Healthy preoccupation

Occupational health should be given far greater prominance in future, sys the Frost/Black review. Anna Scott finds out that it could mean for intermediaries

Private providers of occupational health services will play a role in assessing absent employees’ mental and physical capability to work via a state-funded service, if the government accepts the recommendations of Frost/Black Health and Work – Independent Review of Sickness Absence.

The review has called for an Independent Assessment Service (IAS) which employers may use for employees who have been off sick for more than four weeks, to assess their physical and mental function, whether they are capable of coming back to work and the support they need to achieve a resume their jobs. But the IAS would not be the expensive organisation it has been reported as being, co-author and former director general of the British Chambers of Commerce David Frost told delegates at the Corporate Adviser/Axa PPP Healthcare round table event last month.

“This is not a panel which will have offices in Manchester, Birmingham, Leeds or wherever, where essentially an individual would be sent to be signed off whether they were capable of work or not,” said Frost. “This is not a state service, with any state employees.”

Frost envisions a database of effectively accredited providers that could be accessed remotely by employers, particularly smaller companies, in order to choose an organisation to assess an absent employee and get a clearer picture of their status for work. Designed to assist in the medical certification process, the information gleaned would also be fed back to the individual’s GP.

Employers could save approximately £100m a year in sick-pay costs, and an expected increase in economic output of around £150m a year, the review says.
Estimating a cost to government of £150 per person for the IAS, Frost sees the service’s function as engaging the employee and keeping the employer and GP in the loop as well. “It’s about using some of the models of the private sector,” he said. “There is a whole host of private providers out there perfectly capable of doing this.”

“We have got to identify people, get them into the system, get them treatment or get them on the right benefit as soon as possible. Employers want some certainty and the current system doesn’t give them certainty.”

The current system of GPs issuing fit notes came under criticism in the review, with Frost saying that 85 per cent of fit notes issued for periods of more than one week indicate a person is not capable of doing any work. The study also recommends that the guidance for fit notes focuses on capability for work in general, rather than for specific job roles.

“How do GPs know what an employee’s role is?” Frost said. “Also I think many GPs are an advocate for the individual, rather than perhaps the state. And therefore they just simply sign people off.”

Frost told delegates that the review found private OH providers were very effective at calling sick employees on day one of their absence to find out how they were, and doing this every week of their absence. “I think the majority of cases could be dealt with that way,” he added.

In providers’ and advisers’ experience too, such remote services are effective. “We start off on the basis that we will have a telephone triage,” said David Prosser, group head of health, AXA PPP Healthcare. “50 per cent of cases can be dealt with that way without looking for further information.”

But Katherine Moxham, spokesperson for Group Risk Development, questioned whether remote assessment of sick employees could lead to them exaggerating their symptoms. “It’s very easy to over egg the pudding on the end of a phone or over the internet,” she said. “There is nothing like vocational rehabilitation within the home for an assessor to be able to say exactly what the issues are and see difficulties face to face,” she added.

“I think for certain cases you will have that,” Frost said. “But the model many efficient private providers have is having very, very good rates of return from remote working. And I am struck by how many people when they go off absent are forgotten, and then their condition may morph into something else.”

Those absent employees whose conditions are treatable with early intervention but are left alone by their employer are the group that the Frost/Black Review has aimed to target with its recommendations. “The main focus of the report was on longer-term absence and those at risk of falling out of work altogether,” Frost said.

Mike Tyler, managing director at Buck Consultants, said: “There seems to be coming through the report the recognition that a portion of the people who are absent are genuine cases that clearly you want to do the best for them but in reality they may well end up not being able to work for a raft of reasons. There are others who will recover quite naturally. But you have also got this middle range which if you don’t intervene early enough and mobilise them in the right way, they quickly default to the wrong side.”

This may include staff who want to return to work, but not to their current job, or even their current employer. In these cases the report has recommended some form of job brokerage service, funded by the employer up to 20 weeks of absence and the state thereafter.

“Rather than have someone with a health problem drop out of the labour market, is there some form of service that we could have that could get them working with another employer?” Frost asked, adding that it wouldn’t be a big programme, and may even be a stream of the government’s work programme.

Frost noted, however, the care required to ensure the service doesn’t turn into a brokerage for employees who just want to change jobs. Furthermore, the system needs to consider the order in which individuals get preference.

Funding for these two new services would come from the abolition of two sickness absence-related initiatives, the report has recommended.

Another area of confusion is around benefits. The reviewers found many people didn’t know about the existence of the Employment Support Allowance, which unlike Jobseekers’ Allowance, does not require claimants to look for a job. When people went off sick for a long time “they would ring up Jobcentre Plus to tell them they were going onto sick leave and be told about ESA,” Frost said. “So we are now saying that you should not qualify for ESA until you have a Work Capability Assessment.”

However, he added: “We are clear that those who are too ill to work should be supported. What we are not trying to do is force everybody to stay in work.”

The government is yet to respond to the report’s recommendations, but if the proposals are taken forward, the work intermediaries do around absence, health and wellbeing could be very different in future.