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The Covid-19 pandemic has left occupational health practitioners struggling to cope with massive return-to-work, mental health, risk management and infection control challenges. With the government also keen to reform workplace health provision, now is the time to consider how OH can more effectively ‘scale up’, argues Dr Sheetal Chavda.
Covid-19 is likely to lead to a changing economy and new health at work issues that will need to be dealt with competently. Disabilities affecting work and workplace risks have not disappeared, only transmuted into different presentations and challenges. This will also drive the need for research and innovation within occupational health. Musculoskeletal and mental health problems remain prevalent within our society and therefore there remains a need for strong evidence-based treatment and management options.
OH professionals – as we all know – advise businesses and organisations on when and how to bring workers back safely. They provide medical input on risk assessments, give guidance for at-risk groups and, of course, assess individuals when necessary to advise their managers on safe return to work.
Currently only half the UK’s workforce has access to OH. This paper aims to outline the strategy that, we’d argue at SOM (the Society of Occupational Medicine), is required to ensure occupational health has the necessary resources to scale up to meet this rising demand.
A major challenge within this is attracting new OH workforce entrants and then providing relevant training. This paper also aims to identify how we can use technology to provide much-needed occupational health advice in the short-term, and the role of the government to support this.
SOM has already produced a paper on The Future of the Occupational Health Workforce that has made recommendations on how to address this issue in the future. It is important there remains a focus on this, as scale-up is unlikely to function in the medium to long term without adequate resources.
OH is critical in helping to reopen the economy using available guidance and best practice, and its value has never been more evident than at the present time. It is possible that demand for OH services will increase significantly as employers and employees seek to return to work and advice is needed on whether it is safe to do so and how. Furthermore, as we have already seen, workplaces such as meat processing plants and clothing factories are hotbeds for localised outbreaks and rapid infection spread, making it essential that occupational health are involved to mitigate against these risks.
It is important the government recognises that this function cannot be carried out effectively by health professionals from other specialties. GPs and other physicians are well placed to advise on testing and treatment, but it is occupational clinicians who are specifically trained to understand workplaces, the associated risks, and how that impacts on individuals, at risk groups and the rest of the population.
They are uniquely placed to give evidence-based advice on what actions employers and managers should take to make their workplaces safer, in addition to being able to frankly discuss with employees the risks that may remain following interventions and how to manage them.
It also important that managers, companies, government, and affiliated professionals such as human resource professionals and the Health and Safety Executive understand the value of OH and ensure that the people with the right experience and knowledge are the ones giving advice.
Prevention is also critical – everyone should have the opportunity to live, work and age in the conditions that support good health. Good quality work is part of this, and evidence-based interventions targeted at individuals in workplaces need to be complemented by workplace level policies across government.
Scale-up challenge one: greater use of technology by occupational health
Many OH providers and clinicians are already carrying out telephone consultations, and this has increased during the lockdown. Video consultations can be used where it is important to develop rapport or use visual cues as part of the assessment, saving the clinician and client time and money by eliminating travel.
Future services will offer a more personalised wellbeing solution to employees and using technology, will be scalable and affordable. For example, online delivery of one-to-one and group?coaching offering personalised wellbeing services linked to health screening, which can help to coach people to change behaviour.
For simpler cases, it may be that competent persons and managers use algorithms or guidance documents (such as the SOM return-to-work toolkits) to make decisions and advise employers accordingly. Any issues arising from this that are more complex or needing individual assessment can then go to occupational health advisers and physicians, who have the expertise to deal with them.
Actions
- The Work and Health unit of the Departments of Health and Social Care and Work and Pensions should engage with SOM and the OH industry in regards to technology innovation – possibly offering innovation grants.
- The government should provide guidance on the role of OH, where specific advice can be obtained and who to refer to in cases of doubt, using an OH accredited specialist.
- The government, in combination with industry, should build an online purchasing platform, for example via SOM’s “find an OH professional” and “find an OH corporate” platforms.
- The government, with the OH industry, should launch a national OH dataset.
Scale-up challenge two: the role of government to support occupational health
The government consultation paper Health is everyone’s business published in July 2019 emphasises the need for employers and self-employed to be able to access high-quality, cost-effective OH services.
OH will also contribute towards the government’s ambition for everyone to have five extra years of healthy, independent life by 2035 and to narrow the gap between the richest and poorest.
It is imperative that the government incentivises OH provision and access by making it more cost-effective for small and medium enterprises. At present, there does not appear to be any clear incentive or advantage for employers to consider OH as essential, and this may worsen as businesses seek to cut their costs or become more “lean”. This is also especially since it has been shown that the majority of the costs of employees with disabilities (particularly those who end up out of work) are borne by the government (and eventually taxpayers).
In the absence of OH, it usually falls to the GP who will provide fit notes for the employer. It is unreasonable to expect GPs to provide any meaningful advice on occupational health, as many do not have the training or the time to address this.
