The new health and work service
The new Health and Work Service starts in October 2014 and will be fully operational by May 2015. The government has out-sourced the service to Health Management Limited (HML), a subsidiary of Maximus Inc, a US corporation which manages social programmes in the USA, Canada, Australia, Ireland and Saudi Arabia.
The key features of the service are that HML will offer generic health and work advice through a website and telephone service, available to anyone, and OH assessments. The assessment service is designed to provide a free OH assessment of employees who have been, or who are likely to be, on sick leave for 4 weeks:
- the assessment service will primarily operate by telephone and the internet. Employees will rarely see an OH practitioner;
- GP's will be instructed that referral for assessment is the "default option and the reasons for non-referral will be limited and defined". Employers will also be able to initiate a referral;
- the assessment will look at non-health and non-work issues as well as those related to health in the context of work. It will be conducted by "healthcare professionals who have an occupational health care qualification; occupational health experience; or are able to demonstrate experience and skills appropriate to working in an occupational; health context";
- case managers will oversee the process and the service will provide a return to work plan containing specific advice. This will be treated as evidence of entitlement to SSP replacing fit notes. It will also be evidence of fitness for work; and
- first assessments will take place within two working days of the referral and return to work plans will be provided within a further two working days.
On 23 October last year, the DWP told prospective service providers that the scheme's annual budget is capped at "around £38.6m". It also told them to expect 350,000 – 700,000 referrals per annum but it's now talking about 960,000 people reaching the referral trigger each year.
In 2007, Maximus was subject to legal action by the US Department for Health and Human Services concerning alleged false claims under Medicaid. It made a payment of $30.5m to settle the case.
At first glance, this is good news especially for smaller businesses which may not be familiar with the options which a good OH specialist can offer. However, we're concerned this is window dressing which is more likely to be misleading and unhelpful.
The DWP implies the referral for assessment will be automatic but that can't be right because employees must consent to the release of medical histories to third parties and to be valid, that consent must be properly informed. Prospective suppliers were told the referral scheme is voluntary. In our opinion this must be correct. It's also unclear how doctors will respond to instructions from the DWP which could be seen as overriding or impugning their clinical judgement. Then there's the basis on which the OH assessment will be made.
We understand HML's brief is to use a biophysosocial (i.e. a very wide holistic) approach. This approach is criticised in some medico-academic circles for a tendency to classify the patient's condition as psychosomatic and therefore likely to fall outside the scope of work-related welfare packages. That's a scientific issue for the medical community but the rest of us need transparency about the basis on which the OH assessments will be made
DWP's budget seems to indicate that it's allowing £40 – £110 for each assessment (before the service providers fee is brought into account). We're not persuaded a skilled healthcare professional can produce a meaningful report for that sort of fee. It wouldn't surprise us to see the emergence of new fault lines through which parties retaliate with counter-reports leading to an escalation of tension, increased cost and satellite litigation which Employment Tribunals are ill-equipped to resolve.
Employers will continue to be accountable for decisions they take about an employee's fitness for work. A return to work plan will certainly provide evidence but as we've just indicated, its value may be questionable. Blithely accepting a negative plan could be unreasonable leading to claims of unfair dismissal.
Notwithstanding the polished rhetoric about this scheme helping everyone, we suspect this is just an oblique way for the government to reduce health and work related welfare payments. We hope to be proved wrong; time will tell.