Fit Note Consultation

Posted 3rd July 2009

John Armstrong from Benefits Now, gives some food for thought with some concerns about the 'Fit Note' in their latest newsletter.

Last year I reported on Dame Caroline Black's report 'Working for a healthier tomorrow' which, amongst other things, recommended the replacement of sick notes by 'fit' notes whereby a doctor would be able to state the tasks that a patient was capable of doing rather than the current sick note which just differentiates between being fit and being unfit for work. The government has taken up this suggestion and has put its proposed changes out to consultation.

Before considering the proposals, I think it is important to give some consideration of the wider picture. This has to be seen as part of the 'work is good' strategy which is characterised by a desire to get as many people as possible off benefit and to prevent those who become unwell from joining the ranks of the unemployed. Nobody would argue that productive, fulfilling work is beneficial and effective in promoting self-esteem and a sense of participation. However there are many low paid jobs that cannot be described as either productive or fulfilling. There are also some jobs which are quite stressful and contribute to ill health initially. I do however recognise that most people with disabilities actually want to work and would support any government efforts to help overcome the very real barriers to the workplace that currently exist. What I'm not keen on is 'shoehorning' people with disabilities into jobs that are going to exacerbate their health condition.

The other piece of context is the various reforms to the benefits system which make it harder for people with disabilities to be considered as disabled and which use a much more coercive approach to getting people to look for work.

The 'fit note' proposal is therefore an example of what could be described as joined up thinking in that it tackles what is seen as the readiness of GPs to sign people off for quite trivial reasons. The new note will contain an additional category, 'may be fit for some work now' to indicate that the patient has an ailment but is nevertheless capable of performing some tasks. The new form will also allow GPs to "record information to help inform discussions between individuals and their employers about whether there are any changes to the employee's work environment or job role which could help in achieving an early/earlier return to work. The consultation makes it clear that employers will not be bound by a doctor's suggestions.

In my first report on this initiative I reported the concerns expressed by the BMA and others that this move compromises the doctor/patient relationship by expecting GPs to become an extension of employers' personnel function. Doctors' sole function should be about tending to our well-being and not about cajoling us back to work. The other concern is that of confidentiality, at the moment GPs write "stress" on sick notes for those patients who are experiencing mental health problems. This is sufficient information for employers without letting them know that their employee has a diagnosed mental health condition. This is done so as to avoid the stigmatising response that often occurs when managers get an inkling of a mental health 'problem'. The proposed routine sharing of information between doctors and employers puts this kind of discretion in jeopardy.

Response to the consultation are invited from GPs, employers and their representatives, health professionals (including experts and advisers), trade unions, other employee stakeholders and others with an interest in health and work issues.

The consultation period ends on August 19th.

John Armstrong - Benefits Now

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