Fit for Work Scheme - Question for Short Debate

– in the House of Lords at 7:36 pm on 19th October 2016.

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Photo of Lord Young of Cookham Lord Young of Cookham Lord in Waiting (HM Household) (Whip) 7:36 pm, 19th October 2016

My Lords, as this is now last business, the time limit has been extended to 90 minutes and the limit on individual speeches to 10 minutes.

Photo of Lord Luce Lord Luce Crossbench

My Lords, I am most grateful to the Minister for replying to this debate and to all noble Lords who will be offering their distinctive contributions. In July 2010 I led a short debate asking the Government what was being done to provide access to multidisciplinary pain management services in the NHS for those suffering chronic pain. Since then, the work of the Chronic Pain Policy Coalition and other specialist bodies has ensured progress, but it has been too slow.

I have suffered from chronic pain, caused by musculoskeletal problems, for more than 45 years. Thanks to prompt and effective support from private sector specialists in partnership with NHS doctors, I have been fortunate enough to be able to perform a wide variety of public responsibilities. Many people with chronic pain do not have the same opportunity to find effective support to keep them in work. I want all who suffer to have sufficient support to enable them to stay in or return to work after absence through sickness.

The latest available research, published by the British Medical Journal, estimates that 8 million adults are living with chronic pain serious enough to prevent them from working or participating in normal everyday life. Moreover, the research estimated that over 40% of the population suffer chronic pain at some stage in their working lives which will affect their ability to work. This evidence makes it clear that it is not only the individual who suffers but society as a whole.

Society needs the maximum number of productive years from as many people as possible. The ratio of earners and wealth generators to dependants—children, pensioners, the unemployed—should be as high as possible, because those not working depend on those who are. Fortunately, people are living longer and retirement age is becoming more elastic. Individuals can contribute to the labour force for longer, so long as they are sufficiently well, mentally and physically, to work. I therefore welcome the Secretary of State’s recent letter to me confirming that a Green Paper will be published before Christmas to consult on ways to ensure that government support meets the needs of people with health conditions in the workplace, and their employers.

It is shocking that the employment rate for adults with long-term conditions that affect their daily lives is only 46%, compared with 73% for the whole working-age population. The major long-term conditions include pain, musculoskeletal problems, stress and anxiety. Two major policy initiatives since 2008 have been the fit note and the Fit for Work service. Both are intended to enable sick individuals to return to work as soon as possible, with appropriate support. Early intervention is crucial to prevent a slide towards the benefits system. I know that the Minister is strongly committed to the Fit for Work service. I am giving him an opportunity to explain how it is developing and can be helped to succeed. Its effectiveness is something noble Lords will wish to probe.

Let me look briefly at the evolving history of sickness absence and its effect on society. In 2010, after 50 years of the sickness absence system, the Government replaced the sick note with a fit note. This was based on Dame Carol Black’s report, Working for a Healthier Tomorrow. This note enabled GPs to focus for the first time on a patient’s capacity to return to work, rather than their incapacity and the frequently repeated description “sick”.

In 2011 came the publication of another report, Health at Work—An Independent Review of Sickness Absence, by Dame Carol Black and Mr David Frost. In 2013, the Government accepted their main recommendations: to establish a health and work advisory assessment unit and to introduce a Fit for Work service—government funded and designed to help workers with ill health. It includes an occupational health work-focused assessment for employees who are off sick, or likely to be so, for four weeks or more and an advice service for employees, employers and GPs. It is now fully rolled out so that GPs and employers throughout Britain can refer patients or employees to it. This service has the potential to fill a massive gap in current provision.

I want to take this opportunity to highlight my belief that this early intervention scheme is needed. Its success could bring enormous benefit to society, and some statistics will illustrate the point. Overall, working-age ill health costs the economy more than £100 billion, including lost productivity, sickness absence and other costs. The latest figure available on chronic back pain, from 2000, shows that it cost the economy £10 billion; it will therefore be far higher now. We also know that 900,000 people are absent through sickness for four weeks or more each year and that more than 25% of the working population have a long-term condition or impairment, particularly in the 40 to 55 age group. We know that more people want to work past pension age, which will inevitably mean many more with long-term health conditions at work. Chairing recently two Westminster Employment Forum seminars on this subject, my attention has also been drawn to something called presenteeism, where a large number of employees are not working to full capacity due to their lack of health and well-being.

