The Scottish Government response to the UK Government's Independent Review of Sickness Absence

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1 Sickness Absence Review - Scottish Government Response The Scottish Government response to the UK Government's ndependent Review of Sickness Absence ~ The Scottish Government 1

2 Sickness Absence,"View - Scottish Government Response The Scottish Government response to the UK Government's ndependent Review of Sickness Absence ' ntroduction 1. Since 2004 Scottish Government policy has recognised the important links between work (paid or unpaid, or other meaningful activity) and the health of an individual. For most people of working age, work is a key social determinant of health. Employment is, generally; protective of good health and maintaining a good degree of health is important for an individual to gain and maintain employment. 2. n the context, situation and analysis review 1 of the EU-funded Working for Equity in Health programme a~ assets model approach is considered, which recognises the health benefits of '[good" work as well as noting that good health and wellbeing are among the most valuable assets that workers possess. This review draws on an extensive body of evidence from within the UK and across the EU. 3. The Scottish Government'sl Health Works 2 strategy and the cross-government Health Works and Wellbeing strategy (in collaboration with the Welsh Government, Department for Work and Pensibns (DWP), Department of Health (DH) and the Health and Safety Executive (HSE)) have sought to build understanding of the important links between health and wellbeing, employment and the workplace, recovery and recuperation, and economic performance. n Scotland this includes support for employers through the Scottish Centre for Healthy Working Lives, access to healthcare services for some workers through Working Health Services Scotland, the introduction of the fit note to help GPs advise on return to work, and a raised understanding of the importance of work for health amongst healthcare workers. 4. Against this background, Scotland has a working age population of approximately 2.5 million, aroun~ half of whom work for small or medium-sized enterprises (SMEs, employing <250 staff). Many employees of SMEs in Scotland do not have access to employer-provided occupational health services and are reliant on the NHS when they fall ill or injured. There are also approximately 250,000 people on health-related unemployment benefits. Scotland has an ageing population and in the next 10 years there will be a bulge in the number of 50+ workers facing a longer working life before retiring. This last group are at increased risk of continuing to work with at least one long term health condition. 5. n broad terms, the Scottish Government accepts that unnecessary and prolonged sickness absence is not usually in the best interests of the individual, their family, the employer or the wider economy. Ensuring that workers are not absent from their work longer than is necessary entails an understanding across a range of parties. The employer must recognise that it is not in his interests for a member of staff to be off longer than necessary, that a return to work can be part of the recovery process and the worker may be able to return before fully recovered, and that a temporary or permanent change to normal work patterns, as required and agreed, is 1 Workinq for Equity in Health - The role of work. worklessness and social protection in health inequalities. Scottish Government and Health Action Partnership nternational, Health Works, Scottish Government,

3 Sickness Absence Review - Scottish Government Response usually possible and should be considered. Employers, faced with an ageing workforce will need to embrace their role in supporting workers with long term health conditions who may need both workplace adjustment and increased flexibility in hours to attend healthcare services. 6. The employee should understand that absence from work may not be the best route to recovery and that they should be prepared to discuss modifications to their normal work with the employer as part of their recovery. Workers will also need to recognise that flexibility from an employer to accommodate the consequences of a health condition will need to be reciprocated by a degree of flexibility from the employees. 7. There is also a need for better understanding of the complex links between work and health by healthcare professionals, particularly in Primary Care. The emphasis should be on addressing further risks to a patient's health and helping to reduce the impact on their families and the adverse economic consequences, from prolonging the absence from work. Healthcare professionals in primary care need to be supported to understand and promote the importance of returning to work as soon as possible, including ensuring that patients get the best from the intended purposes of the fit note, as well as sign-posting where further advice or support can be found. 8. Significant progress has been made in raising awareness and understanding of the intrinsic links between health and work. However, there remains a challenge in ensuring that employers understand the benefit to them of supportive workplace practices, that employees seek timely support from their employers and health services, and that healthcare professionals recognise the importance of encouraging and supporting return to work as part of the patient care pathway. 9. The report of the Sickness Absence Review made a number of recommendations. The response of the Scottish Government to each of these follows below. Health at work - an independent review of sickness absence Supporting employees at work 10. Recommendation 1: Government should fund a new ndependent Assessment Service (las). The AS would provide an in-depth assessment of an individual's physical and/or mental function. t would also provide advice about how an individual on sickness absence could be supported to return to work. This service should usually be accessed when an individual's absence spell has lasted around four weeks. 11. Scottish Government Response: The Scottish Government agrees that for people with prolonged periods of sickness absence that, subject to the caveats in the paragraphs below, there may be merit in an independent assessment of functional capacity could provide patients with an objective assessment of their ability to 3

