In a recent address, Prime Minister Rishi Sunak unveiled the government's plans to reform the benefits system, targeting the challenges faced by those unable to work due to illness. He also characterised the UK as having a "sick note culture". Whilst some do not share the Prime Minister's diagnosis of the issue, official statistics show that 11 million "fit notes" were issued in the UK last year, with the vast majority of those signing individuals off as "not fit for work". Such figures present significant challenges for employers and suggest a broader economic impact.

Fit notes

After the first seven days of a period of sickness absence, an employer can require an employee to provide a fit note or other acceptable proof of incapacity for work to be eligible for statutory sick pay. The fit note is usually issued by the employee's GP and indicates whether they are "not fit for work" or may be "fit for work subject to advice". In the latter case, the fit note may suggest potential adjustments or adaptations that could facilitate a return to work. This should inform the employer's decisions regarding sick pay, managing ongoing absences and return-to-work plans that accommodate the employee's health condition.

Economic inactivity

Recent statistics from NHS Digital indicate that the number of fit notes issued last year did not exceed the figures from 2019. Nevertheless, the landscape of employment has shifted, with statistics indicating an increase in economic inactivity. This rise is not solely due to physical ailments, but is also impacted by mental health issues, with an upsurge in disability benefit claims, half of which are related to anxiety or depression. For employers, these statistics underscore the reality of a changing workforce, where understanding and addressing both the physical and mental health needs of employees is not just compassionate but a strategic imperative for maintaining a robust and productive workforce.

Fit note reform proposals

The government has issued a call for evidence to explore reforming the fit note process, which closes on 8 July this year. The evidence gathered will serve as an introduction to a comprehensive consultation on detailed policy proposals that the government plans to initiate later in 2024.

Employers, employees and healthcare professionals are invited to share their insights on the current system's effectiveness, suggest improvements and discuss the potential benefits of additional information on "may be fit for work" fit notes. The consultation also addresses the emergence of private online fit note services and whether this warrants further scrutiny. Clinicians and other professionals are encouraged to weigh in on the appropriateness of GPs issuing fit notes, the practicality of in-depth work and health discussions, and how best to identify those who would most benefit from such conversations.

The government has expressed plans to tighten eligibility for both incapacity and disability benefits. His reform plans suggest that individuals with mental health conditions receiving Personal Independence Payments (PIP) could be offered treatment as an alternative to financial assistance. However, whilst the Prime Minister mentioned that depression or anxiety affected half of those receiving PIPs, these are frequently secondary issues rather than the primary health concern. A 2023 analysis by the Office for National Statistics revealed that nearly 40% of people unable to work due to long-term sickness suffered from five or more health issues. This highlights the complexity of the multiple health problems that can contribute to individuals' inability to work.

The government's review of the fit note system proposes that issuance of fit notes could shift from GPs to "specialist work and health professionals". The Prime Minister suggested that these individuals would possess the necessary time and expertise to objectively evaluate a person's capacity to work and to determine the specific support required.

Employers may see benefits from such specialist input, as it could lead to more nuanced and practical advice for managing staff absences and facilitating returns to work. However, the proposals are at an early stage and raise several considerations. Whilst promising to alleviate the current pressure on GPs, this also introduces questions about the training and resources needed for these new professionals. The success of this initiative will ultimately hinge on effective collaboration between these specialists and employers, as well as appropriate processes to ensure consistency and fairness in assessments.

How can employers manage sickness absence?

In recent years, the onus on employers has expanded beyond strict legal compliance. There is now an expectation that businesses will cultivate a healthy workplace culture, proactively manage health-related absences and address the underlying causes of absence with a compassionate and holistic approach that supports the overall wellbeing of their employees.

Employers can seek to manage sickness absence through the following strategies:

• Create clear absence policies: Develop and communicate clear policies regarding sickness absence, including procedures for reporting illness, providing fit notes and the process for return-to-work.
• Prompt communication: Encourage open communication between managers and employees. Promptly reach out to employees who report sick to understand their situation and expected duration of absence.
• Return-to-work interviews: Conduct return-to-work interviews to discuss the employee's health, any ongoing issues and whether further support or adjustments are needed.
• Record-keeping: Keep accurate records of sickness absences to identify patterns, such as frequent short-term absences, which may indicate underlying issues.
• Monitoring and review: Regularly review absence data to identify trends and assess the effectiveness of absence management strategies. Consider reviewing sickness policies in staff handbooks and sickness provisions in contracts of employment, and update as necessary.
• Engage occupational health (OH) services: Collaborate with OH to assess and understand the medical aspects of an employee's absence. Utilise OH recommendations to tailor support and adjustments for employees.
• Promote health and wellbeing: Implement wellness programmes that promote physical and mental health, such as exercise initiatives, stress management workshops and health screenings.
• Manager training: Provide managers with specialised training on absence management policies and procedures. Equip managers with the skills to handle potentially difficult and sensitive conversations. It is generally more effective to help an employee return to work than terminating their employment and recruiting someone else – but this works best if there is an open dialogue from the outset.

Conclusion

The government's proposed shift to involve "specialist work and health professionals" in the fit note process could offer a more nuanced approach to managing health-related work absences. However, these proposals remain at an early stage. As the government's consultation unfolds, it will be essential for employers to stay informed and prepared to adapt to any changes, ensuring that they continue to meet both their legal duties and the evolving needs of their employees.

From an employer's perspective, this involves not only fulfilling legal obligations but also actively promoting a culture of health within the workplace. By implementing clear policies, fostering open communication and providing supportive measures, employers can better manage absences and facilitate a healthier, more engaged and productive workforce.