Not Fit for Purpose

An Appraisal of the ‘Fit Note’ and Assessments of Fitness for Work

April 13, 2024

A new report calls for the Government to overhaul assessments of fitness to work, including the ‘fit note’ and incapacity and disability assessment as part of a package of measures to curb long-term sickness absence and an unsustainable trajectory for welfare spending.
Based upon an analysis of the latest data on the use of the ‘fit note’ published by NHS England, Policy Exchange found:

  • The total number of ‘fit notes’ issued each year since 2015 has doubled from 5.3m in 2015/16 to over 11m in 2022/23.
  • That 93% of ‘fit notes’ are currently designated ‘not fit for work’, with no adjustments suggested.
  • Around a third of all ‘fit notes’ are issued for five weeks or longer – 20% of those in receipt of a fit note of this length will not return to work.
  • 71% of all ‘fit notes’ issued between April 2021 and December 2023 contained no diagnosis of an individual’s condition(s), creating an ‘information gap’ for employers.
  • Mental and behavioural disorders meanwhile are cited as the reason for ‘fit notes’ being issued in 37% of cases (where a diagnosis provided).  Of these instances, 41% are ‘signed-off’ for between one and three months.

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Dr Sean Phillips

Head of Health and Social Care

Stuart Carroll

Senior Fellow, Health and Social Care

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