Council for Work & Health

Changes from 1 July 2022 on health professionals who can provide a fit note

5th July 2022

From 1st July 2022, fit notes can now be certified and issued by registered nurses, occupational therapists, pharmacists and physiotherapists, in addition to doctors.  In the Government guidance for employers[1], the Department for Work and Pensions (DWP) makes clear that not all individuals within these professions will be suitably experienced and qualified to certify and issue fit notes, so will only do so where they have the relevant training and knowledge to make an assessment of a person’s fitness to work.

 

The organisations that form the Council for Work and Health include doctors, nurses, occupational therapists and physiotherapists, and other professionals with training and knowledge who can advise on health and work, and who can also advise on training for those now providing fit notes.

 

Unless they themselves are working in the NHS, doctors, nurses, occupational therapists and physiotherapists working in occupational health will not usually have access to paper or digital versions of the ‘Med3’, which is the form these health professions working in NHS primary care will use, or the F Med 10, which these professionals working in NHS hospitals may now use.  Other forms of medical evidence, including private medical certificates, occupational health reports and an Allied Healthcare Professionals Advisory Fitness for Work Report can be accepted as medical evidence in the same way as a fit note, subject to the employer’s agreement.  DWP go on to advise that in this instance the employer does not need to ask their employee to obtain further fit notes from their GP.

 

Other aspects of the guidance have not changed, but the following are areas in this guidance where over recent years we have come across some misunderstanding:

 

  • The employee can come back to work at any time, even if this is before their fit note expires.  They do not need to go back to their healthcare professional first.

 

  • The fit note belongs to the employee and they should keep the original.  The employer may decide to take a copy for their records (this is usual).

 

  • People do not need to be signed back to work and there is no option on the fit note to do so.  If the employee’s healthcare professional assesses that they are fit for work, they will not be issued with a fit note.

 

  • For a limited number of jobs, there are separate procedures to ensure someone is fit to carry out their role.  The HR, occupational health or legal department should know if this applies to the employer’s organisation.

 

  • If the organisation has a separate policy which requires someone to obtain medical evidence that they are fit for work, this should be arranged through an occupational health specialist[2].

 

  • The fit note is not binding on the employer. The assessment about whether the employee is not fit for work or may be fit for work (and any other advice in the fit note) is classed as advice, and it is for employers to determine whether or not to accept it.   The employer is within their rights to gather other evidence about their employee’s fitness for work from other healthcare professionals (such as an occupational health professional). The employer can choose to give this other evidence precedence over the advice in the fit note.

 

  • For complex or possible work related conditions, support from occupational health specialists should be seriously considered.

 

  • For more information, the employer could consider advice from an occupational health specialist.  The employer can also write to the treating healthcare professional for more information, although they may have to pay for this service and healthcare professionals may not be able to respond immediately.

 

 

[1] Guidance for employers on the fit note (updated 1 Jul 2022) at: https://www.gov.uk/government/publications/fit-note-guidance-for-employers-and-line-managers

[2] Government guidance on the further support provided by occupational health services at: https://www.gov.uk/government/publications/fit-note-guidance-for-employers-and-line-managers/getting-the-most-out-of-the-fit-note-guidance-for-employers-and-line-managers#further-support

 

Changes to the professionals who can provide a Fit Note

13th June 2022

The Government have announced today (13 June 2022) that with effect from 1st July 2022 legislation is being introduced across Great Britain that will allow more healthcare professionals to certify fit notes to patients. Information on the Fit Note can be found at: https://www.gov.uk/government/publications/fit-note-guidance-for-employers-and-line-managers/getting-the-most-out-of-the-fit-note-guidance-for-employers-and-line-managers

 

Currently only doctors can legally certify fit notes, but the Department for Work and Pensions (DWP) is now changing the legislation to allow a further four professions to do this.  These professions are nurses, occupational therapists, physiotherapists, and pharmacists.

 

The Council for Work and Health welcomes this move.

 

We would also endorse the comment that has been made by DWP that not everybody working within these professions should issue fit notes.  We agree that health professionals providing fit notes should be working in a suitable environment and have the necessary skills and training to have work and health conversations with patients.  This task needs to be within their professional scope of practice, and we note that new guidance and training has been developed which will help professionals to identify if this task is suitable for them.

 

The Council will be pleased to offer guidance on appropriate training and other advice for these groups of professionals who may now be in a position to offer advice on fitness for work.  The Fit Note represents the first line of advice; professionals represented within the Council’s membership are able to provide more specialised and a breadth of advice to employers on fitness for work.

