Pilot scheme tackles long-term sickness absence

Sick leave leads to long-term absence from work in too many cases, the government says. It hopes a new scheme will get people off benefits and back to work much more quickly. But will it work, and will it be fair?

Carl Lightbown had a very common problem. A work-related injury. But how it was treated was far from usual.

A few weeks into a new warehouse job, Carl started having problems with his shoulder - a classic complaint which afflicts many manual workers and could have led to months off work.

"The easy option would have been for me to go home and spend weeks, months on the sick," he said.

But because Carl lived in Leicester, he was able to use a government pilot scheme set up to help people like him back into work quickly before a few weeks off turned into months.

His GP referred him to the Leicestershire Fit For Work pilot, which offers a free occupational health service available to employees in the area. It also manages their return to work.

This government-funded assessment and advice service is expected to be up and running across England, Scotland and Wales from next year.

'Self-worth'

The Fit For Work service was able to get Carl physiotherapy sessions immediately, rather than him having to wait several weeks for an NHS appointment. He was also offered help in arranging a phased return to work.

"Basically they were there to support me while I was out," he said.

His doctor had initially thought he would be off for several months, but he was back at work in just under four weeks.

Julie Potts, a director of North Supply, where he works, says the quick reaction of the Fit For Work service meant that Carl kept his job.

"I'm not sure if Carl had only had the support of the NHS whether he would still be employed," she said.

The Leicestershire service is one of seven government-backed pilot schemes which emerged out of the first of two reports on sickness absence written by Dame Carol Black, adviser on health and work at the Department of Health.

Around 300,000 people a year make claims for long-term sickness benefit, and sickness absence is costing Britain an estimated £15bn in lost economic output.

Dame Carol believes early intervention to help someone back to work is vital:

"If you have been out of work for 20 weeks then you have a very low chance of returning to your own job - that chance may be only 25%."

She said the problem is that too many people drop out of work for potentially manageable health reasons, like stress or back pain, and do not return.

"It wastes human life. It ruins people's sense of self-worth, dignity. It's bad for families, bad for the economy and bad for the community."

Carrot or stick?

Lord Freud, Minister for Welfare Reform, has said that where employers suspect that sickness absence is being abused, the new service will also offer an independent view of the situation.

He said that "in a proportion of cases disciplinary action may be appropriate".

The Department for Work and Pensions is still working on the details of the new scheme, but Lord Freud said that most people would be expected to go to the service after four weeks of sickness absence unless there is a specified reason not to, such as a serious long-term illness.

He expects employers to contribute to the cost of some treatment, such as private physiotherapy, helped by a tax break announced in the last Budget.

Dame Carol Black has stressed that she wants to see a positive and proactive assessment service with disciplinary action a last resort.

But not everybody wants to see GPs lose control of their patients' return to work.

Karen Jennings, assistant general secretary of the public sector union Unison, is worried that the new service, once put out to tender, could be target-driven meaning some patients are forced back to work too early.

"If you've got targets, you'll do everything that you can to make sure you meet those targets regardless of the individuals involved," she said.

Barriers

However, Dr John Canning, a GP in Middlesbrough and a committee chairman at the British Medical Association, welcomed the changes.

"I think it will be seen by many as another stick with which to beat people who are not well - but everything that I have read so far suggests that it is a carrot."

But he is worried that "the funding seems relatively little". The government is spending up to £50m a year on the new service and Dr Canning is concerned about "how robust it will be and whether it will be as resilient as we would like it to be".

He also welcomed the changes because they would relieve doctors of the need to negotiate with employers about their worker's return to work.

This began three years ago, when the old "sick note" became a "fit note". It states what a patient is capable of doing, rather than not doing, and has room to suggest modifications to their work.

However, it became apparent that assessing a patient's work capability and liaising with their employer was too big a task for GPs on their own.

The new service also aims to look beyond medical problems to other factors that may be preventing people going back to work.

Dame Carol recommended that the new service offer advice on issues which might be affecting a person's ability to do their job, such as debt or difficulty with their line manager.

Case workers will have to find out a lot about people's lives and "where the barriers are to returning to work", said Dr Rob Hampton, a GP in Leicester and a founder and clinical director of the Leicestershire Fit For Work Service.

He said that in a quarter of the cases they see, poor relationships at work are behind sickness absence.

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