On 19 October 2016 Lord Luce led a short debate in the House of Lords on a question: “To ask Her Majesty’s Government what progress has been made with the Fit for Work scheme in enabling those with long-term health problems like chronic pain to return to or stay in work.” The Bishop of Derby, Rt Revd Alastair Redfern, made a speech:
I shall look at the progress of the Fit for Work scheme. As the noble Baroness, Lady Thomas, hinted, there has been a lot of negativity. I remember that when it was first introduced the press called it a test about whether people were fit for work. There have been pilots and a lot of chunter about the slow development of the rollout. We need to remember that it is a huge shift for the medical professional, employers and employees, and we need to encourage the Government to look carefully at the rollout to see what can be learned as it unfolds. As the noble Lord, Lord Fink, mentioned, there may be issues about how small businesses can access this opportunity.
I want to endorse the important potential of the scheme. Many of us know that when people fall out of work—and the problem is doubled, in a way, with ill-health factors—there are often issues with isolation, depression and not being in the social environment from which we human beings gather our identity and energy. When they feel excluded, people need to recognise that there is the possibility of inclusion in the future. That is why this scheme is so important and significant.
To try to draw that out, I shall offer an illustration from my work as a priest. I work with lots of individuals, including people with terrible, chronic, long-term pain and illness, and I also work in communities. I shall offer an analogy. We spend a lot of money in communities over many years and do not see many results. We pour it into outer estates, inner cities and needy groups, and 10 years later they want another round of grants and we wonder what has been achieved.
Noble Lords will know that there has been a recent move towards what is called “Asset Based Community Development”. That means that if you try to develop a community by putting in things and adding value, you will discover what assets are already there in the people’s gifts and in their interests, so that the people who live in a place or in a project own what is offered and imbibe it. It then becomes part of them and the whole thing involves people standing on their own feet and participating in the growth and development of their community.
The Fit for Work scheme could learn something from this, because there is a danger as the scheme unrolls—as the critics rightly say, it could be improved here and there—that we will develop an ever more sophisticated bureaucracy: we will tick that box, offer that service and make this available. But the whole point is to allow individuals who are suffering, and feeling isolated and possibly depressed, to own the possibility, with the scheme, of having their gifts and contribution recognised and to be given a platform, as the noble Lord, Lord Luce, said so eloquently, to participate in the world of work, in society and in business.
It would be very interesting if the Minister would reflect on this fact. As we learn from the pilots and the scheme is rolled out slowly and carefully, how can we enable the scheme, through the training of medical people and employers, to have the flexibility and the sensitivity to recognise that each person is an asset, as the noble Lord, Lord Luce, said? We should not just make them go through a scheme but enable them to feel, “I can participate in ways that suit my chronic pain”—or back injury or whatever it is—“and still make a contribution and still be included”.
It is all about pace and timing. The danger of any scheme is that it gets its own bureaucracy and it rolls on. That is why community development so often does not work. But if you can adjust the pace and the timing to allow creative participation from the individual concerned, the investment will be much more fruitful, there will be a much higher chance that people will get back into work in a strong way, and the scheme will flourish.
That is a massive ask of the Government and of those running the scheme: I recognise that. But I would invite the Minister to share his reflections on what we can learn from that asset-based approach, and on how the Government can ensure that those who administer the scheme can be as highly trained as possible to have that sensitivity and flexibility to allow the individual to be involved in the process and to be an asset in their own precious way so that they have dignity at work and a long-term future in it.
Lord McKenzie of Luton (Lab) [extract]: Press comment, as others have noted, has suggested there is some confusion about the interpretation over the referral guidelines, at least so far as GPs are concerned. Is the Minister aware of this and can he say what the problem is? A DWP study apparently suggested GPs are likely to refer some 36% of their eligible case load to the service, but referral rates in practice vary. Why is this? The process involves at least the first assessment being undertaken by phone rather than face to face, and the nature of the assessment is determined by the occupational health professional. How many assessments are undertaken face to face and how many by phone? It is understood that a re-referral cannot be made within 12 months of a previous one where a return to work plan has been agreed. What is the position where an assessment is under way? Is it an iterative process, with potentially several telephone calls and meetings until a return to work plan is agreed? What is the experience of eligible employees who refuse consent for a referral? What information does the service hold on the outcome of return to work plans, in particular on whether they lead to long-term, sustainable, positive outcomes? The right reverend Prelate the Bishop of Debry offered an interesting parallel with asset-based community development and the potential that offers the Fit for Work service.
The Minister of State, Department for Work and Pensions (Lord Freud) (Con) [extract]: Both the right reverend Prelate the Bishop of Derby and the noble Baroness, Lady Thomas, asked who the health professionals are. They come from a wide range of backgrounds. They will signpost to other services if appropriate. I hope they are creative; they can refer on to hydrotherapy, for example, and the noble Baroness knows that I am a believer in much colder water than she is.