Should occupational health welcome the Fit for Work service? At first sight the government’s own description of the service is compelling! It’s “a free service that helps employees stay in or return to work. It provides an occupational health assessment and general health and work advice to employees, employers and GPs”. The word ‘free’ might well attract attention but what is the service’s remit and potential value to employers? Certainly, its objectives of early intervention to address sickness absence are honourable – we know from the days of Dame Carol Black’s report “Working for a Healthier Tomorrow” back in 2008 that this, along with rehabilitation and retention of staff in the workplace, will become increasingly critical for employers to address.
Are expectations matched by reality?
Are the aims of the Fit for Work service matched by the experience of service users? Can it really achieve what it sets out to? Is its remit really ‘occupational health assessment’ in the fullest sense of a competent, comprehensive occupational health service? We can’t speak for other organisations and these are big questions, but our own analysis is that whilst the service plugs an important gap – particularly for smaller organisations with no occupational health service – it has some significant limitations… In fact we’ve debunked the myth that it’s “either occupational health or Fit for Work service” – they are best managed as complementary services.
Fit for Work parameters for referral are pretty narrow and so won’t cover the majority of cases handled by a full occupational health remit – including the prevention side issues of ill health, surveillance and risk assessment. I’m sure you’ll agree that occupational health is so much more than just a focus on ‘return to work’.
It’s interesting that Fit for Work focuses on employees who have a “reasonable likelihood of making at least a phased return to work”. It won’t cover hospitalised in-patients, those who don’t have a good prospect of returning or those who are either terminally ill or in an acute phase of an underlying medical condition. Yet all these cases still need to be managed and an employer still needs good advice to manage them!
As many an employer and occupational health professional will testify, patterns of sickness absence are more complex than just blocks of 4 weeks for a chronic health problem. What about (single or repeated) absence spells of, say, 2 or 3 weeks? Or the shorter ‘day here and there’ spells that often mask underlying physical or mental health problems – or aren’t actually to do with genuine health issues at all?
Here, occupational health plays a huge role in working closely with a client organisation to understand and grapple with solutions to address these shorter absence patterns which cumulatively become costly and disruptive to an organisation.
On-going management of cases
Interestingly employees can only be referred to Fit for Work once in every 12 months. Generally, an employee will be ‘discharged’ from the service two weeks after they have returned to work or the employee has been in the programme for 3 months more, or where a return to work has not been possible after 3 months.
Quite where this leaves an employer when the problem persists beyond this time, and there is no access to sound occupational health advice, is anyone’s guess!
I wonder how many cases – especially those with a mental health component – can be fully and effectively managed via an advice line – because that’s really the main option Fit for Work offers after the employee has been discharged and if further absence occurs within the 12 month period. With repeated longer spells of absence it can be crucial for a competent professional to speak face to face with an employee and that’s where the on-going involvement of occupational health adds most value to resolving a longer term absence case.
In fact The RCGP (Royal College of General Practitioners) signalled that the national service could be “too reliant on telephone rather than face-to-face contacts with patients Return to work plans”.
It’s encouraging to see the emphasis Fit for Work places on an agreed return to work plan and/or reasonable adjustments, but again there are limitations… What if these need to be formally reviewed or re-assessed because the health picture changes after the employee has been discharged from Fit for Work? Again – is the advice line adequate to pursue this in more complex cases? Nothing can replace week by week support given by a professional who has the trust of the employee and the employer.
Prevention and strategic partnership
A focused referral and assessment service – which is Fit for Work’s core service – doesn’t remove the huge benefit of occupational health as a strong strategic partner of an organisation – integrated on all levels and working proactively to both resolve and prevent sickness absence challenges.
Dr Paul Nicholson, chair of the BMA’s occupational medicine committee has been clear in his concerns, referring to frustrations that the Fit for Work service is referred to as offering an ‘occupational health assessment’ rather than a more accurate “fitness to work” assessment. He has hit the nail on the head in terms of the potential confusion caused by lack of understanding of the much wider roles played by occupational health professionals.
Surely though the flip side of this is opportunity? The strength of an integrated occupational health service is the knowledge it builds of the organisation, its different roles and demands and of course the impact of health on work and vice versa in the client setting. So, all of us in occupational health have a perfect opportunity to more proactively engage with clients to increase their understanding of the full offering of a competent and comprehensive occupational health service.
The impact of Fit for Work is firmly in our hands…