Fitness notes – another useless initiative

Over the last couple of days, the newspapers have been full of stories about sick-note Britain. Apparently, the government wants us all to stop lounging around at home and get back to work. It is concerned that absenteeism and long-term sickness is costing the country a fortune. Sick notes cost Britain £100 billion, scream almost all the newspapers.

Well, yes, sort of. In Carol Black’s report, the figure given is between £103 – £129 billion a year. Of this, between £34 and £40 billion is government spending, in the form of benefits and the burden on the NHS, and £28 – £36 billion is accounted for by lost taxes – i.e. taxes people would have paid had they been at work earning their full wages. The rest, somewhere around £63 billion, is the cost to employers in lost production and sickness payments.    

Why is this important? Because, for the most part, sickness and absence from work starts in the workplace. There are a few chronically sick and long-term unemployed people but most of those on long-term sickness or incapacity benefit have, at some stage, been employed. The government can bring in rules to try to get people off incapacity benefit but reducing the country’s overall sickness bill is something that only employers can do.

Which is why the idea of asking GPs to issue fitness notes instead of sick notes is tackling the problem from the wrong end.

As the BBC’s tame GP Rosemany Leonard pointed out yesterday, doctors are almost obliged to issue sick-notes if people claim to be ill. They can’t disprove what a patient says and, if they were to send someone to work who was genuinely ill, they could find themselves facing legal action. The definition of illness is now so broad that it includes stress, depression and other psychological complaints. It could be argued that just by being in a doctor’s surgery claiming to be too ill to go to work, a patient has demonstrated that he is too ill to go to work.

GP Ann Robinson makes a similar point in the Guardian:

It’s true that sick notes have become a bit of a joke. Most GPs I know will sign a Med 3 (pdf)sick note for pretty much anyone who asks. They are usually for a week at a time and most GPs faced with a patient who says they can’t work for a week, will tend to believe them.

The commonest reasons that we sign sick notes for, like back pain and stress or depression, are impossible to prove or disprove.

She argues that GPs should not be required to herd people back to work:

GPs don’t want to police the system. We’re not trained to do it, we’re rubbish at it and it gets in the way of the primary relationship which is between patient and doctor.

The responsibility for getting the long-term absentees back to work and for stopping the short-term absentees becoming long term ones rests with employers. That £63 billion is primarily their responsibility, not the GPs. Blaming GPs for issuing sick-notes at the drop of a hat is a classic management cop out. Even if an employee is certified as sick, there are things you can do to address the situation and, if necessary, to terminate that person’s employment.

If the government really wants to help employers tackle absenteeism, it should forget fitness notes and look at changing some of its legislation. Rather than bring in yet another procedure, which managers will have to learn about and implement, the government could, for example, change the law on harassment. At present, if employees are off with stress or depression, they can claim that any attempt to contact them amounts to harassment. In most cases it doesn’t but the burden of proof is on the employer.

Going off sick and then claiming harassment when the employer tries to get them back to work has become a favourite tactic of those lead-swingers who know the law.

I’m not saying that we should not have laws against harassment but the combination of all the government’s recent employment legislation, and the trend towards placing of the burden of proof onto employers, has left all but the most tenacious managers reluctant to tackle issues like absenteeism. Confronting an employee about his or her sickness record is uncomfortable. If you are unsure of the law and feel you are on dodgy ground, it is all too tempting to just ignore the problem and hope it will go away.

Combine weak managers with complex employment law and you end up with £63 billion a year in lost production due to absence. Carol Black’s wellness notes are not even going to make a dent in that.

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3 Responses to Fitness notes – another useless initiative

  1. Pingback: fitness

  2. Jonathan says:

    Years ago, part of my empire was the supervision of concessionary travel passes for the elderly & disabled.

    OAP is easy to prove but for the disabled, the transport act specified certain criteria. Deaf/Blind/ etc etc
    The Doc signs the form and they get a pass.

    Famously in answer to the question is the person “unable to walk 50 yards unaided” – a doctor once wrote

    “he says so” and signed it


  3. In response to previous post:

    Famously in answer to the question is the person “unable to walk 50 yards unaided” – a doctor once wrote

    “he says so” and signed it

    I’m still cracking up over this……………….

    Most doctors are on the up and up and can tell when someone is dragging the chain a little although there is the occassional fraud that gets through I don’t personally believe it is at epidemic proportions to warrant this type of action.

    Great blog by the way.


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