 

The Council brings together the bodies which represent the wide range of professions that deliver health, safety and wellbeing services at work, as well as other bodies with a close interest in health and work, which include DWP.  The Society of Occupational Medicine (SOM) and the Faculty of Occupational Medicine (FOM) are  members of the Council, whose membership includes most doctors working in occupational medicine practice.  The Council also has representation from the Royal College of General Practitioners (RCGP).  The Council includes those bodies representing the health professionals who as well as doctors will now be able to sign Fit Notes, including the Royal College of Nursing (RCN), the Faculty of Occupational Health Nursing (FOHN), the Association of Occupational Health and Wellbeing Professionals (iOH), the Royal College of Occupational Therapists, the Chartered Society of Physiotherapists and the Association of Chartered Physiotherapists in Occupational Health and Ergonomics (ACPOHE).

 

We would highlight that there are many other health professionals that make a substantial contribution to health and work, also represented on the Council.  These and the other bodies with a close interest in health and work are detailed on the members page of our website at: https://www.councilforworkandhealth.org.uk/about/our-members/

 

 

 

 

The mental health and wellbeing of UK university employees

16th November 2021

The findings of our three national surveys of UK university employees (conducted between 2008 and 2014) found that the overall level of work-related wellbeing was poor. Most of the psychosocial hazards included in the Health and Safety Executive (HSE) Management Standards framework increased over time, particularly job demands, control, role and relationships, and the extent of self-reported mental health problems also gave cause for concern. Earlier this year, we were commissioned by Education Support to revisit the wellbeing of university staff and identify their support needs.

Our sample comprised 2,046 academic and academic-related employees working in UK universities. As well as revisiting the HSE hazards and other key sources of strain, we also examined employees’ perceptions of the psychosocial safety climate of their institutions, mental health and work-life balance. Some key findings include:

  • The psychosocial safety climate was typically perceived to be poor – more so than in studies of other organisations. More than three-quarters of the sample (78%) strongly disagreed or disagreed that their psychological health is considered as important as productivity.
  • University employees continue to report lower wellbeing than average for all the HSE’s psychosocial hazard categories. Job demands, support from managers and colleagues, working relationships and role clarity were all identified as requiring urgent action.  The HSE framework recognises that job control can help employees manage the demands of their work, but this has also been steadily eroding among university staff over the years.
  • The overall level of mental wellbeing found was considerably lower than population norms.Using a well-validated measure (the Warwick Edinburgh Mental Wellbeing Scale), less than one-third of respondents (29%) achieved scores indicating average mental health with more than half (53%) showing signs of probable depression. Moreover, many were showing signs of burnout, with 29% feeling emotionally drained from their work daily.
  • The pandemic was generally thought to have intensified workload pressure with key difficulties including the challenges of working online, inflexible deadlines and managing students’ expectations and wellbeing.
  • More than six respondents in ten (62%) reported regularly working over 40 hours a week and 22% at least 50 hours. Unsurprisingly, work-life balance was poor, with 36% indicating that they always, or almost always, neglect their personal needs due to work demands.
  • Respondents who reported poorer wellbeing relating to job demands, control, support, relationships and role and who worked longer hours were at greater risk of poor mental health, burnout and work-life conflict.
  • The support that was most commonly available to help employees manage their work demands tended to be at the individual level (e.g. stress management training and mental health first aid), whereas the initiatives considered to be most effective were at the organisational level (e.g. tackling stress at source, input into decision-making and feeling appreciated and respected).
  • Common barriers to accessing support for wellbeing were lack of time due to a heavy workload and an inflexible schedule and little information on what was available.
  • Seeking help for work-related stress and mental health can be stigmatised in UK universities More than half of the sample (59%) feared being seen as weak if they sought support for their wellbeing, with just over seven out of ten (71%) agreeing or strongly agreeing that it would harm their career.
  • Although respondents generally considered counselling and coaching to be helpful in supporting their wellbeing, they expressed some concerns about limited availability and a lack of insight among practitioners into their work pressures.
  • Respondents who reported being able to access a wider range of support initiatives tended to perceive a more positive psychosocial safety climate at their institution. They were also at lesser risk of mental health problems and burnout and had a better work-life balance.

 

In our report, we provide recommendations to improve the support available to university employees and ensure it is fit for purpose. These actions will help institutions meet the challenges of the COVID-19 outbreak and ‘build back better’ in terms of a healthy and satisfied workforce. The full report can be found here.

