Government to introduce ‘fit notes’ to reduce cost of workers’ ill-health

The UK government announced in November 2008 that it will be introducing ‘fit notes’ to replace the practice of doctors issuing workers with health problems with sick notes from work. These fit notes will specify what work the workers are able to do. The measure seeks to cut the cost to the economy of absence in the workplace due to sickness and has been broadly welcomed.

The system of general practitioners (GPs) issuing workers with a sick note if they are ill has not been changed since the National Health Service (NHS) was established in 1948. However, in a report entitled Improving health and work: Changing lives (1.76Mb PDF), published on 25 November 2008, the Department for Work and Pensions (DWP) and the Department of Health (DH) announced that sick notes are to be replaced by ‘fit notes’ as part of a package of reforms to manage sickness absence more effectively.

Details of package

The package will cost GBP 45 million (about €49.4 million as at 6 January 2009) over three years. It aims to support disabled people, or those who become ill, to return to or stay in work by helping them to manage their condition and get help so that they can keep their jobs. This will involve:

• creating a national centre for health and well-being;

• launching a health telephone helpline for small companies;

• attaching employment advisers to GPs’ surgeries.

The Secretary of State for Work and Pensions, James Purnell, outlined: ‘everyone has the right to work and we want to design a fair system which supports people so they can work when they are able.’

Black review on health

The government’s announcement was in response to Dame Carol Black’s review of the health of Britain’s working age population – entitled Working for a healthier tomorrow (2.23Mb PDF) – which was published in March 2008. The review estimated that the total cost of ill-health to the British economy was in the region of GBP 103 billion (€113.3 billion). Ms Black proposed a new ‘fit for work’ service based on a case-managed, multidisciplinary approach, which would provide treatment, advice and guidance to people in the early stages of sickness absence. The fit for work service would provide access to a non-traditional and wide range of services, which could include advice and support for social concerns, such as financial and housing issues, as well as more traditional NHS services, such as physiotherapy and ‘talking therapies’.

Reaction to proposals

Employers have largely welcomed the government’s announcement, although the trade unions have criticised the proposals for not going far enough. The General Secretary of the Trades Union Congress (TUC), Brendan Barber, commented: ‘The new notes will only help ill or injured workers get back to their jobs more quickly if GPs are better trained in how to recognise occupational diseases and if they know what a patient’s work entails.’ Mr Barber argued that more must be done to stop employees from becoming ill or injured in the first place and that greater resources are needed to increase the number of health and safety inspectors.

The Chair of the GP Committee of the British Medical Association (BMA), Dr Laurence Buckman, highlighted: ‘We believe a fit for work service to help people back into employment may be the right way forward. The new fit note has potential, but we would like to see the findings of this evaluation because it is crucial that GPs can continue to act as the patient’s advocate and don’t end up policing the system for the DWP.’

Specialist occupational health (OH) nurses and doctors reacted to the new measure by highlighting that more emphasis should be put on improving access to OH services rather than placing the onus on GPs. The President of the Society of Occupational Medicine (SOM), Dr Gordon Parker, stated that while fit notes might be part of the answer, the real issue was helping GPs to access support for their patients. OH practitioners feel that too little is being done to educate GPs and employers about the role of OH in enabling employees to return to work.

Commentary

This latest measure is part of a more general change in the approach to sick and disabled people and work, which is also reflected in recent changes to the assessment for incapacity benefit (UK0501106F) and to employment and support allowances. The new approach seeks to determine what people could do at work instead of what they cannot. However, many employers are currently failing to provide access to adequate OH, as reflected by the Black review which found that only 44% of large companies and 6% of companies with 10–50 employees provide comprehensive OH support. Therefore, employers need to be encouraged to strengthen OH provision at the workplace.

Helen Newell, IRRU, University of Warwick