As the contract for the new national Health and Work Service (HWS) has finally been awarded, Janet Patterson looks at the broader implications for occupational health (OH) delivery.
Sickness absence has always been high on employers’ agendas due to its obvious financial implications. Approximately 2% of total working time is lost annually to sickness absence, which costs employers £9 billion per year (Young and Bhaumik, 2011). Sickness absence also costs employees £4 billion in lost earnings and the Government £2 billion in sick pay and associated taxes. The government review of UK sickness absence (Black and Frost , 2011) and subsequent “Fitness for work: the Government response to ‘Health at work’ – an independent review of sickness absence (2013)”, called for a number of improvements to tackle sickness absence. The key recommendations were announced in the Budget and Autumn Statement in 2013 and included:
- a state-funded health and work assessment and advisory service from 2014, to be known as HWS, run by the Department for Work and Pensions (DWP);
- the abolition of the percentage threshold scheme to fund this service;
- access to Universal Jobmatch for those requiring a job change;
- retention of tax relief on employee assistance programmes;
- abolition of statutory sick pay record-keeping requirements;
- publication of revised fit note guidance.
For OH practitioners, the most contentious recommendation is the proposed HWS, whose aim, we are told, is to provide “occupational health advice and support for employees, employers and GPs to help individuals with a health condition to stay in or return to work”. While the service is intended to be delivered with a unified brand and scope, it will be delivered by a different provider in Scotland to that in England and Wales and there will be no service in Northern Ireland. In July 2014, the Government announced that the contract to run the service had been won by OH provider Health Management, which is part of the Maximus government international services group.
Summary of the key elements of the HWS
I attended an employer briefing given by the DWP on 10 July on the intended roll-out of the HWS. Key issues with the proposed service were as follows:
- The service is not mandatory – the GP can suggest referral to HWS but the patient does not have to accept. The opportunity for a telephone case assessment by the HWS and return-to-work/rehabilitation plan is only initiated if the employee agrees and consents.
- The referral is intended to be initiated when the GP feels the issue of a four-week or longer fit note is necessary, however it cannot be for any potential absence of more than 12 weeks. Any absence beyond 12 weeks is deemed to be beyond the scope of the advisory service.
While there will be revised fit note guidance, there will not be any adaptations at the initial stages to alter the fit note to include a referral to the HWS. Arguably, this is a missed opportunity. The fit note currently has four tick boxes to include scope for modified work or adjustments upon return to work. To include a further box for referral to HWS or the employees’ own company OH service would raise awareness of the need for relevant work assessment and considerations that the GP has not got the time or specialist knowledge to advise upon.
More information will also be required on the availability for employers to refer into the service. It is understood that this is a possible route of referral in exceptional cases and only with employee consent. Employers would need to review their current policy to include this as a possible facet to the sickness absence process.
The HWS intends to provide advice for employees, GPs and employers via the internet and a telephone advice line. The sole intention of this advice centres on return to work or work retention for individuals with health issues. Just how this will be delivered will be clearer once the contract providers are in place and such details are finalised.
It is thought that the return-to-work/rehabilitation programme recommended by the HWS will be used much like a fit note for pay purposes, and ultimately it is up to the employer to determine just what they can reasonably accommodate in terms of adjustments and phased return to work.
Implications for the OH arena
The benefit of early intervention in managing health issues and the health benefits of good work are well documented. The value of robust absence policies has been discussed (Ford, 2014) and while many larger employers already have a sickness absence policy with time triggers for management with the inclusion of OH referral, there are many businesses that lack policies, processes or resources to make a positive and timely impact on absence management.
The HWS offers the potential to close the gap where individuals fall outside of company-managed absence and offers small and medium-sized employers, who may not have resources or robust sickness absence policies in place, to manage absence in a timely manner. There is significant evidence that the longer individuals refrain from work, the less likely they are to return. Early intervention is key to assisting individuals back to work – the golden period to facilitate return to work is prior to four to six weeks absence (Waddell, Burton and Kendall, 2008). While OH professionals will agree with the need for timely advice, arguably the final decision as to whether or not adjustments can reasonably be accommodated by the workplace has to lie with the employer.
Opportunity for OH
In summary, while there has been a mixed response to the launch of the HWS, this may be a great opportunity to raise the profile of OH practice in terms of promoting relevant timely advice. On a positive note, we may see more job opportunities to fill the resource needs of the HWS. The tax exemptions on medical treatments recommended by HWS or in-house OH providers may serve as a profile raiser for seeking OH advice. The DWP will be providing more information on how this will be available and how it can be claimed.
However, the platform for promoting OH should continue to focus on the benefit of full OH services with key facets being the prevention of ill health and work-related conditions and promoting general wellbeing, which are all important drivers in managing absence and reducing sickness. My advice is to carry on doing what we do well and follow, with interest, the proposed changes and roll-out of the HWS. Time will tell whether or not GPs and the HWS can make it work and if patients are willing to take up this new service. HWS is not intended to replace OH services; it is intended to provide a tool to reduce the financial loss related to sickness absence.
Black C, Frost D (2011). “Health at work – an independent review of sickness absence in Great Britain. Department for Work and Pensions.
Department for Work and Pensions (2013). “Government response to the review of the sickness absence system in Great Britain”.
Department for Work and Pensions analysis of Labour Force Survey Oct 2010-Sept 2013 and data relating to Young V and Bhaumik C (2011). “Health and well-being at work: a survey of employees”. DWP Research Report No.751.
Ford C (2014). “Help with managing absence”. Occupational Health; vol.66, no 4.
Waddell G, Burton AK and Kendall NAS (2008). “Vocational rehabilitation, what works, for whom and when?”. The Stationery Office.