Fit for Work service launched and guidance published
In 2011, Dame Carol Black undertook a review of sickness absence to identify ways of minimising absence and to improve the sickness absence and benefits system. A lack of access to occupational health services, particularly for small and medium sized businesses, was identified as a significant issue in preventing employees returning to work. Consequently, one of her key recommendations was the setting up of a state-funded health and work advisory and assessment service.
The Fit for Work service was launched with relatively little publicity on 16 December 2014 and the DWP has recently published three separate Guidance notes for employers, employees and GPs.
There are two elements to the service, advice and assessment. Only the advice service has been launched so far and free, impartial work-related health advice can now be accessed by employers, employees and GPs via a telephone advice line and website. Individuals can call the advice line, chat online to specialist advisers or e mail a query and the website also contains a selection of materials on health and work topics.
In relation to the assessment service, there will be a phased roll out over the next few months and the details will be published shortly by the DWP. Roll out is expected to be completed nationally by May 2015.
Publication of the Guidance now gives us a clearer idea of how the service will operate but concerns remain about how effective the service will be in practice. So how will the service work? There are effectively three stages.
The first stage is the referral for assessment. Once the employee has reached, or their GP expects them to reach four weeks of sickness absence the GP can refer the employee for a free occupational health assessment. Note that self-certified sickness absence counts towards the four weeks.
Although referral for assessment is considered to be the “default” position, crucially, the employee must consent to the referral. The Guidance states that consent “must be explicit, informed and freely given and should be obtained at each point in the process.” Subject to the employee’s consent, the GP can refer earlier or later than four weeks if they judge that to be appropriate. The Guidance gives the example of an employee who has undergone hip replacement surgery where referral after four weeks might not be appropriate but referral after six weeks would be. It is for the GP to exercise their clinical judgment about whether or not to make the referral and they may decide not to do so in certain circumstances. For instance, if the employee does not have a realistic prospect of returning to work or the employee is in the acute phase of their medical condition.
The employer can also refer the employee if the GP has not done so after four weeks' absence and once again, the employee must consent to the referral. There is no limit on the number of employees who can be referred for assessment by the employer. Whether the GP or employer make the referral they must consider that it is reasonably likely that the employee will make at least a phased return to work. Where the GP has made the referral, the Guidance suggests that it would be helpful for the employee to inform their employer of this.
Finally, an employee can only be referred for one assessment in any 12 month period.
An occupational health professional (who then becomes the case manager) will contact the employee within two working days of receiving the referral to carry out a telephone assessment. In certain circumstances (probably only a minority of cases) a face to face assessment may be recommended and this will take place within five days of the referral and within 90 minutes travelling time by public transport of the employee’s home. The employee will be paid reasonable travel expenses to attend and if they are unable to travel, the service “will explore other ways” to conduct the assessment.
The employee must consent to taking part in the assessment.
The assessment will take a "biopsychosocial" approach and the employee will be asked about their condition, their job and any factors including health, work, home and any other difficulties preventing their return to work.
The employee and case manager will then agree a Return to Work Plan and if the employee consents, the case manager may contact for example, the employee’s line manager, if further information is needed to complete the Plan. Examples given in the Guidance include the case manager needing to know more about the specific workplace context or where the relationship with the employer has been identified as one of the obstacles to a return to work.
Return to Work Plan
Following the assessment, a Return to Work Plan will be prepared containing advice and recommendations on assisting the employee’s return to work and the steps to be taken by the employee, employer or GP. The period of time covered by the Plan will be stated and it will also include a timetable for progressing the recommendations and for returning to work.
As with the other elements of the process, consent is crucial and if the employee consents, the Plan will be shared with the GP and employer. Alternatively, the employee may ask for specific parts of the Plan to be removed before it is shared with the GP and employer. However, consent is relevant for the employer too and they cannot be compelled to progress the recommendations set out in the Plan.
The case manager will contact the employee at an agreed point to check progress on the Plan and again shortly after the anticipated return to work date. If however the employee is not able to return within the estimated timescale the case manager will consider whether a further assessment is required and whether the Plan should be revised and cover a longer period of absence.
Because the Plan will state whether or not the employee is fit for work or may be fit for work if the recommendations are followed, it can be accepted by the employer in place of a GP’s Fit Note for sickness absence purposes.
The employee will be discharged from the Fit for Work service:
- Two weeks after they have returned to work (including a phased return)
- On the date the service decides that there is no further support they can offer the employee which will either be when the employee has been with the service for three months or at the point the service decides that the employee will be unable to return to work for three months or more.
Concerns about the service
It is a consent-based service which could limit its effectiveness. If the employee refuses to consent to the referral that is the end of the process. Similarly, the employee may refuse to consent to disclosing the Return to Work Plan to the employer and GP and even if it is disclosed, the employer may decide not to act on the recommendations. The Guidance states that because of the potential benefits, all parties will want to engage with the Fit for Work service and actively manage sickness absence by following the advice in the Return to Work Plan.
Another potential problem is that GPs will have to exercise their clinical judgment about whether or not to refer an employee for assessment (subject to the issue of consent). A DWP survey of GPs in October 2014 showed that the proportion of likely referrals varied considerably from 11% to 72%. Some of the reasons given for non-referral were the nature of the health problem, whether the employee was already receiving sufficient support or concerns about the employee’s motivation about returning to work.
The service is intended to complement, rather than replace, employers’ existing occupational health provision. Many large organisations with access to established occupational health services may make no use of the Fit for Work service at all whilst many SMEs may find that in practice, the new service will not work as effectively as they had hoped. However it is important to be aware that from 1 January 2015, the government introduced a tax exemption of £500 per employee per tax year where medical treatments have been recommended by the Fit for Work service or by health care professionals within the employer’s own occupational health scheme. This measure removes the tax and NIC liability that previously existed and it is hoped, will act as an incentive to fund medical treatments which may help to reduce sickness absence.
Although there is still no information about the roll out of the assessment part of the Fit for Work service and even though some employers will continue to use their current occupational health services, employers are nevertheless advised to update their sickness absence policy to refer to the new service and how it will work. This is because referral for assessment can be initiated by the GP, the case manager may contact the employer for further information for the Return to Work Plan and because the Plan removes the need for the employee to provide a Fit Note for a certain period. In addition, employers may want to publicise in their policy the advice that is available from the Fit for Work website and telephone advice line.