Page last updated at 14:23 GMT, Monday, 17 March 2008

Q&A: Work and health

The sick-note culture is costing Britain 100bn in lost productivity, taxes and benefits.

Dame Carol Black, the national director for health and work, believes an overhaul of the system is needed. What is being proposed and will it work?

GP writing a prescription
Sick notes need redesigning, the report says

What is the scale of the problem?

Some 175m working days are lost each year to sickness.

This is the equivalent to seven days for each working person.

What is more, 2.7bn - 7% of the working-age population - is on incapacity benefits after rates have trebled since the 1970s.

It has left Britain with one of the worst records in this area and comes at a time when the employment rate is at one of its highest.

It is this apparent contradiction that has driven ministers to ask Dame Carol Black to look at the issue.

What happens at the moment?

People who are sick only need to visit their doctor if they are off work for longer than a week.

It is then up to the GP to decide whether to sign them off. They have the power to do this for six months, after which the case is passed on to the centrally-administered incapacity benefits system.

Some 350,000 people a year transfer from sick notes on to incapacity benefit.

But GPs have long expressed dissatisfaction with sick notes, which actually date back to the 1920s.

They say it is often impossible to tell if a person is too sick to work as they do not know what their job entails.

What is Dame Carol proposing?

She wants to see the creation of fit notes, spelling out what the individual can do rather than cannot.

This could then be fed back to employers so they can tailor support through, ideally, their own occupational health and rehabilitation teams.

This may include changes to jobs, including shorter working weeks and different duties.

Dame Carol also wants to see employers doing more to promote healthy lifestyles by offering staff discounted gym membership and encouraging them to walk and cycle to work.

The NHS should also integrate occupational health into their services more. Ever since the health service was set up in 1948, occupational health has not been a core part of its remit.

She said it was now time for that to change through the piloting of fit for work schemes.

Fit for work would operate via GP referral. A case manager would be appointed to tailor a programme to get the individual back to work. They would have access to physios, counsellors and advice.

There is a particular stress of mental health as that is the most common reason why people end up on incapacity benefit.

Will it work?

It is now up to minister to decide whether to implement Dame Carol's recommendations.

The report has been broadly welcomed. Dame Carol believes early intervention can have a major impact on the 460,000 who are signed off for between four and 28 weeks.

Just reducing that absence by a week for half of them would save 88m.

It is also envisaged the fit for work schemes would prevent those who are signed off sick ending up on incapacity benefit.

Dame Carol also said the system could be used to get those already on the benefit back into work.

But there are concerns. GPs have raised fears about the fit notes, pointing out they are not there to police the system.

Small businesses are also concerned about the cost of these schemes.

Questions also need to be answered as to whether the NHS could really fund the level of support required as Dame Carol's review did not go into this.

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