Helpline 0131 669 1600
Rt Hon Iain Duncan Smith MP
Secretary of State for Work and Pensions
The House of Commons
London SW1A 0AA
Dear Mr Duncan Smith
An Open Letter Regarding Health and the Workplace
First of all I congratulate you on your appointment to the post of Secretary of State for Work and Pensions. You have been an excellent constituency MP to us here in Chingford and I am sure you will carry through your efforts and attention to detail to this new portfolio.
I write to you this open letter. You may recall that I am a General Practitioner and that my father and I represent collectively more than half a century of service to the people of Chingford within the National Health Service.
What you are probably unaware of is my special professional interest regarding health and the workplace largely mental health. I am write this letter to you which will be published in the web periodical RehabReview to which I am a contributor. I write from my perspective and experience a frontline NHS General Practitioner.
Recently, in the twilight hours of the last government, sickness certification was changed and the Med 3 certificate to incorporate more emphasis on planning a return to work early and the ability to communicate/articulate some these ideas through the “fit note”. This is a welcome change and I am grateful that the new coalition government has not sought to change this sterling body of work. Work is good for health and wellbeing in a vast number of ways.
I do however wish to raise a few concerns regarding the response from employers and to a lesser extent the patients whom I certify themselves.
On no less than three occasions in the last week or so, I have been contacted by employers trying to coerce me into changing my recommendations. All three certificates were regarding fellow constituents and on all three occasions the employer took issue with an early return to work.
I will cite one example. A patient of mine had sustained an injury to her (dominant) hand. Her job is as a Special Needs assistant. She wishes to return to work and I encouraged her to do so for temporarily amended duties whilst she recovers the use of her hand. I suggested in the fit note that there were basic administration duties that she could assist her workplace with or while not literally being “hands on” she could supervise a colleague whom was being inducted into the workplace. My comments, I accept are recommendations only, but I was very taken aback by the quite hostile response from the patient’s line manager whom demanded that I alter my recommendations. More annoying was the fact that this was not communicated directly to me but via my patient. I refused despite pressure, some of it ricocheting off the patient.
I did receive a letter outlining my patient’s usual work duties (which I was fully aware of) peppered with some comments about Health and Safety. Evidently, her workplace totally lacked any imagination and were quite happy for this lady to sit at home, relatively able bodied, for the five to six week time horizon whilst her hand healed. The patient is upset as although she is willing and able to work, she will have these many weeks recorded as sickness.
The other two cases were very similar and again in both cases relatively able bodied people and willing people were kept off work because their workplaces could not some and I emphasise some of their workplace skills and duties from them.
I am deeply alarmed at this. All three of my patients, all in similar circumstances, had relatively minor health problems. Yet, from my experience it is this very group, through employer behaviours like this, who teeter on the brink of long term worklessness. This is especially true with respect to the low level mental health problems that at least a quarter of my patients bring to me each surgery session. I am sure that there is an evidence base to this but, the genesis of worklessness usually has relatively minor health conditions in the early stages, not necessarily serious illness.
I fully understand, being an employer in effectively a Small to Medium Sized Enterprise, that times are very difficult and I am sure will become tougher. However, whilst I accept that there is a hard core of folk with long term health problems whom successive governments have, with great resources, to assist back to the world of work, relatively little is being done to prevent the former critical mass of people becoming ever larger by helping people stay in work.
Enabling people capable of work, which is inevitably going to improve their wellbeing, to be retained in their usual or at least a workplace will require the input of all of us involved. An important part of this will have to be a cultural paradigm shift from employers. I understand that in many of the consultations regarding the “fit note” employers and their representatives were indeed constructively engaged. I now challenge whether that sign up to the new paradigm of work and health is as pervasive in employers as we all would like.
The best of health to you
Shahid Dadabhoy
Dr M.E. Dadabhoy
MBBS MFFP FRSH