All this means that society suffers. Employers face a loss of productivity; the nation spends considerable sums of taxpayers’ money; and last but most important, the quality of life of many individuals is seriously undermined. Being out of work jeopardises any individual’s self-esteem and morale. So I ask the Minister: what is working well, and how can the service made more effective?

A number of questions arise. GPs and other health professionals seem to lack awareness of this service, so is it publicised enough? Do GPs realise that their workload will be reduced by referring more patients to the occupational health service? Is there enough face-to-face contact for employees, in addition to the initial telephone advisory service? Do employees know that they can get help after four weeks off work by asking their GP or employer for a referral?

There are some successful examples of large companies helping affected employees. BT has helped some 30,000 people in the last eight years. I have heard that Anglian Water has achieved a return of £3 for every £1 spent in helping an employee and the Royal Mail a return of £5 for every £1, cutting absence by 25% over three years. But the Fit for Work service was intended to make occupational health advice available nationwide. This is difficult when, as I am told, there are only some 4,000 occupational health professionals, compared to more than 45,000 GPs and physiotherapists. What number of specialists are needed to provide a nationwide Fit for Work service? It would be helpful if the Minister could say something about progress on these matters, especially how the service is currently supporting small and medium-sized enterprises, which are less likely to be able to employ their own health specialists.

A major question arises: how well equipped is the NHS to give adequate professional support for those with long-term illnesses? I can speak only about chronic pain and muscular-skeletal issues, while other noble Lords can no doubt speak of other areas. Patients with chronic pain need to learn how to manage their pain and to know to what medical support they can turn—which may include physiotherapists, osteopaths, acupuncturists, psychologists and so on. A wide range of things can be done to keep us active and positive but many areas have inadequate or no multidisciplinary support for chronic pain. There is still a long way to go.

However, given an effective Fit for Work scheme, most suffering employees can be helped to stay in or return to work. Everyone stands to benefit: the individual, the employer and the nation. I congratulate the Minister on introducing this scheme. Would he be prepared for me to bring a small team from the Chronic Pain Policy Coalition and other interested Peers to discuss this scheme in more detail with him and, if possible, with Department of Health officials? I look forward to the Minister’s response.

Photo of Lord Fink Lord Fink Conservative 7:46 pm, 19th October 2016

My Lords, I thank the noble Lord, Lord Luce, for introducing the important topic of helping and enabling those with long-term health problems to return to or stay in work. I know that he identified chronic pain as a major category of health-related issues but those of us who have looked at some of the statistics know that mental health problems, as well as untreated drug and alcohol addictions, are also major causes of long-term health problems and unemployment. I believe that any effective initiatives that help society to deal with these problems are most laudable and I too congratulate the Minister on introducing these measures.

Traditionally, the first or only point of call for someone with such a health problem was the family GP. I know from direct experience how overworked our GP service is and while it usually does a good job in identifying and often in treating common health problems, particularly acute ones, its ability to help manage long-term chronic ones, particularly in the difficult areas of mental health, is rather more sorely tested—especially as a typical appointment with a doctor lasts less than 10 minutes.

As an employer, I also know how difficult it is to deal with employees who have chronic health problems that subsequently lead to extended time off work. Sadly, while many employers show compassion, some—particularly small businesses which have limited staff resources and important deadlines to work to—may focus more on the needs of the business than their employee’s needs. Indeed, many small companies will not even have personnel departments to help them deal with the balance between showing the right compassion to the employee, respecting all of that employee’s legal rights and the difficult job of meeting the business’s needs.

As I understand it, while it is not a direct replacement of the traditional sick or fit note the Fit for Work initiative provides an integrated service, helping to improve health outcomes as well as employment outcomes by supporting both employees and employers. Given how much I believe that work is a great therapy that generates a sense of self-esteem, such esteem and purpose can help to offset many health problems such as depression. It can even take people’s minds off pain. Indeed, long-term unemployment and depression can cause a vicious cycle, with negative effects on society in general and potentially devastating effects on the individual and his or her family. I look forward to hearing my noble friend the Minister describe the progress that the scheme has achieved.

