Black report on UK health: the government’s response
Occupational Health provides a breakdown of findings from the government’s response to Dame Carol Black’s review, and explains what they mean for occupational health.
On this page:
Replacing the Med 3 sicknote with a new fit note
Piloting of a Fit for Work service and other interventions
More education and training in OH for GPs and nurses
Creation of a council for occupational health
National Centre for Working-Age Health and Wellbeing
New guidelines, standards and OH accreditation
Funding for health, work and wellbeing co-ordinators
Businesses to be encouraged to measure and report more on health
Funding for NHS Plus and a new national OH helpline
Development of a National Strategy for Mental Health and Employment
Review of workplace ill-health within the NHS
Tax breaks for employers?.
In March 2008, national director for health and work Dame Carol Black unveiled her Working for a Healthier Tomorrow blueprint for the future of workplace health, and it was seen by many as a once-in-a-generation opportunity for occupational health (OH). But the key as to whether it would end up gathering dust on a shelf in Whitehall or actually make a visible difference largely lay in how the government responded.
Eight months on, at the end of November, that response finally came.
Although some had feared that, in the current straitened economic climate, it was almost inevitable that Black’s ambitious proposals would be watered down, what was unveiled by health secretary Alan Johnson and work and pensions secretary James Purnell went further than many in the profession had dared to hope, with the vast majority of Black’s recommendations accepted, and even some new proposals thrown in. In fact, the report makes it clear in its conclusion that it is even more important now, when times are hard, to act.
“Our response is being published at a challenging economic time,” it says. “But the measures proposed are as relevant in difficult times as in good. Health is not something we only think about when life is easy – it is a long-term commitment which produces benefits for all.”
What is also clear is that the year ahead is likely to be a seminal one for OH professionals, who will now be at the heart of profound changes to how workplace health is perceived, presented, measured and managed.
The key points of the response are as follows.
Replacing the Med 3 sicknote with a new fit note
The report confirms the government is committed to replacing the Med 3 sicknote with a fit note in 2009, following a consultation on the regulations required to make the change.
The new form is intended to encourage GPs to provide advice to patients on their fitness to work as well as help employers consider whether their workplace could accommodate the patient returning to work at an earlier point.
A draft of the form has already been tested with more than 500 GPs across the UK. On top of this, ministers have said they are committed to “rolling out an electronic certificate”, with a version currently being tested in Wales. “We are also exploring whether we can introduce the new ‘fit note’ and electronic format simultaneously,” it adds.
Piloting of a Fit for Work service and other interventions
Possibly the most radical of Dame Carol’s recommendations was for the creation of, in effect, a work-related national health service.
While the issue of who will fund a national Fit for Work service has, for the moment, been kicked into the long grass, the government has, to its credit, agreed to run a number of pilots examining the various ways such a service might work in practice.
The idea is that it will offer workers access to case managed, multi-disciplinary early intervention. This may not necessarily be health related and could mean help with housing or debt or retraining – the idea is simply to offer people who have been off work because of sickness, particularly mental illness, support back into work.
The government has said it will set aside central funds to “pump prime” a network of local pilots to test different delivery models. The Department for Work and Pensions later confirmed to Occupational Health that £13m has been allocated to support 10 pilot areas.
The details of the formal bidding process are due to be unveiled in the next few months, with the report stressing that many components that might make up pilots are already in place and being funded. The intention is for the pilots to run until “at least” 2011 (in other words, until after the next general election) after which they will be evaluated.
However, Fit for Work is not the only intervention highlighted. During the coming year, pilots will be run placing employment advisers within the Improving Access to Psychological Therapies (IAPT) programme, which is creating a network of centres where cognitive behavioural therapists can be accessed by people suffering from mild depression and anxiety.
This IAPT programme is expected to cover more than a fifth of primary care trusts (PCTs) in England by early this year, up to half by 2011, and 100% thereafter.
