Tag Archives: fit notes

How The DWP Is Drafting In Doctors To Promote Iain Duncan Smith’s Warped Ideology

fit-note-guidanceAre you working hard enough?  Are you sure?  What if you get sick, or have an accident?  Are you prepared to go to work anyway, even if you don’t think it would be good for your health?  What if your doctor and boss agree you could do something other than your usual job instead of malingering at home?  Like making cups of tea all day, or cleaning the bogs, or any form of work your empoyer can dream up to force you not to take time off.  Because that is now the chilling reality as the DWP attempts to inject Iain Duncan Smith’s warped ideology into the NHS.

Last week the DWP issued patronising new guidance to GPs on when they should issue a Fit Note.  Doctors are warned of the dangers of ‘worklessness’ and told they must consider “the vital role that work can play in your patient’s health”.  According to the department, “the evidence is clear that patients benefit from being in some kind of regular work”.

This is an outright lie.  What the evidence says is that on balance most people might be better off working but the beneficial health effects depend on the nature and quality of that work.  In the report on which the DWP’s claims are based – a paper incidentally commissioned by the DWP themselves – the authors actually warn that “a minority of people may experience contrary health effects from work”. 

This study – called Is Work Good For Your Health and Well Being (pdf) – has formed the basis of government policy ever since the Labour administration launched the despised Work Capability Assessment for out of work sickness benefits in 2008.  It features a reasonably wide-ranging review of the evidence of the health risks and benefits of work and concludes that work, on balance, is better for most people’s health than unemployment but with important caveats.  These findings have been consistently misrepresented by politicians who have used them to claim that any kind of work is good for health, and that this applies to everybody.

The study found that in some cases – possibly 5-10% – unemployment can lead to improved health and well being.  It warns that negative health impacts of unemployment are “at least partly mediated through socioeconomic
status” – meaning it is not work that is good for you, but poverty that is bad for you.   The review points out that whilst the evidence is conflicting, shift work and long hours could have a weak negative impact on health.  It also finds that school leavers who move into ‘unsatisfactory’ employment can experience a
decline in their health and that economically secure people who retire early may experience beneficial effects on their health.   Even if this report is taken at face value – and it comes loaded with assumptions about the social and moral imperatives of work – all it shows is that work can be good for your health – but only if it’s a good quality well paid job.

If you are in low paid or insecure work then what your GP should tell you – based on the existing evidence – is to take a few days off if you aren’t happy or feel unwell.  Perhaps they should warn that you might be one of the 5 or 10% of people who are healthier if they are unemployed, despite the loss of income.  A more recent study carried out in Australia, and quoted on The Conversation, found that people “who moved into poor-quality jobs showed a significant worsening in their mental health compared to those who remained unemployed.”

What the new guidance to GPs is intended to do is impose workplace dicipline via the healthcare system.  Much like a seven day NHS is a health service for bosses, not patients, and likely to lead to pressure on workers not to book medical appointments in working hours, the Fit Note scheme is designed to bully people into the workplace even if they are sick.  That is why the guidance states that if GPs consider their patient could do any work at all, regardless of their usual job, then they should tick a box suggesting amended duties, or workplace adapatations rather than issue a full Fit Note.  And if doctors are too squeamish to treat patients this way then they are instructed to refer them to Maximus – the shadowy US conglomerate brought in carry out health assessments under the new Fit For Work scheme.

To help doctors decide what is best for their patients, or more correctly their patient’s employers, the new Fit Note guidance features case studies, with recommended courses of action that GPs should take.  They include an example of someone diagnosed with anxiety disorder who says that her work in customer services is giving her panic attacks and that she is too distressed to carry out her duties.  According to the DWP her doctor should first warn her that working is important for her mental health and “remind her that there are still other things that she can do – for example, physical tasks or back-room duties.”  This will help her feel more positive according to the department.  Then she should be referred to Maximus who will develop  a plan with her boss, such as sending her on a course to learn coping techniques, or doing quieter shifts.  And of course bosses, being always right and always reasonable, will not abuse this new power to force sick employees into the workplace.

Yet even the most bullying of bosses are to be accommodated according to the DWP.  Another case study features someone – a woman again – who complains that a poor relationship with her manager is causing her severe stress.  She says the manager has been ‘really horrible’ to her and she feels unable to cope.  Rather than raise any concerns about what seems to indicate workplace bullying however, her doctor is instructed to declare she does not have a health problem and she should speak to her human resources department, or union rep.  She should not be issued with a Fit Note and her GP should explain that they are “acting with her health interests in mind.”  It is better for her health to be bullied and abused in the workplace than be workless, even for a short while, according to the DWP.

The introduction of this guidance makes it clear that the scroungers vs scroungers narrative is now impeding on healthcare even amongst those who are not on benefits.  It is not hyperbole to suggest that the credibility of doctors is now at stake.  For too long the entire healthcare sector has remained silent whilst scientific evidence is distorted to further the ideology of modern capitalism and increase the power of employers over their staff.  Any GP who believes in evidence over rhetoric should tell Iain Duncan Smith to stick these guidelines up his fucking arse.  Anything else is a betrayal of the role of doctors as guardians of our health and well being.

