Improving Lives: the Work, Health and Disability Green Paper Work and Health Unit Improving Lives: the Work, Health and Disability Green Paper

What will it take to transform the employment prospects of disabled people and people with long-term health conditions? In the Green Paper we ask:

The case for action

Building a shared vision

Building a movement for change: taking action together Achieving real and lasting change will be challenging and Government cannot act alone ‘Improving Lives – the Work, Health and Disability Green Paper’ was published in October last year by the Department for Work and Pensions and the Department of Health. Intention to work with others to change perceptions and transform the culture around disability, health and work Launch of public consultation to spark a proactive, wide-ranging and challenging conversation The Green Paper is consulting on: How to bring about a shift in society’s attitudes to make progress and achieve long-lasting change What the role of government is in bringing about positive change to our attitudes to disabled people and people with long-term health conditions

Key consultation themes

Green Paper proposals - Employers A balanced package to encourage action and innovation while also committing to understanding what works with a view to longer term reform Providing the support needed to recruit and retain disabled people Announcing Disability Confident Business Leaders Group to increase engagement around disabled employment Consulting on evolving current Government schemes and barriers to take up of Group Insurance Products Helping employers manage sickness absence, including consulting on reform of Statutory Sick Pay Changing culture to improve workplace wellbeing and retention of disabled employees: Consulting on how: Government can best provide and publicise accessible information and guidance; to facilitate employer networks; to empower employees to manage their condition and help employers make adjustments Encouraging employers to collect data on disability and ill-health Building the business case for investing in supporting health and disability in the workplace. Setting out where the public sector is an exemplar

Green Paper proposals – Health services Helping people access the right support at the right time: Review of Fit Note, and options for referrals to OH assessment and advice as a matter of course where appropriate; Trialing mental health support in new settings Consulting on how Occupational Health, vocational rehab and related provision can be better matched to individuals’ needs Announcing plans to increase access to IAPT programme and more than double number of Employment Advisers in talking therapies Consulting on developing and testing new and more effective pathways of care for MSK conditions Embedding work as a health outcome, including through building workforce capability and capacity Supporting joined-up health and employment services, which are locally designed and delivered Consulting on our intention to set a standard for employment information in NHS health data sets, to monitor working-age health and employment Consulting on plans to provide a basket of health and work indicators at local level Consulting on improved sharing of health and employment data, innovation, co-location and local networks, all to support local service integration

Consultation Ways to get involved Citizen Space online survey 31st October 2016 – 17th February 2017 Ways to get involved Citizen Space online survey Simple and accessible way to respond to all consultation question https://consultations.dh.gov.uk/workandhealth/consult/ Series of stakeholder-led consultation events Tweet using #workandhealth Contact the Work and Health Unit Email workandhealth@dwp.gsi.gov.uk Write to The Work, Health and Disability Consultation, Ground Floor, Caxton House, 6-12 Tothill Street, London, SW1H 9NA

Occupational Health

Occupational Health Provision Occupational Health is the promotion and maintenance of the highest degree of physical, mental and social well-being of workers in all occupations by preventing departures from health, controlling risks and the adaptation of work to people, and people to their jobs. (ILO / WHO 1950) Vocational rehabilitation is a process which enables persons with functional, psychological, developmental, cognitive and emotional impairments or health disabilities to overcome barriers to accessing, maintaining or returning to employment or other useful occupation. (Vocational Rehabilitation Association UK) For the purposes of this policy development OH is being considered in the broadest sense to encompass all aspects of OH support rather than the purist definition.

