The flagship programme was supposed to get the long-term sick back to work, but many expect its ‘soft’ approach will give way to something more prescriptive
For a service that is dedicated to physical and mental wellbeing, these are stressful times for the government’s Fit for Work (FfW) programme. In November, it will be put under the microscope when the official green paper on work and health assesses its impact and makes broader recommendations on improving employee wellbeing. From there, the debate will only heat up further.
Few expect FfW to entirely solve the UK’s £13bn annual sickness absence bill, but examining why its progress has (some fear) been subdued gives us a few clues about a crucial, weightier question: who will pick up the spiralling tab for ill-health among employees?
FfW was initially conceived as a GP-led absence-management service but, since September 2015, it has been available to businesses, too. At its heart is a free telephone and online advice resource, including a health assessment service that both explores the reasons for any absence beyond four weeks and helps facilitate a return to work – a service viewed as being of particular benefit to smaller firms struggling with employees on long-term sick leave.
Referrals can be made by either GPs or employers for individuals with a realistic chance of returning to work; the programme lasts for three months and includes a £500 tax exemption to be used towards treatments and therapies.
Phil Kirk, director of marketing and communications at occupational health (OH) provider Health Management, which manages the £170m FfW contract, defends the lack of information about the service’s take-up to date, and suggests it should be expanded. “I’m painfully aware that people must be given hard data if they are to evaluate our success so far, but the decision not to share numbers as yet has been taken by the Department for Work and Pensions, not ourselves,” he says.
“I believe we must widen our remit to include what we call ‘frequent flyers’ – staff who go off sick frequently but for just a few days at a time – as well as introduce self-referral for the growing army of the self-employed.”
Kirk believes the founding model, which targeted smaller companies without a dedicated OH resource, should change. But that hints at the broader tension that underpins the debate over long-term sickness: a widespread assumption on the part of businesses that the government wants them to take on increasing responsibility for employee sickness, on the grounds that work-related stress is an ever-more prevalent cause of absence. In short – you caused it, so you solve it.
With a rapid rise in referrals from larger and medium-sized organisations in recent weeks, Kirk believes FfW should “pivot towards a business-led, rather than clinician-led service” and use “larger organisations with established HR and OH infrastructures to boost overall take-up and drive traffic”.
Although Naeema Choudry, partner in the human resources practice group at Eversheds, believes there is a danger of a “doubling-up on the OH services already offered by large firms while leaving SMEs forgotten yet again”, Kirk defends the game-change: “I don’t see FfW as replicating or replacing existing provision, but I do see us as a triage service that can lift the day-to-day burdens on HR professionals and leave them free to focus on more strategic matters.”
The obvious areas for “more FfW hand-holding” would, he says, include “time-consuming maintenance of regular contact with absentee staff and listening to their concerns over returning to work, as well as helping smooth the path to any necessary adjustments in tandem with their line managers”.
While Kirk estimates that musculoskeletal referrals already account for more than a third of FfW’s business, he stresses that what can appear “a simple referral for persistent back pain” is often overlaid with debt and relationship problems as well as addiction and other complex mental health issues.
As wellness at work continues to climb both the political and business agenda, the schism between what employer-led interventions can achieve and what must be tackled by the state has become more pronounced. Mental health, the fastest growing aspect of absence and by some measures now the largest cause of long-term sickness, is complex and expensive to treat – which means a model that focuses on improving physical wellbeing through gym memberships and nutritional advice often isn’t enough on its own says Stephen Bevan, head of HR research development at the Institute for Employment Studies and a member of the Fit for Work Coalition that advised on the FfW scheme.
“Theresa May’s government has already proved, via the apprenticeship levy and national living wage, that it is prepared to use the tax and national insurance systems to lubricate the wheels of change,” he says. “I am optimistic that the green paper will contain significant content around the role that employers should be playing in tackling the chronic mental health and long-term sickness issues that so damage productivity, yet which many are still not prepared to talk about.”
