Carol M. Black

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Dame Carol Mary Black, DBEFRCP (born 26 December 1939) is a policy advisor on work and health to the British Government. She is Chair of the Nuffield Trust.

Student years[edit]

An only child, Black was born into an unacademic family in rural Leicestershire a few months after the outbreak of the Second World War. She attended grammar school in the 1950s where she became head girl.[1][2]

She studied history at Bristol University, graduating as a Bachelor of Arts. She then moved to a British colony - the Gilbert and Ellice Islands in the Pacific Ocean - where she worked as a schoolteacher.[1]

In 1965, at the age of 25, Black enrolled in the first intake of undergraduate medical students to Bristol University, where she sparkled - winning prizes in surgery, obstetrics and pathology.[3]

She graduated in medicine in 1970 and obtained full registration with the General Medical Council the following year.[4]

Clinical career[edit]

After graduating, Black stayed in Bristol to work in general hospital medicine as a junior doctor. She gained a higher degree by researching the rare skin disease scleroderma and in 1974 passed the Royal College of Physicians membership examination.

Black moved to Hammersmith Hospital in London the following year for specialist training. In 1981, she took up an offer of an appointment as a consultant rheumatologist at the nearby West Middlesex Hospital.

After only eight years in a general hospital as a consultant, Black opted for a move into academic medicine at the Royal Free teaching hospital in Hampstead.[1] The rheumatology clinic she established there is a national tertiary referral centre for scleroderma, although a specific treatment for the disease remains elusive.[5]

Board appointments[edit]

Black was President of the Royal College of Physicians between 2002 and 2006.

In 2004, she made controversial comments[6][7] about the role of women in medicine, suggesting that Russian doctors were poorly paid and had low status and that this was because they had an almost entirely female workforce (rather than it being to do with Russian 20th century political history). She then drew a parallel between doctors and teachers, saying: "Years ago, teaching was a male-dominated profession - and look what happened to teaching".[8] She later clarified her comments, explaining that her intention had been to warn that unless provision was made for female doctors to balance work and family life and be given extra support with childcare and flexible hours, they would tend not to enter what she called "the more demanding" branches of medicine or to serve on government committees.

Black has sat on numerous committees and still works as an advisor to the consultancy firm PwC[9] and with the Work Foundation.[10]

Health and work[edit]

In 2006, the Labour Government led by Tony Blair made Black its national director for health and work to promote the Government's policies on health, work and wellbeing across Whitehall.

In 2008 she authored Working for a healthier tomorrow, a report which focused on the impact of sickness absence on the health of the working-age population and on the economy. [11]

The key points of the 2008 report were:

  • Intervention in the early stages of an employee's sickness absence could help prevent the absence becoming a long-term one
  • Managers should be flexible when an early return to work is recommended
  • GPs should be "supported to adapt the advice they provide, where appropriate doing all they can to help people enter, stay in or return to work"
  • The sick note should be replaced by a 'fit note' that outlines what the patient can do at work, not just what they can't do
  • Occupational health services should be expanded, and more of these services should be provided by the NHS
  • Occupational health services should also be made available to people who are out of work

The fit note was introduced in 2010.[12]

Though no longer a national director, Black leads the 'health at work network' at the Department of Health; through it, she is part of a drive to encourage commercial, public and third sector organisations to improve the health of their employees.[13]

'Fit for work' service[edit]

In 2011 the new Prime Minister, David Cameron, asked Black to work with the Director General of the British Chambers of Commerce to compile another report on sickness absence. The study was sponsored jointly by the Department for Work and Pensions and the Department for Business, Innovation and Skills, and was entitled Health at work - an independent review of sickness absence.[14] The work built on Black's 2008 report into sickness absence and explored largely the same themes.

One recommendation of the joint report was the creation of an independent assessment service, provided by the private sector but funded by central government, which could be used by employers and employees working in organisations that did not have their own in-house occupational health service, as well as by GPs considering whether to 'sign someone off sick'.

