Summary of Annual CCHSR Lecture: "Work: A Health Problem?"

Dame Carol Black

Carol Black, the government’s adviser on work and health, gave the annual CCHSR lecture in Cambridge on 4th December 2013. She was uncompromising that work is important for human health and quoted Galen (AD 129-200) who wrote “Employment is nature’s physician and is essential to human happiness”. Work promotes recovery and rehabilitation from illness, reduces the risk of long term disability and improves quality of life and wellbeing.

However, not all work is ‘good work’. Black identified ‘good’ jobs as those that were stable, gave the individual some control over what they did, provided opportunities for progression, and provided reasonable income and security. ‘Good work’ increases self-esteem and a sense of belonging to society. She was critical of jobs which didn’t have these qualities – being employed in a ‘poor job’ could be as bad for health as being unemployed.

Given the known adverse health effects of unemployment (poverty, poor physical and mental health, loss of self-worth, greater use of medical services), Black was very critical of the sickness absence system in the UK which, until recently, allowed GPs only to certify people as ‘fit’ or ‘unfit’ for work. She noted that she persuaded government to introduce a new type of sick note – a ‘fit note’ so that GPs can help people get back to work earlier after illness by signing them as ‘fit for work within limits’. But she said GPs haven’t made much use of this and still feel caught – 77% of GPs still feel obliged to give sick notes for non-medical reasons. She rather likes the Netherlands system where occupational physicians decide when a person is fit to work, taking the decision away from GPs. However, she admitted that this would be too expensive to introduce in the UK.

Black was also very critical of employers. Too many took the view that their employees should return to work when they were fully fit, she said. The NHS was particularly bad in this respect, with a poor sickness absence record. She cited the example of one NHS trust which had reduced its bill for sickness absence by 72% by taking a more proactive approach to sickness absence. Employers should take a much more active role in improving working environments, she said, to stop people going off sick (especially for work related stress) as well as getting them back quickly.

So neither GPs nor employers are doing enough to get people back to work or stop them going off sick in the first place, according to Black. A review by the government (which Black chaired) wants a new Employment Advisory Service which will see all people who’ve been off work for a month or more. If something isn’t done, the costs of ill health to the economy and to the NHS will rise. In the next few weeks, the government will announce how it plans to act on its own report.