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

2. 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:

3. The case for action

4. Building a shared vision

5. 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

6. Key consultation themes

7. 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

8. 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

9. 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
Series of stakeholder-led consultation events
Tweet using #workandhealth
Contact the Work and Health Unit
Write to The Work, Health and Disability Consultation, Ground Floor, Caxton House, 6-12 Tothill Street, London, SW1H 9NA

10. Occupational Health

11. 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.

12. 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

13. 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

14. How are we addressing this issue?
March 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.

15. 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?

16. 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?

17. Fit for Work

18. 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 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

19. 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

20. 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 for all; and An assessment service accepting referrals of employees from GPs and employers.

21. 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

22. Fit for Work : Assessment Service

23. 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

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

25. 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.

26. 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?

27. 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?

28. Fit note

29. 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.

30. 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.

31. 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?

32. 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?

33. 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
Series of stakeholder-led consultation events
Tweet using #workandhealth
Contact the Work and Health Unit
Write to The Work, Health and Disability Consultation, Ground Floor, Caxton House, 6-12 Tothill Street, London, SW1H 9NA
For Employers – please Lucy Dugmore at to discuss SSP/GIP or any other employer related issues raised in the Green Paper