The other recommendations were:

  • Further modification of the fit note to make it less job-specific
  • Better management of sickness absence in the public sector
  • Changes to Statutory Sick Pay administration
  • The abolition of the Percentage Threshold Scheme, which compensates employers in firms with high rates of sickness absence
  • A job-brokering service, to find new work for employees on long-term sick leave
  • Changing the benefits system to reduce the number of claimants waiting for a Work Capability Assessment

'Fit for work', the national assessment service envisaged in the report, was launched in 2015.[15] It gives advice to employers and GPs over the telephone or online. The vast majority of employee assessments - which are voluntary - are carried out over the telephone by an unspecified occupational health professional. For face-to-face assessments - expected to be undergone by only a "limited number of patients" with "complex" problems[16] - the off-sick employee will need to travel for up to 90 minutes to meet their assessor.[17]

Welfare and work[edit]


One conclusion of Black's 2011 report concerned the sickness benefits system. Black felt that a high proportion of new claims for the out-of-work sickness benefit Employment and Support Allowance (ESA) did not meet the threshold for eligibility, yet an assessment only took place after an 'assessment phase' lasting at least 13 weeks (during which, the claimant received no more money than they would if they were on Jobseekers Allowance). She was concerned that this phase represented a substantial delay in returning to work for those claimants who were not incapable of work; she therefore recommended that the assessment phase be abolished and that ESA only be considered when a Work Capability Assessment (WCA) has taken place and when the claimant has been found unfit for work.[18]

The DWP did not take up her recommendation.

In 2014, the number of jobless claimants on the WCA waiting-list ballooned to more than half a million because of problems with the delivery of the WCA itself.[19] This exacerbated the situation that Black had identified in 2011: the waiting time for a WCA now stretched well beyond 13 weeks but these claimants were not included in the official 'claimant count' - a key indicator of the level of unemployment nationally - nor available to Jobcentre Plus staff for help in finding work.


In February 2015, the Prime Minister asked Black to advise him on whether the option of withdrawing out-of-work sickness benefits from obese people and those struggling with drug and alcohol addiction would encourage them to seek further medical help for their problems.[20] The Prime Minister re-announced the study in July 2015, with Black expected to submit her report by the end of the year.[21][22][23]

The proposed review encountered early criticism from other experts.[24][25] As Black herself said in the executive summary of her 2008 report: "Many common diseases are directly linked to lifestyle factors, but these are generally not the conditions that keep people out of work. Instead, common mental health problems and musculoskeletal disorders are the major causes of sickness absence and worklessness through ill-health".[26]

Less than a tenth of one percent of people on out-of-work sickness benefits have obesity as their main disabling condition; less than 3.5% have any form of substance misuse as their primary diagnosis, although as many as 11% might have a drug or alcohol problem, if background lifestyle factors are taken into account.[27][28]

Other appointments[edit]

Black is Principal of Newnham College in Cambridge, a trustee of the National Portrait Gallery and a member of the governing body of Uppingham School.[29]

Awards and honours[edit]

She was awarded the DBE in 2005 for her services to medicine.[30]


  1. ^ a b c
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  3. ^ "People of today: Carol Mary BLACK". Debrett's. Retrieved 29 July 2015. 
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  7. ^ Jones, Sam (2 August 2004). "Women doctors at top 'harm status'". The Guardian. Retrieved 2 August 2015. 
  8. ^ "Women docs 'weakening' medicine". BBC News. 2 August 2004. 
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  13. ^ "Public Health Responsibility Deal: Health at Work Network". Department of Health. Retrieved 2 August 2015. 
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  19. ^ "Hundreds of thousands hit by benefits backlog". BBC News. 11 June 2014. 
  20. ^ "Go on a diet... or lose your benefits: PM to announce £500m clampdown". Daily Mail (London). 14 February 2015. 
  21. ^ The Sun (London)  Missing or empty |title= (help)
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  29. ^ "Past, present and future: The Governing Body". Uppingham School. Retrieved 2 August 2015. 
  30. ^

External links[edit]

  • profile on Newnham College website
  • profile on Nuffield Trust website
Academic offices
Preceded by
Sir Kurt George Alberti
President of the Royal College of Physicians
Succeeded by
Ian Gilmore
Preceded by
Dame Patricia Hodgson
Principal of Newnham College Cambridge