After years of delays and changes, the Fit for Work Service has finally launched. Helen Swire investigates what the service will entail and whether it is fully understood – and asks if it can work in practice


Even by the standards of government bureaucracy, the launching of the Fit for Work service has been slow.

When Dame Carol Black and David Frost published their independent review of UK absence in November 2011, few thought that it would be more than three years before action was taken.

The decision to accept the recommendation to create a new health advisory and assessment service was delayed until January 2013; in the December the government announced a £500  employer interventions tax break; and unveiled the ‘Health and Work Service’ in February 2014.

The April 2014 launch date was delayed; in the November the title of the service was changed to Fit for Work.

Finally, in December the website and telephone advice line were launched; and the £500 healthcare tax break finally saw the light of day in January 2015.

But the service is raising more questions than it is answering. Why has it taken so long to launch? What will it actually do? Will it accomplish its aims of getting employees back to work?


In the government’s defense, Fit for Work is very much ‘something from nothing’.

“They’re creating something that hasn’t existed before – a national, free-to-access, occupational health service,” points out Elliot Hurst, director of health consulting at AXA PPP Healthcare. “We’re stepping into the unknown, and on that basis it would always have been a challenge.”

Initially between 350,000 and 700,000 absent employees were to have been referred by the Fit for Work service; however, the Department for Work & Pensions’ new criteria for assessment have significantly lowered those numbers – possibly through a realisation the service would not immediately have the necessary capacity.

The delays have caused some scepticism. “The track record in producing timely, pragmatic interventions is not good,” suggests Inji Duducu, HR director at Benenden Health.

Hurst, however, remains positive: “Yes, it’s taken a long time – but hopefully by doing so they are devising the right solution and outcome for the workforce.”


A point to reinforce is that Fit for Work is not trying to replace or act as a substitute for existing employer occupational health, but rather to remove some of the tax barriers around getting staff back to work. If an employee has been absent for more than four weeks, their employer can, tax-free, pay £500 for them to go via the employee’s GP through to the Fit for Work service.

Another element of Fit for Work has been grounded in the idea that ‘well notes’ work more effectively than sick notes. Employers are now able to refer employees that have been off for some time so that GPs can assess their capacity to be in work and treat or advise them appropriately.

In principle, argues Hurst, “employers should welcome the support that might help an absent employee who genuinely wants help get back to work. If it’s correctly and appropriately explained, both should be positive towards it.”


The GP involvement in the service has been a cause of concern. Many doctors don’t understand how the service works, or what type of case could be referred for assessment.

Furthermore, a major part of having an occupational health specialist is the understanding they have of each employee’s workplace environment.

“Although this has been done with the best intentions, a remote occupational health service is not going to have the understanding or knowledge of the policies, procedures, cultures or workplace nuances of each employer,” argues Hurst.

Meanwhile, for those employers that do not have occupational health, then something that they might refer to for support is better than nothing – but they, too, might lack fundamental understanding of what Fit for Work does.

“The access points for the service are not clear,” says Paul Avis, marketing director at Canada Life. “It should be made clear to employers is that the £500 tax exemption is exactly that – not a payment. Employers still have to pay for the treatment, which might lead them to invest in a health cash plan or private medical insurance which, in turn, are not covered by the £500 tax exemption.”

Duducu agrees: “I’d like clarification on the real granularity of logistics – I’ve read the guidance and none of it is immediately obvious. Is this the most effective way to tackle workplace healthcare?”


Fit for Work is intended as a single, one-off intervention to deal with an absent employee’s specific situation. For that reason, experts say the service should be fitted in with intervention or rehabilitation programmes that are run through other elements of workplace healthcare.

The current absence notification period of four weeks is also subject to change, depending on how many people are initially referred through the service. This flux may also inadvertently affect the provision and usage of other workplace healthcare.

Duducu remains unconvinced about whether Fit for Work can be a substitute for workplace occupational health. He says: “It’s rare to get really good occupational health advice – someone who understands the nature of the business, understands the work the individuals undertake, and have a commercial and pragmatic outlook as well as a healthcare outlook.”


Although the delays, budget cuts and lack of understanding gave Fit for Work a bad press before it even started, the motivation behind the service and the light it has cast on workplace healthcare has been praised.

Fit for Work will encourage employers to look at the broader picture of staff health, wellness and rehabilitation, and will enable healthcare providers to promote their offerings to staff.

AXA’s Hurst is positive. “It’s taking away some of the tax barriers that might otherwise stop an employer from funding treatment,” he says. “Absent employees have a better chance to get back into the workplace. That’s a good thing for both the employer and the staff member, but also for the NHS and the state benefits budget.”

Benenden’s Duducu adds: “It’s very positive that the government realises the importance of health and wellbeing in having a productive and engaged workforce. But there are a lot of question marks about how this scheme will work in practice.”