Sickness absence review holds promise for occupational health

The Government has announced that it is to launch a major review into the sickness absence system in the UK. The outcome of this review could open up a world of opportunities for occupational health professionals, says Noel O’Reilly.

Like politicians, it is not often that journalists admit that they might have got something wrong. But, for once, it is time for a personal mea culpa. In the January 2011 edition of Occupational Health magazine I made a somewhat pessimistic prediction that, come April, a cuts-obsessed Government could well have let the Fit for Work pilots run into the sand and even “dropped the pilot”, in the shape of national director for health and work Dame Carol Black.

At the time, and given the rather vague noises that the Government was then making about its future plans for workplace health, it seemed a plausible enough scenario, and at least worth raising as a possible talking point.

Unfortunately for me, although very fortunately (at least potentially) for occupational health practitioners, events – in the shape of a wholesale review into sickness absence announced by the Government in February 2011 – have proved that prediction to be distinctly wide of the mark.

Showing promise

Not only is Dame Carol, along with David Frost, director-general of the British Chambers of Commerce, now gainfully employed on a major new piece of work designed to complement her groundbreaking 2008 Working for a healthier tomorrow review of workplace health, the Government also announced an extra £12 million of funding for the Fit for Work service and occupational health telephone advice line for small and medium-sized businesses. Before this, both of these pilot operations only had funding until March this year, hence the previous uncertainty.

As Helen Kirk, OH consultant and OH rep­resentative on the Royal College of Nursing’s public health forum, explains, all this means that, first, the momentum of Dame Carol’s work has not been lost under the new Government but, in fact, has been given further impetus.

quotemarksIt opens up the opportunity for more focus on support for people at work, which must be good for OH nurses.”

Helen Kirk
OH consultant

“Second, it means that Dame Carol’s work, which has been such a boost to OH, is continuing. Third, it opens up the opportunity for more focus on support for people at work, which must be good for OH nurses. Finally, sickness absence is also relatively high within nursing, so this might mean better support for nurses so they can get on with their work,” adds Kirk.

Project scope

So, what is the review all about and what difference could it potentially make to OH?

The review (see panel) is very much focused on exploring the current sickness absence system, the incentives, costs and barriers within that and how to encourage greater as well as earlier interventions by businesses.

To set it in context, it is being presented as a key strand of work and pensions secretary Iain Duncan Smith’s welfare reform agenda (and was actually announced on the same day as his Welfare Bill).

In launching the review, the Government made a clear link between it and the “burden” to the state of long-term ill health, with, as it argued, more than 300,000 people leaving work to claim sickness-related benefits each year, around half of the total flow on to employment and support allowance.

The Government has also emphasised that the review will feed into its wider review of employment law, which is looking at ways to reduce red tape and “maximise flexibility” for employers and employees.

The fact that the review also has Frost on board to bring a business “head” to the proceedings and will include a panel of “experts from business, trade unions and health” may also give it an intriguing flavour.

Improvement focus

While there are always dangers in trying to pre-empt reviews such as this, at a “sounding board” meeting for OH stakeholders around the time of the launch, Deborah Jamieson, cross-government head of the health, work and wellbeing strategy unit, outlined the review’s goals. These were to “drive improvements in access and delivery” of occupational health; foster more partnership working; and to create a “modernising” occupational health service.

quotemarksI do think that occupational health could have an important role in how return to work is managed.”

Stephen Bevan
The Work Foundation

Desired health, work and wellbeing outcomes now and into the future included better use of the workplace as an early indicator for risk factors; better maintenance of health and “resilience”; more focus on prevention and early intervention; and a more “sustainable” workforce.

There also needed to be more of a focus on influencing employers to provide workplaces that promote health, as well as better support around managing sickness absence and more emphasis on the links that exist between good management, health, engagement and productivity.

Stephen Bevan, managing director of the thinktank The Work Foundation and a member of the expert group that will be advising the review, is upbeat about the potential for a review like this to effect real change.

“If we can put this together with the Government’s Welfare Bill proposals then I think this does have the potential to offer a route back into the workplace for a lot of people for whom their health has become detached from the labour market,” he says.

“It is about helping return to work on a phased or partial basis and how that is being managed effectively, by people with professional knowledge, and ensuring that people are not being punished by the benefits system. It may be, for example, that we see people being able to taper their benefits as their earnings increase with their progress in returning to work, and that there is less of a cliff edge between being in work and out of work,” he adds.

One important remit of the review will be to examine what tends to work well elsewhere in the world, especially in Europe, and what lessons the UK could learn or implement.

“For occupational health, certainly this is an opportunity. If you look at countries such as the Netherlands, employers there are much more actively encouraged to take occupational health advice very early on. So I do think that occupational health could have an important role in how return to work is managed and encourage people to take account of their health conditions, even self-manage,” Bevan explains.

Talking points

“There will also need to be a focus on how employers can make reasonable adjustments. Employers often do not know how to redesign their workplaces, even temporarily to manage people back to work. So it is about how to help line or senior managers help people to return to work. I hope this review will look at it from the employer’s end as well,” he adds.

quotemarksWhat I would like to see is the review bolstering the business case for employers to invest in occupational health, particularly small and medium-sized businesses.”

Ben Willmott

“With the fit note, we are finding that GPs are getting quite good at ticking the boxes, but are perhaps not as good at providing a narrative of what the adjustment might be. OH advice may be one way to make that happen more. It is about getting GPs to think about work as one of their clinical outcomes, and having access to OH may help them in that.”

