UK-wide sickness absence assessment service announced

The Government has pledged to establish a new national health and work assessment and advisory service by the end of next year at the latest, in a move that promises to bring profound changes to the profile and prominence of occupational health.

The creation of the service was outlined in January in the Government’s long-awaited response to the 2011 report “Health at work – an independent review of sickness absence” by Dame Carol Black, then national director for health and work, and David Frost, then director general for the British Chambers of Commerce.

The new service is expected to cost between £25 million and £50 million, but will benefit the Exchequer to the tune of between £100 million and £215 million, with employers forecast to save between £80 million and £165 million.

It will be run by an external provider, with a tendering process set to start early this summer and a contract expected to be awarded by the end of the year.

Huge demand for occupational health practitioners

The Government said it anticipated the service will require between 330 and 740 OH professionals and between five and 10 physicians specialising in OH and/or vocational rehabilitation. There will also be demand for the equivalent of between 240 and 1,300 full-time healthcare professionals to provide interventions such as physiotherapy, talking therapies or workplace mediation, it added.

“The service will increase the demand for healthcare professionals. We will continue to keep market capacity under consideration as we refine the service delivery model and what roles professionals play in it,” the report said.

It is clear that OH professionals will be at the heart of the new service, delivering state-funded assessments of employees who are off sick for four weeks or more.

The report said: “At the core of the service is the requirement that GPs will refer patients who have been on sick leave for four weeks, unless there are clear and well-defined reasons for not doing so. We will also be exploring whether or not the computer-generated fit note could offer a suitable vehicle to do this.”

Other announcements included the extension of the telephone and web-based OH advice service pilots for another year. These were due to finish next month but will now run until March 2014.

The six Fit for Work pilots in England and Wales, however, have not had their funding extended, and a final report on them is due to be published later this year. Both models are likely to be incorporated, in some form, into the new advisory service. The Government has also pledged to publish new fit-note guidance “shortly”.

No tax breaks

However, there was disappointment for those who have been lobbying for tax breaks to encourage employers to invest in medical treatment or vocational rehabilitation, which the Frost/Black report had recommended.

The report argued the idea that “all expenditure on medical treatment or vocational rehabilitation for basic-rate taxpayers should attract tax relief” was “too broad”.

But it added: “The introduction of an assessment and advisory service gives us the opportunity to consider whether a more targeted relief focused on the cost of interventions recommended by the service, or an alternative approach based on the allowable business expense regime, would be effective in encouraging employers to provide greater support and provide greater value for the Exchequer.”

It said a decision would be announced in next month’s Budget. But the report confirmed the existing tax relief on employee assistance programmes would be retained, as recommended by the review.

Initial reaction (see below) was positive, although questions remain about the capacity of the profession to rise to the challenge and how the new service will be funded, sustained and delivered.

Key recommendations

  • The establishment of a health and work assessment and advisory service during 2014, to include:
    • a state-funded assessment by OH professionals for employees who are off sick for four weeks or more;
    • signposting to appropriate interventions including “universal jobmatch”;
    • an online job search service for employees who are able to work but are unlikely to return to their current employer; and
    • case management for staff with complex needs.
  • The Government to consider the introduction of a tax relief on medical interventions, with a decision expected in next month’s Budget, but tax relief on employee assistance programmes to be retained.
  • Abolition of the percentage-threshold scheme to release these funds to be reinvested in the new assessment and advisory service.
  • Removal of the statutory requirement on employers to maintain sick-pay records.
  • Use of the Employer’s Charter to provide better guidance on what employers can do to manage sickness absence.
  • Improving standards of sickness-absence management within the public sector.
  • Commissioning research to explore the details of sickness absence, management and sick-pay regimes in different types of organisations.
  • Publication of revised fit-note guidance.
  • More of a focus in the future on the health needs of the older working population.


“The introduction of the health and work assessment and advisory service is an important step forward. The effectiveness of the new service will only be realised with improved access to quality-assured specialist occupational health advice and tangible support, together with positive incentives for employee, employer and GP to use them.”
Dr Richard Heron, president of the Society of Occupational Medicine

“We welcome proposals to implement the independent assessment service after four weeks of absence. This is a critical time, just ahead of the six-week period that research shows is the tipping point where employees are less likely to return to work.”
Terry Woolmer, head of health and safety policy at the EEF

“The new service will fill a gap in the market by providing free, independent, objective assessment and advice to help people make quicker and lasting returns to work.”
Ben Willmott, head of public policy at the Chartered Institute of Personnel and Development

“We would like more employers to understand the business case for good health and safety and to recognise that, as well as benefiting workers, good feelings about work have been linked to higher profitability, productivity and customer and worker loyalty.”
Richard Jones, head of policy and public affairs at the Institution of Occupational Safety and Health

“The proposed health and work assessment and advisory service, which is to be externally provided, should be especially helpful to smaller-sized employers who often struggle to access the kind of expert occupational health services typically used by larger employers. As a provider of occupational health services, we look forward to learning more of the Government’s plans to invite providers to tender to provide their services.”
Chris Jessop, managing director of Axa PPP healthcare’s specialist health services division

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