Beyond a 'sick note' culture

Britain is signing people off work, then writing them off. Here’s how we fix it. By Professor Neil Greenberg leading clinical psychiatrist, workplace mental health expert and President of the Society of Occupational Medicine.

Professor Neil Greenberg (c) Society of Occupational Medicine

Professor Neil Greenberg (c) Society of Occupational Medicine

One 10-minute GP appointment can end up shaping whether someone stays in work for the next 10 years. After more than two decades working in mental health, including with the armed forces, I have seen how often people reach that appointment only after months of struggling.

Picture this: you've been battling with mounting work-related stress and anxiety for months - eating away at your sleep, quality of life and work performance. Eventually, you book a GP appointment, and after a considerable wait, you get 10 minutes with a doctor who understands your symptoms, but knows very little about your workload, working environment or relationship with your manager. Too often, the result is a sick note signing you off work for a month.

You return to work, but nothing has changed. The stress and anxiety also return. The cycle repeats. You fall behind, lose confidence and become increasingly isolated. Your manager wants to help but does not know what adjustments to make. Feeling completely detached from work, you decide the easiest option is to resign.

You probably know this story: it's happened to a colleague, friend, family member - or perhaps you.

This autumn, as millions of people return to work, we should be asking a bigger political question: why are so many people still falling out of work because of ill-health?

Around 2.8m people are economically inactive because of long-term sickness. Meanwhile, sickness absence remains three times higher in the NHS than in the private sector, with staff absence directly affecting the ability to deliver care. This is not simply an NHS problem or a workplace problem. It is a national economic difficulty too.

We cannot eliminate lengthy waiting lists while the NHS is losing staff to ill-health and absence. Nor can we expect people waiting months for treatment to navigate their way back into employment without occupationally focused advice to help them, and their employer, understand what they can safely do at work while they recover.

GPs are trained to diagnose and treat illness; most have no occupational health expertise at all. Employers are expected to manage productivity, performance and attendance, but often lack the expertise to determine which adjustments might help someone with a health condition work safely and effectively. Occupational health - the profession linking health and work - is available to only about half of the UK's working population. Employers often ask for occupational health advice only after someone has been absent for a long time, making a return to work far harder.

If someone is becoming unwell because of excessive workload, poor management, unsafe staffing levels or an unhealthy organisational culture, the answer cannot simply be to teach that individual how to cope better. Employers have to look upstream to change the conditions that are making people unwell. However, for people facing personal or financial strain, or chronic loneliness, work can be a lifesaver if employers make simple, reasonable adjustments to their roles.

Occupational health can provide the missing link between someone's health and their ability to remain in work - supporting GPs, employers and employees. These professionals can help determine whether someone can work, what adjustments they may need and how they can return safely. That might mean temporarily reducing hours, changing shift patterns, modifying duties or redesigning a role. Early intervention is not just about keeping people in jobs at any cost; it's about identifying what prevents someone from working and whether that barrier can be removed.

It's no secret that Yvette Cooper's hands are full with waiting lists, social care, maternity, mental health and access to GPs. Occupational health must be seen as part of the solution to several Government priorities at once: helping people remain economically active, reducing avoidable pressure on the NHS and preventing longer-term dependence on welfare or care.

That should start with the NHS itself. The 10-Year Health Plan commits to staff treatment hubs and universal access to occupational health. As part of our Healthy Staff, Better Care campaign, we are calling on the Government and NHS leadership to simply deliver on their promises.

As we await the next iteration of Alan Milburn's work on economic inactivity, the Government has an opportunity to join up two challenges that are too often treated separately: the health of the workforce and of the NHS. Stronger occupational health provision, particularly for smaller employers, alongside much better links between employers, GPs, occupational health and employment support, is a critical starting point.

Britain must get better at acting when somebody first begins to struggle, rather than waiting until they are seriously unwell, on a waiting list and disconnected from work. Health and work can no longer be treated as separate problems. The goal should be to intervene before someone falls out of work, and with effective occupational health advice, that goal is highly achievable.

 

 

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