Fit for Work Scheme

Baroness Thomas of Winchester Excerpts

Wednesday 19th October 2016 Lords Chamber

[Baroness Thomas of Winchester (LD)]

My Lords, the noble Lord, Lord Luce, has done us all a service by highlighting this little-known scheme which was launched two years ago. The aim of the scheme is admirable and should help both the employee by facilitating a return to work and the employee’s GP by preventing them having to write out yet more sick notes. At this point, I shall say how nice it is to have a different cast of characters speaking about DWP matters. I am sure the noble Lord agrees that it is very good when more people engage with DWP matters.

One only has to look at press comment about the scheme to see where some of the problems lie. When it was introduced, press headlines made it sound like a mandatory scheme, which it is not, to force sick employees back to work. I fear that a lot of damage has been done within the past decade by press comment ramping up the “shirkers and scroungers” mentality, thus tending to make those quite legitimately on sick benefits feel like frauds. The very title of this scheme—Fit for Work—sounds so like yet another assessment while a person is off sick that it is little wonder that some people may be getting the wrong end of the stick. Perhaps the scheme should be renamed and relaunched. I agree with the noble Lord, Lord Luce, that more positive and better publicity is certainly needed, not least because the number of referrals is well below what was expected.

The first problem is that the scheme is not known about nearly enough by employers and employees. The second problem is whether four weeks is too long an absence before a business can request help from the scheme. I gather that GPs can refer both earlier and later. Four weeks might be too long for employers, considering that the scheme is not mandatory. Perhaps there could be some flexibility.

Looking at the scheme itself, I understand it is to complement existing occupational health provision, where it exists, but we know that it exists only in large firms. We have heard about some of them. It will not exist in small businesses, where the bulk of employment lies. Small businesses are unlikely to know about the scheme. For that reason, I hope it will become much better known.

If the scheme is taken up, a telephone assessment will be undertaken by an occupational therapist—an OT—in the first instance who will prepare a return-to-work plan. Having taken advice from some OTs working in central London hospitals who have experience of treating those with long-term neuro or neuromuscular problems, I shall share their comments, which seem to me to be sensible and practical. The first thing they say is that OTs with a nursing or medical background often give general advice on what a person can or cannot do without giving more creative advice about how a person might adapt their usual way of going about things. In other words, a more specialised OT might know from experience how to find a way around a difficulty. Perhaps specialised advice should be sought by some of the more general OTs.

My advisers also wonder what medical notes the Fit for Work scheme advisers have access to. If the answer is that they do not have access to such notes, then is an employee with complex needs going to be well served? Another problem is the telephone assessment. A lot of people do not like talking about confidential medical matters on the telephone. I know that face-to-face assessments are possible for those with complex conditions, but the travelling time to these assessments might be as much as 90 minutes. I wonder whether that will be having an impact on the take-up of this scheme and whether home visits are possible.

Then there is the problem of disclosure. A lot of employees, especially those with long-term conditions, will be very cautious about talking with a stranger about medical matters that might be shared with an employer. This last point is also one which is likely to apply to those with a mental health problem. The workplace mental health support service run by Remploy, which was set up to help those in work with a range of mild to moderate mental health problems, is slowly becoming more accessible and better known, and is, of course, part of access to work. Perhaps the Minister will tell us how this service fits into the scheme.

That brings me to the difficult question of the quality of assessors. My OT advisers are much too polite to make trenchant comments, but even they doubt whether there are enough well-trained, experienced OTs throughout the country to ensure enough consistency in assessments and advice. Are we spreading the available pool of OTs too thinly? Are more being trained for these and all the other assessments? If these problems I have mentioned could all be addressed, then I am sure the scheme would be much more successful.

As I have a minute more, I shall quickly make a point about chronic pain. It is a huge problem for a lot of people. It is reported to affect around 8 million adults. It is also reported that chronic back pain alone costs the country about £10 billion per annum. There is anecdotal evidence that the right degree of physical exercise can be beneficial. The noble Lord, Lord Luce, the Minister and I have talked before about the benefits of hydrotherapy for people with all kinds of severe musculoskeletal problems. Sadly, there is a terrible lack of hydrotherapy provision round the country, and hospital pools are closing for lack of money to maintain and staff them adequately. Considering that warm water exercise is beneficial for so many conditions, I wish the Government would give it their backing. I look forward to the Minister’s reply.