4 Sickness Absence Review - Scottish Government Response undertake work activity and provide advice and support to enable an effective and sustained return to work. 12. There would need to be clarity on the primary purpose of an ndependent Assessment Service (AS), whether its aim is to support a return to work or to act as a gatekeeper for the welfare benefits system. There would also need to be clarity on the relationship between the AS land Primary Care - is the AS providing a service to the patient directly, on behalf of the Government or employer or all three, after 4 weeks and following the ceasing 6t the role of primary care? This also raises issues about ownership and passage of patient data between the las, the clinician and, possibly, the employer. 13. There is a question about where the AS would sit and who would be responsible for commissioning a~d paying for these services. Occupational health services and, by extension, vocational rehabilitation services are not the responsibility of NHS under statute. Clearly it could be provided from within the NHS, or by a third party contractor, wo~king within the procurement legislation. This may be determined by how the role of the AS is defined as identified above. 14. The scope of those eligible would need to be determined - would it apply to those presenting to Primary Care only, and after receiving a Fit note for four weeks, or would it also be accessed by others, for example, earlier than 4 weeks by specialists looking after people su~h with mental health conditions? f so, who pays? How would it link to the NHS rehabilitation services, e.g. post-operative recuperation, cardiac or pulmonary rehabilitation? 15. We recognise that there is a risk that some primary care practices may opt to sign a patient as unfit for work for 4 weeks on the basis that, after that period, the patient is diverted to another service. While the risk may be low, the system design should aim to discourage such approaches. 16. The review identifies saving that would arise from the las, however, these savings would accrue to the UK Government through reduced benefit payments and increased tax revenues. The savings would not off-set costs to the Scottish Government, if the Scottish Government is expected to commission and fund AS in Scotland, e.g. as a service delivered by NHSScotland. 17. The issues noted above could be addressed through running a number of pilot services. The Scottish Government would welcome a discussion with the UK Government on conducting such a pilot in Scotland. 18. Recommendation 2: Government should revise fit note guidance to ensure that judgements about fitness to work move away from only job-specific assessments. 19. Scottish Government Response: The Scottish Government has been supportive of the introduction of the fit note and has noted the mixed success that has been achieved so far. We would be happy to work with the UK Government to continue to support and educate healthcare professionals both in the use of the fit 4

