Executive Summary
iOH welcomes fit note reform and WorkWell pilots (Broken fit note system to be overhauled – GOV.UK) but emphasises that outcomes depend on shifting from certification to workability, engagement, and integrated support.
The Case for Reform
The current system produces high volumes of certification but limited functional support, failing to consistently support recovery, employer action, or return to work.
What Drives Outcomes
Successful outcomes require functional workability assessment, access to occupational health expertise, and clear employer guidance supported by ongoing engagement.
Risks
Key risks include continued diagnosis-led models, lack of Occupational Health (OH) access, unclear employer outputs, absence of pathways, and reliance on conditionality.
WorkWell-Aligned Model
A workability-based system should include personalised plans, tiered expertise, integrated pathways, and continuous review.
Safeguards
Clinical governance, financial stability, mental health support, integrated services, transparency, and monitoring of harms are essential.
Measuring Success
Success should be measured by sustained return to work, engagement, wellbeing, employer implementation, and equity.
Conclusion
Reform must shift from certification to workability, from compliance to engagement, and from fragmentation to integration.
Annex A – Evidence Base
Evidence indicates that sanction-based approaches may produce short-term compliance but are associated with poorer long-term outcomes, reduced engagement, and adverse mental health effects.
Support-led and occupational health-informed interventions are more effective in achieving sustained work participation.
Annex B – Risks Register
- Diagnostic focus rather than function
2. Lack of occupational health access
3. Unclear employer guidance
4. Absence of pathways
5. Conditionality risk
Annex C – Definitions
Workability: Functional assessment of capability, risk, and job demands.
Engagement: Sustained participation in work and health support pathways.
This statement was prepared by Lucy Kenyon, Trustee and Board Director iOH