HomeCourses & TrainingCourse datesAboutServicesSolutionsContact UsPrivacy Policy
Centres of Expertise
To provide an evidence based approach
Occupational health
Healthier Tomorrow
Website Links
Healthier Tomorrow


Dame Carol Black's Review of the health of Britain's working age population

Key challenges and recommendations for reform

Key challenges

1 The economic costs of sickness absence and worklessness associated with working age ill-health are over £100 billion a year – greater than the current annual budget for the NHS and equivalent to the entire GDP of Portugal.

2 The evidence base to support the business case for investment in the health and well-being of their employees is inadequately understood by employers.

3) Lack of appropriate information and advice is the most common barrier to employers investing in the health and well-being of their employees. This is particularly true for smaller organisations which tend not to have access to an occupational health scheme.

4 The importance of the physical and mental health of working age people in relation to personal, family and social attainment is insufficiently recognised in our society.

5 GPs often feel ill-equipped to offer advice to their patients on remaining in or returning to work. Their training has to date not prepared them for this and, therefore, the work-related advice they do give, can be naturally cautious.

6 The current sickness certification process focuses on what people cannot do, thereby institutionalising the belief that it is inappropriate to be at work unless 100% fit and that being at work normally impedes recovery.

7 There is insufficient access to support for patients in the early stages of sickness, including those with mental health conditions. GPs have inadequate options for referral and occupational health provision is disproportionately concentrated among a few large employers, leaving the vast majority of small businesses unsupported.

8 The scale of the numbers on incapacity benefits represents an historical failure of healthcare and employment support for the workless in Britain. Furthermore, the flow of recipients of other benefits onto incapacity benefits suggests a failure in other employment and skills programmes to identify developing health conditions at a sufficiently early stage.

Pathways to Work, while successful overall, has had limited effect for those whose main health condition is a mental illness. Furthermore, over 200,000 people with mental health conditions have flowed onto incapacity benefits each year over the last decade.

9 Detachment of occupational health from mainstream healthcare undermines holistic patient care. A weak and declining academic base combined with the absence of any formal accreditation procedures, a lack of good quality data and a focus solely on those in work, impedes the profession’s capacity to analyse and address the full needs of the working age population.

10 Existing departmental structures prevent Government from fully playing its part in meeting the challenges set out in this Review.

Main recommendations

1 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.

2 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.

3 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.

4 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.

5 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.

6 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.

7 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.

8 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 provision of Pathways to Work to cover all on incapacity benefits as soon as resources allow, and explore how to tailor better provision for those with mental health conditions.

9 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; clear standards of practice and formal accreditation for all providers; a revitalised workforce; a sound academic base; systematic gathering and analysis of data; and a universal awareness and understanding of the latest evidence and most effective interventions.

10 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.


Body mass index

A measure of body fat based on height and

(BMI) weight which applies to adult men and women. BMI is calculated as:

(weight in kilograms) / [(height in metres) x (height in metres)].

BMI categories are:

• Underweight = under 18.5

• Normal weight = 18.5 to 24.9

• Overweight = 25 to 29.9

• Obese = 30 or over

Cognitive behavioural therapy (CBT)

A treatment for mental health conditions which combines cognitive therapy (which can modify or eliminate unwanted thoughts and beliefs) with behavioural therapy (which can help change behaviour in response to those thoughts).


A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

Occupational health

The promotion and maintenance of the highest degree of physical, mental and social well-being of workers in all occupations by preventing departures from health, controlling risks and the adaptation of work to people, and people to their jobs.

Public health

The science and art of preventing disease, prolonging life and promoting health through the organised efforts and informed choices of society, public and private organisations, communities and individuals.

Sick note

The sickness certification form issued by healthcare professionals to people of working age, normally required to claim Statutory Sick Pay.

State Pension age

For women 60 years, and for men 65 years. Due to rise to 68 years for both men and women by 2046 (in the UK).


The subjective state of being healthy, happy, contented, comfortable and satisfied with one’s quality of life. It includes physical, material, social, emotional (‘happiness’), and development and activity dimensions

[Waddell & Burton, 2006].

© Crown Copyright 2008

Produced by the cross-government Health, Work and Well-being Programme

Full article available from: http://www.workingforhealth.gov.uk/documents/working-for-a-healthier-tomorrow-tagged.pdf

Home|Courses & Training|Course dates|About|Services|Solutions|Contact Us|Privacy Policy