Read My Response to the Fit Note Consultation
In early 2017 I was reading IOSH Magazine and notice the Government plans a fit note consultation. Aha!
I am interested in how the fit note use is progressing as I did the introduction of the Fit Note for my Masters. The fact that the Fit Note is up for review means the teething problems I noted way back, have not gone away.
Three hours later I am knee high in consultation questions and still writing my points. For health professionals, that is, me, there are thirty-seven questions to answer.
Here are some of my answers.
1.1 What innovative and evidence-based support are you already delivering to improve health and employment outcomes for people in your community which you think could be replicated at scale? What evidence sources did you draw on when making your investment decision?
I advise the organisations I work for on the fit notes potential and how managers can have a discussion before going to the doctor. They talk about what is available for the GP to recommend – done in the hope that the fit note doesn’t come from the GP with unreasonable demands such as “can work 4 hours a day for 1 month” which is entirely unreasonable.
GP’s generally have little idea what is reasonable for each employer and tend to take the patient/employee’s word for possible alternatives to their regular job.
In my experience, workers come in two categories (about wanting to work). Some want to work but have lost faith in the potential employers and have given up even trying.
The second group, don’t want to work and make a poor show of being able to work either in their paperwork or when attending for interview. I have often done pre-employment health checks on applicants who say “I am only here because the jobcentre says I have to.”
Such a waste of time and effort on everyone’s behalf.
2.2 What specialist tools or support should we provide to work coaches to help them work with disabled people and people with health conditions?
I think you have to work on each side of the equation. It’s no good just tackling the GP’s or the employers or the workers. Somehow you need to change the whole perception of work and people’s right to work. What benefits work gives them etc. Maybe give a financial reward to the employers as an incentive for individuals taken off the benefits list and the same rewards to GP’s. That might make the difference.
The UK current benefits system gives exactly the wrong messages – for example, many people I know have mobility cars – brand new cars, subsidised by the Government for those who don’t even have mobility issues.
To be honest, it’s almost a disincentive for the disabled even to try to work.
3.1 What support should we offer to help those ‘in work’ stay in work and progress?
That is a difficult question. Most people in long term jobs want to stay at work. They need support from business.
However, some take days off at the drop of a hat; this can be for a variety of issues – maybe the workplace is stressful, maybe they have domestic problems, perhaps they are just lazy, who knows?
Without addressing the underlying issue, whatever it may be, is going to be difficult. One size will not fit all.
I’m not sure what you mean by the term “progress”, but I assume it means progress in seniority in a workplace. If so, you need to do more to make the UK general population accepting of the face of illness and health diversity. We need more role models such as David Blunkett; people who have got to the top because they are good – not because a company wants to tick a box.
Political correctness was a splendid idea, but today it is viewed as being a means to end. It has made real opinions go underground and become subversive. Today, to my mind, managers are told ‘Shut up you can’t say that’ without addressing the issue of why they can’t, and how it hurts a company’s reputation.
People now pay lip service to disability issues – everyone knows what to say and says it. How many truly believe it?
3.2 What does the evidence tell us about the right type of employment support for people with mental health conditions?
Mental health conditions cover a broad range of health issues from stress and anxiety (common) to schizophrenia and bipolar disorders. Even sufferers family’s struggle to cope with the most severe types of mental ill health especially in the acute phases of illness where hospital treatment is the only option.
You cannot expect a workplace to deal with this type of situation in any helpful way. But you can ask to keep jobs open until the person recovers or recognise signs of relapse.Regarding anxiety and stress, expect employers to at least look at stress and work overload in each workplace. And yes I know there are guidelines from the HSE on stress risk assessments but in my experience, no one has done them with anything like a meaningful outcome or commitment to improvements. In fact, the opposite is true. Everyone in today’s offices – even you reading this response, know there are serious issues, yet it still continues.Employers get away with overloading and bullying people in the name of the business, but it is not good for the workers.Such an elephant in the room
6.1 Should the assessment for the financial support an individual receives from the system be separate from the discussion a claimant has about employment or health support?
We already have a separate system.Someone close to me has was told by a Specialist they cannot work again. My ‘friend’ has taken this to heart and become a professional disabled person. He hasn’t even tried for different work. He is written off. I cannot change his mind. Yet he could work. At home, take up a new training for a different job or even go to University or college to retrain. But he believes what the Doctor told him. How sad is that?
He was then assessed by Atos and was astounded when they said he could do some work. He saw his specialist who said something along the lines of “Over my dead body” which is a bit scary.
The individual’s GP and Specialist tell their patients their prognosis and the patient listens. The health professionals in our health system have such power that the majority of people believe everything said to them. It becomes an undeniable fact; unchanging, unless the health professional changes the prognosis.
I believe this is detrimental to the population. No one should be written off.
In some cases, the health professional does more harm than good and does not take into account a person’s motivation and a business’s willingness to help an individual. It takes a strong person to go against a health professionals advice about working. Moreover, the patient sometimes has their own agenda.
I have seen this so many times.
I don’t have the answer, but whatever you decide, please take into account the attitude of the medical profession to any attempt of reducing this power – it will be a difficult subject to tackle.
If it were me? I would put together a group of professionals by invitation only. Not the usual ‘I am a committee member’ type of person but someone who has original ideas that fit a new information age with it’s diminishing number and types of jobs, and can look at the whole situation in a new light.
It might just work.
13.1 How can occupational health and related provision be organised so that it is accessible and tailored for all?
I have always advocated a national occupational health service and not one that just deals with absence. In truth, occupational health is not about absence or disability at all. You need to change the name to healthy work or workplace health or working for health. Do not use the term occupational health because absence and fitness is not what I do – it’s a part, but not the sum total.
The current Fit for Work service with HML is a good idea but if it’s voluntary for the workers, then it falls down at the first hurdle. People are afraid of being sacked and believe that going to a fitness for work appointment is to find out if they are really sick. Fit for work will send you back to work no matter what. People have their own doctors. They trust them. They do not trust a government-appointed service that has yet to prove itself. Atos did a lot of damage in the PR stakes.
Set up a national OH service. It will work. Set it in a local hospital – link it to the NHS services. We all trust the NHS.