended to provide support to sickness absentees in the deprived coastal area of Margate. The aim is to focus on improving GP referrals of sickness absentees and will be part of, and build on, the government’s ‘Total Place’ initiative, which has been looking at how local public agencies, such as local authorities, can better deliver front-line services.

Kensington & Chelsea

Delivered through NHS Plus, this Fit for Work Service will be a case management-led partnership with the Royal Borough’s environmental health team. There will be a particular focus on supporting employees of SMEs, with links being made to local employment and skills providers, including the government’s proposed Adult Advancement Careers Service. This is a new service first outlined by the Department for Innovation, Business and Skills in 2008 and due to be rolled out during 2010.

Wakefield District

The intention here is to examine how a Fit for Work Service might be established from scratch in an area of high deprivation, including how it might work in partnership with other local services.

Return to work

Of these, NHS Stoke-on-Trent will be the lead accountable organisation, with NHS North Staffordshire the lead provider, through the NHS’s Condition Management Programme, which aims to support unemployed people with long-term health problems to return to work.

“Our aims are to catch people at four- to six-weeks of sickness absence from work and try to prevent the flow of people on to benefits such as Employment Support Allowance,” explains Judith Parker, programme manager for the Staffordshire NHS Condition Management Programme.

“It is about trying to support people so they do not lose their job because of being off sick, about preventing them deteriorating so badly that they subsequently lose their jobs,” she adds.

The emphasis will be on working with people who have long-term health conditions and supporting them back to work using the biopsychosocial model and through, as with other pilots, a case management-led approach.

Clear pathways

“We will also be working with employers, particularly SMEs, who may not have an OH service already. There will be the standard forms for referral, including a website and phone line. The referral pathways will be very clear. And there will be the option of self-referral or referral from other sectors,” says Parker.

“We will be looking at medical issues as well as psychological and social issues; so it is about looking at the whole person and how their health issues are impinging on their life,” she adds.

The pilot will also establish a multi-disciplinary team of health professionals, including occupational therapists, physiotherapists, nurses and mental health nurses, as well as social care professionals.

“It is about getting people back to work as quickly as possible, taking into account their health problems and dealing with any employment-related issues, so it is looking at the whole issue affecting that person at that time,” says Parker.

Much as in Leicester, the team will be working closely with GPs, in this case to design a software tool that can alert them to the existence of the Fit for Work Service as an option for referral.

Parker says: “So it may say when someone has been signed off for four weeks ‘have you thought of sending them to the Fit for Work service?’, or something like that. We will have a cohort of GPs working with us. It is something we are really excited about.”




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