Return-to-work outcomes and usefulness of actual fit notes received by employers

Background: GPs can use the fit note to advise that a patient ‘may be fit’ or is ‘not fit’ for work. Previous employer-based research on the fit note is largely qualitative and based on general perceptions and past experience. Knowledge of the return-to-work outcomes and usefulness of actual fit notes is needed to strengthen the evidence-base and inform practice. Objective: To investigate the return-to-work outcomes of fit notes issued to employed patients, and their employers’ opinions as to the usefulness of each note. Methods: Participating organizations collecting fit notes were asked to rate the outcome and usefulness of each fit note via postal questionnaires. Quantitative data were analysed descriptively; qualitative data were analysed using thematic content analysis. Results: Five hundred and sixteen questionnaires were posted, with a 97% return rate (n = 498). More than 80% of employees (n = 44) returned to work after the expiry date of a ‘may be fit’ note compared with 43% (n = 167) of those issued with a ‘not fit’ note. Fit notes were considered more useful if they provided information on the condition and its effect on the employee’s ability to work, if they stated whether or not the employee needed reassessment and if clear advice regarding return-to-work had been provided. Conclusions: ‘May be fit’ notes are useful in helping employees return to work. However, this option is infrequently used, and the completion and content of many fit notes does not meet employers’ needs. These factors need to be urgently addressed if the fit note is to reach its full potential

Disability Costs and Equivalence Scales in the Older Population in Great Britain

We use a standard of living (SoL) approach to estimate older people's disability costs, using data on 8000 individuals from the U.K. Family Resources Survey. We extend previous research in two ways. First, by allowing for a more flexible relationship between SoL and income, the structure of the estimated disability cost and equivalence scale is not dictated by a restrictive functional form assumption. Second, we allow for the latent nature of disability and SoL, addressing measurement error in the disability and SoL indicators in surveys. We find that disability costs are strongly related to severity of disability, and vary with income in absolute and proportionate terms. Older people above the median disability level require an extra �99 per week (2007 prices) on average to reach the SoL of an otherwise similar person at the median. Costs faced by older people in the highest decile of disability average �180

Moral Argument and the Justification of Policy:New Labour’s Case for Welfare Reform

This article proposes a framework for exploring how politicians use moral arguments to win support for their policies. It proceeds from the premise that the formulation of such arguments is mediated by three factors that constitute a general context of justification - ‘ideology,’ ‘argumentation’ and ‘hegemonic competition.’ For analytical purposes, the framework reconstructs the process of justification as one in which argumentative strategies are selected, modified and utilised in the light of these factors. The framework is applied to New Labour’s case for the New Deals and Flexible New Deal. The analysis reveals that these initiatives and the moral arguments used to promote them are broadly consistent with New Labour’s ideology; the arguments are appropriate to the policies; and that New Labour succeeded in setting the agenda on welfare reform

Exclusionary employment in Britain’s broken labour market

There is growing evidence of the problematic nature of the UK’s ‘flexible labour market’ with rising levels of in-work poverty and insecurity. Yet successive Governments have stressed that paid work is the route to inclusion, focussing attention on the divide between employed and unemployed. Past efforts to measure social exclusion have tended to make the same distinction. The aim of this paper is to apply Levitas et al’s (2007) framework to assess levels of exclusionary employment, i.e. exclusion arising directly from an individual’s labour market situation. Using data from the Poverty and Social Exclusion UK survey, results show that one in three adults in paid work is in poverty, or in insecure or poor quality employment. One third of this group have not seen any progression in their labour market situation in the last five years. The policy focus needs to shift from ‘Broken Britain’ to Britain’s broken labour market

Women’s experiences of menopause at work and performance management

Presenting findings from our global evidence review of menopause transition and economic participation emboldened us to establish a menopause policy at the university where we all worked at the time. Our report was published in July 2017 and the policy was in place by November that year. Our critical reflection on this activism focuses on issues that are not commonly recognized around such interventions, and which we ourselves have only been able to acknowledge through engaged action. Challenges remain in normalizing menopause in organizations, specifically around gendered ageism and performance management. In drawing on Meyerson and Kolb’s framework for understanding gender in organizations, we highlight how policies are both vital and yet insufficient in and of themselves in revising the dominant discourse around menopause at work. At the same time, we highlight the importance and shortcomings of academic activism within these processes

Quantity over quality: a political economy of ‘active labour market policy’ in the UK

This article offers a critical evaluation of recent ‘active labour market policy’ (ALMP) initiatives in the UK, focusing on the coalition government's Work Programme and its immediate antecedents. ALMP exemplifies a supply-side employment strategy, reorienting the state away from supporting labour demand and towards promoting the ‘employability’ of individuals within existing labour market structures. The article locates the rationale for this policy agenda within the wider politics of economic growth. Belying its status as a pioneer of ALMP, the UK spends very little on supply-side labour market interventions relative to other European countries. This can be explained with reference to the type of ALMP interventions prioritised in the UK, which in turn is explained by the growth model that ALMP is designed to sustain. The UK's growth model requires an abundance of low-paid jobs in the labour-intense and volatile services sector. Ostensibly, ALMP fulfils this requirement by ensuring that individuals are immediately available for work, marginalising concerns about pay and job quality. Moreover, ALMP also serves to inculcate the desirability of certain behaviours at the individual level. The coalition government's approach demonstrates an intensification rather than transformation of previous practice, indicative of its support for resurrecting the UK's pre-crisis growth model

Social Desirability and Cynicism Biases in CSR Surveys: An Empirical Study of Hotels

Purpose: Previous studies support the notion that corporate social responsibility (CSR) initiatives can have a positive effect on customers in the hospitality and tourism industry. However, most of these studies have ignored response biases and none have incorporated them into their analyses numerically. This study aims at closing this research gap. Design/methodology/approach: We utilized a hybrid choice model to test for the hypothesized effects of social desirability (SD) and cynicism biases on reported purchase intention. We further compared the results with those of analyses that ignore these biases to demonstrate their distorting influence. Findings: Our results indicate that SD and cynicism biases have a moderating effect on reported purchase intention. Older generations and frequent travelers seem particularly prone to bias, and the biases have a distorting effect on the overall survey results. Research limitations/implications: Traditional analyses that exclude biases, incorrectly, suggest several aspects of CSR that are significant (or insignificant) to purchase intention and provide unreliable results. We did not generalize bias-prone respondent segments but urge future research to investigate this. Practical implications: Hotel managers aspiring to gain competitive advantage through CSR investment must consider biases in their market research. Otherwise, they risk developing CSR initiatives that do not instigate positive customer behaviors, leading to the failure of the investment. Originality/value: We quantified SD and cynicism as significant causes of response bias, which distorts survey results. Previous studies have conceptualized SD without quantifying its impact, while cynicism has been identified as a novel source of bias in the industry. This study further introduces hybrid choice modeling as a novel approach to address response bias that could extend itself beyond the industry studied here

Effective communication with older people

Effective communication with older people is an important aspect of nursing practice. Ineffective communication can lead to older people feeling inadequate, disempowered and helpless. Nurses have a duty to ensure that older people think they are being listened to and that their concerns are being validated in a non-judgemental way. Central to effective communication is the ability of nurses to be self-aware, and monitor their thoughts and feelings about, for example, negative stereotypes associated with the ageing process. Effective communication can sometimes be difficult to achieve due to the effects of ageing, but nurses can overcome some barriers through thoughtful interventions. It is important to treat older people as individuals, and to monitor and adapt communication accordingly. By doing so, nurses can ensure older people feel empowered, respected and able to maintain their independence