I could see the rationale in expanding the scope of who can sign off a fit note to include Nurse Practitioners, in order to ease the pressure of doctors (GPs in particular) to sign off fit notes. But making it harder to get a fit note is nothing more than a way of helping Occupational Health providers to make a lot more money by making them into the sole professional arbiter of fit notes.

It won't solve the problem it's setting out to address. It will create a whole host of new problems. And along the way, some close personal friends of the Prime Minister will make a tonne of money. Hmm...

Whilst I agree that long-term sickness absence has gone up over the last few years, I think this can be attributed to:

1. Increased understanding among both employers and employees of what counts as protected disability, leading to a greater reluctance to dismiss.
2. Reduced confidence of line managers arising from a two decade decline in investment in management training, leading to a greater reluctance to engage in absence management.
3. Increased access to the workplace for people living with disabilities but who are statistically more likely to require long-term sickness absence during their employment.
4. Long COVID and other aggravations of absence arising from COVID infections.
5. Increasing numbers of employers pushing back on remote working arrangements that were mitigating the need of some people with serious conditions to take time away from the workplace.

There is an interesting debate about the pros and cons of this policy. However, the statement by the Prime Minister seems to be part of a slew of statements designed to grab headlines ahead of a general election rather than something which is likely to pass successfully through parliament.

In reply to Steven :

Some of us remember Work Fit or whatever it was called which failed spectacularly just a few years ago. It was supposed to be staffed by OH professionals but it almost certainly was not.

I also remember being a proper HR Manager who did recruitment and would have great difficulty persuading colleagues to accept the recruitment of a potential liability of an employee. Unless the government address the issue of making people employable at little risk/cost then it will go nowhere.

In reply to Peter Stanway:

Fit For Work. Not, in itself, a bad idea but a classic "government solution" of creating a free OH service within the NHS without anticipating that the NHS didn't have enough OH professionals to staff it adequately and that it would take ten years to train and recruit enough to deliver the actual outputs the service was supposed to provide, so the NHS (as usual) provided a stop-gap solution with less qualified staff that therefore didn't deliver the outputs so the whole thing got canned.

In reply to Robey:

I like some of your ideas Robey.

My concern with point 1 is that I'm not convinced that providing sufficient protection (and awareness of protection) actually makes a positive difference because it doesn't change the practices that should enable that protection to work. In my experience, when businesses hear that someone has protection they are more likely to shy away from any form of normal absence or performance management (when potentially they should be more conscious of good management be more hot on the support those processes are supposed to offer) due to fear of getting it wrong (tying in with your point 2). This leads to either:
- Long periods of underperformance with inadequate feedback. When an employee doesn't advance as they would like or they eventually do get feedback, it feels like an attack and is far from their own perception - and often the sickness/disability is the "easiest" pinpoint as the key difference so a belief comes in that they are being unfairly managed on performance due to sickness. At the heart of it, they are only being treated differently because of the protection they have - so it is discrimination, but probably not in the way it is perceived and probably in a way that is very hard and messy to prove and/or fix.
- Alternatively they have regular and/or long periods of absence that go unaddressed, without any meaningful efforts to support a return to work or dismissal. This means an individual is out of work for a really long period of time, adding more time and adjustments and items to the need for support, before eventually possibly losing their job, and that gap makes it even harder to find another job - even though it doesn't show on their CV, they feel it.

Further, having a "reluctance to dismiss" based on someone being protected in my opinion leads to employers who are:
- more reluctant to hire people that they think may qualify for protection, because of past experience of not being able to dismiss even when it's reasonable (due to poor management);
- employees feeling less happy at work because they know they are not wanted, but reluctantly kept;
- employers trying to find other ways to remove employees rather than tackling the issue head on.

Instead I would love to see more investment in identifying practical solutions to the most common causes of "being not fit for work". For example, I read that half the individuals currently unfit for work are unfit due to mental health. That can be really challenging to make *reasonable* adjustments for because the adjustments can be so varied, often required for long periods of time and are often an ongoing cost rather than finite. E.g. with a physical disability you can pay for screen-reading software, physical adjustments to a building, a new chair etc. and the cost is not often ongoing, or is pre-defined as ongoing so you know what the annual cost is. We have a better understanding of how to tackle most physical illnesses so the adjustments "work" more reliably. With mental health, the adjustments I've seen work are things like paying for coaches or mentors to "buddy" someone. There's no clear timescale for how long and once you've started down that path and see it has *some* positive effect but the time needed is actually double what you thought, the cost can become astronomical. And you come back to the reluctance to hire...

Absolutely agree with point 2 and it needs to be a focus for investment.

In reply to Sophie:

The term "reasonable adjustment" is clearly defined in law. By emphasising the word "reasonable" is your implication that employers should do more to challenge the definition?

In reply to Adam:

I emphasised the word reasonable because I think for the majority of conditions it is possible to make adjustments to enable an individual to work. If there are unlimited funds, resources and time, there are few conditions that would change an employees ability to remain in work. The challenge, in my opinion, comes because no business has unlimited funds, resources and time and so it is making adjustments that are reasonable that is where the challenge lies.

It's not about employers or employees challenging the definition of reasonable and I don't think that would be helpful (especially as there are context-specific elements, so no matter how "clearly defined in law" it might be, the law requires interpretation). It's about employers and employees working together to identify adjustments and then getting the "best fit" within being reasonable.

In reply to Steven :

I think an autumn General Election means any scheme that would take the task of issuing fit notes away from GPs is unlikely to get over the line.

In reply to Sophie:

That makes sense, thank you - as you say resource is a consideration, as is whether the adjustment will be effective in removing the disadvantage, which is something that can only be determined by employers and employees working together. More widely this issue is clearly more complex than some of the press commentary implies - CIPD's Health and wellbeing at work 2023 report indicates that presenteeism continues to be a major problem for employers.