The full roll-out of the Fit for Work Service happened six months ago. Helen Swire examines the impact it has had – if any – on workplace healthcare


The extra 0.5% increase to insurance premium tax (IPT) announced in this year’s Budget – only 12 months after the last increase – was unsurprisingly met with fierce criticism amid increased concerns that health insurance will become yet more expensive.

But, fear not, said the government – the Fit for Work Service is now fully in action and here to get your employees healthy and rehabilitated. So has it?

While it is not there to act as a substitute for existing occupational health, it aims to remove some of the tax barriers that are around getting people back to work.

If a staff member has been absent for more than four weeks their employer can, tax-free, pay £500 for them to go via their GP through to the Fit for Work Service. The GP can assess their capacity to be in work and treat or advise them and their employers appropriately. The service has now been in place for six months.

“The early take-up among employers has been extremely encouraging,” says Dr Lucy Goundry, medical director, Fit for Work Service. “We are regularly receiving referrals from all types and sizes of businesses, as well as GPs, with employers using the Return to Work Plan and replacing the need for a ‘fit note’.”

However, a less positive picture has been painted by industry experts: many have said that the service has not had a significant impact on workplace wellness at all.

Steve Herbert, head of benefits strategy at Jelf Employee Benefits, says: “The problem is that awareness about Fit for Work is incredibly poor. The penny has not yet dropped and there has not been much patronage or money spent by the government to promote exactly what this is or why employers should be using it.”

Employers (particularly the larger ones) that have faced ill health and return-to-work issues are likely to have been proactively managing the issue for some time, and are already likely to be using an occupational health specialist.

So many companies already have an process in place to cover the same problems as the service.

A disconnect in the message

While the established commercial relationships of larger businesses fill the same gap as Fit for Work, it would likely be a helpful service for smaller companies.

Smaller businesses tend to have fewer long-term sick issues, and these tend to be at the serious end of the spectrum – so not under the remit of Fit for Work, according to Tristram Hawthorne, a principal in JLT Employee Benefit’s consulting division.

However, he too comes back to the same issue around promotion of the service. He says: “There’s a problem with the marketing. We’re aware of the service, but don’t have it embedded into our consciousness as something we should be using and relying on.”

Herbert agrees. “I don’t think it’s anything more complicated than that – employers just genuinely aren’t aware of it. And with the increasing and common trend in the papers to talk about testing for state benefits, there is the – incorrect – belief that this has some correlation with that.”

But what about on the part of GPs? The last time they were involved with a similar process was the requirement for fit notes.

“If you ask HRs if the fit note has made any difference to the way they receive notifications about employees, the answer, almost universally, is no,” says Herbert. “And that was something GPs were required to do. Fit for Work is something they can choose to do – assuming they know about it. So we’re a long way off GPs engaging with this en masse.”

Building the relationship

However, industry experts acknowledge that the push needs to come from the government. So far there has been no obvious government champion or active promotion from leaders.

“There’s a lot that can be done just in marketing and communications.” says Hawthorne. “Fit for Work simply hasn’t had the same airtime as bodies such as the Money Advice Service (MAS).”

Hawthorne’s example of high promotion – the MAS – is now seeing a post-Budget restructure along with The Pensions Advisory Service and Pension Wise, perhaps suggesting that some promotion and publicity around Fit for Work is needed.

The service’s marketing budget has been described as ‘shoe-string’ – but plenty can be achieved with parliamentary support.

The service directors themselves, it has to be said, are doing what they can to increase engagement and make Fit for Work as relevant as possible.

“We’re really proud of how the service is working so far, helping employees across England and Wales to make a successful return to work after a significant period of absence,” says Goundry.

Nonetheless, she adds: “We’re continually evaluating and assessing Fit for Work to make sure the service is constantly moving with the times and adapting to the needs of employers and their staff.”

A healthier alternative?

Perhaps conversely to the intentions of the service, Fit for Work has triggered a reaction across healthcare providers.

Among income protection providers in particular, there has been a movement to show to employers that they, too, can provide the service that Fit for Work is putting forward: encouraging an increasing awareness in the need for employees to have access to such products.

The majority of income protection providers now offer an add-on occupational health service to help an absent staff member get back into work successfully: much as Fit for Work aims to do.

Although this might seem a negative for Fit for Work, the industry insists that it is simply a positive reaction to realising they need to get out the message about the importance of early intervention.

“We need to respond to those companies who have got no support at all through Fit for Work, and also those that have some protection in place but need to use it better,” says Herbert. “This is an encouraging industry reaction, because we aren’t going to solve the sickness absence problem unless we tackle it from both ends.”

And as the industry starts to appreciate the importance of demonstrating what their products can do to help get people back to work, better employer conversations are also happening: asking both what they can do better for their staff, and also what tools they already have in place that they can maximise.

Room for improvement

Nonetheless, there is still some way to go in closing this UK protection gap.

“There is a need to redress health concerns for both employers and employees, and indeed a need for a whole drive from government to improve productivity across the UK,” warns JLT’s Hawthorne.

While in the past defined benefit pension schemes would offer someone with serious ill health the financial means to take early retirement, now there is no such security, so rehabilitation services are becoming increasingly important.

“The government and the NHS need to do more, and the Fit for Work Service is a huge step,” Hawthorne adds. “But in the main, people aren’t yet interacting with it in the way it was intended.”

Fit for Work’s Goundry remains positive: “We know that having a valued member of staff away from work on long-term sickness absence has a real impact on a business’s bottom line, as well as affecting productivity and morale of other team members. Our ultimate goal is for Fit for Work to become the default service in that situation.”