Occupational health services is patchy Organisation size Access to occupational health services (% of employers) Subsidised private medical insurance Small (1-50) 11 18 Medium (51-249) 46 53 Large (250+) 79 61 All 13 20 Only 30% of UK workforce in 2010 had access to specialised occupational healthcare Urgent measures are required… if the level of capacity of the occupational medicine workforce is to meet the nations’ needs. APPG on Occupational Safety & Health Source: Health at work – a

What can we do to improve on this? Occupational health and related services are currently variable and fragmented. Provision can be inconsistent, not easily accessible for all, and not well tailored to the different needs of individuals. Provision needs to respond more widely across the spectrum of need, including those who are self-employed or out of work, as well as those who are currently off sick from work. The Government is determined to take a whole person approach and offer the right support at the right time

How are we addressing this issue? March 2008 - review of the health of Britain's working-age population ‘Working for a healthier tomorrow’ by Dame Carol Black. Advocates clear standards of practice and formal accreditation of all OH providers who support people of working age. The Government’s response to the review – the Improving health and work: changing lives Green Paper, endorses that recommendation.

Green Paper Questions How can occupational health and related provision be organised so that it is accessible and tailored for all? Is this best delivered at work, through private provision, through the health system, or a combination? What kind of service design would deliver a position in which everyone who needs occupational health assessment and advice is referred as matter of course? What are the key barriers to increased take up of Group Income Protection – especially for SMEs?

Questions for the room How can occupational health and related provision be organised so that it is accessible and tailored for all? How/should the wider healthcare workforce be better used to build OH capacity and reduce some burden on GPs? How can we create a system/culture change so that everyone who is eligible for occupational health assessment and advice is referred as a matter of course? What are the key barriers to increased take up of Group Income Protection – especially for SMEs? What needs to change? Who can change it? What would a ‘good’ model look like?

Fit for Work

In the UK, 139 million days were lost to sickness absence in 2015 Sickness absence is estimated to cost: The Government £2 billion in sick pay and foregone taxes Employers £9 billion per year in sick pay and associated costs Employees £4 billion in lost earnings* It further reduces the UK’s economic output by £15 billion per year. Long-Term Sickness Absence (LTSA): An absence away from work lasting 4 consecutive weeks or more In a period of 12 months, 1.8million employees have a LTSA; equating to 6% of all employees Employees aged between 55-64 are more likely to have a LTSA than any other age category Disabled employees are more likely to have a LTSA than non-disabled employees Employees in large firms (250 or more staff) are more likely to have a LTSA than those working in firms with fewer than 250 staff In 2015, 32 million days were lost due to musculoskeletal problems and 18 million days lost to mental health reasons. The longer someone is off work on a period of sickness absence, the harder it is to get back to work and research suggests that long-term worklessness is damaging to health, social and financial wellbeing. 18

Review of Sickness Absence - (Dame Carol Black and David Frost) The recommendations called for a number of improvements including: A state-funded heath and work assessment and advisory service from 2014 (now Fit for Work) The abolition of the Percentage Threshold Scheme to fund this service Access to Universal Jobmatch for those requiring job change Retention of tax relief on Employee Assistance Programmes Abolition of SSP record-keeping requirements Publication of revised fit note guidance Budget and Autumn Statement 2013: tax exemption on medical treatments recommended by Fit for Work or employer-arranged occupational health services

What is Fit for Work? Fit for Work supports individuals with a health condition to stay in or return to work. It provides: Expert and impartial work-related health advice via web/phone and email for all; and An assessment service accepting referrals of employees from GPs and employers.

Fit for Work is being delivered across Great Britain with a unified brand and scope, but by different providers Overall Same service and outputs across Great Britain Service now live England and Wales External procurement Fit for Work being delivered by Health Management Ltd, a MAXIMUS company Scotland Fit for Work Scotland is being delivered by the Scottish Government via NHS Scotland on behalf of DWP

Fit for Work : Assessment Service

The science bit …. A biopsychosocial, stepped case managed approach. Most people who experience sickness absence can return to work. Most do. Those that don’t, hit obstacles SOCIAL context, systems, culture Deals with personal and psychological issues. CM Recognises biological factors PSYCHO- illness behaviour, beliefs, coping strategies emotions, distress BIO- neurophysiology, physiological dysfunction, tissue damage Identify-Plan-Action: case manager identifies the obstacles; develops a RtWP; makes it happen; escalates if they can’t identify

