Fit Notes, Welfare, and Work: Lessons from the House of Lords Report
This week, the House of Lords economic affairs committee published their findings following an inquiry into the relationship between long term sickness absence and the welfare system.
The full letter is worth a read but here are my takeaways. Some of the points made by the committee really go against the grain on other parameters in the work/ health welfare debate.
Is the rising number of people on benefits due to long term ill health affecting their ability to work EVEN CONNECTED to deteriorating population health???
The committee cast doubt on whether the health of the nation has deteriorated in the past decade
The inquiry predicted that even an improvement in NHS waiting lists was unlikely to result in a reduction in the long term sickness benefits bill
Detaching the rise in the number of claimants to whatever is going on with the nation’s health and health services is interesting. If accurate, it means there are separate forces driving welfare claims up, aside from health changes. This implicates the social security system itself.
The inquiry accepted the FIT NOTE IS LIMITED in its scope for nuanced assessment and support.
Instead, the committee suggested occupational health referral
This recommendation is interesting in the context of the current lack of universal access to occupational health
I agree with the barriers to effective use of the fit note in general practice- it is something I have been concerned about for some time with the fit note being the gateway to longer term sickness absence. This said, the most recent significant fit note reform pushed the fit note in the other direction…opening fit note authorisation to a larger group of allied healthcare professionals who may not have any targeted training. An overhaul and pivot to OH referral would necessitate a change in OH access and provision...
The inquiry concluded the current long term sickness benefits system is RIGGED AGAINST return to work.
Both financial disincentives…
…And limited scope to reassessment were identified as significant barriers to moving back into work
This resonates with me. Reassessment is so important when thinking about work and health because there is so much scope for change (in work, health, and psychosocial factors), and with that, scope for improvement in function. I also think the financial insecurity that comes with moving off social security and into work has psychosocial impact and can be a barrier to progress.
The social security system needs to focus less on what people CAN’T do and more on what people CAN do
This goes for the professionals undertaking eligibility assessments
As well as the current and prospective recipients of social security
I would say this is a universal learning point, regardless of whether you have any dealings with the welfare system or not! It is a perspective shift that can be useful across domains. Changing from a position of disadvantage to a position of empowerment is hard work but it can be done. It’s a skill that people build and lean on in corporate environments as well as in their lives outside of work. Some can do this innately, others need support to help them pivot the narrative that they, or others around them, may have been ascribing to for a long time, sometimes even forever. Either way, if the social security system and the people within it can achieve this, there will be so much to gain.
