Archive for 2013

Government sees some sense on tax relief

Dec 06, 2013

It’s pleasing to see that the proposed tax relief for employers spending up to £500 on clinical intervention to help employees get back to work is now being extended to all OH services and not just the new Health and Work service as announced in the Autumn statement yesterday.  You can read more here

This will allay many of the fears already expressed in previous blog posts and is a sign that the treasury are now listening to the right arguments on employee health.

DWP’s Health and Work Service advice plans slammed as ‘templated rubbish’

Nov 25, 2013

I don’t know independent OH adviser Lindsey Hall, but his concerns about the New Health and Work Service as reported here are fully justified.

I hope someone can apply the brakes to this before it’s too late although I understand that an outline tender document is already with some potential providers.

The Importance of Clinical Intervention

Oct 17, 2013

The Work Foundation has just released a 10 page report showing the benefits of early intervention in the treatment of musculoskeletal disorders (MSDs) citing a really good study from Madrid to support the case. You can read the full report by clicking here. 

It also highlights the barriers to successful early intervention including this one:

Health Technology Appraisal (HTA). In some countries, HTA (the mechanism which assesses whether the costs of medical treatments and devices are balanced by the benefits and therefore will be reimbursed) looks at the economic and societal benefits of giving patients access to treatment which will help them remain in work. In others only the direct clinical benefits and costs are examined, but not the labour market impact.

I’d like to know whether the UK government only examines the direct clinical benefits and costs. The Madrid study showing a cost benefit of 1:15 should make the UK government  realise that this really is an area where investing to save is the winning economic argument and that at the very least, there should be tax breaks on any employer spend on clinical intervention.

New Independent Assessment Service Launch to be delayed

Oct 08, 2013

“One of the problems is going to be if you have someone going to your occupational health (OH) service and getting some advice and then being sent by their GP to the IAS and having different advice. What do you do? This is why it’s been really difficult, so don’t hold your breath about when it’s going to come out.”

“It is taking time. It is very sensitive this whole thing and it isn’t as clear as we thought it might be,”

“And do you really think we’re going to have a national service from day one? If you were going to see how to fail abysmally; launch something nationally from day one,”

Professor Sayed Khan, EEF Chief Medical Adviser and IAS project steering group member.

Says it all really, well not all, but thank goodness this whole proposition is being scrutinised for what it really is.  The £500 cap for tax relief on clinical spend needs to be part of that greater scrutiny.

Dame Carol Black on Tax Relief

Oct 04, 2013

At the Cover & Protection conference yesterday, Dame Carol Black gave an update on the government’s health and wellbeing initiative.

She said that getting the Treasury to agree to tax relief on £500 employer spend for a clinical intervention to rehabilitate an employee was a major achievement.  I suggested to her and the audience that the cap of £500 bore no relation to clinical need and the fact that it could only be offered on recommendations by the new Independent Advisory Service after an absence of four weeks was a nonsense. We had a private chat later and in principal, I don’t think she disagreed with me and sounded quite frustrated.

I raised the same issue in a conversation with Paul Burstow MP another speaker who was up until last year, a Minister of State in the Department of Health.  He told me that the current government has no appetite in investing to save.

If only we could see the economic argument that the Treasury put forward in not allowing tax relief on any employer clinical spend on rehabilitation.

BMA Right on Narrow Tax Breaks in Work Place health

Sep 27, 2013

You can read The British Medical Association (BMA) views on the new proposed tax break on £500 spend rehabilitating employees by clicking here.

Whilst they have a vested interest in ensuring their members don’t lose out in providing occupational health services, they make some good points including the new Independent Assessment Service ( IAS ) possibly becoming a monopoly.

Why should the tax break only be available on recommendations by a government body not any other recognised occupational health professional that employers are already paying to make these kinds of decisions?

Let’s also not forget that the IAS will only make a recommendation after 4 weeks absence, yes 4 weeks.  At the same time, the limit of £500 is totally arbitrary and  bears no relation to any clinical need on a case by case basis.

It really is a nonsense.


IOSH Right on Narrow Tax Breaks in Work Place Health

Aug 27, 2013

The Institution of Occupational Safety and Health (IOSH) has issued this press release calling on the government to remove three restrictions from its decision to remove tax disincentives for certain employer-provided health support and access to physical activity and sports.

IOSH is absolutely right.

The government intends to cap the tax free amount that employers can invest in a clinical intervention to £500. It’s a nice round number but completely arbitary. It has no clinical basis and ignores the cost benefit analysis of cases where spending more on treatment results in a much greater amount of reduced cost.  There should be no cap.

Employers can only benefit from treatment tax breaks following recommendations from the new Health and Work Service – primarily designed for small employers who cannot afford their own Occupational Health services. This is a bit like the joke about crime in a multi-storey car park – wrong on so many different levels.