Photo of Baroness Thomas of Winchester Baroness Thomas of Winchester Liberal Democrat 7:50 pm, 19th October 2016

My Lords, the noble Lord, Lord Luce, has done us all a service by highlighting this little-known scheme which was launched two years ago. The aim of the scheme is admirable and should help both the employee by facilitating a return to work and the employee’s GP by preventing them having to write out yet more sick notes. At this point, I shall say how nice it is to have a different cast of characters speaking about DWP matters. I am sure the noble Lord agrees that it is very good when more people engage with DWP matters.

One only has to look at press comment about the scheme to see where some of the problems lie. When it was introduced, press headlines made it sound like a mandatory scheme, which it is not, to force sick employees back to work. I fear that a lot of damage has been done within the past decade by press comment ramping up the “shirkers and scroungers” mentality, thus tending to make those quite legitimately on sick benefits feel like frauds. The very title of this scheme—fit for work—sounds so like yet another assessment while a person is off sick that it is little wonder that some people may be getting the wrong end of the stick. Perhaps the scheme should be renamed and relaunched. I agree with the noble Lord, Lord Luce, that more positive and better publicity is certainly needed, not least because the number of referrals is well below what was expected.

The first problem is that the scheme is not known about nearly enough by employers and employees. The second problem is whether four weeks is too long an absence before a business can request help from the scheme. I gather that GPs can refer both earlier and later. Four weeks might be too long for employers, considering that the scheme is not mandatory. Perhaps there could be some flexibility.

Looking at the scheme itself, I understand it is to complement existing occupational health provision, where it exists, but we know that it exists only in large firms. We have heard about some of them. It will not exist in small businesses, where the bulk of employment lies. Small businesses are unlikely to know about the scheme. For that reason, I hope it will become much better known.

If the scheme is taken up, a telephone assessment will be undertaken by an occupational therapist—an OT—in the first instance who will prepare a return-to-work plan. Having taken advice from some OTs working in central London hospitals who have experience of treating those with long-term neuro or neuromuscular problems, I shall share their comments, which seem to me to be sensible and practical. The first thing they say is that OTs with a nursing or medical background often give general advice on what a person can or cannot do without giving more creative advice about how a person might adapt their usual way of going about things. In other words, a more specialised OT might know from experience how to find a way around a difficulty. Perhaps specialised advice should be sought by some of the more general OTs.

My advisers also wonder what medical notes the fit for work scheme advisers have access to. If the answer is that they do not have access to such notes, then is an employee with complex needs going to be well served? Another problem is the telephone assessment. A lot of people do not like talking about confidential medical matters on the telephone. I know that face-to-face assessments are possible for those with complex conditions, but the travelling time to these assessments might be as much as 90 minutes. I wonder whether that will be having an impact on the take-up of this scheme and whether home visits are possible.

Then there is the problem of disclosure. A lot of employees, especially those with long-term conditions, will be very cautious about talking with a stranger about medical matters that might be shared with an employer. This last point is also one which is likely to apply to those with a mental health problem. The workplace mental health support service run by Remploy, which was set up to help those in work with a range of mild to moderate mental health problems, is slowly becoming more accessible and better known, and is, of course, part of access to work. Perhaps the Minister will tell us how this service fits into the scheme.

That brings me to the difficult question of the quality of assessors. My OT advisers are much too polite to make trenchant comments, but even they doubt whether there are enough well-trained, experienced OTs throughout the country to ensure enough consistency in assessments and advice. Are we spreading the available pool of OTs too thinly? Are more being trained for these and all the other assessments? If these problems I have mentioned could all be addressed, then I am sure the scheme would be much more successful.

As I have a minute more, I shall quickly make a point about chronic pain. It is a huge problem for a lot of people. It is reported to affect around 8 million adults. It is also reported that chronic back pain alone costs the country about £10 billion per annum. There is anecdotal evidence that the right degree of physical exercise can be beneficial. The noble Lord, Lord Luce, the Minister and I have talked before about the benefits of hydrotherapy for people with all kinds of severe musculoskeletal problems. Sadly, there is a terrible lack of hydrotherapy provision round the country, and hospital pools are closing for lack of money to maintain and staff them adequately. Considering that warm water exercise is beneficial for so many conditions, I wish the Government would give it their backing. I look forward to the Minister’s reply.

