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Is the government’s response to the sickness absence review good enough?

Wednesday, January 23rd, 2013

Dr John Chisholm CBE is a member of the Fit for Work UK Coalition, representing the Royal College of General Practitioners.  He is also a member of the Council for Work and Health and the National Stakeholder Council for Health, Work and Wellbeing.  This commentary is written in a personal capacity.

Most GPs will have welcomed the government’s response last week to the Sickness Absence Review by Dame Carol Black and David Frost (published in November 2011). In particular, the way sickness absence is managed in the future will radically change when the independent, state-funded Health and Work Assessment and Advisory Service is rolled out in 2014. Most GPs are only too aware that the longer someone is off sick or out of work, the harder it is to get back to work. The new service can help assess individuals earlier, offer advice to employees, employers and GPs, as well as ensure each case is managed, followed up and includes appropriate interventions where necessary.

The government’s response is a significant step forward, yet it remains somewhat vague about the funding and delivery of the necessary interventions. GPs are often frustrated by delays in access to NHS services – including physiotherapy and cognitive behavioural therapy – that may result in unnecessarily prolonged sickness absence and long-term worklessness. It is therefore essential to introduce mechanisms to achieve early intervention, including obligations on employers to implement the service’s recommendations on workplace adjustments whenever possible.

It is also not clear how GPs will refer patients to the new service. The report implies that the fit note itself will trigger referrals, but also assumes that eligibility to be seen will be restricted to employees without access to occupational health services at work. At a time of rising GP workload, GPs will want the referral system to be simple and streamlined, without requirements for detailed referral letters or questioning of patients about their employers’ occupational health arrangements.

In addition, there are potential problems with using a large number of occupational health professionals in the new service at a time when they are already in short supply and when many are heading towards the end of their careers, So it is important that the new service can find the workforce it needs without detriment to other occupational health provision. In parallel with this, the quality and standards of the service must be monitored to ensure it is delivering the necessary benefits.

One of the key points of the report is the importance of data in monitoring progress. Analysis of information available from the roll-out of electronic fit notes and from the new Assessment and Advisory Service will help, as will monitoring progress on the Health, Work and Wellbeing initiative. This uses such indicators as reducing the proportion of people out of work due to ill-health and improving access to appropriate and timely health service support. However, more data could be collected on longitudinal employment outcomes through the mechanisms already in place to collect patient data, as staying in or returning to work is an important indicator of clinical success. Such attitudinal change and data collection can be incentivised through the Commissioning Outcomes Framework.

The government response will undoubtedly have a major impact on how sickness absence is managed in Great Britain, in particular through the introduction of the new Assessment and Advisory Service next year. However, there are still some issues to be resolved in respect of referrals, interventions, workforce, quality monitoring and data collection. GPs and other stakeholders will be keen to work with the Department for Work and Pensions to ensure the new processes not only lead to cultural change but produce benefits for employers, taxpayers, the economy, health care professionals and most importantly for the future of those employees and patients at risk of long-term worklessness.


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