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Last Updated: Monday, 17 March 2008, 13:26 GMT
Ill health 'costs economy 100bn'
Depressed woman
People with depression often claim incapacity benefit
A fundamental overhaul of the support given to workers who are off work through illness is needed, a government adviser says.

Dame Carol Black, the national director for health and work, said ill-health was costing the economy 100bn a year.

Her report, commissioned by ministers, called for a new fit-note system as well as fit for work schemes embedded in the NHS to help people back to work.

She said the reforms could help cut the numbers on incapacity benefit.

Some 350,000 people a year move from long-term sick notes in to the system.

GPs - Current sick note system should be reformed to create fit notes, spelling out what the patient can do
Employers - Should offer more support to staff including healthy lifestyle promotion, such as subsidised gym membership, as well as access to occupational health teams
NHS - Call to pilot fit for health scheme, which will work via GP referral. Case managers appointed to manage absence through access to physios, counselling and advice

It means Britain has one of the highest proportions of people on the benefit in Europe after numbers have more than trebled since the 1970s to 2.7m.

Dame Carol believes workers need help at an earlier stage to stop them slipping out of work and into this spiral of dependency.

Some 175m working days are lost each year, costing the economy 100bn in lost productivity, benefits and taxes.

She has proposed creating a new fit note which encourages GPs to spell out what the individual can do rather than cannot do.

She also said the notes should be passed on to employers - so they can given the individual support to return to work - if the patient agrees.

The report said businesses should do more to facilitate flexible working, such as shorter working weeks or a change of duties, to get staff back as quickly as possible.

Firms, especially the big employers, should also establish their own occupational health and rehabilitation teams and promote healthy lifestyles through subsidised gym membership and encouraging staff to walk and cycle to work.


And it said fit for work schemes should be piloted.

These would work via GP referral with case managers appointed to tailor a programme to get the person back to work.

The case managers would have access to counselling, physios, occupational health and financial and family advice.

Such a system would be essential to smaller companies which could not support their own occupational health teams, the report added.

And Dame Carol said the fit for work schemes, if successful, could also be targeted at those on incapacity benefit.

Telecommunications experts ClinPhone has developed a sickness absence system to help their 726 staff when they are ill.
As soon as a member of staff is signed off work with a sick note, the line manager and HR team proactively work with their occupational health adviser, the employee and GP to formulate a return-to-work plan
This includes access to physios and counsellors as well as any necessary changes to working practices.
The firm also promotes active and healthy lifestyles, giving workers information on diet and exercise
As a result, the firm averages just 3.2 days absence per employee each year - half the average rate. Staff turnover rates are also low.

She said the government's recent announcement that those claiming the benefit would have to undergo tests to prove they were unfit was welcome, but could not address the issue by itself.

She said: "100bn sounds a large figure. But I think the cost to human life is much larger.

"For most people their work is a key factor in their self-worth, family esteem and identity.

"But it is so easy to fall out of work and move to a place where your confidence and well-being suffers. We must do more to help people, because if you intervene at an early stage you can stop the longer-term problems emerging."

The simple problem is it is far too easy to be signed off from work
Ashley Smith, Luton, UK

The reforms were broadly welcomed by the doctors trade union, the British Medical Association,

BMA chairman Dr Hamish Meldrum said: "The BMA has long called for the sick note system to be reviewed.

"A major problem is that GPs can have huge difficulties in accessing physiotherapy and counselling services that would help patients to return to work more quickly."

But he warned the fit notes needed to be carefully looked at as doctors were not there to police the system.

Trades Union Congress general secretary Brendan Barber said: "There is currently insufficient support for people who are off work because they are ill or injured and the TUC agrees with Dame Carol that more needs to be done to encourage those on long-term benefits back into the labour market.

"This is best done by doing more to prevent workplace accidents and illnesses, and by giving ill or injured workers early access to rehabilitation."

But shadow work and pensions secretary Chris Grayling said the issue should have been addressed years ago.

Lib Dem spokesman Danny Alexander added: "This report highlights once more the human and economic cost of mental health which the government has ignored for years."

It is now up to the government to decide whether the proposals should be introduced with ministers are expected to respond in full in the coming months.

One company's measures to improve staff health

Q&A: Work and health
17 Mar 08 |  Health
Incapacity tests raise concerns
13 Mar 08 |  UK Politics

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