Photo of The Bishop of Derby The Bishop of Derby Bishop 7:57 pm, 19th October 2016

My Lords, I, too, thank the noble Lord, Lord Luce, for introducing this debate with his characteristic mastery of the territory, context and issues.

I shall look at the progress of the Fit for Work scheme. As the noble Baroness, Lady Thomas, hinted, there has been a lot of negativity. I remember that when it was first introduced the press called it a test about whether people were fit for work. There have been pilots and a lot of chunter about the slow development of the rollout. We need to remember that it is a huge shift for the medical professional, employers and employees, and we need to encourage the Government to look carefully at the rollout to see what can be learned as it unfolds. As the noble Lord, Lord Fink, mentioned, there may be issues about how small businesses can access this opportunity.

I want to endorse the important potential of the scheme. Many of us know that when people fall out of work—and the problem is doubled, in a way, with ill-health factors—there are often issues with isolation, depression and not being in the social environment from which we human beings gather our identity and energy. When they feel excluded, people need to recognise that there is the possibility of inclusion in the future. That is why this scheme is so important and significant.

To try to draw that out, I shall offer an illustration from my work as a priest. I work with lots of individuals, including people with terrible, chronic, long-term pain and illness, and I also work in communities. I shall offer an analogy. We spend a lot of money in communities over many years and do not see many results. We pour it into outer estates, inner cities and needy groups, and 10 years later they want another round of grants and we wonder what has been achieved.

Noble Lords will know that there has been a recent move towards what is called “Asset Based Community Development”. That means that if you try to develop a community by putting in things and adding value, you will discover what assets are already there in the people’s gifts and in their interests, so that the people who live in a place or in a project own what is offered and imbibe it. It then becomes part of them and the whole thing involves people standing on their own feet and participating in the growth and development of their community.

The Fit for Work scheme could learn something from this, because there is a danger as the scheme unrolls—as the critics rightly say, it could be improved here and there—that we will develop an ever more sophisticated bureaucracy: we will tick that box, offer that service and make this available. But the whole point is to allow individuals who are suffering, and feeling isolated and possibly depressed, to own the possibility, with the scheme, of having their gifts and contribution recognised and to be given a platform, as the noble Lord, Lord Luce, said so eloquently, to participate in the world of work, in society and in business.

It would be very interesting if the Minister would reflect on this fact. As we learn from the pilots and the scheme is rolled out slowly and carefully, how can we enable the scheme, through the training of medical people and employers, to have the flexibility and the sensitivity to recognise that each person is an asset, as the noble Lord, Lord Luce, said? We should not just make them go through a scheme but enable them to feel, “I can participate in ways that suit my chronic pain”—or back injury or whatever it is—“and still make a contribution and still be included”.

It is all about pace and timing. The danger of any scheme is that it gets its own bureaucracy and it rolls on. That is why community development so often does not work. But if you can adjust the pace and the timing to allow creative participation from the individual concerned, the investment will be much more fruitful, there will be a much higher chance that people will get back into work in a strong way, and the scheme will flourish.

That is a massive ask of the Government and of those running the scheme: I recognise that. But I would invite the Minister to share his reflections on what we can learn from that asset-based approach, and on how the Government can ensure that those who administer the scheme can be as highly trained as possible to have that sensitivity and flexibility to allow the individual to be involved in the process and to be an asset in their own precious way so that they have dignity at work and a long-term future in it.

Photo of Baroness Walmsley Baroness Walmsley Liberal Democrat Lords Spokesperson (Health) 8:02 pm, 19th October 2016

My Lords, I, too, congratulate the noble Lord, Lord Luce, on initiating this debate and I echo his call and that of other noble Lords for the benefits of the Fit for Work scheme to become more widely known. It really is mad that this great network of provision has been set up at great expense but that so many of the people who should know about it, especially GPs, do not make use of it.

