The government needs to go “further and faster” on reforming occupational health, SOM (the Society of Occupational Medicine) has said, and this needs to include rethinking the fit note.
The call has been made in discussions with the Treasury ahead of chancellor Jeremy Hunt’s next Budget on 15 March.
SOM said the cross-departmental Work and Health Unit needed to accelerate the activity outlined in the government’s response to the Health is Everyone’s Business consultation. The government responded to the 2019 consultation back in 2021 and since then the pace of change has been glacially slow.
SOM in particular called for the Treasury to sign off on pilots for the proposed subsidy model to incentivise businesses to invest in occupational health, especially small and medium-sized employers.
It also needed to give the green light to funding plans for wider training of professionals both inside health (such as social prescribers) and outside health (such as work coaches) to carry out health and work conversations.
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As part of its longstanding campaign for universal access to occupational health, SOM urged Hunt to accelerate OH input into primary care and continue to put more investment into OH within the NHS, especially within the NHS Workforce Plan and NHS England’s Growing occupational health and wellbeing strategy.
SOM also said it wanted to see new pilots being agreed and funded to bring OH more into the hospital discharge process for people of working age.
All this links back to long-term barriers to accessing occupational health, SOM has argued.
These include a lack of knowledge about OH by employers. More communication and marketing is needed, as SMEs often do not want to take the perceived financial ‘risk’ to invest in OH.
There is a greater need to invest in long-term OH staffing by both the NHS and commercial OH companies.
The fit note also needs a significant rethink, SOM argued. As things stand, the fit note was little more than “a gateway to long-term sickness absence”, it argued.
“95% of the time, it is used to sign people off work altogether. One third of people are signed off work for four weeks or longer, by which time 20% will never return to work. Once signed off work for six months, 80% will never return to work. Early intervention is key,” SOM said.
“Across government, there should also be greater leadership as to the advantages of staying in work, that work is generally good for health, and what OH can offer,” SOM added.
Occupational health physician Dr Lara Shemtob, of London’s Imperial College and who has been working with SOM on this, said: “Barriers to using the fit note to its full potential in general practice include time and expertise, and that is where specialist occupational health knowledge can help. Perhaps the biggest barrier to using the fit note effectively in practice is the widespread narrative around the ‘sick note’.
“Most people do not realise that the fit note can be used to suggest changes to their work to help support them to keep working when living through a period of ill health. We must support people who are living through ill health to understand that work can be good for their health, and using fit notes effectively can be a way of achieving this,” Dr Shemtob added.
More positively, it is expected that moves to develop a new Centre for Work and Health could take a step forward next month, as part of a new round of research grants from the National Institute for Health and Care Research.