Fit for work -Are you ready?Issues forum – April 2010

Fit for work - Are you ready? – April 2010

Contents

Fit for work - Are you ready?Why was this necessary? 1

A change of emphasis 2

Expected benefits 2

Impact on claims 2

12 Steps to prepare for theFit Note 3

Government’s here to help! 4

Golden rules for implementinghealth in the workplace 4

Conclusion 5

From 6 April 2010 the Sick Note has beenreplaced by the Fit Note. This is the firstchange in the way sickness absence isreported in over 80 years with the aim ofshifting the focus to what employees cando as opposed to what they can’t do. It isessential that businesses are ready to takeadvantage of the potential benefits the newsystem brings as well as understanding thepotential pitfalls.

Why was this necessary?The government’s first ever review of thehealth of Britain’s working age populationwas published in March 2008 and carriedout by Dame Carol Black. Her reportidentified that the annual cost of ill healthis more than £100 billion, with 175 millionworking days lost per year. Evidenceindicates that the UK lags behind manyother developed countries where thepositive impact of effective early health careintervention has long been recognised. Forexample in Scandinavia 50% of individualsreturn to work following a major injury and inthe US it’s 33%, but in the UK the figure is alowly 16% (Bonato and Lusinyan 2004).

This indicates that the current system isfailing a large number of individuals in theUK and one area considered responsibleis the out dated Sick Note. One of its majorflaws is the fact that it focuses solely onwhat an individual is unable to do. There isno encouragement for GPs to suggest howan injured employee could return to work.As Dame Carol Black states “it reflectsan age when an employer expected anemployee to do a specific job rather thantoday’s flexible workplace”. The Fit Noteaims to change all this.“The Sick Note reflects an age when an

employer expected an employee to doa specific job rather than today’s flexibleworkplace”

Dame Carol Black

Fit for work -Are you ready?

Fit for work - Are you ready? – April 2010

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A change of emphasisGPs will now be asked to play a moreactive role in making recommendationsto employers regarding their patients’capabilities to work. Rather than just statingthey are either physically or mentally toounwell the new system will allow doctorsthe following two options:

• Unfit for any type of work OR

• Fit for some type of work.

When the injured party is assessed as being“fit for some type of work” GPs will need todecide on one of the following options,whilst also providing a small amount ofinformation for employers.

• Phased return

• Altered hours

• Altered duties

• Workplace adaptations.

Expected benefitsOrganisations of all sizes should view thereform positively, as it will produce undoubtedbenefits for the UK economy. For example:

• Organisations should see fewer of theiremployees signed off sick, with obviousbenefits through reduced absence

• Evidence shows that better sicknessmanagement leads to reduced costsand increased company productivity.(Pricewaterhouse Coopers 2007)

• GPs will be providing more informationon how an individual’s health conditionaffects their ability to complete theirwork, alongside how these could beaccommodated in the workplace. Thiswill hopefully lead to more collaborativeapproach between employers andemployees to reduce unnecessaryabsence

• People will have fewer forms to dealwith. From the 6 April 2010 the Med 5form will no longer be in use, replacedby the new Med 3 form.

(Taken from the DWP’s Fit Note Guidancefor Employers)

Impact on claimsIf the new Fit Note achieves its aim of gettingpeople back to work earlier than they mighthave previously then ultimate claims costscould benefit with a reduction in the loss ofearnings component. It also raises issuesaround an injured party mitigating theirlosses, as they have a duty to do, especiallyif the employer is able to accommodate therecommendation contained in the Fit Note.Despite an employer being flexible an injuredparty could still feel unable to return to work.The ultimate effect of this change within theclaims process will not be seen for a numberof years.

QBE believes that the most effective wayof managing the cost of work relatedclaims is by implementing effective absencemanagement procedures. QBE’s onlineMinor Injury Management Service hasdemonstrated 29% quicker return to workwith a loss of earning saving of over a £1000per claim, notwithstanding the hidden costssavings.

