According to the latest Jelf Employee Benefits survey, published in October, UK employers appear willing to engage with the government’s new Fit for Work service.
The service, to recap, offers a combination of a free health and work website and telephone advice line and a free, voluntary referral (via a GP or employer) for an “occupational health” assessment for employees who have reached, or whose GP expects them to reach, four weeks of sickness absence.
This assessment then leads to the creation of a return-to-work plan recommending interventions, adjustments or treatments, which can be accepted as evidence of sickness absence in the same way as a GP-issued fit note.
Asked if they would be happy to signpost absent employees towards the new service, almost seven out of 10 of those questioned by Jelf said they would be prepared to refer in some or all. Nearly half (45%) also intended to communicate details of the service to employees over the next year.
Superficially, of course, this is great news for the government. However, while Jelf clearly managed to find a robust sample of engaged employers who knew about – and had an opinion on – Fit for Work, chances are it took quite a bit of digging.
This is because when you speak to GPs, workplace health professionals and employer representatives – let alone individual employers – the constant complaint is that its public profile remains miniscule to non-existent.
As Iain Laws, managing director for healthcare and group risk at Jelf Employee Benefits, says: “We think it is a really strong initiative, but it has been poorly communicated and is currently poorly understood. The vast majority of UK employers do not know it exists. There has been virtually no communication about the service now being rolled out nationally.”
To be fair, the government in October did unveil a programme of awareness-raising roadshows to run throughout the autumn, featuring early adopter-employers, the conciliation service Acas and even former director-general of the British Chambers of Commerce David Frost, one of the architects of the Fit for Work blueprint.
But the view of Carl Chapman, head of wellbeing at consultancy Barnett Waddingham, winner of the Best Workplace Wellbeing Intermediary category at this year’s Health Insurance Awards, is certainly not untypical.
“The idea behind it is sound,” he says. “It is a good idea to ask people to think about how healthy they are rather than just how ill. The problem is it has had a very low profile.
“I don’t get a sense people on the intermediary or insurance side have got that much exposure to it, either. I would have liked to have seen much more marketing, advice and attention around it.”
So, where does this leave insurers (especially group risk) and intermediaries? Assuming they’ve even heard of it, how relevant do they feel it is? Do they see it as a threat or opportunity, and can – or even should – the industry play a role in filling the information vacuum that appears to be bedevilling the service?
“We believe this service is a good ingredient in the whole debate around work being good for health,” says John Letizia, head of public policy at Unum.
“But the lack of awareness is very worrying. Intermediaries are starting to get to know about the service and what it offers but, again, it is primarily through word of mouth and industry networks.
“The larger or specialist group income protection [GIP] intermediaries, especially those involved in the SME market, will be engaged and aware of it, and all conscientious and professional intermediaries should be aware of its existence. It is a big change in the environmental circumstances affecting GIP,” says Peter Le Beau of the Seven Families income protection campaign.
For big companies that already have bespoke in-house or retained OH services, the engagement they have with the service is likely to be limited, he argues.
“But for the SME there might be a big difference, as people off work for a month or who have the prospect of being so may be referred to the Fit for Work scheme,” he adds. “It is probably too early to draw strong conclusions, but it is likely people may be shepherded back to work more quickly than perhaps has been the case hitherto.”
Might this therefore make GIP or group risk more or less attractive?
“I think it could change things in a very positive way,” argues Katharine Moxham of Group Risk Development (GRID).
“When you look at Fit for Work, in many ways it is trying to emulate with group risk already does. There is a gap in occupational health provision in terms of supporting people get back to work or to stay in work; GIP in particular is tremendously geared towards that.
“While the service may be able to provide a level of support, the assessment is free but the rest of it is not. So it could change perceptions of the value of something like GIP.”
Indeed, GRID’s own research has suggested just 15% of employers would be happy to pay for a recommendation of an intervention or treatment by the service, despite the £500 tax break that comes with it, suggests Moxham. And herein lies the opportunity.
“Very often the sort of outcome recommended by the service will be the sort of thing that, as an industry, we fund to help people get back to work,” she says. “So we need to engage with employers. We should be asking them ‘have you heard about it’, ‘how do you think it will help you’, ‘is there anything we can help with in terms of adding value’?”
“Insurers and intermediaries cannot wash their hands of this. Our view is the Fit for Work service could be a way of opening those conversations,” agrees Unum’s Letizia.
More widely, Fit for Work may yet be a step, albeit a small one so far, towards a more employer-led, employer interventionist, even co-funded workplace healthcare future, suggests John Ritchie, chief executive of group risk insurer Ellipse.
“I see it as part of a process whereby the government is conditioning everybody to the idea of early intervention,” Ritchie says. “The government is endorsing the idea that you have got to get to absent people by four weeks, at the latest, which is what insurers have long said too.”
Whatever the long-term perspective, and however the service beds down, the reality is it is now here and something the industry needs to be engaging with, emphasises Jelf’s Laws.
As he says: “Intermediaries have a role to make people aware of it, that it is a service available to the employer to assist in workplace absence; that this is now part of the absence management landscape.”
FIT FOR WORK – A TIMELINE
November 2011 – Dame Carol Black and David Frost publish an independent review of sickness absence, including identifying a lack of access to occupational health advice as one of the obstacles to people returning to work.
January 2013 – government responds, accepting its recommendation for the creation of a new health advisory and assessment service.
December 2013 – the chancellor outlines a £500 tax break for employers investing in health interventions recommended by the new service.
February 2014 – new “Health and Work Service” is officially unveiled by the government.
August 2014 – Five-year £170m contract for running the service in England and Wales awarded to occupational health provider Health Management. The service in Scotland will be run by the Scottish government.
November 2014 – government announces new service will now be known as Fit for Work.
December 2014 – Fit for Work website and telephone advice line launched. Assessment pilots start across Sheffield, gradually extending to Nottinghamshire, Yorkshire and Wales.
September 2015 – national roll-out of GP referral service completed.
October 2015 – service opens to employer referrals. Fit for Work agrees link-up with conciliation service Acas to unveil a programme of awareness-raising events around the country.
VIEWPOINTS
“The longer someone remains out of work due to sickness, the greater the cost to their career, income and future earnings. Fit for Work will ensure that people get the right help when they need it to get back to work so they can continue to support themselves and their families.”
Welfare reform minister Lord Freud
“It’s good to see the government giving people extra support to get back to work after extended sick leave, and will also mean that firms can avoid losing talented staff to long-term absence. Businesses welcome the Fit for Work service and it is great to see it rolling out nationally. In the longer term we would like to see GPs using service as a default option for those absent for four weeks or more.”
Neil Carberry, CBI director for employment and skills
“It is positive that all GPs in England and Wales now have access to the service… but GPs had hoped Fit for Work would have been more hands-on, rather than relying on telephone contact for the vast majority of patients.”
Dr John Chisholm, health and work lead for the Royal College of General Practitioners
“As it stands, Fit for Work is no panacea. The service… is limited to employees who are off work, whose absence has lasted or likely to last for more than four weeks and for whom there is an expectation they will return to work. Arguably, this will not best serve employees for whom an earlier referral for assessment and treatment would be beneficial – for example, those affected by mental health conditions. Fit for Work is not a replacement for an existing employer occupational health programme, many of which will be well established and bespoke for employers’ particular needs.”
Elliott Hurst, director of health consulting at AXA PPP healthcare