Rishi Sunak has revealed plans to move responsibility for assessing fitness to work away from GPs to “specialist work and health professionals” in England.
Announcing plans to overhaul the benefits system, the prime minister said that the focus must shift away from what people cannot do to the work they might be able to carry out.
“We don’t just need to change the sick note, we need to change the sick note culture so the default becomes what work you can do – not what you can’t,” he said.
“Building on the pilots we’ve already started we’re going to design a new system where people have easy and rapid access to specialised work and health support to help them back to work from the very first fit note conversation.
“We’re also going to test shifting the responsibility for assessment from GPs and giving it to specialist work and health professionals who have the dedicated time to provide an objective assessment of someone’s ability to work and the tailored support they need to do so.”
A call for evidence has been published, which will seeks responses from healthcare professionals, employers and individuals around how the current system works and how it can be improved.
Fit note system and long-term sickness
ONS: Economic inactivity higher than previously thought
Early OH intervention can slash sickness absence by two-thirds
People with long Covid being failed by return-to-work policies – study
Extent of ill health among Universal Credit claimants revealed
NHS data showed almost 11 million fit notes were issued last year in England, with 94% of those signed “not fit for work”. Many of these were repeat fit notes.
Ben Harrison, director of the Work Foundation at Lancaster University, said the prime minister is right to tackle the issue of rising economic inactivity, but pushing people with mental or physical health conditions into “any” job by threatening to remove their welfare benefits could make their conditions worse.
“Instead, the focus should be on de-risking returning to work for those with long-term health conditions, and critically, on stemming the flow of people who are leaving work due to sickness,” he said. “That means making big improvements to the quality of work on offer so that they can find sustainable employment.
“The government has failed in its promise to deliver an Employment Bill this Parliament, leaving 6.8 million people in severely insecure jobs which can have a negative impact on individuals’ health and mean they cycle in and out of work and remain dependent on Universal Credit. Addressing this must be a priority in the next Parliament.
“We also have to ensure that job flexibility is a day one right so that those with health conditions can have confidence they can agree arrangements that work for them when applying for roles. And we must strengthen statutory sick pay, so that those with fluctuating conditions can sustain employment over the long-term.”
Who will certify fit notes?
In 2022, more health professionals were given the power to certify fit notes, including occupational therapists, pharmacists and physiotherapists.
It is not yet clear who Sunak has in mind for fitness to work assessments, but the Society of Occupational Medicine (SOM) called for fit notes to be reviewed by people trained in occupational health, and said people responsible for declaring fitness to work should have to undergo clinical and medical training.
The focus should be on de-risking returning to work for those with long-term health conditions, and critically, on stemming the flow of people who are leaving work due to sickness,” – Ben Harrison, Work Foundation
“SOM would like to see fit note certification acting as a triaged referral point to an occupational health professional to support return to work, and skills in occupational health are barriers to using the fit note to its full potential in general practice,” it said.
“Only 50% of UK employees have access to OH and the government needs to fund OH to support people with health issues to stay and return to work.”
Gwenllian Wynne-Jones, professor of nursing at Keele University, said: “There is a clear need for better support for those struggling at work though better access to OH. However, we must ensure that we don’t disassociate the health system and healthcare professionals from supporting people to work. Effective management of sickness absence requires all stakeholders to be engaged in supporting people to manage their health work.”
‘Over-medicalising’ everyday challenges
Sunak said that a “significant number of working aged people have become inactive due to long-term sickness which has in large part been driven by mental health conditions”. He also warned against “over-medicalising the everyday challenges and worries of life”, echoing comments about mental health awareness that were made by work and pensions secretary Mel Stride last month, but said the government would “never dismiss or downplay the illnesses people have”.
Dr Sarah Hughes, chief executive of the mental health charity Mind, said: “We are deeply disappointed that the prime minister’s speech continues a trend in recent rhetoric which conjures up the image of a ‘mental health culture’ that has ‘gone too far’.
“This is harmful, inaccurate and contrary to the reality for people up and down the country. The truth is that mental health services are at breaking point following years of underinvestment, with many people getting increasingly unwell while they wait to receive support.”
We must ensure that we don’t disassociate the health system and healthcare professionals from supporting people to work. Effective management of sickness absence requires all stakeholders to be engaged in supporting people to manage their health work,” – Gwenllian Wynne-Jones, Keele University
Karl Bennett, wellbeing director of employee benefits platform Vivup and chair of the Employee Assistance Professionals Association, said it was “incredibly insulting” to presume that people visiting their GP with mental health concerns were taking GPs away from other patients.
“The issue is not having the capacity to issue ‘fit notes’, it’s having the resources available within the NHS to support those people when they are at their most vulnerable,” he said.
“It takes courage to ask for help if you are struggling with mental health issues. Visiting a GP may be a last resort for some, so investment is needed to support people, rather than increase access to fit notes.”
He said employers needed to do more to recognise when an employee was feeling low and have tools that can support mental health issues.
“This includes regular training for managers around the services available to their teams and focus on organisational culture – which needs to be one of inclusiveness without fear of consequence when asking for help,” he said.
Presenteeism still rife
Meanwhile, a recent poll by HR, payroll and finance firm MHR found 71% of employees have worked while unwell because of the negative perception of calling in sick. Three-quarters said they feared calling in sick would damage their career progression.
Sign up to our weekly round-up of HR news and guidance
Receive the Personnel Today Direct e-newsletter every Wednesday
Jeanette Wheeler, chief HR officer at MHR, said: “The findings of our research are alarming and point towards a worrying culture of presenteeism in the workplace. It almost goes without saying that employees should be encouraged to take days off when they are sick – either this is not happening, or the message is not being communicated properly and employees don’t believe it when they are told this.”