Although employers already have a clear legal duty of care to look after their staff, Bevan believes that “more stick than carrot” is now required to move the entire wellness agenda forward. “Our over-burdened NHS and ageing workforce represent a huge challenge for both regulators and businesses, and whether we opt for a Dutch-style system – where employers are obliged to pay for an OH assessment and a return-to-work plan – or simply proper tax incentives for private healthcare, fresh thinking is required.”
There are contrasting views over whether FfW itself should become compulsory. But business psychologist Professor Ivan Robertson, co-founder of Robertson Cooper and co-author of Well-being: Happiness and Productivity at Work, agrees the current balance of responsibility must change. “In the coming years, organisations will undoubtedly take on more moral and financial responsibility for employee wellness and, given the plethora of studies demonstrating that a happier, healthier workforce is substantially more productive, this is only right and proper,” he says.
“But as with discrimination in the workplace, and also with the ongoing gender pay gap issue, we will only see real change once new legislation is brought in.”
If compulsory health insurance would be seen by many commentators as a step too far, Nick Summerton, GP and medical director at health screening firm Bluecrest, believes there could be more support for mandatory health screening. “FfW was a good idea but in my view it hasn’t worked because GPs simply don’t have the time or expertise to give proper advice over something as specialist as a return-to-work programme. If a new, lower-cost screening model was to become more widely available and made fully allowable as a business expense, mandatory screening across all job functions may start to be widely welcomed.”
Dr Sayeed Khan, chief medical officer at the manufacturing organisation EEF, has been close to the FfW project since its inception. While he notes that awareness among GPs has remained “disappointingly low”, he agrees that take-up among employers is starting to build. “I advised the FfW people from the start that they would need to get positive buy-in from clinicians if the service was to have any chance of thriving, but this never happened and today GPs still aren’t aware and therefore don’t refer.
“Since employers themselves have been involved, there do appear to be welcome signs of a surge in the numbers – even though some sectors, including manufacturing, appear to be far more engaged than others.”
Khan questions whether the tax-relief ceiling enshrined in FfW does any more than cover routine absence administration costs, and argues that, while it is a step in the right direction, businesses of all sizes must be offered “meaningful tax breaks” to help reduce the burden of sickness absence on the NHS. “As it stands,” he says, “FfW is based on the sound premise that early intervention and treatment can work well in an OH setting, but, to deliver real change in this area, the government needs to start grappling with a range of financial incentives.”
While Choudry expresses impatience at FfW’s continued lack of impact – “I don’t know of any client who uses it and I’m not convinced that it is even widely available,” she says – Rachel Suff, public policy adviser for employment relations at the CIPD, is in favour of the principle behind it. “Until we see further data, it’s hard to make an informed judgement on its effectiveness – but it’s an initiative that we welcome and we also recognise that, in terms of take-up, it’s still very early days,” she says. “While we don’t have any reason to believe that awareness among employers or GPs is very high as yet, in the context of Dame Carol Black’s 2011 vision that OH should be available to all who need it, we think FfW is a progressive step with enormous potential.”
The factors behind the current uplift in interest in wellness among politicians and employers are clear, she believes. “People who are long-term unemployed are often isolated and disengaged, and although we know that working can be good for our mental health and self-esteem, people who have been off sick for a while can quickly be left behind by the rapid changes in the UK workplace.”
The majority of employers, agrees Choudry, already understand that health and wellbeing sits firmly in their remit and that “long hours and complex responsibilities over different jurisdictions take their toll on both the mental and physical health of all staff”.
Indeed, Eversheds, she says, has a number of clients who already, albeit reluctantly, foot the bill for staff to attend counselling services or cognitive behavioural therapies “rather than go absent from work while waiting for an NHS referral”. But she too believes that the question of financial incentives is a critical one for the green paper and beyond: “I think employers are willing to pay their share of the bill when it comes to boosting productivity and lessening the impact of chronic ill-health on taxpayers, but more radical initiatives will need to be hammered out if the government wants them to climb fully on board.”