Covid-19 offers occupational health ‘a unique opportunity’

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As the first “crisis” phase of the coronavirus pandemic eases, but with the threat of a second wave still all too real, now is an opportune moment to reflect on what occupational health sector has learnt so far from the Covid-19 pandemic, argues Nick Pahl, chief executive of SOM.

At SOM (the Society of Occupational Medicine), we responded quickly to the coronavirus pandemic. There were dark days in the spring where OH professionals were being furloughed or made redundant at the same time as the government struggled with healthcare work protection.

A SOM snapshot survey in April found over 1,500 OH professionals not being used either by being furloughed or underemployed. We facilitated members volunteering and working in the NHS, procurement of OH within the NHS and provided daily updates for members.

A great opinion piece in the Health Service Journal by the then SOM President, Dr Will Ponsonby, highlighted the need for health leaders and politicians to step back, avoid the use of military style language and consider the hierarchy of controls to protect healthcare workers.

SOM started a campaign for “no more health care work deaths”, supported by the BMA and others. We proactively challenged government, offering support and advice. We were pleased that Miriam Margolyes spoke out in support of occupational health professionals as a core part of the pandemic response.

We could not have done it without many partners and experts. Professor Ewan Macdonald advised on the need for evidenced-based standards for PPE. Our toolkits on return to work would not have been anywhere near as good or effective without CIPD, BITC, Acas and Mind.

SOM has facilitated regular multi-disciplinary OH meetings with organisations from the Association of Local Authority Medical Advisers (which has produced an excellent Covid Age risk assessment), the British Occupational Hygiene Society, the British Psychological Society, Chartered Institute of Ergonomic and Human Factors, VRA, iOH and the Faculty of Occupational Health Nursing.

This has allowed effective liaison with the Health and Safety Executive (HSE). We worked with the Faculty of Occupational Medicine on advice on face-to-face medicals in the light of HSE guidance on health surveillance. SOM was also pleased to partner with the Royal College of Psychiatrists and CIPD on advice on mental health in the workplace – an area of concern going forward.

We continue to work with the Royal College of Nursing both on technical occupational health advice but also on webinars and events. There is now a myriad of webinars, with SOM hosting and partnering with the WHO, ACOEM in the US, in Middle East, the US and Ireland as well as the UK. SOM’s Journal of Occupational Medicine has recently published several key articles with some ground-breaking research by researchers from across the world – to be published shortly in a Covid-19 “special issue”.

Occupational health leadership

Have organisations that have occupational health as core to their business fared better? Talking to CMOs recently, it does seem that the “insurance” of OH has really helped business in pandemic planning and recovery. Leadership from OH within organisations is key. We now need to support and encourage new occupational health leaders – SOM is hosting a “next generation” leadership group shortly and can help by providing mentoring, peer support and occupational health management support.

Beyond “catastrophising” mental health and job loss

With public concern about job losses, exploitation, and the precarious nature of work for many people we need to stand up for good quality jobs. People need to be treated with respect and decency at work. Occupational health has a key role in helping people to stay healthy and happy and in doing so will help deal with the challenge of low productivity and business resilience.

SOM is fortunate to have Professor Neil Greenberg as a new trustee. He has wise, evidence-based advice for us not to “catastrophise” mental health issues – it may be an opportunity for change and growth. Also, it is worth noting practical aspects – such as organisational screening not being effective.

Political advocacy

SOM has written to health secretary Matt Hancock, the HSE’s CEO and other key stakeholders during the pandemic. The crisis has demonstrated a lack of government expert advice in occupational medicine – in Public Health England and key government departments such as the DWP and DHSC. This needs to change.

There is now a unique opportunity for OH to positively influence the health and wellbeing of the working population and the prosperity of the nation. By investing in OH, the government can support employers to safeguard their workforce and manage risks. We have support from the RCN, the Faculty of Occupational Medicine, BMA and the Unite union and TUC in this work. SOM would like to work with DWP/DHSC and HM Treasury to act swiftly in the light of the Covid-19 crisis to ensure the UK population has a clear offer of access to OH advice and assessment.

SOM recently asked a Parliamentary question about the government’s plans to publish the response to the consultation “Health is everyone’s business: proposals to reduce ill health-related job loss” later this year. As readers hopefully know, the consultation set out proposals to encourage all employers to take positive action to support employees who are managing health conditions in work, and to manage sickness absence more effectively. This is now expected in the autumn.

There is now an even stronger economic case to implement access to OH for all employers to improve productivity. OH services are key in supporting employees back to work and keeping them in work safely during these challenging times. Small and medium enterprises and the self-employed will need support to ensure safe work environments, with a focus on mentally healthy workplaces. Early research shows that many people returning to work during the Covid-19 crisis will return with somewhat “depleted” mental health. OH services have been proven to enable those on sick leave due to mental health problems to return to work successfully. Preventative measures in place through the application of occupational hygiene is also critical.

As part of our new “Universal Access to OH” campaign, SOM would like to see:

• Health Education England and its equivalents in the devolved administrations invest in training of OH professionals such as occupational medicine trainees and OH nurses.
• Investment in expert OH advice in government, the establishment of a OH national data-set and UKRI investment in a research Centre for Health and Work to translate evidence into policy.
• Tax incentives by the Treasury so employers can invest in occupational health.
• Access to OH for GPs.
• A national clinical director for work and health to lead this work.

Let us get occupational health ahead of the change curve and scale up. The next phase will be complex and potentially more difficult to navigate. Data from the Office for National Statistics shows there is clear risk for public-facing roles such as bus drivers, security guards and care workers. Future outbreaks seem to be coming from workplaces such as the meat factories in Wales and so, ensuring decisions on return to work are correct are viewed through a reputational lens of “building back better”, is important.

Now we are talking about the “new normal” we need to move from “respond” to “recover” and then “thrive”. This involves placing occupational health as central to business. As Rolls Royce said to SOM: “In the post-pandemic world there will be greater scrutiny and expectation from stakeholders including investors, regulators and current and prospective employees to understand what organisations are doing about the health, safety and wellbeing of their workers. Occupational health is ideally placed to fulfil these expectations.”

The new SOM Occupational Health Commercial Providers’ group, chaired by Dr Mike Goldsmith, has been reviewing how scale up of occupational health can occur – be it through:

• Using technology – developing video and telephone consultation and use of “robotic OHTs” to take tests.
• Investing in the education of new OH doctors/ nurses; hosting by commercial providers, the military and NHS.
• Training managers, and HR, on OH and what to look for and how to refer.
• Encouraging more people to enter OH by ensuring Universities ensure all health professionals understand OH principles and see work as an integral part of a healthy lifestyle.
• Engaging health professionals to learn about OH not only at undergrad level but also at mid-career level, e.g. via diplomas.
• Offering regular series of workplace visits for to learn about OH regularly to encourage trainees.

I encourage readers to join our campaign for universal access to occupational health. It aims to articulate politically and to the public as to what OH can do for its employees, how to use OH, and the return on investment.

Finally…

There is still a long way to go in this situation, but what will be interesting is whether the Covid-19 pandemic sees fundamental changes to support OH. Crisis and resilience will become more high profile, and perhaps OH will finally be regarded as a truly strategic capability. So, readers:

• Contact your MP asking for them to support the SOM universal access to occupational health campaign – details on our website.
• If you are a nurse, Professor Anne Harriss, the new SOM president, is leading a group looking to feedback your views regarding the SCPHN qualification/training consultation that the NMC is currently carrying out.
• Send us examples of cases where occupational health has really helped e.g. someone who has been in ITU with Covid-19 who has returned to work.