Black Review on Health and Work

Government, healthcare professionals, employers, trades unions and all with an interest in the health of the working age population should adopt a new approach to health and work in Britain based on the foundations laid out in this Review.

The existing cross-Government structure should be strengthened to incorporate the relevant functions of those departments whose policies influence the health of Britain's working age population.

NHS professionals and their organisations – along with their regulators – should recognise retention in or return to work as a key indicator of the successful treatment of working age people and appropriate data should be collected to monitor it.

Medical professional bodies, together with Government, should consider the establishment of a network of GPs interested in health and work to be a source of growing expertise at a regional and local level.

Government agencies, and other bodies concerned with economic development and business, should promote employers' understanding of the economic case for investing in health and well-being.

Government should explore practical ways to make it easier for smaller employers and organisations to establish health and well-being initiatives.

Schools and Further Education colleges should consider including the benefits of work in their health promotion for children and young people.

Any awareness-raising campaign about health, work and well-being should aim to demonstrate the benefits of being in work – not just for parents and carers but also the knock-on positive effects for their families and communities.

Government should accelerate and broaden its work in applying the 'Healthy Schools' approach to further education to create expectations among new entrants to the workforce on the health and well-being support employers should offer.

Government should monitor the baseline set out in this Review and commission a coordinated programme of further research to inform future action with a comprehensive evidence base.

Government should work with employers and representative bodies to develop a robust model for measuring and reporting on the benefits of employer investment in health and well-being. Employers should use this to report on health and well-being in the board room and company accounts. Safety and Health practitioners and, where present, trades union safety representatives, should play an expanded role in acting to promote the benefits of such investment.

Government should initiate a business-led health and well-being consultancy service, offering tailored advice and support and access to occupational health support at a market rate. This should be geared towards smaller organisations. It should aim to be self-sustaining in the medium-term, and be fully evaluated and tested against free-to-use services.

Government should launch a major drive to promote understanding of the positive relationship between health and work among employers, healthcare professionals and the general public. This should include encouraging young people to understand the benefits of a life in work and its impact on their families and communities.

Building on the commitment from the leaders of the healthcare profession in the recent consensus statement, GPs and other healthcare professionals should be supported to adapt the advice they provide, where appropriate doing all they can to help people enter, stay in or return to work.

The paper-based sick note should be replaced with an electronic fit note, switching the focus to what people can do and improving communication between employers, employees and GPs.

Government should pilot a new Fit for Work service based on case-managed, multidisciplinary support for patients in the early stages of sickness absence, with the aim of making access to work-related health support available to all – no longer the preserve of the few. Pilots should test various models of service delivery, including variations in the timing of intervention and the mix of providers from public, private and voluntary sectors. The service should be comprehensively evaluated.

When appropriate models for the Fit for Work service are established, access to the service should be open to those on incapacity benefits and other out-of-work benefits. Government should fully integrate health support with employment and skills programmes, including mental health support where appropriate. Government should expand the provision of Pathways to Work to cover all incapacity benefits claimants as soon as resources allow, including appropriate provision for those with mental health conditions. To support the development of its proposed mental health employment strategy, Government should review mental health support within current policies and seek to determine the most effective method of assisting this group of people back into work. Government should consider offering advice and limited funding to help local partnerships kick-start health and work activity. Government should encourage the provision of vocational rehabilitation services by employers, building on the findings of their ongoing vocational rehabilitation review and providing guidance for employers. Government should consider the use of incentives for employers to support the employment of those with disabilities or health conditions.

An integrated approach to working-age health should be underpinned by: the inclusion of occupational health and vocational rehabilitation within mainstream healthcare; clear professional leadership from the occupational health and vocational rehabilitation communities to expand their remits and work with new partners in supporting the health of all working age people; clear standards of practice and formal accreditation for all providers engaged in supporting working age people; a revitalised workforce with the development of a sound academic base to provide research and support in relation to the health of all working age people; systematic gathering and analysis of data at national, regional and local level to inform the development of policy and the commissioning of services relating to the health of working age people; and a universal awareness and understanding of the latest evidence on the most effective interventions developed by organisations such as the Occupational Health Clinical Effectiveness Unit.