 

Professor Gail Kinman, CWH Director and Visiting Professor of Occupational Health Psychology, Birkbeck University of London and Dr. Siobhan Wray, Associate Professor, University of Lincoln.

 

 

 

 

New factsheets to help organisations and individuals meet the challenges of Covid-19

4th September 2021

New factsheets to help organisations and individuals meet the challenges of Covid-19

Professor Gail Kinman

CWH Director and Visiting Professor of Occupational Health Psychology, Birkbeck University of London

The Covid-19 pandemic has had a profound impact on the way that we live, and how and where we work. For many people it has been a time of setbacks and loss as businesses close, health is threatened, redundancy looms, and the effects of inequalities become ever more apparent. Although the economy seems to be recovering and we are gradually moving towards some degree of ‘normality’, the post-pandemic future is uncertain and little is yet known about its long-term implications for individuals and organisations. It is therefore crucial to support organisations and individuals in maintaining health and wellbeing during the pandemic and beyond and help policy makers meet the challenges they are facing.

Early in 2021, Public Health England commissioned the Society of Occupational Medicine (SOM) to organise a series of webinars and linked factsheets on the theme of ‘work, worklessness and wellbeing’. The project aimed to provide organisations and employees with practical guidance on key issues of concern during the pandemic. The project was guided by a steering group comprising leading experts and representatives from employers’ organisations. Along with the SOM, I organised these webinars and wrote the factsheets with input from the speakers and feedback from relevant bodies.

The webinars included high-profile speakers from organisations such as MIND, the Chartered Institute of Personnel and Development, Business in the Community, the British Psychological Society, the Health and Safety Executive, the Centre for Better Ageing and the Carnegie Trust. There were also presentations from leading academics in the field of work and wellbeing, business leaders and trade unions and professional associations. They were very well attended and feedback was overwhelmingly positive. Recordings of the webinars can be found here.

The factsheets have just been launched – each is informed by a review of research and provides a range of evidence-informed resources and tools to help organisations and individuals ‘build back better’.  The topics addressed by the factsheets are shown below with links to download them:

  1. Supporting businesses to build back better: The benefits of age diversity
  2. Supporting your approach to workplace diversity and inclusion
  3. Creating better quality work and workplaces
  4. Managing stress, burnout and fatigue in health and social care
  5. Supporting workplace mental health and wellbeing during COVID-19 and beyond
  6. Developing a COVID-19 secure mental health and wellbeing strategy
  7. Managing change – restructuring, redundancy, and homeworking

 

Please disseminate the factsheets via your networks.

Working safely during the COVID-19 pandemic as community restrictions ease (8 July 2021)

8th July 2021

Council for Work and Health guidance for employers as of 8 July 2021

Working safely during the COVID-19 pandemic as community restrictions ease.

As set out in their guidance at: https://www.gov.uk/government/publications/covid-19-response-summer-2021-roadmap/covid-19-response-summer-2021, the Government have announced that they intend to remove all legal restrictions to stop the spread of COVID-19 in England from 19 July 2021. This does not however change the employer’s responsibilities to provide a safe place of work.  In this guidance the Government have made clear that “Working Safely: guidance will be updated to provide examples of sensible precautions that employers can take to reduce risk in their workplaces. Employers should take account of this guidance in preparing the risk assessments they are already required to make under pre-pandemic health and safety rules”.

The Council for Work and Health, comprises members from the broad range of organisations involved in health and work.  The aim of this briefing note is to provide guidance to employers on how they can protect the health of employees and others affected by the activities of their organisation, in the context of rising levels of COVID-19 infection in the community, and the potential disruption to business continuity through loss of manpower through self-isolation.

Whereas the requirement for self-isolation for contacts who are double vaccinated and children is to end from 16thAugust (at: https://www.gov.uk/government/news/self-isolation-to-be-eased-for-fully-vaccinated-adults-in-step-4), there are likely to be significant numbers of employees unavailable due to existing legal requirements to self-isolate following notification by NHS test and Trace that they are a contact (at: https://www.gov.uk/guidance/nhs-test-and-trace-how-it-works).  Keeping transmission of infection in the workplace as low as possible will promote health of the workforce, and the business.

 

The Health and Safety Executive (HSE) guidance on making the workplace COVID secure is the principal reference, at: https://www.hse.gov.uk/coronavirus/working-safely/index.htm.  HSE intend to update this guidance on 19thJuly, but the following principles would endure:

We recommend all employers review their workplace risk assessment, to review known hazards and to identify new potential hazards to health, and any change in the likelihood of employees and others coming to harm as a result.

