The Minister of State, Department for Work and Pensions (Lord Freud) (Con)
My Lords, I too thank the noble Lord, Lord Luce, for introducing this debate. I have spent a lot of time trying to get the service in, and it is absolutely vital that we have this kind of support for people, to stop the inflow at a time you can do it. That is what this service is designed to do. I also acknowledge the noble Lord’s concerns about employees who are facing long-term sickness absence. We debated it quite some time ago now, I think when the independent review of sickness absence report, led by Dame Carol Black, came out. I hope I will be able to answer the bulk of the many questions that noble Lords have asked me.
I start by giving a picture of how the workforce in Great Britain has been affected by long-term sickness absence, a set of figures that has been touched on. In 2015, 139 million days were lost to sickness absence, and the independent review in 2011 on this came out with a total cost figure of £9 billion in sick pay and associated costs, with the whole cost to the economy running at £15 billion. Many noble Lords here today will remember that a significant proportion of sickness absences result from musculoskeletal conditions such as back or knee pain. The other big factor is mental health conditions, such as stress, depression and anxiety. Clearly, the fact that we have an ageing workforce adds to the necessity of having really good services in place to help those affected by health conditions to go back to work or to remain in work. As people are now living longer and healthier lives, it is vital that occupational health services are accessible for such workers so that they can continue to live at a better, healthier standard. The noble Baroness, Lady Thomas, asked me how many occupational health practitioners we really need in this country. That is a difficult question for me to answer. I think the answer is probably more than we have, but I cannot help her much more than that.
I do not want everyone to think that we focus only on services to help older workers to stay in work; age and health are not necessarily related. Many businesses already understand the benefits of providing occupational health support to employees but, as several noble Lords have pointed out today, one of the major issues is with the SMEs that do not have access to such support or have very limited access to it. That was one of the key findings from Dame Carol Black in her review, where she pointed out that it was the lack of access here that was preventing employees from returning to work. That led us to the establishment of the Fit for Work service.
As the noble Lord, Lord McKenzie, pointed out, we started with a gradual rollout in December 2014. We have now rolled out nationwide, and we offer occupational health assessments for those suffering from long-term sickness absence. We also provide an advice service for employers, GPs and employees that is free to use for all. That means that whenever an employee is absent from work due to illness for four weeks or more, they can be referred to Fit for Work by either their GP or their employer. It is interesting that the figures for employers have been moving ahead of those for GPs. Those who are referred are allocated their own experienced case manager who will conduct an assessment with them that will take into account all the issues—health, work and social issues—that may be preventing the member of staff from returning to work. The employee will receive a return to work plan detailing the steps that he or she, their employer or their GP can take to help them to return to work sooner. Then, provided that the employee consents, the plan is also sent directly to their employer or GP.
I turn to the question asked by the noble Baroness, Lady Walmsley, and the noble Lord, Lord McKenzie, on the qualifications of the healthcare professionals. They are professionals who have an occupational health qualification or occupational health experience or who are able to demonstrate the experience and skills appropriate to working in an occupational health context. Health professionals must be registered with the relevant regulatory and/or professional body on the appropriate parts of its registers. Fit for Work has an accredited specialist in occupational medicine providing clinical supervision of the service, and provides appropriate supervision from more experienced professionals from whom they can seek advice.
Both the right reverend Prelate the Bishop of Derby and the noble Baroness, Lady Thomas, asked who the health professionals are. They come from a wide range of backgrounds. They will signpost to other services if appropriate. I hope they are creative; they can refer on to hydrotherapy, for example, and the noble Baroness knows that I am a believer in much colder water than she is.
Employees and employers can contact the advice service on any work and health matter, and that includes people who are still in work. Someone—I have forgotten who but I think it may have been the noble Baroness, Lady Walmsley—talked about the stiff upper lip. The service is available for those with a stiff upper lip who are struggling at work. They do not have to be off work in order to take that advice.
The referrals are an iterative process, as said by the noble Lord, Lord McKenzie. An initial assessment will be done and an initial return to work plan issued. Further assessments will take place if required—for example, if an individual does not return to work as expected—and the service will provide support for up to three months if required.
