Chris Jackson, NASHiCS National Chair, welcomed delegates to the seminar and thanked the sponsors who had made the day possible. He stated that the HSE’s Matthew Hamar, who was due to speak was unable to attend but had sent an update via email that would be discussed during the open forum.
Chris then handed over to John England, Deputy Director of Adult Services, Leeds City Council.
John welcomed everyone to the John Charles Centre for Sport owned by Leeds City Council. It is a national and international facility and a popular venue for both indoor and outdoor sports. Leeds is the second largest council in England. Over the last 10 years Leeds has been transformed from a predominately industrial area into a centre for finance, commerce and law. The Social Services Directorate is the largest in the council with a budget of £119 million. The council is already under major financial pressure and has identified areas of overspend prior to the comprehensive spending review.
Legislation had not changed though and councils are expected to deliver as much, if not more. Councils are finding it increasingly difficult to compete with the private sector; Homecare is an example of this with the unit cost much higher within the local authority.
Personalisation – re-ablement – is being funded by the government in an attempt to get people back on their feet and therefore reduce the cost of support services that are required.
More will be expected of families and carers too. On a positive note Social Care and Health are working together with more integrated services available. GP’s are now commissioners and this means that there will be additional integration with social services departments – for example residential and nursing care.
John concluded his address with a quote from ‘Think Local, Act Personal,
‘Next Steps for Transforming Adult Social Care – Change of this kind will require the harnessing of the sector’s long tradition of voluntary and community action, so that people and their communities can play a bigger role in supporting themselves and others. It will build on existing strengths: the disabled people’s movement, the huge contribution of family carers and the input and experience of people as they grow older.
Organisational and professional culture and practices will need to adapt to facilitate greater freedom for people and their communities to shape their support.’
There are major challenges ahead for all of us.
A welcome was given to Professor Sayeed Khan – Board member of the Health and Safety Executive and Chief Medical Adviser of EEF. Sayeed began his address, entitled ‘What’s happened to the fit note?’ by discussing the development of the fit note.
Analysis of statistics from 2006 to 2009 indicated that 60% of long-term sickness was caused by staff that had undergone surgery or were awaiting surgery /medical tests.
The breakdown of the 60% was as follows:-
25% waiting for an appointment or diagnosis of illness
28% for treatments or operations
89% waiting for recovery from treatments or operations
These figures could suggest a system failure within the NHS, although in 2009 the percentage of people waiting for treatment had dropped to 48% indicating that some progress has been made.
Statistics show that the main barriers to successful rehabilitation in 2005 were the employee’s health condition (57%) closely followed by the general practitioner (41%).
The fit note was developed to try to overcome these barriers.
There was evidence that 45% of GP’s were unhappy with the existing ‘sick note’ system which had been in operation for 60 years. Only 28% of GP’s were satisfied with the current existing system. The sick note, in general, acts as a barrier to rehabilitation.
In a pilot exercise for the introduction of the fit note, GP’s found that more people were fit for some work rather than no work at all. The introduction of the ‘fit note’ has not been without its problems thought.
Typically these are:
• Few are filled in correctly.
• The Occupational Health Support tick box option has been removed, despite the fact that most employers with over 400 employees will have Occupational Health arrangements.
• Staff sometimes do not send their fit notes to their employer immediately.
• 10% of fit notes are still being sent to payroll and this, in turn, slows down the process.
• Some Consultants are unsure how to complete the fit note and may send the employee back to the GP for a fit note – the GP then may send the employee back to the Consultant etc. thus delaying the process.
• Fake fit notes are available on the internet.