5 Sickness Absence Review - Scottish Government Response note and more widely on the health benefits that accrue from work and other meaningful activity and the risks to health that arise from avoidable worklessness. 20. However, we believe that it is also important for employers and the workingage population to have a better understanding both of the importance of remaining fit for work and that workplace adjustments to a persons work should be considered a reasonable and practicable approach to retaining and supporting staff. The majority of healthcare practitioners are not normally equipped to provide job-specific or workplace specific advice. The aim should be to equip the patient with advice that allows them to have discussion with their employer. The Scottish Government would welcome discussions with the UK Government on how best to improve the understanding of healthcare professionals, employers and the working population of the risks associated with sickness absence and the benefits of support to return to work. 21. Recommendation 3: Government should <:10 more to improve knowledge and awareness among healthcare professionals, particularly those involved in certification, of the WCA and the benefits system generally and the importance of work for health. 22. Scottish Government Response: As noted above, the Scottish Government believes that healthcare practitioners would benefit from a better understanding of how to use the fit note and on the links between health and work. However, surveys3 have suggested that general practitioners are not confident that they have sufficient understanding of the welfare benefits system. GPs should not be expected to have a detailed understanding but should know sufficient to understand implications for a patients health and wellbeing, and know where information and advice can be obtained. 23. Through the Scottish Government's Health Works strategy NHS Boards are expected to map out local employability networks or "pipelines". These show the role of different local organisations in supporting individuals towards employment and could act as a source of information and advice for GPs and other healthcare professionals, as well as the patient. 24. The Scottish Government is content to work with the DWP to improve healthcare professionals understanding of benefits to a level that allowed then to offer advice that was commensurate with improving and sustaining patient health. 25. Recommendation 4: Expenditure by employers targeted at keeping sick employees in work (or speeding their return to work) such as medical treatments or vocational rehabilitation should attract tax relief. This should be targeted at basic-rate taxpayers. 3 An evaluation of the Statement of Fitness for Work: qualitative research with General Practitioners. DWP

6 Sickness Absence Review - Scottish Government Response 26. Scottish Government RJponse: The Scottish Government is supportive of measures that would encourage employers to be more proactive in supporting sick employees access supportive healthcare services. 27. Recommendation 5: Existing tax relief on employee assistance programmes (EAPs), which provide informatioh, advice and counselling on a variety of issues causing absence and/or performahce problems should be retained. 28. Scottish Government Response: The evidence submitted to the review suggests that there is a case to retain existing tax relief on EAPs. The Scottish Government would support this view. 29. Recommendation 6: Government should abolish PTS which compensates mainly smaller employers for Very high rates of sickness absence in their organisations, but reduces incentives to manage absence. 30. Scottish Government Response: This is an area reserved to the UK Government and the Scottish Gov~rnment does not wish to express a viewpoint. 31. Recommendation 7: Record-keeping obligations under SSP should be abolished, thereby helping to reduce employer administrative burdens. 32. Scottish Government Response: This is an area reserved to the UK Government and the Scottish Gov~rnment does not wish to express a viewpoint. 33. Recommendation 8: Government should update its Employers Charter to address misconceptions around sickness absence management, especially legal uncertainty. 34. Scottish Government Response: This is an area reserved to the UK Government and the Scottish Government does not wish to express a viewpoint. 35. Recommendation 9: Government should carry out further research into the reasons behind the significant number of people claiming ill health benefits who come straight from work, especially from smaller employers, but appear not to have been paid sick pay by their employer beforehand. 36. Scottish Government Response: The Scottish Government would be happy to work with the other administrations to further explore the issues. 37. Recommendation 10: Public sector employers should take immediate action to bring the worst performing parts of the public sector up to the standards of the best. Government should also review Occupational Sick Pay in the public sector. 6