I can give some numbers for the scheme. From the figures from March 2015 until last month, we are just shy of 10,000; some 9,000-odd people have gone through. For commercial reasons I cannot disclose our expectation but I will not disguise that that is a lower level than we had hoped for at this stage, and clearly we are concerned to do something about that. One thing we will do is reflect some of that in the Green Paper that is due between “shortly” and “soon”—we have had many debates about what those two words actually mean.
Some noble Lords mentioned some of the parallel services to Fit for Work. Noble Lords will remember that we introduced a tax exemption of up to £500 a year per employee for medical treatments recommended by Fit for Work with an employer-arranged occupational health service, so that is designed to act as an extra incentive for employers to make use of Fit for Work.
The Access to Work scheme provides practical and financial support with the additional costs faced by individuals whose health or disability affects the way they do their job. The amount of help that an individual may receive from Access to Work will depend on their individual need and personal circumstances, but the figure is now up to a maximum of £41,400 a year of support. The Access to Work programme is delivered by Jobcentre Plus. The awards are usually made for a period of three years and are reviewed annually. In answer to the question from the noble Baroness, Lady Thomas, I can say that Fit for Work will signpost to Access to Work as necessary. This will be recorded on the return to work plan for both the employee and their employer.
We know there is a consensus here. I am always delighted when the noble Lord, Lord McKenzie, and I agree on some of these matters; that was not always the case. This Government are committed to helping more people with mental health conditions to find and retain work, as well as testing how to improve both the well-being and the employment prospects of claimants with mental health conditions. There is investment of an extra £1.25 billion in mental health support and we have pledged over £40 million over the next three years on a range of voluntary pilots to test how best to support people with mental health conditions to gain and retain employment.
The real issue here is that we often simply do not know what works. This money is really important to find some of those answers. I assure noble Lords that no one in the world knows them, so it is very important that we find out how to do it.
Government cannot do this on our own: we need employers and healthcare professionals. We believe that for Fit for Work to be more successful, for more people to go through it, there needs to be a change in culture among GPs and employers, particularly SMEs. There have been marketing campaigns to the medical community and to employers’ representative bodies. Through them, the providers of Fit for Work have been working to increase awareness of the service across Great Britain but clearly—this is a point made by several noble Lords—we have a deal more work to do to get the word out.
The noble Lord, Lord McKenzie, asked about evaluation. An evaluation strategy is in place for Fit for Work. It is being undertaken by an independent research organisation on behalf of the work and health unit. It will include feedback from employee users, GPs and employers. The initial satisfaction data we have received from independent performance monitoring is that the service has been welcomed by GPs, employers and employees.
The noble Baroness, Lady Thomas, asked: should we rename and relaunch? We are looking at this whole area—should we expand, what is its role?—in the Green Paper, so we will be able to return to that topic. On the key question that she asked about sharing information, most people are relaxed about sharing information with their GP or employer. About 30% of people do not want to share the information.
The noble Lord, Lord Luce, asked whether the telephone is the right method. It is speedy, cost-effective and works in many cases. In some cases, it is not appropriate, and we will conduct face-to-face assessments when necessary.
My noble friend asked how well-equipped the NHS is to give support. NHS England commissions specialised care for patients whose pain cannot be successfully controlled or is particularly complex to manage. NICE has published several clinical guidelines and produced a range of best practice guidance on pain management for specialised drugs and treatment, as well as specific conditions, including chronic pain.
Too many individuals are still prevented from participating in the labour market by health issues. We have established the cross-government work and health unit jointly with the Department of Health. That is designed to lead the drive to improve work and health outcomes for people by improving integration across the healthcare and employment services. That combination is the driving factor behind Fit for Work.
We know that many larger companies see the benefit of supporting their workforces through occupational health—around 80% of large companies do that—but that only one in 10 small companies do so. That is where the Fit for Work service is designed to fill the hole. As I said, we will be exploring this area further in the Green Paper.
Let me conclude by again expressing my thanks to the noble Lord, Lord Luce. This is a key programme for us. It has not gone as rapidly as I hoped. I hope that, if we can get it up successfully and get the message out better, the benefits will be compelling: for employers, to reduce sick pay and increase productivity; for the state, as the noble Baroness, Lady Walmsley, said, through reduced long-term worklessness; but, most importantly, for the people involved, it just makes their lives more meaningful.
We are committed to doing everything we can to ensure that Fit for Work plays as full a part as possible in what is an extraordinarily important objective of helping people stay in work.