A major expansion in occupational health services to keep people in work and off disability benefit is likely to be recommended in a report to be published today.

The report, by Dame Carol Black, the National Director for Health and Work, calls for universally available, stronger and more integrated services designed to detect problems early and allow people to continue working.

Many workers, including some in industries with a high risk of work-related injuries, have no access to occupational health services.

Dame Carol’s report is expected to say that services need to be combined with social care and advice about debts and stress, to try to prevent a short-term absence from work turning into a lifetime on benefits.

How such a service will be delivered is not clear, but the Society for Occupational Medicine estimates that it will require an extra 1,800 doctors who specialise in occupational health. “We are keen to work with government in identifying appropriate models of delivery of such a service, through the NHS or other providers, but the resourcing issues need to be addressed urgently in a medical speciality that has been something of a Cinderella since the inception of the NHS,” said Dr Gordon Parker, president of the society.

Dame Carol’s report is expected to recommend a Fit for Work service that would enable GPs and employers to send people to an expert team able to recommend treatments and changes to work practices that would help them to return to work.

Part of the motivation is to reduce costs to the social security system, but there is also evidence that people who work live longer and healthier lives.

The sooner people return the better, because those who stay on benefits for a year or more find it increasingly hard to get back into work.

The report could also bring changes in the style of sicknotes signed by GPs, with a greater emphasis on what work people are capable of doing, rather than simply laying them off sick. Alan Johnson, the Health Secretary, has called this a shift from the sicknote to the wellnote culture.

But GPs may not be very willing to take on more responsibilities, especially if they appear to clash with their primary duty to look after the health of their patients.

The present certification system is complex. Sickness benefit is payable from day three of an illness and can be “self-certified” by the worker using a form provided by the employer.

But after seven days the GP becomes responsible and can issue sickness certificates until week 26. Thereafter patients move to Incapacity Benefit, but this is not determined by GPs. Dame Carol is expected to call for intervention early in this process, with the state taking a hand.

Ministers are concerned about the development of a “welfare culture” in which hundreds of thousands of people live their entire lives on benefits. They suspect that the children of single-parent families, half of whom are economically inactive, are disproportionately likely to become welfare recipients themselves.

Sickly state

2.6m
Incapacity benefit claimants

175m
Working days lost each year to ill health

36m
Working days lost to occupational ill health

£13bn
Estimtated cost to economy of lost working days in Britain each year

Source: CBI, Health and Safety Executive

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