Key changes• Move to focusing to what people

can do opposed to what theycan’t do

• Discourage the notion thatsomebody has to be 100%fit before returning to work

• Encourage a dialogue betweenemployers and employees tofacilitate an earlier return to work

• The longest a GP will be ableto sign somebody off sick for isto be reduced from 6 months to3 months.

12 Steps to prepare for theFit Note1. Understand the change of

emphasis: Essentially the Fit Note doesnot change an employer’s obligation toits employees; the underlying objectiveis to encourage open dialogue betweenall parties, with GP’s being encouragedto play a more active role in the process.The Department of Work and Pensions(DWP) have however made it clear that“it is the employer’s responsibility tocarry out a risk assessment (whenappropriate) when an employee returnsto work to ensure there is minimal riskto the employee and others in theworkplace.”

2. Educate all key stakeholders withinthe business: The DWP and TUC haveissued complementary guidance andACAS is offering training courses tohelp businesses prepare. Thisinformation should be cascaded downthrough the business to all thoseinvolved in absence management.

3. A Fit Note can still become aSick Note: DWP have indicatedthat employers will not be able touse the note as the basis for statingan employee has to return to work.If no effective agreement can bereached the Fit Note will work in exactlythe same way as the Sick Note did.

4. Be prepared for new challenges:Everybody is moving into uncharteredterritory and even the governmentcannot fully predict what challenges itwill bring. Employers should considerappointing somebody within thebusiness who is responsible forcascading the information to keystakeholders, ensuring the businessis ready and assessing the impact.Currently, important departmentswithin the absence managementprocess often work as lone silos with a

lack of cross disciplinary communication.There needs to be a coherent approachbetween key business areas includingHR, Occupational Health, RiskManagers, Health and Safety, linemanagers and operational managers.

5. Understand its limitations:Employers are often frustrated by GPs,but they must understand the challengefacing them in managing absence.A GP spends on average 10 minutesper person and are expected to gaininformation, make a judgement, decideon treatment and write the Fit Note.Under the new system they are alsoallowed to assess individuals overthe phone. It is also important tounderstand that the information theyreceive regarding work and job rolescomes from the patients themselves.A GPs role is to act in the best interestof their patient. There is the potentialfor conflict when GPs are faced with apatient who strongly believes that workcaused or will make their injury worse.

6. Review your policy for managingsickness absence: This provides anideal time for a review of sickness andabsence policies, as these will have tobe updated to incorporate the Fit Note.For example, employers could introducereturn to work risk assessments,considering any necessary controlmeasures and/or change of dutiesrequired – to be agreed and signed byall parties before the return to work date.

7. Consider the DisabilityDiscrimination Act (1995): Employerscould find themselves at an increasedrisk of disability discrimination claimsi.e. the Fit Note might highlight changesthat an employer could make to theemployee's duties or workplace thatwould enable them to work. Failure toconsider such suggestions seriouslycould result in a tribunal finding that the

employer has failed in its duty to makereasonable adjustments – a requirementunder the Disability Discrimination Act1995. This will be a particular challengefor smaller employers, as they oftenhave fewer resources and less flexibilityto accommodate injured employees.

8. Be aware of support servicesavailable for SMEs: Alongside thereforms of the Fit Note the governmenthas recognised that smaller employersneed more support managing absence.As a result, they have put in placeprovision such as the Health and WorkAdvice Hotline, Fit for Work Pilots andAccess to Work to help SMEs.

For information on how this servicecould benefit your business pleasecontact your QBE account manager.

Fit for work - Are you ready? – April 2010

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9. Understand your organisation’s rolein managing absence: Employersshould not rely solely on the GP if theywant to have a robust and effectivepolicy for absence management.Occupational Health sits outsidethe remit of the NHS and it is theresponsibility of individual organisationsto ensure their employers are fit for work.

10. Review Occupational HealthProvision: By encouraging theemphasis on a new collaborativeapproach, many believe that thegovernment has placed the spotlightfirmly on organisations’ ability tomanage absence. One way of achievingthis is by having in place effectiveoccupational health provision, butonly 40% of UK companies actually do.Where occupational health is in place itis often restricted to health surveillancerequired to comply with Health andSafety legislation e.g. audiometrictesting for noise legislation. Providers(in-house or outsourced) may not beproactively involved with return to work.

