Dr Teck Khong is a Leicester GP and a forensic physician for
Northamptonshire Police who contested Bradford North at the 2005
General Election and remains on the Approved Candidates' List. Here he critiques the drive by the Department for Work and Pensions to
reduce absenteeism and sickness benefit claims with the "Fit Note".
No one would deny that we need to tackle abuse of the benefit
system; but the Labour Government's strategy to deal with the economic
impact of unwarranted sickness leave with the "Fit Note" – due to be implemented today – looks set to create a huge range of difficulties and hit the vulnerable in our society.
Although sound clinical judgement is made in estimating the most
likely time for sufficient recovery from a condition to enable a return
to work, the reality is not so straightforward. Even clear-cut cases of
specific illnesses have variations in recovery times depending on the
severity of the condition in each case, the ability of the individual
to recover, any associated complications and any unexpected interceding
event. There are, of course, the more nebulous conditions without
objective and demonstrable pathologies that vex both GPs and the
Department for Work and Pensions and cost the country heavily with
dubious validity of the claims.
With the Fit Note, a new feature not found in the sick note is the
option of graded return to work. The difficulty then arises regarding
what constitutes an appropriate gradation of workload increase. What
are the implications of omitting a phased return to work or advising a
phased return that is too rapid and an accident happens or health
deteriorates as a result? I was medical officer to a major bus company
that operated an all-or-none policy – either a bus driver was fit for
work or was unfit; the manager informed me he was not prepared to take
risks with partial working with the connotations of incomplete
recovery. With the launch of the Fit Note, it is inevitable that the GP
will be drawn into a legal minefield.
Two distinguishing features of the Fit Note are recommendation for
amended duties and altered hours. With the former, colleagues are
uneasy about advising amended duties as they are not trained in
occupational medicine or fully cognisant of the situation at work. On
the latter, a GP could not refuse a request by a night shift worker to
undertake only daylight duties to help with sleep disturbance and
depression and that could involve a discussion with the employer. The
employer might then have to make adjustments to his workforce planning
and productivity. But what if other employees similarly claim that
night shift also causes them to feel unwell?
Perhaps the most controversial element of the Fit Note is workplace
adaptation. Most GPs are not qualified to recommend employers workplace
adaptations, and apart from safety issues, GP involvement in deciding
changes in the workplace could lead to conflict with employers over
legal and financial implications. Already, many firms are struggling to
survive in the present economic crisis and making modifications however
minor may ruin their viability.
Unless new jobs come on stream, the loss of income for many people
will be ‘medicalised’ adding to the economic burden. We have seen how
communities were affected with the decline of the steel and coal
industries. This single-parent 45-year-old ex-food factory packer who
requested a sick note epitomises the flaws of the benefit system:
“Doctor, the lady at the Benefit Office advised me to
see you for a further sick note to continue receiving payments as I
haven’t found a job in six months. There aren’t many jobs around and no
one would employ me with a past history of backache. I know what you
say about my condition and I admit I feel a lot better but I will lose
my benefits, my house will be repossessed and my family will suffer. I
am now getting depressed and if you don’t give me a sick note to say I
have backache or depression, I will have to find another GP.”
There has to be a sea change of social values, particularly with
regard to the work ethic, and the sick note should be strictly that and
not used as a financial security net. The next government, hopefully a
Conservative one, should not only be careful in refloating our economy
but it must also introduce policies that influence a shift away from a
culture of dependency; it must show courage to change for the better.
The inculcation of moral and civic responsibility is long overdue.