I was so glad that my noble friend Lady Thomas of Winchester and the noble Lord, Lord Fink, both mentioned people with mental health problems. As the noble Lord said, they are often the primary cause of people being away from work for a long period, but I am sure we all know that many people who have chronic pain or another serious condition also have mental health problems that need to be addressed. I ask the Minister: what training do the occupational health advisers in the scheme have in identifying the mental health aspects of a person’s absence from work and in signposting those people towards treatment that will help them overcome it?

I will concentrate my brief remarks on the issue of chronic pain. As we have heard, 8 million adults report chronic pain that is moderate to severely disabling, such that it prevents them working or living a normal life day to day. But many more people live with lesser levels of chronic pain. The incidence is, understandably, much higher in the older age groups. However, few of those people are likely to be in work and are therefore not affected by the Fit for Work programme that we are debating. However, it often prevents them volunteering in the way that they would like—and we all know how important older people are in that capacity. Most charities would fall apart without them.

In the working-age group, one of the conditions that produces chronic pain is fibromyalgia. I know something about this because a member of my family suffers from it. It is incurable and variable. She had such a level of pain and stiffness as to make it impossible for her to carry on with a job in the public service that she very much enjoyed. Eventually she was forced to take early retirement, which penalised her financially until she reached pensionable age. I know that her employer was very sorry to lose her, and I wonder whether she might have been able to carry on if the Fit for Work programme had been available at the time.

However, the rules of Fit for Work, as I understand them, are such that you are not eligible unless you have been, or are likely to be, absent from work for four weeks. I happen to know that my relative, although she suffered a lot of pain at work, did not have long periods of absence. But in the end, she found it just too difficult and retired early. I suspect that many people like her soldier on with a stiff upper lip, taking stronger and stronger painkillers, perhaps performing well below their capacity and not enjoying life at all. In many cases the employer, too, will suffer from their reduced productivity. I wonder whether more people could be helped if the scope of the programme were expanded to help people stay in work, rather than just to return to work from sick leave. Back pain is so common that I would be very surprised if there were not hundreds of thousands of people working below their full capacity because of it.

My family member worked in the public service and did not have an occupational health department to turn to. The Fit for Work programme fills that gap and is aimed at small and medium-sized businesses that often do not have the resources that are available to big corporates. But the point must be made that public service workers often do not have that, either, because they are scattered in smaller units around the country.

Occupational health professionals can often identify the obstacles that prevent a person returning to work or working at full capacity, and can avert the need for them to leave their job. Indeed, I suspect that these professionals would have a lot more clout when negotiating with employers about reasonable adjustments that could be made than the employee herself or himself. It would seem sensible and desirable that, just as reasonable adjustments must be made for workers with a disability, employers should also be prepared to make reasonable adjustments to help people with chronic pain retain their job and help the employer retain an experienced worker.

I am afraid my remarks have gone somewhat wider than the Fit for Work programme, but I think what I am calling for would also achieve some of the Government’s objectives in setting up the scheme—for example, helping workers, improving productivity and increasing the tax take. I wonder therefore whether the Minister can tell me what action the Government are taking to widen the net and provide more help to a broader group of workers who are living with chronic pain but who keep calm and carry on in the good old British fashion.

Photo of Lord McKenzie of Luton Lord McKenzie of Luton Shadow Spokesperson (Work and Pensions) 8:08 pm, 19th October 2016

My Lords, this has been an informed but brief debate and we should be grateful to the noble Lord, Lord Luce, who rightly prompted us to seek an update on the Fit for Work scheme, which has now been under way for more than a year. The particular focus of the noble Lord—and of others—was on chronic pain, for the reasons he outlined. The noble Lord also, in common with a number of other contributors, made the point forcefully that the service is as yet not well known.

The service has a direct link to the work of Dame Carol Black, and in particular to the analysis that she undertook, together with David Frost, that looked at sickness absence in the UK. Its focus on the period when people first became vulnerable to disconnection from the labour market was an important development and a component of emerging strands of policy that spanned Governments. Introduction of the service followed a series of pilots between April and June 2010 which looked at different ways of supporting employees in ill health to stay in or return to work after a period of sickness absence. These pilots grew out of Dame Carol’s review of the health of Britain’s working-age population, which showed the staggering annual economic cost of ill health in working days lost and worklessness to be over £100 billion.