Hazardsinclude a biological hazard, COVID-19, and specifically the Delta variant causing the current third wave, and which is known to be more transmissible than the Alpha variant dominant until now.

In considering those who may be more vulnerable, employers may have taken advice from occupational health professionals on those people who may be more vulnerable to COVID-19.  Factors increasing risk of individuals coming to harm if infected include age, gender, ethnicity, obesity, and health conditions the evidence shows increase vulnerability, and particularly in combination.

There are also potential psychological hazardse.g. from those who have been working from home during the pandemic anxious about coming into the workplace, or those in public facing roles.

In the context of risk assessment, it is important for employers to consult with employees and/or their representatives. Where feasible coproduction of this risk assessment is likely to identify the potential hazards and the associated risk, for employees, and others affected by the organisation’s activities.

Having considered hazards and the risk posed by these hazards, risk management controls should be reviewed. These are best considered within the “hierarchy of controls”.  We are pleased to note that the Government are adopting this approach in their guidance, for example updated guidance on risk assessment for schools at: https://www.gov.uk/government/publications/actions-for-schools-during-the-coronavirus-outbreak/annex-a-health-and-safety-risk-assessment:

  1. Elimination. To stop an activity that is not considered essential if there are associated risks.
  2. Substitution. Replacing an activity with another may reduce the risk. e.g. home working. It is important to note that substitution can create another risk, and there are mental health implications that have been seen through isolation over this last year or so. There are also physical hazards, and we have seen significant numbers of people who have work-related upper limb disorder due to unsuitable display screen equipment workstation setup at home.
  3. Engineering controls. These are ways to design out risk, or to use physical means to separate people from source of the risk. This will also include ventilation, fresh air being important to reducing the amount of virus that is in the air that people breathe in workplaces.
  4. Administrative controls. These include making space between people, and although the Government is likely to remove the legal requirement for social distancing, employers may consider whether it is necessary to have all employees within the office at one time. Keeping occupancy in the workplace below pre-pandemic levels will reduce the risk of transmission, and so reduce the likelihood of employees being infected in their work, or when commuting to and from work.
  5. Personal protective equipment. With the legal requirement to wear face coverings in shops and on public transport likely to be ending, businesses can still decide whether their employees should still wear masks or other PPE in the workplace. They also may require those visiting the premises wear to face coverings where risk assessment and control measures cannot reduce risk as low as reasonably practicable. In healthcare and in care homes, this is likely to remain a requirement in these settings for the foreseeable future.

Testing. Testing is an administrative control. Employers may consider introducing twice weekly rapid home testing if they are not already doing so.  Employees can order lateral flow device (LFD) tests through the Government website at: https://www.gov.uk/order-coronavirus-rapid-lateral-flow-tests. By taking an LFD test before coming to work, this allows those people who are infected, but do not know it, to avoid infecting others.  Positive or negative results should be reported whether positive or negative each time at: https://www.gov.uk/report-covid19-result. And of course, those who have symptoms must self-isolate, and obtain a PCR test as soon as possible. Those testing positive on LFD testing should also self isolate and obtain a PCR test as soon as possible (as at: https://www.gov.uk/get-coronavirus-test).

Immunisation.Immunisation may also be seen as a risk management control. The evidence shows that the vaccinations currently in use in the UK remained effective against the dominant Delta variant, although both doses are needed to gain maximum protection (as reported on 8 Jul 2021 by the REACT study at:https://www.gov.uk/government/publications/react-1-study-of-coronavirus-transmission-june-2021-interim-results. Being double vaccinated may therefore allow those who are more vulnerable to work in a public facing role, together with other risk management controls that the employer considers appropriate following risk assessment.  However, we do not know as yet whether being vaccinated substantially reduces the risk of passing the infection onto others. Therefore until otherwise, those who are vaccinated must still “follow the rules” in the community, and in workplaces.

Communication and training. It is essential that all staff are fully aware of the rationale for the risk management controls. The effectiveness of controls may be enhanced through coproduction where this is appropriate, but consultation with employees and/or their representatives is always needed.

Review. Risk assessment and controls should be reviewed at periods that the employer determines, and specifically when the situation changes.

Professional advice.  Advice on keeping risks to health in the workplace as low as reasonably practicable may be obtained through providers of occupational health and safety services, and from human resources, workplace mental health providers and other professionals represented by the broad range of members that form the Council for Work and Health at: https://www.councilforworkandhealth.org.uk/about/our-members/.