7 Sickness Absence Review - Scottish Government Response 38. Scottish Government Response: Scottish Ministers are committed to the reduction of sickness absence rates and agree that appropriate interventions should continue to be applied across the public sector to improve absence management. 39. Recent efforts to reduce average rates of sickness absence have had a positive effect with rates of absence 'across the main public sector pay groups (the civil service, NHS, police and teachers) continuing to improve. The latest available data suggests that rates of sickness absence have declined by 15% in the Civil Service, 15% in the NHS, 7% for Police and 13% for Teachers. 40. The Scottish Government believes that current arrangements for public sector Occupational Sick Pay (OSP) in Scotland are adequate and does not create a perverse incentive to long-term sickness absence. There are good examples of public sector employers who have substantially reduced sickness absence without the need for modification of OSP. 41. Recommendation 11: The introduction of a new job-brokering service to help long-term sick employees find new work (where appropriate) before they fall onto the benefits system. This service should be offered free by the State in cases of very long-term absence (at 20 weeks or sooner if the Government is convinced of the business case to do so), but should be available earlier for individuals and employers that are willing to pay for it. Government should consider delivering the service as an extension of the Work Programme. 42. Scottish Government Response: The Scottish Government believes that there is some merit in the suggestion on jobbrokering service. Delivery through the current Work Programme would enable links to local job markets and vacancies. However, the Scottish Government is of the view that alongside any service there is a need to create a more positive view of job change with employers.and workers which would encourage a degree of pro-activity in recognising poor fits between job and worker. n particular, larger employers should embrace the approach internally and to promote it as something positive where it helps an individual. 43. There may be a number of employment ~w issues which would need to be considered, such as implications for constructive dismissal as a result of a job change or refusal of a change. 44. The Scottish Government would welcome a pilot trial of the brokering service to test the approach and identify potential issues a1ndunintended consequences. mprovina the benefits system 45. Recommendation 12: The Government should end the ESA assessment phase altogether. People should go onto ESA only if they qualify after a WCA, or as at present, if they qualify to pass directly onto ESA without a face-to-face WCA Scottish Government Response: 7

8 Sickness Absence Review - Scottish Government Response, n many cases, there will be no filncial difference for someone on the assessment phase of ESA if they are in receipt of Jobseekers Allowance (JSA). The Scottish Government would wish assurance that removal of the assessment phase would not result in vulnerable people beingl prevented from claiming a benefit to which they were entitled. Similarly, the Scottish Government would wish to be assured that an immediate Work Capability Assessment would not result in people being pushed back to employment that they are not ready or equipped to deal with. 47. Recommendation 13: The recommendation above should be supported by changes to Jobcentre Plus' claims policies and processes to prevent large numbers of people being inappropriately dir~cted towards ESA Scottish Government Response: This is a matter for DWP. Hpwever, the Scottish Government believes that Jobcentre Plus's policies and processes should be geared towards ensuring that those who would benefit from employment are given appropriate support while those who are not capable of work as ia consequence of a health condition are able to access welfare support as quickly as possible. 8

9 Sickness Absence Review - Scottish Government Response Conclusions 49. The Scottish Government acknowledges the work by the reviewers on a challenging issue. Any measures brought forward as a result of the recommendations need to ensure there is a balance between ensuring that people are not unnecessarily encouraged to absent themselves from the workplace and delivering appropriate and timely health care that offers the best scope for recovery and rehabilitation. 50. We are working with colleagues in NHSScotland to ensure that health care professionals appreciate the intimate links between health and work and their role in supporting patients to remain in or return to work when appropriate. This will take time to achieve but we believe that we are already seeing that understanding becoming embedded in healthcare practice in Scotland. Further guidance to doctors on the use of the fit note can only be helpful in improving understanding. 51. A key challenge for the development of an ndependent Assessment Service will be resourcing such a service. t would need to be delivered from with existing resources. The review identifies saving that would arise from the las, however, these savings would accrue to the UK Government through reduced benefit payments and increased tax revenues. - The savings would not off-set costs to the Scottish Government, if the Scottish Government is expected to commission and fund AS in Scotland, e.g. as a service delivered by NHSScotland. 52. Maintaining tax relief on Employee Assistance Programmes seems to be worthy of consideration as EAP represents a relatively low cost means of providing support to employees in the workplace. Extending tax relief to employer provision of medical or vocational rehabilitation services would also be helpful. 53. The delivery of a job brokering service as an extension of the Work Programme would need to be achieved by the UK Government. 54. The Scottish Government recognises that while accepting the principles reflected in the report, the means for delivering on these will require a significant amount of work. We would welcome the opportunity to enter into discussions with colleagues in the other administrations on the best means of addressing this. Scottish Government February

10 Sickness Absence Review - Scottish Government Response F

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