Creating an independent assessment service to advise on employee absence is our chance to create a fair system, say Carol Black and David Frost.

A key recommendation of Health at Work – an independent review of sickness absence was for the establishment of an independent assessment service.

During the course of the review a common theme to emerge from employers of all sizes was that despite introduction of the fit note, the current certification process did not meet their needs. They believe that too many sick people are signed off as entirely unfit for work and too few as “may be fit”.

The evidence is that only 10-15 per cent of fit notes contain a “may be fit” assessment. Early findings suggest that 85 per cent of patients off sick for more than a week are being signed off as entirely incapable of work.

Employers feel unable to challenge these medical certificates. One result is that employees may be needlessly absent from work, some starting out on the route into the benefit system.

Equally, many GPs explained that they are not experts on functional assessment, vocational rehabilitation or occupational health. Nor do they have enough time for such matters in the normal consultation period.  

The complex bio-psychosocial reasons for much sickness absence, and the changing nature of work from industry-based towards a knowledge economy, have altered the health needs of the working-age population – needs which are currently not well met.

To minimise sickness absence, employers, employees and certifying doctors often need additional, expert advice on whether an employee who is not completely fit is capable of working and how they might be helped to do so. An independent assessment service (IAS) could provide such advice, giving the greater confidence that employers need about the capability of their employee to get back to work.

The service would be a source of specialist opinion to which certifying doctors could refer a patient and employers could refer an employee. Referrals would be voluntary in nature. 

An IAS would offer detailed assessment of the person’s function, with advice on what adjustments may be necessary to speed up return to work. If necessary the output of such an assessment could be used by the employer to validate or refute a claim for sick pay.

One of the major reasons prolonged sickness absence can lead to worklessness is that people are often left without any form of contact from the employer. It also appears that skilled early telephone approaches can overcome the problem and are therefore seen as an essential element of the IAS.

There will be people whose illness or injury means that they cannot return to work in their previous role, even with support. They may need to take up a different role within the business, again guided by advice from occupational therapists, physiotherapists and other clinicians within the IAS. 

The service will be run by private and public sector providers, with the chief aim of providing early expert functional assessment and occupational health advice. The results of the assessment, which must be made early, would be made available to the individual, the employer and the GP.

We estimate that up to 200,000 people each year could use the IAS. The cost would be in the order of £30m per year but the savings would well outstrip this. With more people remaining in work, we estimate that the net cost to the state would be £10m per year, and employers could gain an estimated £100m per year through reduced costs of absence.

Initially the state should fund this service, but once it is established and when economic conditions improve a charging model could be considered.

Introduction of the IAS potentially offers the biggest contribution to reducing long-term sickness absence in the UK.