Fit for Work Scheme

Lord McKenzie of Luton Excerpts

Wednesday 19th October 2016 Lords Chamber

[Lord McKenzie of Luton (Lab)]

My Lords, this has been an informed but brief debate and we should be grateful to the noble Lord, Lord Luce, who rightly prompted us to seek an update on the Fit for Work scheme, which has now been under way for more than a year. The particular focus of the noble Lord—and of others—was on chronic pain, for the reasons he outlined. The noble Lord also, in common with a number of other contributors, made the point forcefully that the service is as yet not well known.

The service has a direct link to the work of Dame Carol Black, and in particular to the analysis that she undertook, together with David Frost, that looked at sickness absence in the UK. Its focus on the period when people first became vulnerable to disconnection from the labour market was an important development and a component of emerging strands of policy that spanned Governments. Introduction of the service followed a series of pilots between April and June 2010 which looked at different ways of supporting employees in ill health to stay in or return to work after a period of sickness absence. These pilots grew out of Dame Carol’s review of the health of Britain’s working-age population, which showed the staggering annual economic cost of ill health in working days lost and worklessness to be over £100 billion.

Over recent years, the understanding of the relationship between work and health has changed and indeed improved. We have moved away from the notion that it is always in the best interests of someone with a health condition to be absent from the workplace. Being in work is good for health, and worklessness leads to poorer health—including mental health, a point noted by the noble Lord, Lord Fink. Hence the need to promote the benefits of work to health for individuals, employers and healthcare professionals, a proposition most strongly advanced by Waddell and Burton.

However, there is a need to go further. Bringing the expertise of health professionals directly to bear in support of individuals who are off sick or in danger of being so is something which we support. This is what the Fit for Work service is seeking to do. It is an early intervention, involving a referral after four weeks of sickness—although the noble Baroness, Lady Walmsley, made an interesting point about the relevance of that—for an assessment from a GP or, if not, potentially from an employer. That assessment should lead to a return to work plan. So far, so good, but we need to take stock to see how it is all working out in practice. I have some questions, some of which overlap those presented by other noble Lords. In England the service is contracted to Health Management Ltd. Can the Minister say something about the qualifications of the individuals allowed to deliver these services? What range of qualifications does this cover and what review of quality is being undertaken?

It is understood that the contract is for five years, at an initial value of something like £132 million, although this may have been increased. Can the Minister say how many Fit for Work interventions it is expected this would cover, and can we have an update on how many referrals have been made to date? Can the Minister say what level of referrals was anticipated when the contract was entered into?

Press comment, as others have noted, has suggested there is some confusion about the interpretation over the referral guidelines, at least so far as GPs are concerned. Is the Minister aware of this and can he say what the problem is? A DWP study apparently suggested GPs are likely to refer some 36% of their eligible case load to the service, but referral rates in practice vary. Why is this? The process involves at least the first assessment being undertaken by phone rather than face to face, and the nature of the assessment is determined by the occupational health professional. How many assessments are undertaken face to face and how many by phone? It is understood that a re-referral cannot be made within 12 months of a previous one where a return to work plan has been agreed. What is the position where an assessment is under way? Is it an iterative process, with potentially several telephone calls and meetings until a return to work plan is agreed? What is the experience of eligible employees who refuse consent for a referral? What information does the service hold on the outcome of return to work plans, in particular on whether they lead to long-term, sustainable, positive outcomes? The right reverend Prelate the Bishop of Derby offered an interesting parallel with asset-based community development and the potential that offers the Fit for Work service.

The Question of the noble Lord, Lord Luce, specifically refers to long-term, chronic pain, but of course the service is also available to those with a mental health condition. Can the Minister give us an update on the levels of referral for such individuals? Are such assessments always undertaken on a face-to-face basis, at least initially? It has also been reported that the Fit for Work service is less well used by SMEs, a point that a number of noble Lords made. Is this the Government’s understanding, and what amendments might be made to the service to address that?

The Fit for Work service notwithstanding, major challenges exist. As the Work Foundation report due to launch next week sets out, managing a long-term health condition while also working is a challenge. People who experience multiple long-term health conditions have poorer outcomes from a range of employment-related conditions, which is perhaps not surprising. The Work Foundation reports that one in three current employees has at least one long-term health condition and that 42% report that their health affects their work. This, together with the stigma of discrimination associated with poor health, is argued to be a major contributor to the gap in employment outcomes.

We know that mental illness has a substantial and highly detrimental impact on employment outcomes when it occurs on its own, but an even greater impact when it occurs alongside a physical health condition. Nevertheless, it seems clear that for many people with multiple, long-term health conditions, work is a positive part of their lives. The question is what the Fit for Work service contributes to helping them remain in work. More needs to be done, as noble Lords have said, to enhance awareness of what it can do.