Fit for work -

Are you ready?

Issues forum – 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 the
Fit Note 3
Government’s here to help! 4
Golden rules for implementing
health in the workplace 4
Conclusion 5

Fit for work - Are you ready? – April 2010

Fit for work -
Are you ready?
From 6 April 2010 the Sick Note has been
replaced by the Fit Note. This is the first
change in the way sickness absence is
reported in over 80 years with the aim of
shifting the focus to what employees can
do as opposed to what they can’t do. It is
essential that businesses are ready to take
advantage of the potential benefits the new
system brings as well as understanding the
potential pitfalls.

“The Sick Note reflects an age when an
employer expected an employee to do
a specific job rather than today’s flexible
workplace”
Dame Carol Black
Why was this necessary?
The government’s first ever review of the
health of Britain’s working age population
was published in March 2008 and carried
out by Dame Carol Black. Her report
identified that the annual cost of ill health
is more than £100 billion, with 175 million
working days lost per year. Evidence
indicates that the UK lags behind many
other developed countries where the
positive impact of effective early health care
intervention has long been recognised. For
example in Scandinavia 50% of individuals
return to work following a major injury and in
the US it’s 33%, but in the UK the figure is a
lowly 16% (Bonato and Lusinyan 2004).
This indicates that the current system is
failing a large number of individuals in the
UK and one area considered responsible
is the out dated Sick Note. One of its major
flaws is the fact that it focuses solely on
what an individual is unable to do. There is
no encouragement for GPs to suggest how
an injured employee could return to work.
As Dame Carol Black states “it reflects
an age when an employer expected an
employee to do a specific job rather than
today’s flexible workplace”. The Fit Note
aims to change all this.
A change of emphasis
GPs will now be asked to play a more
active role in making recommendations
to employers regarding their patients’
capabilities to work. Rather than just stating
they are either physically or mentally too
unwell the new system will allow doctors
the 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 to
decide on one of the following options,
whilst also providing a small amount of
information for employers.
• Phased return
• Altered hours
• Altered duties
• Workplace adaptations.
Key changes
• Move to focusing to what people
can do opposed to what they
can’t do
• Discourage the notion that
somebody has to be 100%
fit before returning to work
• Encourage a dialogue between
employers and employees to
facilitate an earlier return to work
• The longest a GP will be able
to sign somebody off sick for is
to be reduced from 6 months to
3 months.
2 for Employers)
Fit for work - Are you ready? – April 2010
Expected benefits
Organisations of all sizes should view the
reform positively, as it will produce undoubted
benefits for the UK economy. For example:
• Organisations should see fewer of their
employees signed off sick, with obvious
benefits through reduced absence
• Evidence shows that better sickness
management leads to reduced costs
and increased company productivity.
(Pricewaterhouse Coopers 2007)
• GPs will be providing more information
on how an individual’s health condition
affects their ability to complete their
work, alongside how these could be
accommodated in the workplace. This
will hopefully lead to more collaborative
approach between employers and
employees to reduce unnecessary
absence
• People will have fewer forms to deal
with. From the 6 April 2010 the Med 5
form will no longer be in use, replaced
by the new Med 3 form.
(Taken from the DWP’s Fit Note Guidance
Impact on claims
If the new Fit Note achieves its aim of getting
people back to work earlier than they might
have previously then ultimate claims costs
could benefit with a reduction in the loss of
earnings component. It also raises issues
around an injured party mitigating their
losses, as they have a duty to do, especially
if the employer is able to accommodate the
recommendation contained in the Fit Note.
Despite an employer being flexible an injured
party could still feel unable to return to work.
The ultimate effect of this change within the
claims process will not be seen for a number
of years.
QBE believes that the most effective way
of managing the cost of work related
claims is by implementing effective absence
management procedures. QBE’s online
Minor Injury Management Service has
demonstrated 29% quicker return to work
with a loss of earning saving of over a £1000
per claim, notwithstanding the hidden costs
savings.
12 Steps to prepare for the
Fit Note
1. Understand the change of
emphasis: Essentially the Fit Note does
not change an employer’s obligation to
its employees; the underlying objective
is to encourage open dialogue between
all parties, with GP’s being encouraged
to 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 to
carry out a risk assessment (when
appropriate) when an employee returns
to work to ensure there is minimal risk
to the employee and others in the
workplace.”
2. Educate all key stakeholders within
the business: The DWP and TUC have
issued complementary guidance and
ACAS is offering training courses to
help businesses prepare. This
information should be cascaded down
through the business to all those
involved in absence management.
3. A Fit Note can still become a
Sick Note: DWP have indicated
that employers will not be able to
use the note as the basis for stating
an employee has to return to work.
If no effective agreement can be
reached the Fit Note will work in exactly
the same way as the Sick Note did.
4. Be prepared for new challenges:
Everybody is moving into unchartered
territory and even the government
cannot fully predict what challenges it
will bring. Employers should consider
appointing somebody within the
business who is responsible for
cascading the information to key
stakeholders, ensuring the business
is ready and assessing the impact.
Currently, important departments
within the absence management
process often work as lone silos with a
lack of cross disciplinary communication.
There needs to be a coherent approach
between key business areas including
HR, Occupational Health, Risk
Managers, Health and Safety, line
managers and operational managers.
5. Understand its limitations:
Employers are often frustrated by GPs,
but they must understand the challenge
facing them in managing absence.
A GP spends on average 10 minutes
per person and are expected to gain
information, make a judgement, decide
on treatment and write the Fit Note.
Under the new system they are also
allowed to assess individuals over
the phone. It is also important to
understand that the information they
receive regarding work and job roles
comes from the patients themselves.
A GPs role is to act in the best interest
of their patient. There is the potential
employer has failed in its duty to make
for conflict when GPs are faced with a
reasonable adjustments – a requirement
patient who strongly believes that work
under the Disability Discrimination Act
caused or will make their injury worse.
1995. This will be a particular challenge
6. Review your policy for managing for smaller employers, as they often
sickness absence: This provides an have fewer resources and less flexibility
ideal time for a review of sickness and to accommodate injured employees.
absence policies, as these will have to
8. Be aware of support services
be updated to incorporate the Fit Note.
available for SMEs: Alongside the
For example, employers could introduce
reforms of the Fit Note the government
return to work risk assessments,
has recognised that smaller employers
considering any necessary control
need more support managing absence.
measures and/or change of duties
As a result, they have put in place
required – to be agreed and signed by
provision such as the Health and Work
all parties before the return to work date.
Advice Hotline, Fit for Work Pilots and
7. Consider the Disability Access to Work to help SMEs.
Discrimination Act (1995): Employers
could find themselves at an increased For information on how this service
risk of disability discrimination claims could benefit your business please
i.e. the Fit Note might highlight changes contact your QBE account manager.
that an employer could make to the
employee's duties or workplace that
would enable them to work. Failure to
consider such suggestions seriously
could result in a tribunal finding that the