Over recent years, the understanding of the relationship between work and health has changed and indeed improved. We have moved away from the notion that it is always in the best interests of someone with a health condition to be absent from the workplace. Being in work is good for health, and worklessness leads to poorer health—including mental health, a point noted by the noble Lord, Lord Fink. Hence the need to promote the benefits of work to health for individuals, employers and healthcare professionals, a proposition most strongly advanced by Waddell and Burton.

However, there is a need to go further. Bringing the expertise of health professionals directly to bear in support of individuals who are off sick or in danger of being so is something which we support. This is what the Fit for Work service is seeking to do. It is an early intervention, involving a referral after four weeks of sickness—although the noble Baroness, Lady Walmsley, made an interesting point about the relevance of that—for an assessment from a GP or, if not, potentially from an employer. That assessment should lead to a return to work plan. So far, so good, but we need to take stock to see how it is all working out in practice. I have some questions, some of which overlap those presented by other noble Lords. In England the service is contracted to Health Management Ltd. Can the Minister say something about the qualifications of the individuals allowed to deliver these services? What range of qualifications does this cover and what review of quality is being undertaken?

It is understood that the contract is for five years, at an initial value of something like £132 million, although this may have been increased. Can the Minister say how many Fit for Work interventions it is expected this would cover, and can we have an update on how many referrals have been made to date? Can the Minister say what level of referrals was anticipated when the contract was entered into?

Press comment, as others have noted, has suggested there is some confusion about the interpretation over the referral guidelines, at least so far as GPs are concerned. Is the Minister aware of this and can he say what the problem is? A DWP study apparently suggested GPs are likely to refer some 36% of their eligible case load to the service, but referral rates in practice vary. Why is this? The process involves at least the first assessment being undertaken by phone rather than face to face, and the nature of the assessment is determined by the occupational health professional. How many assessments are undertaken face to face and how many by phone? It is understood that a re-referral cannot be made within 12 months of a previous one where a return to work plan has been agreed. What is the position where an assessment is under way? Is it an iterative process, with potentially several telephone calls and meetings until a return to work plan is agreed? What is the experience of eligible employees who refuse consent for a referral? What information does the service hold on the outcome of return to work plans, in particular on whether they lead to long-term, sustainable, positive outcomes? The right reverend Prelate the Bishop of Debry offered an interesting parallel with asset-based community development and the potential that offers the Fit for Work service.

The Question of the noble Lord, Lord Luce, specifically refers to long-term, chronic pain, but of course the service is also available to those with a mental health condition. Can the Minister give us an update on the levels of referral for such individuals? Are such assessments always undertaken on a face-to-face basis, at least initially? It has also been reported that the Fit for Work service is less well used by SMEs, a point that a number of noble Lords made. Is this the Government’s understanding, and what amendments might be made to the service to address that?

The Fit for Work service notwithstanding, major challenges exist. As the Work Foundation report due to launch next week sets out, managing a long-term health condition while also working is a challenge. People who experience multiple long-term health conditions have poorer outcomes from a range of employment-related conditions, which is perhaps not surprising. The Work Foundation reports that one in three current employees has at least one long-term health condition and that 42% report that their health affects their work. This, together with the stigma of discrimination associated with poor health, is argued to be a major contributor to the gap in employment outcomes.

We know that mental illness has a substantial and highly detrimental impact on employment outcomes when it occurs on its own, but an even greater impact when it occurs alongside a physical health condition. Nevertheless, it seems clear that for many people with multiple, long-term health conditions, work is a positive part of their lives. The question is what the Fit for Work service contributes to helping them remain in work. More needs to be done, as noble Lords have said, to enhance awareness of what it can do.

Photo of Lord Freud Lord Freud The Minister of State, Department for Work and Pensions 8:16 pm, 19th October 2016

My Lords, I too thank the noble Lord, Lord Luce, for introducing this debate. I have spent a lot of time trying to get the service in, and it is absolutely vital that we have this kind of support for people, to stop the inflow at a time you can do it. That is what this service is designed to do. I also acknowledge the noble Lord’s concerns about employees who are facing long-term sickness absence. We debated it quite some time ago now, I think when the independent review of sickness absence report, led by Dame Carol Black, came out. I hope I will be able to answer the bulk of the many questions that noble Lords have asked me.

