Fit for Work Scheme

Lord Luce Excerpts

Wednesday 19th October 2016 Lords Chamber

Asked by

[Lord Luce]

To ask Her Majesty’s Government what progress has been made with the Fit for Work scheme in enabling those with long-term health problems like chronic pain to return to or stay in work.

[Lord Young of Cookham (Con)]

My Lords, as this is now last business, the time limit has been extended to 90 minutes and the limit on individual speeches to 10 minutes.

[Lord Luce (CB)]

My Lords, I am most grateful to the Minister for replying to this debate and to all noble Lords who will be offering their distinctive contributions. In July 2010 I led a short debate asking the Government what was being done to provide access to multidisciplinary pain management services in the NHS for those suffering chronic pain. Since then, the work of the Chronic Pain Policy Coalition and other specialist bodies has ensured progress, but it has been too slow.

I have suffered from chronic pain, caused by musculoskeletal problems, for more than 45 years. Thanks to prompt and effective support from private sector specialists in partnership with NHS doctors, I have been fortunate enough to be able to perform a wide variety of public responsibilities. Many people with chronic pain do not have the same opportunity to find effective support to keep them in work. I want all who suffer to have sufficient support to enable them to stay in or return to work after absence through sickness.

The latest available research, published by the British Medical Journal, estimates that 8 million adults are living with chronic pain serious enough to prevent them from working or participating in normal everyday life. Moreover, the research estimated that over 40% of the population suffer chronic pain at some stage in their working lives which will affect their ability to work. This evidence makes it clear that it is not only the individual who suffers but society as a whole.

Society needs the maximum number of productive years from as many people as possible. The ratio of earners and wealth generators to dependants—children, pensioners, the unemployed—should be as high as possible, because those not working depend on those who are. Fortunately, people are living longer and retirement age is becoming more elastic. Individuals can contribute to the labour force for longer, so long as they are sufficiently well, mentally and physically, to work. I therefore welcome the Secretary of State’s recent letter to me confirming that a Green Paper will be published before Christmas to consult on ways to ensure that government support meets the needs of people with health conditions in the workplace, and their employers.

It is shocking that the employment rate for adults with long-term conditions that affect their daily lives is only 46%, compared with 73% for the whole working-age population. The major long-term conditions include pain, musculoskeletal problems, stress and anxiety. Two major policy initiatives since 2008 have been the fit note and the Fit for Work service. Both are intended to enable sick individuals to return to work as soon as possible, with appropriate support. Early intervention is crucial to prevent a slide towards the benefits system. I know that the Minister is strongly committed to the Fit for Work service. I am giving him an opportunity to explain how it is developing and can be helped to succeed. Its effectiveness is something noble Lords will wish to probe.

Let me look briefly at the evolving history of sickness absence and its effect on society. In 2010, after 50 years of the sickness absence system, the Government replaced the sick note with a fit note. This was based on Dame Carol Black’s report, Working for a Healthier Tomorrow. This note enabled GPs to focus for the first time on a patient’s capacity to return to work, rather than their incapacity and the frequently repeated description “sick”.

In 2011 came the publication of another report, Health at Work—An Independent Review of Sickness Absence, by Dame Carol Black and Mr David Frost. In 2013, the Government accepted their main recommendations: to establish a health and work advisory assessment unit and to introduce a Fit for Work service—government funded and designed to help workers with ill health. It includes an occupational health work-focused assessment for employees who are off sick, or likely to be so, for four weeks or more and an advice service for employees, employers and GPs. It is now fully rolled out so that GPs and employers throughout Britain can refer patients or employees to it. This service has the potential to fill a massive gap in current provision.

I want to take this opportunity to highlight my belief that this early intervention scheme is needed. Its success could bring enormous benefit to society, and some statistics will illustrate the point. Overall, working-age ill health costs the economy more than £100 billion, including lost productivity, sickness absence and other costs. The latest figure available on chronic back pain, from 2000, shows that it cost the economy £10 billion; it will therefore be far higher now. We also know that 900,000 people are absent through sickness for four weeks or more each year and that more than 25% of the working population have a long-term condition or impairment, particularly in the 40 to 55 age group. We know that more people want to work past pension age, which will inevitably mean many more with long-term health conditions at work. Chairing recently two Westminster Employment Forum seminars on this subject, my attention has also been drawn to something called presenteeism, where a large number of employees are not working to full capacity due to their lack of health and well-being.

All this means that society suffers. Employers face a loss of productivity; the nation spends considerable sums of taxpayers’ money; and last but most important, the quality of life of many individuals is seriously undermined. Being out of work jeopardises any individual’s self-esteem and morale. So I ask the Minister: what is working well, and how can the service made more effective?

A number of questions arise. GPs and other health professionals seem to lack awareness of this service, so is it publicised enough? Do GPs realise that their workload will be reduced by referring more patients to the occupational health service? Is there enough face-to-face contact for employees, in addition to the initial telephone advisory service? Do employees know that they can get help after four weeks off work by asking their GP or employer for a referral?

There are some successful examples of large companies helping affected employees. BT has helped some 30,000 people in the last eight years. I have heard that Anglian Water has achieved a return of £3 for every £1 spent in helping an employee and the Royal Mail a return of £5 for every £1, cutting absence by 25% over three years. But the Fit for Work service was intended to make occupational health advice available nationwide. This is difficult when, as I am told, there are only some 4,000 occupational health professionals, compared to more than 45,000 GPs and physiotherapists. What number of specialists are needed to provide a nationwide Fit for Work service? It would be helpful if the Minister could say something about progress on these matters, especially how the service is currently supporting small and medium-sized enterprises, which are less likely to be able to employ their own health specialists.

A major question arises: how well equipped is the NHS to give adequate professional support for those with long-term illnesses? I can speak only about chronic pain and musculoskeletal issues, while other noble Lords can no doubt speak of other areas. Patients with chronic pain need to learn how to manage their pain and to know to what medical support they can turn—which may include physiotherapists, osteopaths, acupuncturists, psychologists and so on. A wide range of things can be done to keep us active and positive but many areas have inadequate or no multidisciplinary support for chronic pain. There is still a long way to go.

However, given an effective Fit for Work scheme, most suffering employees can be helped to stay in or return to work. Everyone stands to benefit: the individual, the employer and the nation. I congratulate the Minister on introducing this scheme. Would he be prepared for me to bring a small team from the Chronic Pain Policy Coalition and other interested Peers to discuss this scheme in more detail with him and, if possible, with Department of Health officials? I look forward to the Minister’s response.