Fit for Work, the state-funded health and work advisory and assessment service resulting from the 2011 Black/Frost review of sickness absence, has been up and running for a year – but it is yet to prove the kickstart for group income protection that some had hoped, says Edmund Tirbutt
While some group risk experts predicted that the government endorsement of rehabilitation and early intervention in the form of its Fit for Work service would fuel demand for group income protection, there is little evidence of it yet.
The first element of the new service was an advice line launched in December 2014 to give generic advice to employers, employees and GPs. Next came the GP referral service in March 2015, to which GPs can refer when they have signed off a patient from work for four weeks or more. This case-manages the patient for 12 weeks and, once their issues have been identified, potential solutions are incorporated in a Return to Work Plan that is agreed by the employee and then shared with the employer and GP.
The final piece of the FFW jigsaw was the employer referral service, launched in September 2015. This provides the same facility as the GP referral service except that the employer refers once the employee has been off work for four weeks.
If FFW recommends workplace adjustments or medical treatments, it is up to the employer to consider paying for these, although the impact is supposedly softened by a tax exemption that spares the employee P11D costs of up to £500 a year on medical treatments recommended either by FFW or by a company occupational health service.
FFW has no precise usage figures available but has case studies of individuals it has benefited. It says the GP and employer referral services combined have “seen several thousand cases since outset”.
It also reports the advice line to be “ahead of target in terms of numbers” and the GP referral service to be “sort of on target”. The employer referral service was launched too recently to have official targets but demand for it is reported to have significantly outstripped that for the GP service.
FFW director of marketing and communications Philip Kirk says: “We’d seen GPs as the main market for the product but we now realise that employers have more vested interest in making referrals.”
Nevertheless, clearly only a small number of employers are using FFW. The EEF/Jelf 2016 Sickness Absence Survey, published this June, found the proportion to be as low as 6 per cent. Anecdotal evidence does little to contradict this.
Unum head of public affairs John Letizia says: “In principle the service is a good idea, but there is a general consensus that it isn’t delivering. It never really had the marketing and high-profile capability needed for success, particularly among SMEs, which don’t have the internal resources to deal with long-term sickness absence.”
Canada Life Group Insurance marketing director Paul Avis is critical of the fact that employers must consider paying for treatment recommended by FFW and that the employee is exempt from P11D liability on only the first £500.
He says: “There is no obligation on employer or employee to take Fit for Work’s advice and, when treatment exceeds £500, which buys you nothing in terms of vocational rehab, the employee is effectively taxed on it. The employer must decide whether to pay the tax or pass it on to the employee, and it may say it’s not paying if the cost exceeds £500.”
FFW stresses that it strives to minimise treatments that employers must pay for, and the EEF/Jelf survey suggests it is succeeding in this. It is less convincing, however, on the subject of encouraging usage by SMEs.
Kirk says: “An SME may have to use the service only once every 18 months, so there’s no point in doing a mass advertising campaign as they wouldn’t remember and use it.
“So we take a digital approach, ensuring that Fit for Work will be in the top three or four of online searches by SMEs when employees go off sick. We are also working with organisations like the Federation of Small Businesses and Chambers of Commerce to raise awareness, and hope that larger companies will recommend us to SMEs in their supply chain.
“Medium-sized and large employers are almost viewing Fit for Work as a triage-type service, using us for the first 12 weeks and then referring to their own occupational service if employees aren’t back to work. We are telling them to carry on doing this but are also asking them to tell their suppliers about us. We expect to review our approach in mid-2017 and will adapt our plans according to what we find.”
Even the more optimistic commentators acknowledge that FFW has a long way to go before significantly boosting demand for income protection. Premier Choice Employee Benefits head of group risk Steve Ellis says: “It’s a slow burner. Our clients are becoming more aware of the service, which is in turn creating awareness of what they can do themselves. It will develop over time but it’s still embryonic.”
The fact that insurers are far from persuading employers – particularly SMEs – to provide them with early notification of absence indicates the tough challenge ahead. Grid research shows that, in 2015, group income protection providers returned 1,878 employees to work before they claimed; but around 2.1 million employees are covered by their products.
Zurich Corporate Risk group risk propositions manager Nick Homer says: “The fact that insurers are struggling in this respect suggests the Government has an uphill task. It has an even bigger challenge than insurers because, unlike us, it is not fundamentally covering the costs of intervention.”
Furthermore, FFW has come into being just as there is beginning to be a switch in employer focus away from returning employees to work and towards absence prevention.
Andy Bowness, CEO of wellness consultancy Bodireel, says: “When we go into companies, all the emphasis is shifting from reactive care for absentees to preventing people from taking time off in the first place, and improving their productivity. Recent research has consistently borne out that presenteeism in people who show up to work is costing 10 times more than absenteeism.”
RESEARCH SHOWS LOW USAGE OF FIT FOR WORK
The EEF/Jelf 2016 Sickness Absence Survey, based on responses from 306 employers, found that:
- 78% of respondents were aware of FFW but only 6% had used it
- Of those who were aware, 54% would consider using the assessment service but had not yet done so
- 87% of those aware of FFW knew they could refer after four weeks’ continuous absence; but only 74% knew a GP could refer if they thought the individual likely to be off work for more than four weeks
- 18% of respondents did not intend to use the FFW service
- Of the 17 employers that had used the service, 14 referred employees for assessment, 13 of which received Return to Work Plans for some or all employees
- Three of these plans specified medical treatment and a further 17 recommended employee workplace adjustments
- Of the three employers with specified treatment, one paid the full cost, one paid 41–60% of the cost and one did not pay
- 77% of respondents were unaware of the £500 tax exemption
Return to Work Plan comes up trumps
When ‘Lisa’, a 56-year-old production administrator from South Yorkshire, found herself unable to work due to osteoarthritis, her GP referred her to Fit for Work, which completed an assessment on her the same day.
Lisa says: “The Fit for Work case manager was realistic and sensible and told me my recovery would be a long process and wouldn’t happen overnight. I could tell she understood the rehab process, which gave me great peace of mind.”
FFW helped Lisa create a Return to Work Plan, which was shared with her employer, a trailer manufacturing plant with over 500 employees. A suggestion in the plan, supported by her manager, was to undertake ergonomic and risk assessments.
Lisa adds: “The plan guided me through the process of getting back to work in a way that suited me. Many people off sick feel pressure to get back to work and feel they are at home for the wrong reasons. Fit for Work created a realistic plan to help me return to work with adjustments at a sensible pace.”