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NHS Employers fully supports Dame Carol Black's report recommendations for improving the health of the working age health in Britain. This page contains our response to the NHS workforce aspects of the recommendations. We look forward both as an employers organisation and as the representative of the major healthcare provider in the country to working closely with the Health Work and Wellbeing team to implement any changes that come about as a result of this report.
New approach to health and work in BritainAs the largest employer in Europe, the NHS has always taken a lead in improving the health and wellbeing of its staff as a major way of contributing to improved patient care. Occupational health services, health and safety management, risk assessment and management, counselling services, flexible working, sickness absence management, and policies for managing stress, musculoskeletal problems and bullying and harassment already exist in most NHS organisations. We welcome Dame Carol's call for consensus and a new approach to health and work in Britain. This should be underpinned by occupational health and vocational rehabilitation services operating within mainstream healthcare, together with clear professional leadership to expand the remit of these fields and work with new partners to support the health of all working age people. Occupational health as part of mainstream health provisionNHS Employers believes that bringing occupational health into the mainstream of healthcare provision goes some way to addressing the issues which we raised in our consultation response. While we agree that there is room for current occupational health services to be expanded and better managed we would want to ensure enough capacity is left for providing a service to NHS employees. An effective occupational health service is one that has a direct management link to the organisation's board, preferably through a named executive director. It should be adequately funded and provided with suitably qualified staff to provide a range of services including physiotherapy, ergonomic assessments, occupational therapy, and any others considered appropriate after carrying out an organisational risk assessment. It is essential that it should be fully integrated into the management structure of the organisation and training on its use should be provided to line managers and staff as part of induction. Adapting the advice that healthcare professionals provideWe believe that healthcare professionals need to see work as an aid to recovery rather than something to be avoided. We agree that NHS professionals and their organisations - along with their regulators - should recognise retention in or return to work as a key indicator of the successful treatment of working age people and appropriate data should be collected to monitor it. New arrangements for the management of ill health retirement and sickness absence in the NHS will include a framework for managing sickness absences set out in an enabling agreement which will form part of the NHS terms and conditions handbook. These arrangements are the outcome of a review of ill health retirement and sickness absence carried out by NHS Employers and the trade unions. Replacing the sick note with a fit noteThere is also a need for more clarity on the use of medical certificates. Employees assume that they must comply with the terms of the medical certificate and take the stipulated time off work and medical certificates often give no real indication to an employer of what is wrong with the employee, making rehabilitation more difficult. NHS Employers supports the recommendation that the paper-based sick note should be replaced with an electronic fit note, switching the focus to what people can do and improving communication between employers and GPs and is already taking part in the review of the sick note. We are working with the Department for Work and Pensions on the review of the F Med 3, with the aim of developing a document that is more a certificate of capability than a blanket ban on working. It would include information for employers on what tasks the employee is incapable of carrying out, allowing the employer to find tasks that could be performed to enable earlier and more effective rehabilitation. Vocational rehabilitationNHS Employers agrees that the provision of vocational rehabilitation by employers should be encouraged. Rehabilitation is already available for many staff. Evidence collected during the partnership review of ill health retirement, injury benefit and sickness absence management in the NHS found that providing a flexible range of working options to facilitate rehabilitation or redeployment is also important. Employees have differing needs for staying in, or returning to, work and the use of flexible working patterns can cater to these. Equally as important is training managers to use the flexibilities available to them and to accept that there is a need to adjust working patterns to suit the needs of staff who are being rehabilitated. The review partners recognised that further work is needed to overcome the reluctance of some managers to integrate into their teams employees who are seen as not wholly fit to work. Fit for work serviceWe would welcome a Fit for Work Service available to the working age population but will wait to see what the make up of the service might be and where the staff would be drawn from. It would not be appropriate for staff to be drawn from limited NHS resources. Measuring the benefitsNHS Employers welcomes any work that would develop a model for measuring the benefits of employer investment in health and wellbeing. Historically there has been some difficulty in obtaining the data required to enable individual employers to make the business case and most attempts have been at a national level. However, there are examples of the costs to the NHS of not investing in health and well-being. The National Audit Office[1] in its report on health and safety management in the NHS found that in 2003 the NHS was spending in excess of £174 million pounds on the costs associated with health and safety accidents involving staff. Work carried out in 2005 for an NHS Employers' campaign to tackle stress showed that over 30 per cent of annual sickness absence in the NHS could be attributed to stress with estimated costs in the region of £300 to £400 million a year. Viewed on such a large scale, the costs are stark, but all employers will have proportionate costs. More information on Dame Carol's report can be viewed on the Health, work and wellbeing website. Our full response to the consultation can be downloaded here. Further information about creating a trust strategy for workplace health is available on our website. [1] A Safer Place to Work - Improving the management of health and safety risks to staff in NHS trusts. NAO 2003 Last reviewed 17 Mar 2008 |
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