Fitting the bill

Government plans for welfare reform continue apace with the changes set to rewrite workplace absence management strategies. Healthcare professionals will hope the arrival of fit notes this month will nurture
the concept of rehabilitation amongst the nation’s employers.

“If you look back over the five years since the Government started its workplace health strategy, it’s been very busy with a number of reviews into what needs to change,” says Dr Mark Simpson, medical director of Axa Icas.

“These have included Dame Carol Black’s review, ’Working For A Healthier Tomorrow’, as well as the Government’s response, ’Improving Health and Work: Changing Lives’. It all points to change in the workplace.”

These reports have resulted in a number of significant changes, included an overhaul of the incapacity benefit system, replacing it with Employment and Support Allowance, and the launch of pilots to help employees return to work.

The latest initiative, which is set to have a more immediate effect, is the fit note, which is replacing medical certificates or sick notes.Introduced at the beginning of this month, rather than sign an employee off sick, this enables GPs to state whether or not a person is fit for work. If they say the person could be fit for work they can specify in what capacity, selecting one of four options (phased return, altered hours, amended duties and workplace adaptations) and providing further suggestions where necessary.

Its introduction has been welcomed by those in the group risk industry. “The sick note has been a barrier to achieving a sustainable return to work for employees,” says Katharine Moxham, spokesperson for Group Risk Development (GRiD). “It raises awareness that an employee might be able to work in a different capacity.”

There are a few stumbling blocks though. While the length of time an employee can be signed off for has reduced from six months to three months, many feel this is still too long.

John Picken, owner and director of strategic health and wellbeing consultancy Shandwell, explains: “Much can happen to someone’s condition and, as a result, their life in three months. It’s too long to go unchecked. I think this should be a maximum of one month, not three.”

As well as potentially leaving employees out in the cold, he also believes the government has underestimated the impact on employers,
especially those without an in-house occupational health facility. “Line managers will need to look at workplace adjustments and redesigning
jobs on a regular basis. This could be costly and time consuming,” he explains. “The government hasn’t put any figures on these costs to UK plc, although the assumption is that having employees back at work quicker will produce net cost benefits. While a reasonable assumption, without any proper analysis we just don’t know whether this will be the case.”

The other party to be affected by the introduction of fit notes is the GP. But, according to Pamela Gellatly, chief executive of Healthcare Risk Management, understanding of how the fit note can be applied is low among the medical profession. “I do feel sorry for GPs,” she says. “Some take an extra occupational health module but most don’t and I can see many simply ticking the unfit box so they don’t have to provide any additional information. GPs do need to be more involved if this is going to work.”

Unfortunately there does appear to be little appetite among GPs for this new way of working. For example, according to Picken, a large utility
company wrote to 2,000 GPs in its employee catchment area to see whether it could work more closely with them on supporting employees
back into the workplace. It received just three responses.

This apathy could change though. Dr Simpson says: “The cynic in me thinks there’ll be no change and I do suspect that initially many GPs will
treat the fit note like the old sick note and tick the not fit for work box. But, it does bring the issue into the discussion and, in two to three years, this will start to change.”

But, it isn’t only the medical profession that will require education to adopt the new systems. According to GRiD, employers also need to get to
grips with the new regime. “Welfare reform hasn’t been to the fore in employers’ minds. But they could be in for a shock as this, and other initiatives such as the NICE guidance on the management of long-term sickness absence and the government’s National Strategy for Mental Health and Employment, will mean change in the workplace,” says Moxham.

The extent of this was revealed in research carried out on behalf of GRiD last October. This was conducted among 500 UK companies with up to 1,000 employees and found that 36 per cent of employers were unaware of the implications of the Welfare Reform Act. Further, of those who were aware of it, almost half (46 per cent) hadn’t made any changes to their organisation’s health strategy.

Given this lack of awareness, advisers are well positioned to help employers interpret the requirements and adapt their strategies. “Advisers can
talk to clients about what they have in their absence management policy and how it will react when they receive their first fit note. This will entail looking at the services they already have in place and assessing whether they need to invest in new ones,” says Joy Reymond, head of rehabilitation and health management services at Unum.

Occupational health services will certainly become more popular, helping employers to interpret fit notes and recommend the necessary changes. For example, at Axa Icas, a number of services are being rolled out to support the new fit note regime. These include a fit note portal, providing practical tools to help clients deal with a fit note, a fit note advisory line for line managers and HR personnel among its occupational health clients, and a return to work interview service.

As well as the launch of tools to deal with the new welfare reform requirements, one area where vocational rehabilitation is already embedded is group income protection. Over the last decade insurers have developed their services with an emphasis on early intervention and providing support to both the employer and employee to effect a return to work. The services they have developed – as well as those already offered on a stand-alone basis – could become more prevalent.

But, although more of these services may spring up, Reymond believes there are advantages to taking vocational rehabilitation alongside group
income protection. “When the rehabilitation service is part of the insurance, there’s more motivation to get the employee back to work and, if it does go to claim, the two areas are joined together so there’s less disruption,” she explains.

Another, possibly more important, reason is cost. While a stand-alone service will charge a fee for each referral these can quickly mount up and
make group income protection more cost effective.

I do suspect that initially many GPs will treat the fit note like the old sick note and tick the ’not fit for work’ box. But, it does bring the issue into the discussion and, in two to three years, this will start to change. Other areas will also become more popular as the workplace culture changes too. Picken explains: “It’s about more than buying medical insurance and group risk products to address health problems when they’ve
occurred. Employers need to have a strategy to help prevent them in the first place, a great deal of which has little to do with the traditional medicalised approach.”

As part of this, health and wellbeing initiatives are likely to become more commonplace. Insurers have built up their product ranges in these areas over the last few years but Gellatly says that employers can set up their own initiatives to improve employee health relatively cheaply. “It
doesn’t need to cost a lot,” she explains. “They could get an employee social club together and organise social activities to get everyone more active and involved with each other. If they also find champions within the workplace to inspire other employees this will be very beneficial.”

There are also a number of options available from the government (see box) that can be integrated into an employer’s occupational health strategy. “The government does need to integrate the approach more so it’s obvious what support is available but it’s moving in the right direction,” adds Gellatly. “I don’t expect to see huge changes overnight but it’s very positive. Helping employees stay healthy and working is now on the agenda.