  • It’s discriminatory against the larger employer who already pays for OH and an inconsistent treatment of tax which I thought this government was trying to get away from.
  • It’s been proven time and time again that the secret to an early return to work is an early intervention. How confident are we that this new Health and Work Service will be able to deliver its recommendations in the timescales required.  At the moment, the proposal is to offer an occupational health assessment after four weeks absence, yes four weeks !
  • Who is going to be running this new service? The government says it is going out to tender for external private provision. I envisage a big impersonal call centre with advisers who have no knowledge of local issues or indeed the wide range of employment practices over so many small businesses.

The government wants to exclude tax exemption on associated costs to the employer’s health support, such as specialist equipment, workplace adjustments and travel expenses.  Why?  It’s all part of the same objective of getting the employee back to work as quickly as possible incurring the least cost to the state and employer as possible.

In my opinion, the government really needs to be looking at the wider rationale for removing all tax disincentives for employers providing health support services for their employees. Anything that an employer does to help prevent or treat ill health has a positive impact on the wider economy.




NHS Health Check Programme under fire

Aug 20, 2013

There’s a bit of a bun fight going on in the media between Public Health England who run the NHS Health Check Programme and several of its detractors including Professor Clare Gerada, Chair of the RCGP (Royal College of General Practitioners).

Professor Gerada is calling for the NHS Health Check Programme to be scrapped in favour of spending the money elsewhere, basing her reasoning on research carried out by the Nordic Cochrane Centre in Denmark, published last year.

The research was described as ‘a systematic review that concluded that general health checks were not beneficial and would likely lead to unnecessary diagnoses and treatments’. You can read the research by clicking here.

A really good summary of the issues can be found here in Pulse magazine.

Here’s my take on the debate:

  • I’m not convinced that the Danish research – including analysis of many really old studies  – draws on the same tests, rationale and outcomes of the relatively new NHS Health Check Programme.
  • The NHS has allocated a tiny % of its overall budget to the programme with the logically sound argument that prevention is better and lest costly than cure.  As stated in an earlier post, they have started to risk stratify and target expenditure where it is needed most.
  • The NHS have so far failed to show the positive impact of the programme. Although I’ve seen many individuals say how grateful they are for the check as it found something major early on when treatable, the NHS would be in a much better position if they could report on the outcomes of all checks. They may do this already, but I have yet to see it.
  • The people with responsibility for rolling out the programme are GPs – Professor Gerada is chair of their trade association. Running the Health Checks takes up GPs time and there is undoubtedly follow up, which…takes up more time…
  • Were GPs involved in the original planning? If not, this was clearly a mistake.

As is understandable in such big policy decisions there will be those for and those against.  I’m intuitively for the NHS Health Check Programme and those individuals whose lives have been saved or extended by it are unlikely to be against. I just wish that there had been much greater consensus from the medical community from the outset and that we had greater clarification on the positive outcomes.  I hope this comes in due course.

Less than half of patients attend NHS health checks, show official figures

Aug 06, 2013

This is an interesting issue for the NHS and a comparison can be made with decisions that employers take about their own approach to health screening for their employees.

‘NHS Health Checks’ is a Govenment flagship programme which aims to pick up patients aged 40 to 74 at high risk of cardiovascular disease or diabetes  – two of the highest incidence and biggest cost diseases but also two of the most preventable.

Of the 15m people eligible, only 16.5% get invited and  8% actually take up the check – a rate of 50%. Whilst there is concern about this take up rate, I think most employers would be delighted to get the same rate on a company paid initiative.

A study analysing data from the NHS Health Checks scheme in 2011/2012, published last month in the Journal of Public Health, concluded that coverage was too low currently to make the programme pay for itself.  This could well be the case, but the cost benefits of investing in this health programme need to be measured over a longer term – something which employers also need to bear in mind for their own investments in this area.

I’m not defending the current perceived low take up and I know that Public Health England are unikely to hit the original target of inviting 15m people by 2018/19, but the risk stratification approach they are taking deserves some recognition.

The point of comparison is that employers would be well advised to look at their health risks in a similar way rather than invest in non-specific programmes on a one size fits all basis where the take up rate is often signifcantly less than 50% and the value of investment is highly questionable.

Big Discrepancy on Sickness Absence Figures

Jul 25, 2013

Two pieces of research released at the same time, one from PwC and one from the CBI, show a dramatic difference in the levels of sickness absence in the UK.

The PwC research which you can view by clicking here says that in 2013, UK workers take an average of 9.1 days off through sickness each year. That’s nearly double the US rate and 4 times more than counterparts in Asia Pacific.

The CBI research which you can access by clicking here, says that in 2012, the average absence rate for UK workers was 5.3 days.

The difference between the two reports at 3.8 days is staggering or am I missing something here? PwC says the cost to the economy is £29bn whilst the CBI says £14bn

PwC’s research involved data gathered from 2,500 employers.   HR managers in 153 public and private sector organisations responded to the annual CBI survey.

Who do you believe?