Wikipedia

Draft:Health and Work Service


Health and Work Service
Occupational health service overview
Formed2014
Preceding Occupational health service
  • Fit for Work Service pilots (2010)
Dissolved2018
JurisdictionUnited Kingdom (England, Wales, Scotland)
Parent Occupational health serviceDepartment for Work and Pensions

The Health and Work Service, rebranded as Fit for Work in 2015, was a government-funded occupational health initiative in the United Kingdom designed to support employees experiencing sickness absence and help them return to work more quickly. Launched in response to rising long-term sick leave, it provided free assessments, advice, and tailored return-to-work plans, primarily targeting small and medium-sized enterprises (SMEs) without dedicated occupational health resources. The service operated from 2014 to 2018 but was discontinued due to low referral rates and mixed effectiveness, though it influenced subsequent programs like the Work and Health Programme. While it assisted some participants in reducing absence durations, evaluations highlighted challenges such as limited uptake, regional inconsistencies, and barriers for those with mental health conditions.[1][2]

History

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The origins of the Health and Work Service trace back to Dame Carol Black's 2008 review of the health of Britain's working-age population, which identified the need for better support to prevent long-term sickness absence and reduce flows onto benefits.[1] This led to the introduction of the "fit note" in 2010, replacing traditional sick notes with statements allowing GPs to advise on workplace adjustments.

In March 2010, 11 Fit for Work Service (FFWS) pilots were launched across Great Britain to test personalized, case-managed support for workers in the early stages of absence (typically within the first few weeks).[3] These pilots, funded by the government, focused on SMEs and aimed to evaluate different delivery models. A first-year evaluation was conducted by a consortium including the Institute for Employment Studies, though detailed participation metrics from this phase were limited.

Building on the pilots, the full Health and Work Service was announced in July 2014, with Health Management Limited (a MAXIMUS company) selected as the supplier for England and Wales following a five-month tender process.[4] In Scotland, delivery was handled by the Scottish Government on behalf of the UK Government to leverage existing public sector expertise, such as the Healthy Working Lives program. The service had a phased rollout, starting with a "soft launch" for GP referrals in March 2015 and expanding to employer referrals by September 2015.[1] It was rebranded as Fit for Work to emphasize its focus on enabling returns to employment.

The initiative was part of the UK Government's broader economic plan to cut sick pay costs (estimated savings of £80–165 million annually) and boost output (up to £900 million per year), addressing the nearly 1 million employees on sick leave for a month or more annually between 2010 and 2013.[4]

Services

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The service comprised two main elements: an occupational health assessment and general advice provision.

  • Occupational Health Assessments: Available to employees who had been (or were expected to be) absent for more than four weeks, typically referred by GPs or employers. Assessments were primarily telephone-based (98% of cases), with a small proportion (about 5%) conducted face-to-face if needed and within a 90-minute travel distance.[1] They covered health impacts on work, personal difficulties, and attitudes toward returning. Following assessment, a Return to Work Plan (RtWP) was issued within two days, including recommendations such as phased returns (60% in England/Wales, 32% in Scotland), amended duties, altered hours, workplace adjustments, or signposting to resources like self-help materials (98% in England/Wales), NHS counselling, or ACAS.[1] RtWPs were shareable with employers and GPs with employee consent (over 90% agreed to some sharing). Additional case management was offered in 7% of cases in England/Wales.
  • Advice Service: A free helpline, website, and web chat available from 8:30am to 6:00pm, Monday to Friday, open to anyone (not just referred employees). It provided general guidance on managing sickness absence, though usage was not tracked in detail in evaluations.[1]

The service also included a tax exemption for employer-funded medical treatments up to £500, though this was underutilized.

Regional differences existed: Scotland used a two-step enrolment process and integrated with existing programs, leading to higher signposting to local resources (e.g., 49% to advice line vs. 21% in England/Wales).[1]

Implementation and Delivery

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Implementation aligned closely with the original design but revealed variations. In England and Wales, enrolment and assessment often occurred in the same session, while Scotland used a separate enrolment step, potentially contributing to higher pre-assessment drop-outs.[1] GPs in Scotland found referrals easier via the SCI gateway system, compared to the more complex process in England/Wales.

Employers, particularly larger ones (250+ employees), valued the service's independence and speed, using it to supplement in-house occupational health.[1] However, 50% of employers had no direct contact with case managers. Employees generally viewed case managers as supportive, though those with mental health issues sometimes preferred face-to-face options.

