Statutory Sick Pay, Jobseeker’s Allowance, and Employment and Support Allowance are employment-related benefits in the United Kingdom (UK). They correspond to the Injury and Disease Allowance and Unemployment Insurance in Japan. The Government of the UK has reformed the welfare system to make it fairer and to ensure that there are always work incentives, under the slogan, “Welfare to Work”, and in order to resolve poverty and dependency on welfare, the government started a new benefit, “Universal Credit”, from April 2013, in which some non-contributory benefits were unified. The government has also reformed labor policies to provide work incentives for those who continue to work, for example by abolishing the Flexible New Deal program and integrating all the “Welfare to Work” policies into the “Work Programme”.
The Industrial Injuries Disablement Benefit (IIDB) in the United Kingdom is a benefit for people with long-term incapacity for work. IIDB does not cover the self-employed, military personnel, or certain kinds of trainees. As for the payments of IIBD, “accidents at work”, “prescribed diseases” and “jobs” are defined by the Department for Work and Pensions in a list to assess the level of disablement from the accident or disease and determine the amount of benefits. Delivery of medical services, such as the medical treatment benefit in Japan, is not included in this scheme because most medical services are provided for in the scheme of the National Health Service (NHS). Prevention Projects, such as the Follow-up Medical Examination Benefits in Japan, are also not included. Benefits for people who have Pneumoconiosis (including asbestosis) are provided in the IIDB scheme.
How to control the increasing health expenditures is a common problem in the developed countries. The main causes of this increase are ageing of the society and medical innovation. The UK government has introduced a market oriented health reform in order to balance the increasing expenditures and the quality of care. For example, they have introduced the GP Fundholding, Private Financial Initiative (PFI) for construction of public hospital, and personal budget system (a patient owns a budget for buying health services in the deregulated market). However, there is little evidence indicating the effectiveness of these programs. On the other hand, it is important to strengthen the labor policy in order to maintain the social security system. For example, programs for increasing the employment rate and those for increasing productivity work sharing are such policies. From this viewpoint, the EU countries have introduced a series of active employment policies, i.e., job training for unemployed persons and work sharing. Furthermore, as other authors report in other articles of this volume, the government of the UK has introduced the Fit for Work (FFW) program that intends to medically support workers.
The Statement of Fitness for Work, so called Fit Note, was introduced in the UK in 2010. Physicians issue Fit Note to workers when requested. The Fit Note provides the physician’s advice about the worker’s fitness for work when he or she has health problems, writing their advice of either “may be fit for work” or “not fit for work” on the form. The Fit Note also records details of the functional effects of workers’ condition. Then the Fit Note is used to consider and arrange support from employers in order for workers to return to work. This paper reports the general background and practical implementation of Fit Note based on a literature review and interviews from general practitioners, occupational physicians, and physiotherapists in the UK.
The Statement of Fitness for Work (Fit Note) policy was started in the UK in 2010 in order to promote return to work after sickness absence. Fit Note is issued by General Practitioners (GP). We conducted an interview survey of 2 occupational physicians working in the UK to ascertain the impact of the introduction of Fit Note on occupational health in the UK. They regard the low coverage of occupational health services in the UK, especially among small companies and self-employed workers, as a serious issue. Fit Note was regarded as a tool to induce GPs to participate in occupational health services, and it is expected that they will be new partners in occupational health. The English occupational physicians evaluated the Fit Note system highly, and believe that the increasing participation of GPs in occupational health services will be a steady advancement in occupational health in the UK.