11. Consider well-being: Research hasshown that the most effective sicknessabsence policies do not focus solelyon managing problems. Companieswho have taken a proactive stanceon worker health have seen a reductionin absence through simple steps.For example, the Global CorporateChallenge, encouraging employee towalk 10,000 steps a day, has beenadopted by many large organisations.

12. Build a business case for wellbeing:One of the greatest challenges tochange is proving that it is cost effective.Without being able to demonstrate thefinancial sense of investing in the healthof a company’s employees it will bedifficult to achieve the “buy in” ofsenior management. Key governmentorganisations, such as the HSE andDepartment of Health have workedtogether to develop a WorkplaceWell-Being Tool that helps demonstratethe benefits of investing in health.

Government’s here to help!Fit for Work Services - new governmentfunded case management service tohelp small employers manage absence.www.workingforhealth.gov.uk

Access to Work - A JobCentre servicethat is able to come into the work placesand assess and determine whether anyadaptations or equipments are required.This is part funded by the employer andgovernment. www.direct.gov.uk

Health for Work Advice Helpline - This isa hotline with trained occupational healthnurses who can offer advice to anysmall business about return to work.www.health4work.nhs.uk

Golden rules forimplementing healthin the workplaceNot one size fits all - differentorganisations have different requirements.

Buy in and leadership from the toplevel of a company is fundamentalfor success.

Communication of the financial benefitto key stakeholders is important.Consider using the Workplace WellBeing Tool to help you build thebusiness case for wellness.

Consider the various companydepartments required to implementa successful strategy i.e. top levelmanagement, HR, Health and Safety,line managers.

Align your strategy with company goalsand key performance indicators e.g. toreduce to the cost of absence.

Impact should be objectively measuredto determine success.

Line managers need practical skills inmanaging return to work.

Strategies should not solely focuson return to work. Consider otheremployee needs and be inventiveto encourage involvement!http://www.gettheworldmoving.com

ConclusionDespite the challenges the Fit Note willundoubtedly present, QBE welcomesthe positive change in emphasis it brings.Organisations can no longer afford toignore absence management, as it has beenproven to improve the health of employees,prevent business disruptions and reducethe cost of claims. The introduction of theFit Note places the onus on employers toget it right and play an active role in theprocess. QBE recommend that seniormanagers consider the potential impactof the introduction of the fit note system totheir own organisations, and place healthmanagement higher on the agenda. Withoutthe implementation of a cohesive approachbetween all key stakeholders and theformulation of tangible objectives onwellness and sickness absence it willcontinue to be a challenge for businesses.

Can QBE help?QBE have an in-house rehabilitation teamwho have a range of services available topolicy holders to help manage sicknessabsence. They would be happy to helpany QBE policyholders with any queries orconcerns as they get use to the Fit Note.

Author biographyChris Douglas,Rehabilitation Advisor, QBE

Chris joined the QBE Rehabilitation Team in2009. Since qualifying as a physiotherapistin 2005 he has worked in a variety of clinicalsettings including prisons, hospitals,occupational health and even the sportingfields of Africa. Chris’s main area of expertiselies in occupational health, with previousexperience of working in Nestle UK’s awardwinning fast rehabilitation response teamand the Department of Work and PensionsPathways to Work Scheme.

References and furtherinformationWork Absence in Europe(Bonato and Lusinyan 2004)http://204.180.229.21/external/pubs/ft/wp/2004/wp04193.pdf

Working for a Healthier Tomorrow(Dame Carol Black 2008)http://www.workingforhealth.gov.uk/documents/working-for-a-healthier-tomorrow-tagged.pdf

A Statement of Fitness for Work -A guide for employers(Department of Work and Pensions 2010)http://www.dwp.gov.uk/docs/fitnote-employer-guide.pdf

Building a Case for Wellness(Pricewaterhouse Coopers 2008)http://www.workingforhealth.gov.uk/documents/dwp-wellness-report-public.pdf

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