Employment advisers will also be placed within 12 PCTs in England over the next two years, with similar pilots due to run in Scotland and Wales. Through the Pathways Advisory Service, the government has also said it will continue to test the feasibility of locating employment advisers within GP surgeries. While a pilot on this has been running since 2005, this will now be extended for a further three years.
More education and training in OH for GPs and nurses
Last year saw the piloting by the Royal College of General Practitioners (RCGP) of a seminar-based training programme for GPs on dealing with health and work issues. This, the report says, will be rolled out nationally to all GPs from April.
At the same time, the Faculty of Occupational Medicine and the RCGP will develop a competency framework and modular syllabus on health and work issues for GPs which, again, is intended to be available both online and through academic centres from this year.
The Royal College of Nursing, similarly, has been developing an online learning module for nurses, while the Institution of Occupational Safety and Health is piloting a new training programme on health and wellbeing at work for safety and health practitioners.
Creation of a council for occupational health
While the exact details of how this new body will work and who will sit on it remain somewhat scant, the general idea is that it will be a co-ordinating council for the profession, providing multi-disciplinary leadership and direction.
Its key tasks will include exploring methods of joint working, co-ordinating training and the development of key competencies and the development of evidence-based guidelines and standards.
“It will,” as the report puts it, “facilitate the sharing of skills and expertise by gaining consensus and agreement across the professions and practitioner communities for core content for education and training in health, work and wellbeing issues.”
National Centre for Working-Age Health and Wellbeing
Dame Carol’s report highlighted the need for more robust and consistent OH data and standards. The report agrees that at the moment there is no one, authoritative body devoted to gathering and disseminating data associated with the health of the UK’s working-age population.
To this end, the government has pledged to create an independent National Centre for Working-Age Health and Wellbeing, hopefully during this year.
This, it says, will work as an observatory, gathering and analysing data at national, regional and local level, identifying and monitoring trends in the health of the working-age population, building up an authoritative, evidence-based database and identifying evidence gaps and determining how effective interventions and initiatives are or have been.
The hope, say ministers, is that this centre will be located within an existing (no doubt similar) organisation, probably staffed by a core team and supported by remote partners.
New guidelines, standards and OH accreditation
Alongside the new centre, the government is backing a raft of other measures, including the development of a series of leaflets by the Royal College of Surgeons of England giving advice to patients on what they should expect following an operation.
Initially to be focused on seven common operations, the intention is to offer a “traffic light” system that patients will be able to follow to get back to everyday activities, including returning to work.
At the same time, the National Institute for Health and Clinical Excellence, on top of the guidelines it already produces on occupational health conditions and interventions, will begin to include work-related outcomes within its public health guidelines.
NHS Plus and the National Institute of Clinical Excellence will work more closely to align the guidelines each produces. The Vocational Rehabilitation Council has also been drawing up common vocational rehabilitation standards, which went out to consultation in October.
“The Council for Occupational Health will work closely with the Vocational Rehabilitation Council to develop supporting evidence-based standards for care and support across those professions working to improve the health and wellbeing of the population. These standards will cover both protection and promotion of health at work,” the report states.
Finally, the government has committed itself to the development of a national accreditation system for health, work and wellbeing services, including OH and vocational rehabilitation, led by the Faculty of Occupational Medicine.
Discussions on how this might work in practice have already begun, with the government pledging to support the delivery and “first year of operation” of whatever accreditation system is agreed.
Funding for health, work and wellbeing co-ordinators
The report commits the government to funding a network of health, work and wellbeing co-ordinators in England, Wales and Scotland.
These public health ‘champions’ will report to regional directors of public health (and equivalents in Scotland and Wales) and use existing public health networks to promote and share best practice with healthcare professionals, PCTs, employers, business networks and mental health trusts.
“Theirs will be a new role, providing a focal point, working across departmental and partner boundaries and filling a leadership gap in the health, work and wellbeing infrastructure,” the report says.
On top of this, the report outlines a number of public health campaigns that will take place during this year.
These include an alcohol awareness at work campaign that has been piloted among NHS staff in Southampton, and will now be rolled out to workplaces in England late in the year.
