Incapacity benefit reforms and OH

Four major announcements in seven days, a secretary of state talking about OH and rehabilitation – the government’s ambitious reforms to get people off incapacity benefit (IB) and back into work have put the profession in the spotlight as never before.

The flurry of initiatives that emerged from the Department for Work and Pensions (DWP) in early February are breath-taking in their ambition and signal, potentially, a sea-change in Labour’s attitude towards OH.

From being considered, at least politically, something of a backwater (and definitely junior minister territory), the ability of OH and other health professionals to get the long-term sick back to work has suddenly shot up the agenda.

So, what exactly has been announced? The key reform is the expansion of the government’s pilot scheme, Pathways to Work.

The pilots – currently 11 in total – were launched in October 2003, and have been offering people on IB access to personal advisers, to NHS rehabilitation, and links with voluntary and private sector advisers. There has also been close work with local GPs and employers and, critically, the incentive of a 40 a week return-to-work credit.

The government now intends to roll this scheme out across a third of the country over the next two years, with 420,000 people being covered by October and 900,000 by October 2006.

The pilots, which had previously focused mostly on new claimants, will now be extended to those who have been on IB for three years or more.
On top of this, in a move described by work and pensions secretary, Alan Johnson, as “the biggest change in incapacity benefits since they were created”, the phrase ‘incapacity benefit’ is to be scrapped, because of the perception that it classes people as being ‘incapable’.

For the first 12 weeks, IB applicants will be put on a ‘holding’ benefit at jobseeker allowance rates, while a medical assessment is carried out alongside an ’employment and support assessment’.

Two new benefits will be created by 2008: ‘rehabilitation support allowance’ and ‘disability and sickness allowance’. These will be designed to differentiate between those with severe and those with ‘more manageable’ conditions, expected to be the majority of claimants, predicted the DWP.

Specialist ’employment advisers’ will also be piloted in GP surgeries so, the DWP said, such surgeries become “the first step back to work not the route to a life of inactivity”.

GPs have already expressed their disquiet over the proposals. Dr Laurence Buckman, deputy chairman of the British Medical Association’s GP Committee, told the BBC he was sceptical that many of those on IB would in fact be able to return to the workplace, arguing it was unlikely to be much more than 5-10%.

“GPs are not occupational health trained and wouldn’t know if someone’s fit to work or not. What we know is whether they are ill or not,” he added.

The government’s motivation for these reforms is a recognition that, faced with an ageing population, it needs to address the country’s growing skills gap, argues Dr Geoff Helliwell, chairman of the Commercial Occupational Health Providers Association and OH provider, Wellwork.
One way to do this to make more use of migrant workers – politically, a hugely hot potato – while the other is to tap into the vast pool of people on long-term sickness benefit.

But the implications for OH of doing this have probably not yet sunk in for most practitioners, he suggests. “Most of them [OH] do not see it as relevant because their interest is people in work,” he explains.

“But we are either going to see a large number of immigrant workers coming into the workplace or a large number of returners, who are likely either to have chronic health problems or chronic motivational problems,” he adds.

It is also necessary to look at the IB plans in the context of what has become a glut of other government-led announcements, pilots or reforms.
The DWP’s Job Retention and Rehabilitation Pilots – also focused on getting people off long-term sick leave and back to work – run until the end of March, but may end up going on the back-burner in favour of Pathways to Work.

Then there is last autumn’s White Paper on public health, which put OH at heart of improving workplace public health. This included increasing the number and availability of NHS Plus services, an expansion of NHS OH services, and the development of evidence-based guidelines on OH to ensure consistency.

And the pace, if anything, is set to speed up still further. Last month saw the launch of an OH pilot for small and medium-sized businesses, the launch of an OH pilot for the construction industry, and the beginning of pilots assessing how OH might take over some or all of the responsibility for sicknote certification (see pages 4 and 5 of this issue).

Like it or not, OH – already becoming increasingly mainstream in the workplace – is clearly now moving into the limelight politically. But which will the profession be: a startled deer or a star performer? It is interesting times, indeed.

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