As the number of employees signed off sick from work soars to record numbers, the chancellor’s ‘back to work’ budget has placed unprecedented focus on the role of occupational health for keeping people in work. The number of people signed-off sick from work is soaring, with a record 10.4m ‘fit notes’ issued during the year ending September 2022.

Although fit notes were originally intended to reduce the number of people from becoming economically inactive, they have become a gateway to long-term absence. GPs alone cannot be expected to understand what someone’s workplace is like enough to say what they can and cannot still do. This means a third of ‘fit notes’ end up signing people off work for four weeks or more, after which time one in five never return.

Mental health issues, including stress, anxiety and depression, and musculoskeletal (MSK) issues, such as back and upper limb problems, remain the main drivers for sickness absence. So it’s perhaps unsurprising that a key focus of the chancellor’s ‘back to work’ budget is the investment of £400m in occupational health services. These include managers in the process of keeping employees in work, by allowing managers to raise a referral and provide context on the employee’s role and workplace and how they’re currently struggling.

An occupational health clinician can then provide recommendations on what the employee can still do and reasonable adjustments that could be made to keep them in work. Meaning the loop between employer, employee and healthcare professional is finally being closed.

To boost take up of occupational health services, at a time when just one in two UK employees has access to this, compared to 90% of French and German workers, a subsidised pilot scheme is to be rolled out. This will allow small and medium business to pay a small fraction of the cost of raising an OH referral. The supplier will then reclaim the rest.

Unfortunately, although the budget has been billed as a ‘Back to Work’ budget, the lack of any funding for onward treatment, at a time when over 7 million people are waiting for NHS treatment, won’t help those already off sick. Individuals waiting for hip or knee operations, for example, will be living with pain and need help to manage the psychological and social consequences of that. While those struggling with anxiety, burnout or depression may need counselling and other therapies to recover.

Sarah Hughes, chief executive Mind, criticised the lack of extra funding for people on waiting lists for mental health support, saying: “There was no funding to better support our NHS services that enable many people’s recovery when they’re in poor mental health. There were no measures that would help prevent people’s mental health from declining in the first place. And there was little to help employers create more mentally healthy workplaces, so work is something people can to get back to and stay well while doing.”

Used upfront, however, the scheme could help employers to keep people in work. Not least as our own research into the benefits of early intervention shows 64% of absences can be prevented if people are referred into occupational health while they’re still in work.

The chancellor himself, Jeremy Hunt, said he wanted to help people with mental health and musculoskeletal issues before they decide to leave their jobs. This means that for the new focus on supporting people with help conditions to stay in work to succeed, employers must be prepared to act long before people are signed off sick. This will require a shift in culture towards protecting health by using occupational health to identify risks that could make people sick.

That’s important because there were 0.9 million cases of work-related stress, anxiety or depression last year. Plus 0.5m cases of work-related MSK disorders last year. That’s 1.4m people who became sick through work. The DWP will also publish a health and disability whitepaper, which will set out reforms to make sure people with disabilities have the right support, opportunities and incentives to move into and remain in work.

This matters because the number of people living with health conditions is increasing. Employees with cancer and heart disease are protected under the equality act, yet one in two people with cancer feel like they have been forced to change jobs.

Going forward, the increased focus on helping people to stay in their roles will hopefully have a valuable role to play in reducing economic activity. Critical to success will be education about the business benefits of helping people to stay in work. Even if someone can only return to 85% of their former capacity, this is still better than having a vacancy and many people can be helped to recover fully over time.