HR in front line to change employers’ attitudes from ‘too sick to work’ to fit for rehabilitation

HR professionals need to encourage line managers and GPs to help them overcome the £100bn annual cost of workplace absence, Dame Carol Black said in her long-awaited occupational health review last week.

Arguing that her 125-page report Working for a Healthier Tomorrow represented a once-in-a-generation opportunity for real change, Black outlined some hard truths for HR and laid out a potentially far-reaching road-map for the future.

Well-reported recommendations included the creation of a national Fit for Work service and the scrapping of the old-fashioned sicknote in favour of an electronic ‘fit note’ – the latter idea somewhat pre-empted by the government’s announcement in February of a similar well note.

More pertinently for HR, Black made it clear that employers can no longer get away with thinking of workplace health as a medical issue or something to be left to individual departments.

“Senior management interest in these issues and leadership from the very top are vital,” she said. “In addition, line managers have a key role in ensuring the workplace is a setting that promotes good health and wellbeing.”

Line managers needed to be much more proactive about identifying risks and supporting people back into work, taking actions such as adapting work practices, patterns or job roles, Black advised.

Her review also touched on the issues many managers find hardest to deal with when an employee goes off sick: when, how and how often to keep in touch. With 40% of organisations having no sickness absence management policy in place, many employers feel reluctant to contact absent workers for fear of being accused of harassment, she pointed out.

“It is important that line managers feel equipped and confident about approaching sensitive or difficult areas of conversation,” she argued.

And the fit note does not get employers off the hook with GPs. Instead of sitting on their hands getting frustrated, employers are urged to get out more and speak to GPs. They might well be perfectly willing to help if asked about options for a return to work, Black cautioned.

Chartered Institute of Personnel and Development employee relations adviser Ben Willmott welcomed Black’s recognition that employers could not tackle occupational health problems alone.

Her idea of a Fit for Work service has value too, Wilmott said, although he added that there would inevitably be questions about where it would be positioned in relation to the existing – and expensive – workplace health programmes unilaterally put in place by many big employers.

“It will be interesting to know whether this will be something primarily aimed at smaller companies. Perhaps there might be a cut-off for small and medium-sized enterprises,” he said.

Meanwhile Fergus Kee, managing director of BUPA UK Health Insurance, insisted that the Treasury’s long-standing reluctance to offer tax breaks on health and wellbeing investment still needed to be tackled.

“The current tax treatment of workplace health benefits is an obstacle, which, if removed, would allow more companies to play their part in keeping Britain healthy,” he says.

And some commentators remain sceptical as to whether any fancy new bit of paper or electronic form will change how GPs sign people off work.

“The worth of the fit-note proposal depends greatly on the ability and inclination of GPs to specify the range of duties that an employee might undertake,” warned David Coats, associate director of policy at The Work Foundation.

Whether or not all or any of Black’s ideas are accepted – and, crucially, funded by government – the area where HR will most have its work cut out will be in changing the attitudes and practices of line managers when it comes to rehabilitation, according to Willmott.

He agrees with Black that it is important to tackle the institutional beliefs that someone should not be at work unless they are 100% fit, and that being at work impedes recovery.

In fact the CIPD, Willmott points out, is in the early stages of planning joint research with the British Occupational Health Research Foundation on just this area.

“Line managers are going to need the skills to help people come back in a more phased manner,” he said.

Dame Carol Black’s key recommendations

  • Government should work with employers to develop a robust model for measuring and reporting on employer investment in health and wellbeing
  • Employers should use this to report in the boardroom and within company accounts
  • A new Fit for Work service should be trialled by the government, based on case-managed, multidisciplinary support for patients in the early stages of sickness absence
  • The paper-based sicknote should be replaced with an electronic ‘fit note’
  • Government should initiate a business-led health and wellbeing consultancy service, offering tailored advice and support.

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