The period of being off sick is important because it presents opportunities to avoid the need for someone eventually to make an Incapacity Benefit claim.
People had very varied experiences of the period of being off sick from work and in receipt of Occupational Sick Pay or Statutory Sick Pay (SSP) up to the point of making a claim for Incapacity Benefit. For some, the period was relatively lengthy during which time they had contact with health services, employers and possibly others, such as Jobcentre Plus staff. However, it is also important to recognise that for some people this period was very short, and in a few cases, there was effectively no period of ‘being off sick’ because their paid employment ended at the point of first going off sick. In effect, at this stage, a number of people in the sample were sacked, made redundant or left work voluntarily.10
3.4.1 3.4.1 3.4.1 3.4.1
3.4.1 Contact with GP and NHS services while ofContact with GP and NHS services while ofContact with GP and NHS services while ofContact with GP and NHS services while ofContact with GP and NHS services while off sickf sickf sickf sickf sick
At the point of going off sick, or very soon afterwards, most of the people in this sub- group were issued with a sickness certificate by their GP. This was either requested by them or offered by the GP. Often, people spoke about going to see their GP when they had reached some kind of breaking point – for example, a participant with a musculoskeletal condition went to see her GP ‘in tears’ when she was experiencing migraines and exhaustion resulting from not sleeping. She had got to the stage where she could not grip everyday items such as an umbrella, let alone medical instruments at her place of work, and had started to spill pans of hot water at home. Her GP then signed her off sick.
For some people it was hard to distinguish the period before and after making a claim for Incapacity Benefit. For them it was more salient to talk about a single period of being away from work while sick. The point at which they claimed Incapacity Benefit had no bearing on the trajectory of their health condition. Hence, people talked about using a wide range of health services, including referrals to hospital consultants, treatments and diagnostic tests. Being on waiting lists was a common experience and there were examples of GPs lobbying hospital consultants on behalf of patients when they had been informed they would be waiting a considerable time either for an appointment with a consultant or for treatment.
Having entered a period off sick, the subject of returning to work was not, according to the research participants, raised by their GPs. Some people, however, said they had raised it themselves, asking advice on when a return to work might be possible, or what duties they might be capable of while they were either stable or recovering from a health condition. In such cases, people reported that their GPs were
10The Omnibus Survey 2003 suggests that 19 per cent of those on sick leave felt that they felt their job was at risk whilst on sick leave for more than a week. Moving from work to Incapacity Benefit
Moving from work to Incapacity BenefitMoving from work to Incapacity Benefit Moving from work to Incapacity Benefit Moving from work to Incapacity Benefit
3 1 3 1 3 1 3 1 3 1
responsive and either encouraged or supported the desire to start some form of working again, or advised that work was not yet appropriate. A few people had similar experiences when they raised the subject with work or with other health professionals such as physiotherapists or community psychiatric nurses (CPNs). In contrast no-one reported that they discussed work with hospital consultants (although one person said he planned to ask his specialist what he might be capable of when he had his first appointment with him).
3.4.2 3.4.2 3.4.2 3.4.2
3.4.2 Employment conditions and employer rEmployment conditions and employer rEmployment conditions and employer rEmployment conditions and employer rEmployment conditions and employer relationselationselationselationselations
How people were treated by their employers while off sick varied. Where employers kept in contact with employees to find out how they were, employees often took this as a sign that they were valued in their job. Similarly, where no contact was forthcoming from the employer, people could feel that they had been ‘forgotten about’ and feel devalued. Exceptions to this were found in cases of conflict in the workplace (for example, a participant who perceived that they had been bullied wanted no contact from anyone at work and felt ‘hounded’ by phone calls from their employer). At this stage, some employees requested an alternative role to suit their reduced capabilities. However, there were very few successful examples of this actually happening. People in the sample reported that their employers cited, for example, the cost of replacing them or the limited scope for other roles as reasons for inaction.
People had different experiences of occupational health departments. For some, occupational health staff effectively performed the role of informing the participant that they were not fit enough to do their job and referred them to their GP for a sickness certificate. In contrast, some employees signed off by their GP subsequently went to their occupational health department or were called in to see them. In such cases, people valued the confirmation that they were indeed unfit to do their job and in certain instances actively consulted with occupational health staff in order to approach the appropriate people within the organisation with a view to getting an alternative role.
Views regarding occupational health were contextual and sometimes depended on people’s relations with their employer. While generally speaking, services and benefits were viewed in a positive light by the people in the study, there was also a (sometimes strong) perception that occupational health staff were ultimately on the ‘side’ of the employer. In some cases they had recommended early retirement on health grounds.
In contrast, the small number of people who had accessed occupational health services through their GP surgery rather than through their employer did not report such perceptions and were positive about the benefits gained. In such instances for example, occupational health services had helped with support, information on entitlements to benefits and advice on employment legislation. In one case they had contacted a small employer to inform them of their contractual obligation to pay their employee sick pay for longer than the period actually offered.
Moving from work to Incapacity Benefit Moving from work to Incapacity Benefit Moving from work to Incapacity Benefit Moving from work to Incapacity Benefit Moving from work to Incapacity Benefit
3 2 3 23 2 3 2 3 2 3.4.3 3.4.3 3.4.3 3.4.3
3.4.3 Role of family and friendsRole of family and friendsRole of family and friendsRole of family and friendsRole of family and friends
In this time period it was mostly the case that people reported receiving emotional and (depending on circumstances) financial support from family and friends. However, there were also some tensions for some people including spouses and partners having to ‘bear the brunt’ of a participant’s frustrations concerning their ill- health. Some people also reported being worried about their family’s financial situation and a sense of anxiety about what would happen if they were unable to return to work soon.