This post is a direct follow-on to my earlier post regarding fit-notes (and some of the issues surrounding that subject) which can be viewed here:

https://www.jelfgroup.com/blog/?p=2092

Another of the key recommendations of the Sickness Absence Review (SAR) was the creation of a state funded Independent Assessment Service (IAS), which employers could utilise after any employee had been off work for 4 weeks or more. Such a service is badly needed, as many smaller employers currently offer no access to occupational health services, and family Doctors’s are not well placed to provide any assistance in this area either (as explored in the earlier post).

To their credit, the Government’s response to the SAR has included a really strong commitment to delivering the IAS. Indeed, the response mentions that they intend to have this service in place by the end of 2014, and are actually targeting Spring 2014 as a launch date. This may well be ambitious, but at least evidences a desire to make this happen, and happen quickly.

As an aside, the Government have also confirmed that the occupational health advice services pilots that are currently running will continue to do so, and be funded for another year, to help bridge the gap until the introduction of the IAS.

Returning to the IAS, the service is to be outsourced, and tenders for that service will take place later this year. Clearly the finer detail of the offering will be confirmed over time.

In terms of staffing, the IAS will undoubtedly create some jobs, but the report suggests that there are thousands of existing health-care professionals who will be “able to absorb additional demand in their respective markets”. So presumably the intention is to resource this from these existing health-care workers.

According to the document issued last week, the service will aim to provide:

• a state-funded assessment by occupational health professionals for employees after four weeks on sick leave
• signposts to appropriate interventions
• employers and employees with advice on overcoming the barriers that prevent a return to work
• case management for the minority of employees with more complex needs

If you heard me speak on this subject last year, you may recall that I expressed some concern that the proposed funding for the service looked rather thin at £30 million per year. This has also been recognised, and the service is now estimated to cost the Government between £25 million and £50 million per year, for approx 560,000 users.

This is a major commitment by central Government. So what is their driver for doing this?

The financial numbers seem fairly clear. Out of work benefits costs to the Government will reduce by between £30 million and £60 million each year, whilst increased tax and ni incomes will generate another positive to the treasury of between £100 million and £215 million per year. So, if these figures are all correct, this makes good financial sense for the treasury.

But the above costs are not the full story for employers and employees. For although the service is state-funded, the interventions and treatment needed to return the employee to the workplace are not. The following wording caught my eye:

“This assumes that employers will accept all recommendations made by the service and will meet their full cost, including both employer and employee tax and national insurance liabilities that arise. We have also assumed that employees are basic rate taxpayers.”

So, this is evidently not a free lunch for the employer, and it will be interesting to see specifics on this point. But again, the benefits appear to outweigh the costs. Reduced employers sick pay costs of between £80 million and £165 million per year (plus of course improved productivity as well). Or if these numbers are all to large to be meaningful, how about this sentence instead:

“we have assumed that this service will result in a 20% to 40% reduction in the sickness absence duration of those engaging with it”

So, that’s the business case, but how can the service be accessed?

Firstly, the GP remain the starting point for the conversation, but still without needing to be occupational health experts. When a patient has been off work for 4 weeks, they will be referred to the IAS for assessment by the GP. The employer need not make the referral, but if the employee does not engage with the IAS, then the GP will not issue any further fit notes.

There will of course be some grey areas here. For instance, someone with their leg in plaster may well be off for more than 4 weeks, but is clearly likely to return to work in the fairly near future. GP’s will be given clear guidance on this to avoid creating issues where none exist.

And in the period upto 4 weeks, early referrals by GP, employer, or employee will also be possible as well.

So this all strikes me as pragmatic and achievable. My most significant concern at present is (as it was when I spoke about this last year), this:

Will the service be sufficiently funded and efficient that it does not fall into disrepair?

The IAS is potentially a huge step towards tackling sickness absence in the UK, but given the sheer magnitude of the offering, I can’t help thinking that 2014 is too ambitious (particularly if there are limited numbers of new job roles to make this happen). Should the service launch, and then fail, this would damage the validity of the offering in the public’s eyes, which in turn would remove many of the positives of this reform.

My final thought on the this subject for today is this: Will the IAS make employer funded Occupational Health a thing of the past?

Almost certainly not. Employer funded schemes are likely to be more suitable for the employer involved. The service will be more specific and bespoke to that organisation, and potentially quicker and more convenient to access also.

Yet the IAS will complement such cover, and is to be welcomed.

Will keep you posted on this as the subject to develops.

Best regards

Steve