A welfare 'revolution' has begun to whirl through Whitehall with Osborne, Grayling and IDS all hurrying to
slash the millions that are spent on Incapacity Benefit through re-appraisals of recipients ability to work and moving them onto 'active' benefits that require them to look for work. That is the right thing to do as there are scroungers who have been fleecing the treasury for years. But there are also those who have been utterly failed by our health-care system. They have not received the support they needed from their doctor or employer, or been denied the apposite medication. Left without the early intervention that could have kept them in or got them back to work quickly, a short term health investment in support has turned into a long term welfare cost.
2020health launched their latest report this morning Health, disease and unemployment: The Bermuda Triangle of Society with a salient reminder that sick people require quick and appropriate health-care in order to keep them in or get them back to work. It's a two-way street: you need to be healthy to be in work - but work usually has a positive impact on people's health as well. The link between unemployment and poorer health is well established. People with chronic conditions who have not had the necessary support then get caught in a downward spiral of unemployment, deteriorating confidence and poorer health. At our round table round-table debate we discussed the vitally important mindset change that needs to take place amongst the NHS workforce: getting people back to work as quickly as possible should be a measurable clinical outcome of successful treatment.
Dame Carol Black has been the pioneer in this field and continues to lead the joint working between the DWP and DH on Health,Work and Wellbeing. The 'Fit note' that replaced the 'sick note' was her idea and it is a really positive way of encouraging GPs to think about what work people can do, rather than just signing them off work. However there remains a gulf between most clinicians at the frontline and any employment services. The high level joint working approach achieved by Dame Carol needs to reach those actually working closely with those who become ill, many of whom are desperate to get back into work.
There is no silver bullet, but the transformation of occupational health, a progressive approach from company's HR departments, inclusion of occupational training in the post-graduate medical curriculum and ensuring existing Health and Safety rules on stress reduction in the workplace are enforced are all steps in the right direction. Public health needs to reach the workplace if we are going to have the workforce we need and spending on welfare-to-work must be partly funded by the health budget if health professionals are going to take a 'healthy workforce' seriously.