Websites – advice and guidance fitforwork.org gov.uk fitforworkscotland.scot

Green Paper We want to ensure healthcare professionals recognise the value of a referral to Fit for Work for occupational health advice and return to work support and make referrals routine for eligible patients when appropriate. Therefore as part of the Green Paper consultation we want to understand people’s experience of Fit for Work in order to inform integrated provision for the future. To encourage use of Fit for Work, there is a need for a significant culture change among GPs and employers so that they can see the benefits of making greater use of Fit for Work. The Green Paper seeks views on how we might achieve this culture change.

Green Paper Questions What kind of service design would deliver a position in which everyone who needs occupational health assessment and advice is referred as matter of course? What has been your experience of the Fit for Work service, and how should this inform integrated provision for the future? How can we bring about better work-focussed conversations between an individual, healthcare professional, employer and Jobcentre Plus work coach, which focus on what work an individual can do, particularly during the early stages of an illness/developing condition?

Questions for the room How can we create a system/culture change so that everyone who is eligible for occupational health assessment and advice is referred as a matter of course? What are your positive and negative experiences of the Fit for Work service a) clinically and b) in terms of progress? How can we embed work as a health outcome? What needs to change? Who can change it? What would a ‘good’ model look like?

Fit note

What is a fit note? The Statement of Fitness for Work (Med 3), or ‘fit note’, was introduced in 2010 It is the medical statement doctors use to give advice to patients about the impact of their health condition on their fitness for work. Currently only doctors can sign the fit note – usually GPs but can be hospital doctors. The Statement of Fitness for Work, or ‘fit note’ was designed to: encourage fuller discussions about work and health support payment of Statutory Sick Pay by employers or as medical validation to make a claim to health-related benefits. The information fit notes provide can be used by employers or work coaches within Jobcentre Plus to support a return to work.

Fit note proposals in the Green Paper In the Green Paper the Government announced that it intends to review the current operation of the fit note including whether: Fit note certification should be extended from doctors in primary care and other settings to other healthcare professionals The current system meets the needs of its users – doctors and other healthcare professionals, employers, patients/claimants and the benefits system.

Green Paper questions Are doctors best placed to provide work and health information, make a judgement on fitness for work and provide sickness certification? If not, which other healthcare professionals do you think should play a role in this process to ensure that individuals who are sick understand the positive role that work can play in their recovery and that the right level of information is provided? Regarding the fit note certificate, what information should be captured to best help the individual, work coaches and employers better support a return to work or job retention? Is the current fit note the right vehicle to capture this information, or should we consider other ways to capture fitness for work and health information? Does the fit note meet the needs of employers, patients and healthcare professionals? Should SSP be reformed to enable a phased return to work with supportive conversations?

Questions for the room Who is best placed to provide work and health information, make a judgement on fitness for work and provide sickness certification? How might GPs be encouraged/incentivised to make better use of the ‘may be fit to work option’ of the fit note? Should SSP be reformed to enable a phased return to work with supportive conversations? What needs to change? Who can change it? What would a good model look like?

Consultation Ways to get involved Citizen Space online survey 31st October 2016 – 17th February 2017 Ways to get involved Citizen Space online survey Simple and accessible way to respond to all consultation question https://consultations.dh.gov.uk/workandhealth/consult/ Series of stakeholder-led consultation events Tweet using #workandhealth Contact the Work and Health Unit Email workandhealth@dwp.gsi.gov.uk Write to The Work, Health and Disability Consultation, Ground Floor, Caxton House, 6-12 Tothill Street, London, SW1H 9NA For Employers – please email Lucy Dugmore at LUCY.DUGMORE@DWP.GSI.GOV.UK to discuss SSP/GIP or any other employer related issues raised in the Green Paper