Sayeed Khan, chief medical adviser to the manufacturers’ organisation EEF, agrees that the central theme of the review will be to look at how sickness absence (and intervention) actually works; who pays for what, how you increase early intervention and so on.

“It will be looking at what it is that improves or reduces the absence rate and what other EU countries are working on,” he points out.

“The Government is clear it wants to change things, it does not want to go back to the status quo. So it is about looking at the different systems, looking at what works and what makes things worse. So it may not be single things but all sorts of things – the culture and the way we work, self-certification, responsibilities of employers and employees and so on. I think it could be quite radical; it could have some radical suggestions for changing how the system works,” he adds.

When you combine the possibilities of this review with the momentum that is being created through the new Safe Effective Quality Occupational Health Service (SEQOHS) accreditation system as well as ongoing changes to the landscape such as Fit for Work services and the fit note, it all points to OH having a progressively bigger and more important role over time.

“The bottom line is that I do think this will affect OH professionals, and they will end up more involved rather than less involved,” he predicts.

“Working for a healthier tomorrow” was a vitally important milestone for occupational health and has generated some absolutely key reforms, but this review is the next logical step, agrees Ben Willmott, public policy adviser with the CIPD.

“I think that it could shine a light on absence management, uncover best practice and raise the profile and importance of taking a proactive approach to absence management. I think the timing is positive in terms of tying in with the Government’s welfare reform agenda; how to stop people falling out of employment as well as helping benefit claimants back into work. I think OH involvement could well be a critical part of this,” he says.

“What I would like to see is the review bolstering the business case for employers to invest in occupational health, particularly small and medium-sized businesses. I would like it to look at how to use OH in the most effective way. There are still too many organisations in the UK where, even if you have access to OH, it is only used for the management of people with long-term health problems,” he adds.

The role of HR could also become more pivotal in all this, as could the issue of investment in early intervention or referral to specialist support, such as fast-track physiotherapy or counselling.

quotemarksI suspect there will be a lot of looking at how beacons of best practice can become the norm rather than the exception.”

Mark Simpson
AXA ICAS Wellbeing

“Occupational health practitioners need to ensure that the business really understands the full potential of OH and that it is able to take a holistic approach to it. I think what it says about incentives could also turn out to be really interesting, given the austere times that we are living in. Whether it is some sort of tax or around national insurance or whatever. I think it is simply really useful just to explore the potential incentives around health, especially incentives for small businesses,” adds Willmott.

Practical approach

The extra funding for the Fit for Work service is no accident, argues Dr Mark Simpson, medical director at AXA ICAS Wellbeing.

The review will be very much distilling the outcomes of the Fit for Work pilots and looking at practical measures to take forward what has been discovered, such as whether or not people want to have access to fast-track counselling, debt advice and so forth. It will also look at the results that individual pilots have achieved, with Simpson, for one, citing the Nottinghamshire and Leicestershire pilots, which have been investigating alternatives to GP sickness certification and seeing significant increases in the number of people certified as able to work in some shape or form.

“It will be taking things that have been quite theoretical and looking at whether we can turn them into practical measures,” Simpson points out. “The remit is not vague as such, but it is a fairly open remit. But I suspect there will be a lot of looking at how beacons of best practice can become the norm rather than the exception.”

The £12 million for Fit for Work and the OH helpline will be a drop in the ocean compared with the funding required to make such services a permanent part of our landscape. In these austere economic times, this could well be the crunch question that, once the review has reported and made its recommendations, the Government will have to address.

As Simpson acknowledges: “If we are going to have successful Fit for Work pilots, how are they going to be run in the future? How are they going to be funded and what is going to be the model by which they are selected?”

And one key thing on his wish list: “I would like to see [the review] looking at restoring the ‘refer to OH’ tick box on the fit note. There is no reason why OH providers could not take over that sort of certification,” he adds.

What the review will cover

The Government has outlined the scope of the review as follows:

  • To explore how the current sickness absence system could be changed to help people stay in work, reduce and share costs for the taxpayer and businesses, and contribute to economic growth.
  • To examine whether or not the balance of these costs is appropriately shared between individuals, employers and the state.
  • To make tangible recommendations for change.
  • To ensure that recommendations for change are consistent with promoting private sector growth and minimising burdens on business, in particular, small and medium-sized businesses.

To this end, it is expected to address a number of key questions, including:

  • Why do some people with a certain health condition continue to work while others with the same condition do not?
  • How much is sickness absence driven by sick-pay incentives?
  • Why and how do individuals leave work and go onto benefits, and of those, how many would have preferred to stay in work?
  • How will more people on long-term sick leave coming back into work affect those trying to enter the labour market from unemployment or education?
  • What drives the differences in sickness absence rates between larger and smaller companies and between public and private sector industries?
  • In what circumstances does ill health lead to an employer wanting an individual to exit employment, and how does this overlap with underperformance?
  • Are employers more concerned with the cost of sickness, rehabilitation or problems around dismissal?
  • What drives sickness certification behaviour and is there any variation between physical and mental health conditions?
  • How effective is occupational health in facilitating return to work and could its record be improved?

The Government has also confirmed that the review will work to a tight timeframe and is expected to report quickly, later this year. This means that there will also be a strong chance of a government response to its recommendations later this year.

XpertHR provides a model policy that deals with long-term sickness absence.

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