This blog has no sources of funding so here’s a quick reminder that you can help ensure it continues by making a donation.

Join me on facebook or follow me on twitter @johnnyvoid

Work When You’re Sick Say New DWP Guidelines

work-makes-meNew advice issued to doctors, patients and employers on sick pay shows just how far the Government intend to push the brutal regime for people on disability or sickness benefits into the workplace.

The DWP recently renamed ‘sick notes’ as ‘fit notes’ which in the new guidance has led to some genuinely Orwellian gobbledygook such as:  “if your employee’s doctor thinks they are fit for work, they will not be issued with a fit note.”

Just like the despised Atos run Work Capability Assessment, doctors can now declare a patient ‘fit for work’, unfit for work, or capable of some work but not necessarily the job they usually do.  This means that if an employer makes some changes to a staff member’s working conditions then they may be forced back to work.

The new rules, which were devised in consultation with the Confederation of British Industry, seem little more than an attempt to bully people into work when they aren’t really well enough.  The document is littered with bold claims that work is good for your health such as “People can often come back to work before they are 100% fit – in fact work can even help their recovery”.

Nowhere in the documents does it warn that people’s conditions may also be made far worse by going back to work before they are ready.

Bosses have welcomed the chance to force their sick employees back to work with one quoted as calling the new system ‘a joy’:

“The joy of the fit note is that it’s flexible enough for us to interpret and fit the GP’s recommendation within the context of our business.”

The truth is that the DWP are playing a dangerous game and could tempt employers into a legal minefield.  One stark warning says:  “You may need to carry out a risk assessment to accommodate the clinical judgment in the fit note (eg if it states that your employee should avoid lifting, you are liable if you give them work that involves manual handling).”

In a further complication, according to guidance from Citizen’s Advice, if employers refuse to make changes to an employee’s working conditions to accommodate doctor’s recommendations, then they are still liable to pay Statutory Sick Pay.  The confusion doesn’t even end there.  ‘Fit Notes’ are advice only and bosses are not legally obliged to follow that advice.  They can sack you even if a doctor claims you are too ill to work.  They could however then be taken to court.  Employment tribunal lawyers will be rubbing their hands in glee at the DWP’s meddling with an already complex  legal situation.

The DWP have already shown they are happy to play fast and loose with the Courts.  Bosses who act the same way may be in for an expensive shock.

The guidance can be read at: http://www.dwp.gov.uk/fitnote/

(The above google graphic – which is genuine, try it – was stolen from somewhere but I can’t remember where – please put a link in the comments if it was you and I’ll add a credit)

Follow me on twitter @johnnyvoid

Lord Fraud Announces Atos For Everyone!

atos_dr_nickBungling Minister for Welfare Reform, the aptly named Lord Fraud, has today announced that Atos style assessments are to be introduced into the workplace.

The Government is to provide new Occupational Health services for any business that needs them, with the aim of cutting down absence in the workplace due to sickness.

It is claimed that the new ‘advisory and assessments service’  is about preventing people ending up on what’s left of sickness benefits. In truth it is about giving employers the chance to over-ride GP’s decisions on whether someone is too ill to work.

In an announcement today the DWP claim: “Under the current system, the vast majority of fit notes declare employees to be unfit for work.”

‘Fit notes’ are what used to be called ‘sick notes’, but the term was changed recently in yet more Orwellian language mangling by the DWP.  The reason for this change is now clear.  An announcement that the vast majority of sick notes declare employees to be unfit for work would sound a bit silly after all.

Lord Fraud seems to want to be to force people to work even when their own doctor says they are too  ill.  Far from stopping people ending up on sickness benefits, the outcome is likely to be yet more dismissals and more unemployment.  People who are ill are likely to be dragged into the work place after a quick chat with an assessor, or presumably they will face the sack.

It is unclear so far who will carry out these new state funded Occupational Health services, but no doubt Atos – who carry out the desperately flawed Work Capability benefit assessments – will be chomping at the bit at the thought of yet more tax payer’s cash.

Every week people die of their conditions shortly after being declared ‘fit for work’ by Atos.  The stressful process had led to a tragically increasing number of suicides.  Lord Fraud’s announcement means it will no longer be sick and disabled claimants forced into these kind of demeaning and crude health checks, but anyone with the cheek to take a couple of days off with the flu.

Atos already carry out occupational health already for hundreds of thousands of both public and private sector employers.  In yet another corporate subsidy, it now seems that firms who can’t afford a company like Atos to bully staff will have one subsidised by the tax payer.

Atos also offer consultancy in ‘headcount reduction’.  Some people have even been found unfit for work and sacked on the company’s recommendation, and then found ‘fit for work’ at their benefit assessment.

Lord Fraud’s announcement is yet another attack on the working conditions of everyone and viciously undermines the autonomy of doctors.  Anyone left who thinks the war on welfare is just about attacking so called ‘benefit scroungers’ should pay careful attention.

Follow me on twitter @johnnyvoid