The national director for health and work has presented plans for the NHS to take on a wider role in promoting health and well-being at work.

In the first ever review of the working-age population's health, Dame Carol Black called for radical restructuring of occupational health services to see the NHS help ill people return to work quickly.

Her report, Working for Health, says sickness absence costs the economy£100bn a year and there is a "compelling economic and social case" for improving the health of working people.

It proposes a 'Fit for Work' service, with GPs accessing support services including fast-track referral to a physiotherapist or psychologist or for advice on debt and housing.

In the longer term, it says that "occupational health, along with vocational rehabilitation, needs to be fully integrated into the NHS".

Asked whether her team had done any work to cost these proposals, she told HSJ: "No, but we have done some work on what would be saved."

She added: "The NHS has a great incentive to stop writing sick notes and giving people more medication. It would seem to me that there are quite a few drivers to really say we need to deal with problems early rather than later."

She is in talks with six PCTs willing to test Fit for Work, she said.

However, the Society of Occupational Medicine said her proposals would need resources.

President Dr Gordon Parker said: "[We are] keen to work with government in identifying appropriate models of delivery of such a service, through the NHS or other providers, but the resourcing issues need to be addressed urgently in a medical specialty that has been something of a Cinderella since the inception of the NHS."

The report was widely welcomed, including by NHS Employers, the British Medical Association and Mind. But economists have challenged Dame Carol's figures.

Peter West of the York Health Economics Consortium said the report was poorly argued, unreferenced and badly thought out. "The numbers do not add up," he said.

The new NHS-funded services were unlikely to be funded through savings, he added. "Working age people tend not to go to their GP," he said. "It is a very weak argument to say there would be savings here."

NHS Employers head of workplace health Julian Topping said he expected costings to be part of the DH response to the report, which it commissioned from Dame Carol.

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