Data recording inconsistencies were noted, such as lower reported phased return recommendations in Scotland, possibly due to management practices.[1]

Aspect England/Wales Scotland
Assessment Mode 98% telephone, 5% face-to-face 98% telephone, 5% face-to-face
Enrolment Process Often same session Two-step (enrolment then assessment)
GP Referral Ease Complex and time-consuming Easier via SCI gateway
Employer Engagement Higher for large employers Balanced (56% employer referrals)
Data Consistency Higher (e.g., 60% phased returns) Lower (e.g., 32% phased returns)

Evaluation and Uptake

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A process evaluation covering October 2015 to December 2016 analyzed 8,486 referrals/discharges in England/Wales and 1,017 in Scotland.[1] Uptake was low overall: only 59% in England/Wales and 55% in Scotland received assessments, with pre-assessment drop-outs at 41% and 46%, respectively. Employer referrals had higher completion rates (65% in England/Wales) than GP referrals (45%), and older employees (55+) were more likely to engage.

Health conditions included mental health (24–32%), musculoskeletal issues (16–26%), and comorbidities (25–30%). Mental health cases reported higher perceived benefits (72% felt it sped up return) but lower implementation of recommendations (33%).[1]

Effectiveness was mixed: 65% returned to work within 2–3 months, and 56% remained in work long-term, with 87% experiencing no further long absences. Satisfaction was high (78% employees, 89% employers for ease of use), and benefits included improved confidence (27%) and employer changes (27%). However, only 39% of employees and 61% of employers fully implemented RtWPs, citing impracticality.[1] A GP survey found 65% had not referred anyone in the prior year, labeling it a "wasted investment."[2][5]

A number of private and third-party services have since emerged to provide sickness absence and return-to-work support for SMEs, including online platforms offering services such as sick note verification and tailored occupational guidance. Examples of such platforms include digital providers operating in this space.[6]

Metric England/Wales (%) Scotland (%)
Total Referrals/Discharges 8,486 1,017
Employer Referrals 67 56
GP Referrals 33 44
Assessment Uptake 59 55
Pre-Assessment Drop-Out 41 46
Return to Work (2–3 Months) 65 65
Employee Satisfaction 81 95
Condition Sped Up Return (%) Recommendations Implemented (%)
Mental Health 72 33
Musculoskeletal 57 42
Other 54 46

Discontinuation

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The assessment service was discontinued on 31 March 2018 in England and Wales, and 31 May 2018 in Scotland, due to persistently low referral rates.[2][7] Reasons included ineffective GP communication (e.g., emails), lack of awareness, and drop-outs from unverified contact details or perceived lack of benefit (22%). Post-assessment dissatisfaction, particularly with telephone formats for mental health cases, also contributed.

Experts like Professor Sir Cary Cooper called it "flawed" for mental health support, while others noted its well-intentioned but limited national scope.[2] The advice service continued briefly but was later scrapped. The 2017 white paper "Improving Lives" announced an overhaul of the fit note system, extending certification to other healthcare professionals.[2] No direct replacement was established, but elements informed the Work and Health Programme.[8]

As of 2025, there have been no updates indicating revival of the service. Instead, government efforts have focused on broader reforms, including pilots for sick note changes where GPs offer coaching and connect patients to local support services rather than defaulting to "not fit for work" declarations (93% of notes in 2024).[9][10] These align with initiatives like Get Britain Working and the 10 Year Health Plan, emphasizing prevention and employment support without reinstating the original framework.[11][12]

See Also

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  • "Fit for Work: Final Report of a Process Evaluation" (PDF).


References

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  1. ^ a b c d e f g h i j k l m "Fit for Work: Final Report of a Process Evaluation" (PDF). GOV.UK. 2018.
  2. ^ a b c d e "Government right to scrap Fit for Work scheme, say experts". People Management. 2018-01-11.
  3. ^ "Evaluation of the Fit for Work Service pilots: first year report" (PDF). GOV.UK. 2012.
  4. ^ a b "Health and Work Service supplier announced". GOV.UK. 2014-07-25.
  5. ^ Khan, N. (2024-05-13). "What drives the 'sick note culture' in the UK?". The British Journal of General Practice. 74 (744). PMC: 316–317. doi:10.3399/bjgp24X738645. PMC 11221733. PMID 38936864.
  6. ^ "Occupational health and workplace screening services". CAW. Retrieved 2025-08-28.
  7. ^ "Fit note". GOV.UK. 2024-07-09.
  8. ^ "Work and Health Programme provider guidance". GOV.UK. 14 April 2022.
  9. ^ "Sick note pilot will 'help people back to work'". BBC. 2025-07-11.
  10. ^ "GPs to offer advice on returning to work under changes to sick note assessments". People Management. 2025-07-14.
  11. ^ "Get Britain Working: Pathways to Work". Parliament UK. 2025-07-29.
  12. ^ "10 Year Health Plan for England: fit for the future". GOV.UK. 2025-07-03.
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