Changes to the fit note in the Autumn Statement?
Changes to the fit note in the Autumn Statement?
The Spring 2023 Budget had a work and health focus. One of the measures announced was a new pilot service called WorkWell, pitched at integrating health and work support to help people back to work and retain them in the workforce. Exactly what this service will look like, whether it will be delivered local or nationally and whether support will involve health or Department for Work and Pensions staff or both remains ambiguous.
Over the weekend, several media outlets reported on anticipated changes to the fit note pathway.
The Work and Pensions Secretary has acknowledged the challenge faced by primary care teams in completing fit notes in a 10 minute GP consultation (often as a secondary issue alongside another presenting complaint) and the data evidencing that almost 95% of the time, fit notes are signed off as ‘not fit’ without use of the ‘may be fit for work section’.
This relates to the increasing numbers of people moving into economic inactivity due to ill health (now at a peak of 2.6M), with minimal flows out of that group back to unemployment or employment. The fit note is an important backstop and has the potential to be the first opportunity to provide work and health support just seven calendar days into sickness absence.
It is unclear what changes to the pathway will look like, but media reports suggest fit notes may be diverted away from GP teams as default and triaged to a multidisciplinary workforce, which may include non-clinical Department for Work and Pensions staff. The Work and Pensions Secretary has discussed the importance of integrating work and health support from the outset of the sickness absence journey, with a focus on addressing the health issues affecting ability to work and aiming to support people from proceeding to longer term sickness absence.
This sort of intervention could be very positive and help level the playing field when it comes to work and health support for people of working age in the UK.
However, the risk that it will be perceived as punitive is significant.
The narrative on work and health, sick notes and welfare has to change to support people seeking fit notes at a time where their ill health is affecting their function to the extent their ability to work is impacted. This is a very vulnerable time in an individual’s healthcare journey and for many people a ‘fit note’ is an entirely new concept, their expectation being a sick note that signs them off work entirely.
Any plans for reform must be met with clear, evidence based public communications plans empowering people to make use of health and work resources for their own health and socioeconomic benefit. Media coverage on ‘sick note Britain’ or a ‘crackdown’ on ‘sick notes’ can risk creating an atmosphere of fear and defensiveness. With hope of a new intervention in the pipeline it is time for the dialogue to shift to reflect the nuances of work and health support.