Group risk roundtable: The effects of government reforms

If you read nothing else, read this…

  • Government intervention in the form of welfare reforms and National Health Service cuts will force employers to take more responsibility for employee health and wellbeing.
  • Concerns surround the proposed Independent Assessment Service (IAS), particularly with regard to its method and speed of delivery.
  • Fit notes have so far had a limited impact in helping absence management, but some experts believe this will improve with more training for doctors to enable them to play a bigger role in workplace health.
  • The NHS will play a greater role in occupational health, with retun to work being recommended as a clinical outcome in the Department for Work and Pensions’ Health, work and wellbeing strategy.

Government reforms of the welfare state and National Health Service are having mixed results, as responsibility for keeping employees fit for work is increasingly being shifted towards employers, says Sam Barrett

As the coalition government continues to wield its axe on the welfare system and NHS, employers are finding themselves under increasing pressure to take responsibility for staff health and wellbeing.

However, as part of the welfare reforms, Health at work – an independent review of sickness absence, conducted by Dame Carol Black and David Frost and published last November, found that sickness absence systems provide too little support to help people return to work.

The review proposed a number of recommendations, including an Independent Assessment Service (IAS) to which employers and doctors could refer long-term sickness absence cases for bespoke advice. Available after an absence of about four weeks, the IAS would assess an employee’s health, and provide advice about how he or she could be supported back into the workplace.

Employers generally welcome a rehabilitation-based approach to tackling employee absence, but there are questions about its effectiveness.

Katharine Moxham, spokesperson for Group Risk Development (Grid), believes there may be issues around how such a service is delivered. “Most of the support from the IAS would be telephone-based,” she says. “But how will they be able to understand the workplace, and what the employee’s role is, from a telephone-based interview?”

There are also concerns about the speed of intervention, particularly where medical treatment is required to help an employee return to work.

NHS waiting lists

NHS waiting lists mean that employees using the IAS could be forced to wait for treatments, such as cognitive behavioural therapy and physiotherapy.

Steve Bridger, head of group risk at Aviva UK Health, says this is an issue that group risk providers have had to overcome. “Typically, with a musculoskeletal or psychological problem, we will deal with it almost from day one. The employee could be in physiotherapy that afternoon, or have an appointment with a therapist within a couple of days. Early intervention is key to returning an employee to work, but this might not be an option for the IAS.”

The Health and Social Care Act, which was finally passed in March after much political debate, proposes a radical reform of the NHS to achieve £20 billion cost savings by 2015, fuelling concerns that the waiting list problem may get worse.

But Sayeed Khan, chief medical adviser at EEF, believes the reform brings benefits to employers that offset longer waiting times for staff treatments, such as the shift to GP commissioning. Set to come into force in April 2013, the new system will see doctors commissioning treatments for their patients.

Khan says: “[Doctors] are much more holistic and, rather than focusing on numbers in hospital beds, they would view patients as people and commission early intervention services, such as physiotherapy and counselling, rather than high-tech, cutting-edge specialist surgery.”

In the meantime, employers are still getting to grips with recent changes to absence management, in the form of fit notes. These were introduced in April 2010 to replace the sick note, and are designed to shift the emphasis from what employees cannot do, to what they can do, in the workplace.

Fit notes

Fit notes allow doctors to inform employers about what their patient is able to do, and whether they require any adjustments to their workstation, for example, to enable them to return to work. Although a good idea in theory, fit notes have largely been badly received. In its assessment of how the notes had worked so far, Frost and Black’s sickness absence review recommended they be shelved and superseded by the IAS.

A key criticism of the fit note is the relationship between the employee and their doctor. Chris Ford, director of group risk at Jelf Employee Benefits, says: “First and foremost, the [doctor] is the patient’s champion. They won’t really care what their patient’s job is; it doesn’t really come into the discussion.”

The lack of occupational health training among doctors is also a concern. Moxham says: “The challenge with fit notes is that [doctors] have said all along that they’re not qualified to provide advice on vocational medicine. On top of this, in a threeor five-minute appointment, they don’t really have time to explore what a patient needs to be able to do to perform their role at work.”

But Kahn thinks acceptance of the fit note will take at least five years. “Everyone hated the sick note, but let’s not throw the baby out with the bath water,” he says. “It will take time for the fit note to be accepted, and part of the problem is training everybody, including employees and employers, as well as [doctors], to understand how it works.”

Doctors will play an increasingly important role in government efforts to reform the welfare state and increase employers’ responsibility for staff health and wellbeing.

Occupational health

Welfare reform is likely to lead to a greater use of occupational health, either via employers’ providers or the IAS, which doctors can work with to support their patients.

Bridger explains: “[Doctors] are general practitioners and won’t be specialists in everything. If an income protection provider, occupational health or the IAS is involved, the [doctor] can work with them to support and guide the employee or, if they prefer and it is more appropriate, they could hand them over completely.”

Khan welcomes the growing significance of occupational health over the next few years. In fact, he thinks the NHS is already playing a key role in helping employees to return to, or stay in, work. He says this is demonstrated by one of the recommendations in the Department for Work and Pensions’ health, work and wellbeing strategy for the next five years, which requires the NHS to include return to work as a clinical outcome.

“This is a massive step,” says Khan. “There would be a little box at the bottom of each discharge summary which asks whether they have discussed work and what the person needs to do to return to, or stay in, work. This would force the NHS to take health and work seriously.”

Read more from the Group risk roundtable