RETURNING TO WORK AND LONG COVID

16th June 2021

RETURNING TO WORK AND LONG COVID

28 May 2021

Covid legacy will be a long journey back to work for many

Just over a year ago Covid-19 took on the global force of a pandemic. Just about every country in the world would have to bow to the devastating impact this would have on our health, our economies and our quality of life. Despite the desperate death toll there was hope as millions recovered from this cruel disease and we began to find ways to limit the spread of infection and establish a new normal. But, for many, this return to ‘normal’ has not been the journey they were hoping for, with as many as 10 % of Covid-19 patients left living with Long Covid.

What is Long Covid?

Long Covid is a diverse syndrome in patients who are still experiencing symptoms of the disease more than 28 days after testing positive for Covid-19. The symptoms affect multiple body systems with commonly reported symptoms including fatigue, shortness of breath, muscle pains, chest pain, cognitive impairment, headache, and psychological disorders. It is difficult to predict who will develop Long Covid but what is clear is that it is more likely to be seen in people with pre-existing health conditions, who are over 50, obese, female and have had more than five Covid-19 symptoms.

Work and Long Covid

This is a debilitating condition and a patient’s health will fluctuate as symptoms progress or resolve.  Healthcare requires a multidisciplinary team approach focused on rehabilitation and symptom management. The NHS has established nearly 70  Long Covid clinics and several occupational safety and health organisations, including IOSH, have developed guidelines to assist managers with the return to work (RTW) process.  A significant aspect of this journey back to work is assessing a worker’s ability to assume their normal work, with attention given to those with unresolved cardiac, respiratory or neurological symptoms. Long Covid symptoms affecting the ability to cope at work include shortness of breath, fatigue, brain fog and chest pain. Whether it is physical restrictions (shortness of breath) or cognitive impairment (brain fog), you are managing workers who may be unable to cope with work for entirely different reasons, necessitating an individualised approach to care.

So, it is important to include the line manager and the worker in in decision making. Ask the worker for suggestions on working life adjustments (such as working from home, flexible working hours etc) to facilitate RTW. Address the mental health issues through good communication and provide realistic reassurances and advice where necessary. A worker may experience highs and lows and functionality will need to be monitored regularly to accommodate these transitions.

What does the future hold?

The impact of Covid 19 has been massive and its legacy will continue to be felt through Long Covid. It is not clear how long it will take workers to fully recover from Long Covid but there’s a real prospect we’ll have to manage the safety and health of workers with Long Covid for years to come. Successful integration into the workplace will very much call for a collaborative approach, with the wellbeing of the worker, the patient at the centre.

Further information

 

Dr Karen Michell

Research Programme Lead Occupational Health

IOSH

Council for Work and Health: statement on Long Covid

3rd June 2021

Council for Work and Health statement on Long Covid

For people with Long Covid, there needs to be workplace support for return to work.  There needs to be sustained joined up services to assist people with Long Covid who are at work to stay at work, through medical, biopsychosocial and workplace support and vocational rehabilitation.

Many employers have gone above-and-beyond to make sure their staff feel supported as the pandemic has unfolded, and this is essential for people with Long Covid who may benefit from slower graduated returns and ongoing accommodations due to their fluctuating symptoms.  Such support is the right thing to do after the pandemic but may also help organisations avoid talent leaving the workforce and even legal challenge.

We are particularly concerned about the impact of poor management support due to a lack of knowledge, skill and resources to effectively manage people with Long Covid.  Good line management of people with Long Covid is crucial. 

Employers have a duty of care to their staff and now more than ever, every employee with Long Covid needs to be treated with compassion, to be listened to and supported through difficulties that Long Covid presents with. 

As Long Covid is a new health issue, the patient perspective is particularly important e.g. with care taken on physical exertion until appropriate diagnostic tests have occurred.

The Council asks for evidence-based NHS services for people with Long Covid, across the nations of the UK that works with occupational and vocational rehabilitation specialists on return to work. 

The Council also wishes to ensure Long Covid is prevented, fundamentally by avoiding Covid-19 transmission. It notes the risk of workplace transmission at work.  The hierarchy of controls and effective risk assessments remain essential to keep the likelihood of exposure to COVID-19 as low as possible.

Resources:

 

A staggering 1.4 million people in the UK suffer from work-related ill health.  Occupational Hygiene professionals play a vital role in preventing work-related health problems through their expertise in identifying, assessing and applying appropriate controls for many work-related health risks.  Prevention is always better than cure.  Working with the Council helps us to ensure this principle is promoted.  

Dr Simon Festing, Chief Executive Officer BOHS