I start by giving a picture of how the workforce in Great Britain has been affected by long-term sickness absence, a set of figures that has been touched on. In 2015, 139 million days were lost to sickness absence, and the independent review in 2011 on this came out with a total cost figure of £9 billion in sick pay and associated costs, with the whole cost to the economy running at £15 billion. Many noble Lords here today will remember that a significant proportion of sickness absences result from musculoskeletal conditions such as back or knee pain. The other big factor is mental health conditions, such as stress, depression and anxiety. Clearly, the fact that we have an ageing workforce adds to the necessity of having really good services in place to help those affected by health conditions to go back to work or to remain in work. As people are now living longer and healthier lives, it is vital that occupational health services are accessible for such workers so that they can continue to live at a better, healthier standard. The noble Baroness, Lady Thomas, asked me how many occupational health practitioners we really need in this country. That is a difficult question for me to answer. I think the answer is probably more than we have, but I cannot help her much more than that.

I do not want everyone to think that we focus only on services to help older workers to stay in work; age and health are not necessarily related. Many businesses already understand the benefits of providing occupational health support to employees but, as several noble Lords have pointed out today, one of the major issues is with the SMEs that do not have access to such support or have very limited access to it. That was one of the key findings from Dame Carol Black in her review, where she pointed out that it was the lack of access here that was preventing employees from returning to work. That led us to the establishment of the Fit for Work service.

As the noble Lord, Lord McKenzie, pointed out, we started with a gradual rollout in December 2014. We have now rolled out nationwide, and we offer occupational health assessments for those suffering from long-term sickness absence. We also provide an advice service for employers, GPs and employees that is free to use for all. That means that whenever an employee is absent from work due to illness for four weeks or more, they can be referred to Fit for Work by either their GP or their employer. It is interesting that the figures for employers have been moving ahead of those for GPs. Those who are referred are allocated their own experienced case manager who will conduct an assessment with them that will take into account all the issues—health, work and social issues—that may be preventing the member of staff from returning to work. The employee will receive a return to work plan detailing the steps that he or she, their employer or their GP can take to help them to return to work sooner. Then, provided that the employee consents, the plan is also sent directly to their employer or GP.

I turn to the question asked by the noble Baroness, Lady Walmsley, and the noble Lord, Lord McKenzie, on the qualifications of the healthcare professionals. They are professionals who have an occupational health qualification or occupational health experience or who are able to demonstrate the experience and skills appropriate to working in an occupational health context. Health professionals must be registered with the relevant regulatory and/or professional body on the appropriate parts of its registers. Fit for Work has an accredited specialist in occupational medicine providing clinical supervision of the service, and provides appropriate supervision from more experienced professionals from whom they can seek advice.

Both the right reverend Prelate the Bishop of Derby and the noble Baroness, Lady Thomas, asked who the health professionals are. They come from a wide range of backgrounds. They will signpost to other services if appropriate. I hope they are creative; they can refer on to hydrotherapy, for example, and the noble Baroness knows that I am a believer in much colder water than she is.

Employees and employers can contact the advice service on any work and health matter, and that includes people who are still in work. Someone—I have forgotten who but I think it may have been the noble Baroness, Lady Walmsley—talked about the stiff upper lip. The service is available for those with a stiff upper lip who are struggling at work. They do not have to be off work in order to take that advice.

The referrals are an iterative process, as said by the noble Lord, Lord McKenzie. An initial assessment will be done and an initial return to work plan issued. Further assessments will take place if required—for example, if an individual does not return to work as expected—and the service will provide support for up to three months if required.

I can give some numbers for the scheme. From the figures from March 2015 until last month, we are just shy of 10,000; some 9,000-odd people have gone through. For commercial reasons I cannot disclose our expectation but I will not disguise that that is a lower level than we had hoped for at this stage, and clearly we are concerned to do something about that. One thing we will do is reflect some of that in the Green Paper that is due between “shortly” and “soon”—we have had many debates about what those two words actually mean.