A chronic obstructive pulmonary disease campaign has also been developed, to run from early this year, with the aim of raising awareness of the risks of lung damage from smoking and/or from occupational exposure to dusts, vapours, gases and fumes.
There will continue, too, to be major campaigns around smoking cessation as well as work to modernise the NHS stop-smoking support service.
Finally, the report reiterated an earlier government commitment to work with employers and employer organisations to develop pilots exploring how best to promote wellness and reduce obesity.
A key element of this will be the introduction of a new “healthier food mark” for public sector organisations during this year.
Between now and March, a series of “expert employer panels” will also be run where employers can share good practice on improving employment opportunities for disabled people.
Businesses to be encouraged to measure and report more on health
The report highlights the Business HealthCheck tool launched by Black and Business in the Community (BITC) last summer to help businesses estimate the costs of absence within their organisations. To date, it says, more than 1,000 firms have downloaded the tool and are testing it.
Beyond this, the government is pledging to work with BITC to offer more practical advice to businesses as well as encourage more firms to report on employee health as part of the financial reporting regime.
The Department of Health is also working with the employers’ organisation Investors in People to develop an online self-assessment tool as well as a health and wellbeing element, called the Health and Wellbeing Framework, within its existing HR and people-related standard.
This has already been tested by 200 organisations, including Unison, Scottish Provident, The Royal Liverpool Children’s NHS Trust and Peterborough City Council, and will soon enter a final pilot stage, it says.
Funding for NHS Plus and a new national OH helpline
The report pledges a further three years’ funding for NHS Plus, in particular to allow it to continue its work on testing innovative ways of offering NHS OH services to small to medium-sized enterprises (SMEs).
On top of this, the report says the government will test a national OH telephone helpline aimed at SMEs. One intriguing element of this will be how exactly it will differ from the SME-targeted telephone helpline Workplace Health Connect, which it appears may perhaps have been prematurely wound up in February 2008.
The intention is for local partnerships and business networks to bid for funding to design, market and deliver ‘gateways’ (or access points) to the helpline, with pilots due to run from summer 2009 for two years.
The helpline will be tested in two forms: a fee-based service and a free variant, and take-up will be compared between the two.
Development of a National Strategy for Mental Health and Employment
With the Royal College of Psychiatrists estimating that poor mental heath costs the UK more than £40bn a year, and that ignorance, stigma and discrimination are still rife, the report says it has now asked Dame Carol to chair an independent expert steering group into this issue.
The main remit of the group will be to oversee the development of the first cross-government National Strategy for Mental Health and Employment.
On top of this, the Health and Safety Executive, Institute of Directors, Chartered Institute of Personnel and Development and conciliation service Acas are all to work together to promote and disseminate the health and management standards for work-related stress more widely.
Finally, SMEs will be able to access a ‘challenge fund’ to help them improve workplace health, particularly mental ill-health, and develop innovative approaches to improving worker engagement. This fund will be administered by the aforementioned health, work and wellbeing co-ordinators.
Review of workplace ill-health within the NHS
Ten NHS sites have been testing new health and wellbeing programmes for frontline staff, the report says, and, building on this, the Department of Health will now carry a “systemic review of how the health and wellbeing of the NHS workforce is supported”.
This will include looking at where and how the system for NHS OH could be improved, and how the delivery of services at a local level could also be improved.
Tax breaks for employers?
Perhaps one of the most contentious issues building a head of steam over the past year has been the growing calls from employers for incentives, possibly tax breaks, for those that invest in health and wellbeing programmes.
The short answer is that, in this report at least, the issue was ducked and was, at most, conspicuous by its absence.
But that’s not to say the door has been completely shut on the issue. In a single paragraph hidden away near the end of the report, entitled “Whole-system incentives”, the government indicates it may yet be willing at least to have a debate about this issue.
“The costs of ill health and sickness absence in particular fall to individuals, employers and the state,” the report says. “We want to review whether the current system is appropriately balanced,” it adds.
