The government’s Fit for Work service has begun its national rollout, due to be completed by the end of May 2015, but concerns remain over its effectiveness.
The scheme follows a consultation prompted by health expert and Department of Health adviser Carol Black’s recommendation in November 2011 of a government-funded occupational health assessment service. It aims to stamp out the “sick-note culture”, which prime minister David Cameron says is a “conveyor belt to a life on benefits”.
Referrals to the service can be made by GPs or employers. After a telephone assessment, a case manager prepares a ‘Return to Work Plan’, which suggests what the employer can do to assist the employee in returning to work.
It sounds straightforward, but several experts have expressed reservations about the scheme, predicting a number of issues that could arise once the service is rolled out more widely.
Referral issues
One of the main ways employees will be able to interact with the service is through referral by GPs, but The Work Foundation senior researcher Karen Steadman suggests that there could be problems around how the guidelines are understood.
She points to a study produced by the Department for Work and Pensions last year intended to provide an estimate of likely rate of referral, using data collected from fit notes issued by GPs in ?a selection of practices.
It predicted that GPs are likely to refer 36% of their eligible patients to the new service. However, the proportion of referrals varied considerably between practices, and although they were briefed on the criteria, the report concluded: “GPs appeared to have interpreted eligibility for the new service in different ways.”
Healthcare insurance provider AXA PPP head of proposition and intelligence Nick Jeal also points out that while a GP can refer an employee earlier, the employer has to wait for at least four weeks. “If the overarching aim is to have more people more active in the workplace, does the employer not being engaged until after four weeks has passed help that?” he asks.
Jeal also says he would question whether four weeks is the right time period, and whether the £500 tax relief offered is the right amount. The government has introduced new rules on tax relief applying to employer-funded return to work interventions, which is capped ?at £500 per employee per year. Considering the cost of specialist medical equipment, for example, it is not clear how far this amount would go.
Quality a concern
Irwin Mitchell employment partner Omer Simjee believes there may be issues with the first assessment being conducted by telephone. “What has quite often happened is that whenever there has been a telephone assessment, the employee will complain that it was done over the phone rather than face-to-face,” he says.
In this scheme, it is for occupational health professionals to determine if a face-to-face assessment is necessary, but Simjee suggests that it is more efficient to do more assessments by telephone and that the government has effectively “given a mandate” to conduct fewer face-to-face assessments.
Face-to-face assessments are useful, he says, and can, for example, help give a sense of whether the person is not genuinely ill.
There may also be issues with the quality of advice, according to group HR director at healthcare provider Benenden Inji Duducu. “While it is great that the government recognises the benefits to employees and companies of a productive and healthy workforce, in my experience it is incredibly difficult to get pragmatic, commercially-minded occupational health advice,” she says. “My fear is ?that there will be long waiting times for appointments and the advice given will be generic and risk averse.”
Jeal suggests that for employees who haven’t had occupational health advice this scheme “could be a significant improvement” – but adds that for larger organisations the benefits could be “a lot less obvious”.
Barriers for SMEs
When it comes to smaller businesses, they do stand to benefit, but barriers may prevent them being able to access the scheme in the first place.
As with many other government-led initiatives, the extra administrative burden Fit for Work brings could turn out to be difficult for SMEs. They might also be less able to accommodate someone working part-time as part of a phased return to work, Simjee says.
“If an employee is going to argue they are disabled under the Equalities Act the employer could find themselves at the back end of a tribunal over not having made reasonable adjustments,” he adds.
Also for a small business a four-week absence is a fairly long time, Steadman points out. “It’s difficult to see how well it has been thought through, and how easy the service is to access for those businesses that need it the most,” she says.
Forum of Private Business consultant John Kilbey says that a small business would have to consider carefully if it could cope with a phased return to work, adding that a lack of comprehension in government of how businesses are run means that “most government schemes like this have failed”.
Compulsory action?
There are also questions around Fit for Work being a voluntary service. Kilbey suggests that, as the scheme is not compulsory, it won’t address the “hardcore of people” whose intention is not to go back to work and who might abuse the system.
“A government scheme linked to compulsion would help employers,” he says. “Without that I can’t see it’ll be much use.”
Simjee agrees that the question of whether employees will consent to the scheme is a “first hurdle” that could be a key factor in whether the scheme is successful.
He suggests the government should review the scheme after 12 months and make a judgement on whether a compulsory system is the way forward. With millions being paid in statutory sick pay, this route doesn’t seem out of the question: “It could work to everybody’s advantage.”
Steadman agrees that an evaluation of the system once it is up and running will be important. For example, looking at who is being referred could reveal that some groups are being left out entirely, she says.
Such a review of the system will be key for understanding how well founded many of the concerns, and how they can be addressed. Until then, it is clear that many questions remain unanswered about how fit for purpose Fit for Work will actually be.