9. Understand your organisation’s role
in managing absence: Employers
should not rely solely on the GP if they
want to have a robust and effective
policy for absence management.
Occupational Health sits outside
the remit of the NHS and it is the
responsibility of individual organisations
to ensure their employers are fit for work.
10. Review Occupational Health
Provision: By encouraging the
emphasis on a new collaborative
approach, many believe that the
government has placed the spotlight
firmly on organisations’ ability to
manage absence. One way of achieving
this is by having in place effective
occupational health provision, but
only 40% of UK companies actually do.
Where occupational health is in place it
is often restricted to health surveillance
required to comply with Health and
Safety legislation e.g. audiometric
testing for noise legislation. Providers
(in-house or outsourced) may not be
proactively involved with return to work.
4
Fit for work - Are you ready? – April 2010
Government’s here to help! Golden rules for
Fit for Work Services - new government
implementing health
funded case management service to
in the workplace
help small employers manage absence. Not one size fits all - different
www.workingforhealth.gov.uk organisations have different requirements.
Access to Work - A JobCentre service Buy in and leadership from the top
that is able to come into the work places level of a company is fundamental
and assess and determine whether any for success.
adaptations or equipments are required.
This is part funded by the employer and Communication of the financial benefit
government. www.direct.gov.uk to key stakeholders is important.
Consider using the Workplace Well
Health for Work Advice Helpline - This is Being Tool to help you build the
a hotline with trained occupational health business case for wellness.
nurses who can offer advice to any
small business about return to work. Consider the various company
www.health4work.nhs.uk departments required to implement
a successful strategy i.e. top level
management, HR, Health and Safety,
11. Consider well-being: Research has
line managers.
shown that the most effective sickness
absence policies do not focus solely
Align your strategy with company goals
on managing problems. Companies
and key performance indicators e.g. to
who have taken a proactive stance
reduce to the cost of absence.
on worker health have seen a reduction
in absence through simple steps.
Impact should be objectively measured
For example, the Global Corporate
to determine success.
Challenge, encouraging employee to
walk 10,000 steps a day, has been
Line managers need practical skills in
adopted by many large organisations.
managing return to work.
12. Build a business case for wellbeing:
Strategies should not solely focus
One of the greatest challenges to
on return to work. Consider other
change is proving that it is cost effective.
Without being able to demonstrate the employee needs and be inventive
financial sense of investing in the health to encourage involvement!
of a company’s employees it will be http://www.gettheworldmoving.com
difficult to achieve the “buy in” of
senior management. Key government
organisations, such as the HSE and
Department of Health have worked
together to develop a Workplace
Well-Being Tool that helps demonstrate
the benefits of investing in health.
Conclusion
Despite the challenges the Fit Note will
undoubtedly present, QBE welcomes
the positive change in emphasis it brings.
Organisations can no longer afford to
ignore absence management, as it has been
proven to improve the health of employees,
prevent business disruptions and reduce
the cost of claims. The introduction of the
Fit Note places the onus on employers to
get it right and play an active role in the
process. QBE recommend that senior
managers consider the potential impact
of the introduction of the fit note system to
their own organisations, and place health
management higher on the agenda. Without
the implementation of a cohesive approach
between all key stakeholders and the
formulation of tangible objectives on
wellness and sickness absence it will
continue to be a challenge for businesses.
Can QBE help?
QBE have an in-house rehabilitation team
who have a range of services available to
policy holders to help manage sickness
absence. They would be happy to help
any QBE policyholders with any queries or
concerns as they get use to the Fit Note.
Author biography
Chris Douglas,
Rehabilitation Advisor, QBE
Chris joined the QBE Rehabilitation Team in
2009. Since qualifying as a physiotherapist
in 2005 he has worked in a variety of clinical
settings including prisons, hospitals,
occupational health and even the sporting
fields of Africa. Chris’s main area of expertise
lies in occupational health, with previous
experience of working in Nestle UK’s award
winning fast rehabilitation response team
and the Department of Work and Pensions
Pathways to Work Scheme.
References and further QIEL has acted in good faith to provide
information an accurate publication. However, QIEL
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(Bonato and Lusinyan 2004) about the contents of this publication,
http://204.180.229.21/external/pubs/ the accuracy or timeliness of its contents,
ft/wp/2004/wp04193.pdf or the information or explanations given.
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A Statement of Fitness for Work -
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