Some noble Lords mentioned some of the parallel services to Fit for Work. Noble Lords will remember that we introduced a tax exemption of up to £500 a year per employee for medical treatments recommended by Fit for Work with an employer-arranged occupational health service, so that is designed to act as an extra incentive for employers to make use of Fit for Work.

The Access to Work scheme provides practical and financial support with the additional costs faced by individuals whose health or disability affects the way they do their job. The amount of help that an individual may receive from Access to Work will depend on their individual need and personal circumstances, but the figure is now up to a maximum of £41,400 a year of support. The Access to Work programme is delivered by Jobcentre Plus. The awards are usually made for a period of three years and are reviewed annually. In answer to the question from the noble Baroness, Lady Thomas, I can say that Fit for Work will signpost to Access to Work as necessary. This will be recorded on the return to work plan for both the employee and their employer.

We know there is a consensus here. I am always delighted when the noble Lord, Lord McKenzie, and I agree on some of these matters; that was not always the case. This Government are committed to helping more people with mental health conditions to find and retain work, as well as testing how to improve both the well-being and the employment prospects of claimants with mental health conditions. There is investment of an extra £1.25 billion in mental health support and we have pledged over £40 million over the next three years on a range of voluntary pilots to test how best to support people with mental health conditions to gain and retain employment.

The real issue here is that we often simply do not know what works. This money is really important to find some of those answers. I assure noble Lords that no one in the world knows them, so it is very important that we find out how to do it.

Government cannot do this on our own: we need employers and healthcare professionals. We believe that for Fit for Work to be more successful, for more people to go through it, there needs to be a change in culture among GPs and employers, particularly SMEs. There have been marketing campaigns to the medical community and to employers’ representative bodies. Through them, the providers of Fit for Work have been working to increase awareness of the service across Great Britain but clearly—this is a point made by several noble Lords—we have a deal more work to do to get the word out.

The noble Lord, Lord McKenzie, asked about evaluation. An evaluation strategy is in place for Fit for Work. It is being undertaken by an independent research organisation on behalf of the work and health unit. It will include feedback from employee users, GPs and employers. The initial satisfaction data we have received from independent performance monitoring is that the service has been welcomed by GPs, employers and employees.

The noble Baroness, Lady Thomas, asked: should we rename and relaunch? We are looking at this whole area—should we expand, what is its role?—in the Green Paper, so we will be able to return to that topic. On the key question that she asked about sharing information, most people are relaxed about sharing information with their GP or employer. About 30% of people do not want to share the information.

The noble Lord, Lord Luce, asked whether the telephone is the right method. It is speedy, cost-effective and works in many cases. In some cases, it is not appropriate, and we will conduct face-to-face assessments when necessary.

My noble friend asked how well-equipped the NHS is to give support. NHS England commissions specialised care for patients whose pain cannot be successfully controlled or is particularly complex to manage. NICE has published several clinical guidelines and produced a range of best practice guidance on pain management for specialised drugs and treatment, as well as specific conditions, including chronic pain.

Too many individuals are still prevented from participating in the labour market by health issues. We have established the cross-government work and health unit jointly with the Department of Health. That is designed to lead the drive to improve work and health outcomes for people by improving integration across the healthcare and employment services. That combination is the driving factor behind Fit for Work.

We know that many larger companies see the benefit of supporting their workforces through occupational health—around 80% of large companies do that—but that only one in 10 small companies do so. That is where the Fit for Work service is designed to fill the hole. As I said, we will be exploring this area further in the Green Paper.

Let me conclude by again expressing my thanks to the noble Lord, Lord Luce. This is a key programme for us. It has not gone as rapidly as I hoped. I hope that, if we can get it up successfully and get the message out better, the benefits will be compelling: for employers, to reduce sick pay and increase productivity; for the state, as the noble Baroness, Lady Walmsley, said, through reduced long-term worklessness; but, most importantly, for the people involved, it just makes their lives more meaningful.

We are committed to doing everything we can to ensure that Fit for Work plays as full a part as possible in what is an extraordinarily important objective of helping people stay in work.

House adjourned at 8.35 pm.