- Fit for work – fit for purpose?

According to the Department for Work and Pensions, almost 1 million people take sick leave for 4 weeks or more each year, costing employers £9 billion.

A Government review in 2011 identified that a lack of access to occupational health services, particularly for small and medium-sized businesses, was significant in holding up employees from returning to work from sick leave. A key recommendation of the review was to set up a state-funded health and work assessment and advisory service – the ‘Fit for Work’ scheme.

The scheme is intended to complement, rather than replace, employers’ existing occupational health provision (where they have any) and it enables GPs and employers to refer people who have been absent from work for 4 weeks, to be assessed by occupational health professionals and assisted in returning to work. It is targeted to be rolled out nationwide by May 2015, but given that live roll-out only started in March, it seems more likely that the actual date will slip to Autumn 2015.  Knowledge of the scheme is currently low, and employers and medical professionals are questioning how effective the service will be in practice.

GPs’ support for the scheme

GP support for the new scheme seems at best lukewarm.  GPs will have to exercise their clinical judgment about whether or not to refer an employee for assessment (subject to the employee’s consent). However, a Department for Work and Pensions survey of GPs in October 2014 showed that the proportion of likely referrals varied considerably from 11 to 72 per cent.

Both the GPs’ professional body and the General Medical Association have already voiced concerns that the service could force people back to work before they are ready and said that they will not support a scheme that is ‘punitive’ and pressurises patients to go back to work or come off benefits.

Assessments in practice

Although in certain circumstances a face-to-face assessment may be recommended, generally the assessment will be over the telephone. This will take place within 2 working days of the referral and last between 45 minutes and 1 hour.

The assessment will also look at employees’ non-health and non-work issues, described as a ‘biopsychosocial’ approach. (That really is the word used by the service provider to describe the approach, although many may feel the word itself is just so much psycho-babble!)

Many individuals are likely to be reluctant to discuss their health or personal problems with a stranger over the telephone and, as it is not anticipated that the assessor will have access to the employee’s medical records, the effectiveness of the assessment could be limited.

However, following the assessment, the employee will be provided with a return to work plan which lays out recommendations for action to help him/her to return to work. Employers are not involved in the discussions to design the return to work plan, although the return to work plan will be shared with the employer, so long as the employee has agreed it can be.

Fit for purpose?

The scheme’s effectiveness could be seriously limited by the fact that the service is consent-based and its use is entirely voluntary on both the employee’s and employer’s part. There is no compulsory element – if the employee refuses to consent to the GP’s referral, that is the end of the process and employees cannot be compelled to attend the assessment; similarly, the employee may refuse to consent to disclosing the return to work plan to the employer and, even if it is disclosed, the employer can disregard any recommendations made in it.

Perhaps aware of the Scheme’s less than enthusiastic reception, the Government has also introduced a tax exemption of up to £500 (per year, per employee) on medical treatments recommended to help employees return to work. This will be applicable to treatments recommended by health professionals within the Fit for Work service and health professionals within employer-arranged occupational health services.  However, the exemption will only apply where an employee has been absent from work due to injury or ill health for at least 28 days, or they have been assessed as being unfit for work for at least this period. Some may think that this minimum length of absence requirement is unduly restrictive, and it is unlikely that many SMEs will feel this makes up for the abolition of the abolition of the percentage threshold scheme (PTS). PTS  allowed employers to reclaim Statutory Sick Pay (SSP) from HMRC where the total SSP paid in a month exceeded 13% of the employer’s Class 1 national insurance contributions for that month. This meant employers with higher than average sickness absence could recover SSP costs and was primarily of benefit to small employers.

So, the jury’s out on the usefulness of the new scheme.  Large organisations with access to established occupational health services may not need to use it, while SMEs may find that in practice, the new service may not work as effectively as hoped by the Government.  It’s only real benefit for them would seem to be that if taken up, it is free.

Helen Skepper – Research and Communications Advisor
Su Allen HR

Su Allen HR helps employers by providing a range of commercially sensitive HR support and advice to ensure employees are treated in a fair and consistent manner. Contact us on 01582 883299 if you’d like to hear more.