The extent to which the launch of the government’s Fit for Work Service will increase awareness of rehabilitation services divided opinions amongst delegates at a recent Corporate Adviser round table Absence Management – Defining What Good Looks Like, held in association with Aviva.
The pilot launch of the newly-renamed service has been delayed until some unspecified time towards the end of the year, and is scheduled to be rolled out nationally by May 2015, helping employees who have been off on sickness absence for four weeks return to work and to help employers in their management of sickness absence.
With group risk professionals so heavily involved in absence management, pushing the subject of rehabilitation further into the public eye could be counted as positive, but opinion was divided on the potential impact of the new service. In a straw poll at the event no attendees thought it would create a step-change in employers’ understanding of absence management that will translate through to increased appetite for group risk solutions, and 50 per cent felt it would have no impact at all. But half did think a few employers would become more interested in group risk as a result, although the impact would not be that significant.
Group Risk Development spokesperson Katharine Moxham said: “I think the Fit For Work Service might give employers a better idea of the value of group income protection and of the services that come with it. People will be working from scripts but there’s only so much you can do from a script and we have the huge of advantage of dealing with people, and we deal with them as people and by people. So I think it really will bring home the value of having something better.”
Round table delegatesBut delegates were dismayed at the scant level of detail currently available. For example, although it was generally assumed that if an employer has group income protection then the Health and Work Service would recommend that the employee used that route instead, Moxham stressed that it wasn’t quite that black and white. The draft legislation is out for consultation and Grid will be responding to this.
Aviva head of group risk Steve Bridger said: “Presently we don’t really know enough, and until something actually starts you don’t know how effective it is going to be. We know it will be using a script, so by definition the service will be fairly rigid, but if someone doesn’t have private provision our expectation is that there will be a lot of good recommendations. But if the employer doesn’t want to pay and the GP isn’t engaged enough either to push that employer or that person to say ‘this is good for you’ I can’t see a lot of things happening on the back of it.
“It’s a step in the right direction, but a limited one. But we really have an opportunity, certainly over the next year, when implementation takes place more nationally in the first and second quarters it is bound to attract negative press.”
Lark Employee Benefits divisional director Samantha Mistry doubted that GPs would be making the required input into the new service as they were always going on about how little time they had available. Mercer head of health and benefits consulting John Matthews agreed, stressing that it was “Not a seven minute issue.”
He said: “How are they going to deal with it in that time? And even if they can and they end up as a gateway to other services, if there isn’t anything else in there like a private healthcare plan then the employee has got to go into the vagaries of the NHS. They are still going to be off work for a long time because getting in touch with a psychologist or psychiatrist is going to be a lengthy process.
“I think it’s a fallacy that the GP route is going to be helpful. There’s got to be some other way. I
don’t think it will get any shelf-life in the mind of the GP. They never really bought into fit notes. Lots of them just didn’t get them or understand what their role was. So I’m not convinced this will be much different.”
Matthews also felt there would inevitably be conflict between recommendations made by the Fit For Work Service and employers who are not willing to spend on everything that’s been recommended. But Grid’s Katharine Moxham was more positive in this respect.
She said: “I am not necessarily seeing them as conflicting but I think the Fit For Work Service might alert employers to the fact that there is a basic requirement to make reasonable adjustments under the Equality Act. And, if it makes it clear what reasonable adjustments look like from the government’s point of view, the employer might ask if there was something better and, if there is, whether it wanted to do that.”
Delegates questioned the extent to which the new service could influence legal relations between employers and their staff where there were disputes. JLT Benefit Solutions head of healthcare & wellbeing Richard Colver doubted that an employer could actually be forced to provide private treatment because of the availability of the NHS. But Bridger pointed out that in the event of stress that was actually related to work, employers who acted on professional recommendations for treatment or adjustments would probably be in a much stronger position in the event of a constructive dismissal claim.
The draft rules contained in the consultation on the £500 tax break for return to work interventions propose that care benefiting from the tax exemption must be approved by a health care professional who is a registered medical practitioner, a registered nurse, or an occupational therapist, physiotherapist or psychologist registered with the Health and Care Professions Council.
The £500 P11d employee exemption was first proposed in the paper Health at work – an independent review of sickness absence, written by Dame Carol Black and David Frost CBE, which was published in November 2011.
It was not anticipated that the £500 tax break being offered by the Fit For Work Service – which comes in the form of relief from P11D liabilities for employees referred for medical treatment – would result in a spate of new product development. As Grid’s Katharine Moxham pointed out, there have already been return to work products that haven’t been wholly successful.
Moxham said: “Grid asked a question about the tax break in its employer research and the penny hasn’t quite dropped that the £500 will be an expense the employer will incur. £500 isn’t much and doesn’t go a long way, and if an employer has group income protection it quite possibly would get various interventions as part of a mitigation of claims process.”
Employees will be eligible for the break once they have been off work for 28 days. The consultation proposes the tax exemption should also apply for care that commences shortly after an employee returns to work expected to be within 14 days of an employees’ return, or commences while an employee is absent from work due to ill-health or injury, but, once treatment has started, they are able to return to work while the treatment continues.
Employers wishes to benefit from the tax exemption will be expected to retain relevant records such as attendance records, fit notes, including those that indicate an employee ‘may be fit’, and return to work plans.
Overall, the main value of the Fit For Work Service to the group risk field was considered to be the opportunities it offered to get a foot in the door to develop a broader dialogue.
Aviva group risk distribution manager Matthew Whitehouse said: “I see it almost as the leg up to get the conversation. You could go in with your pitch being about the cost of absence and someone won’t really know what the cost is because they don’t monitor it. But if you go in and talk about the Fit For Work Service they will have heard these words and will want to know what it means to them. That’s when you can then talk about some of the other stuff that would fill the gap.”
But there was general agreement that such conversations would stand far more chance of being successful if intermediaries were able to refer to authoritative and independent statistics about the success the field has enjoyed with rehabilitation. Moxham indicated that this would be the next logical step for Grid to take, following its publication of claims statistics last year.
Premier head of risk and healthcare Allyson Gayle said: “You absolutely have to quantify absence in some guise. The HR director gets this but you have to help him sell the return on investment case to the finance director. You just have to be armed with everything because all he is seeing is the cost of everything.”
Mistry reported how she had recently seen a small firm where HR “loved the whole thing” but the finance director baulked at the £60,000 premium and was adamant that he hadn’t spent that much on absence during the last five years.
Bridger said: “It probably had cost him £60,000 in the last five years but it’s all about recording absence and getting into understanding the real costs of it. Are you really recording these half day, one day and one week absences? ”