The fit note is not OH advice and GPs cannot be expected to have the understanding, time, or experience to provide detailed occupational advice. However, GPs are well placed to identify when someone may need occupational health input and provide a gateway for appropriate support. But to do so, there needs to be a clear referral pathway for them to access – which currently does not exist.
Previously, the government has implemented or proposed measures such as tax incentives on health-related benefits. But, without clear occupational health input, it is difficult to determine whether this is likely to deliver return on investment or be cost effective.
OH is central in advising employers on sickness absence, workplace modifications, reasonable adjustments, and medical fitness for work. Therefore, it is important that the government focuses on initiatives that will improve OH access within the workforce.
Perhaps most importantly, key organisations such as the Department for Work and Pensions and the Health and Safety Executive and bigger companies should consider consulting or even employing occupational health clinicians in strategic roles to ensure their voices are heard and they can influence policy at the highest levels.
Actions
- All stakeholders should communicate the role of OH as a core part of employer services to employees. They should encourage OH clinicians and organisations to ensure the voice of OH is heard and can influence policy at the highest levels.
- HM Treasury should facilitate tax incentives on health-related benefits for occupational health input.
- There should be investment into a centre for work and health to ensure evidence is turned into action and advice on initiatives that will improve OH access within the workforce.?
- NHS England, Scotland, Wales, and Northern Ireland should facilitate referral for GPs into occupational health.
- There should be consideration given to the funding of a “value paper” on companies/organisations having chief medical officers or OH clinicians in strategic roles.
Scale up challenge three: training of occupational health professionals by government and industry
Occupational health and medicine have experienced a decline in training posts over the last two decades. However, the demand for it not only remains but, with an ageing population and government drive to keep people working longer, is stronger than ever. Therefore, there is an urgent need for training of clinicians within the field.
Actions
- Health Education England and training organisations in devolved administrations should facilitate more training places for OH clinicians.
- The General Medical Council and Nursing and Midwifery Council should ensure that occupational health is incorporated into undergraduate medical and nursing curriculums.
- Universities should invest in postgraduate training of clinicians in occupational health.
- The National School of Occupational Health, Faculty of Occupational Medicine and SOM should facilitate OH training posts in the NHS, military and commercial sectors.
- The OH commercial industry should encourage in-house and outsourced OH providers to provide specialty training, as well as considering the value paper on benefits of having a training post.
Scale-up challenge four: information
Many allied professionals have a limited understanding of occupational health professionals and what the specialty can offer.
Often, businesses focus on direct costs and return on investment – but there are other benefits that are likely to lead to indirect savings and reduced costs in the longer term.
SOM produced a comprehensive paper (Occupational Health: A value proposition) in 2017 that outlines not just the financial case but also the legal and moral imperative too of investing in OH.
In view of the pandemic, information can be tailored and disseminated so that it is up to date and relevant. For example, OH can provide input on risk assessments for staff, give advice on continuing home working or arrange return to work and where appropriate, advice on testing staff for Covid-19 or providing vaccinations (when available).
OH practitioners are also well placed to provide companies, managers and employees with the latest advice and guidance, and where there is lack of data or sufficient evidence, to ensure that best practice is followed.
Scale-up challenge five: new pricing models for occupational health
New models are required, especially for small and medium sized businesses, to improve OH provision and access so organisations can obtain general advice and have a system for escalating complex issues and requesting individual assessments.
This could follow an employee assistance programme-type model or be based around an insurance policy. But it needs to be developed in a way that is cost-effective for the business.
Commercial OH providers may have the right expertise and resources to be able to lead on this, but will need to ensure that quality and safety are not compromised.
Conclusion: an opportunity to change disability-free life expectancy
Occupational health has contributed to health and safety at work, improved productivity, and prevention of disablement. Longer lives are one of society’s greatest achievements and we should take pride in occupational health’s contribution to this.
But, currently, too many people spend a significant proportion of their later life in poor health or disability which can force them to drop out of work prematurely and with the right input, might have been preventable.
There are also huge inequalities in healthy and disability-free life expectancy across the country. Their impact, certainly in the workplace, can be minimised with the right occupational health intervention and support.
Dr Sheetal Chavda is an occupational health physician and independent consultant, and was formerly consultant and lead physician (rail) at Optima Health. This paper was also reviewed by the SOM OH Commercial Providers’ Leadership Group.
References
Work-related stress, anxiety or depression statistics in Great Britain (2019). Health and Safety Executive, available online https://www.hse.gov.uk/statistics/causdis/stress.pdf
Sickness Absence in the Labour Market (February 2014). Office for National Statistics. Newport 2014.
Health and wellbeing at work: a survey of employees (2014). Department for Work and Pensions 2015. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/447127/rr901-health-and-wellbeing-at-work.pdf
The Future of the Occupational Health Workforce. Dr Nupur Yogarajah (SOM 2019). Available at: https://www.som.org.uk/future-occupational-health-workforce#:~:text=Increasing%20Occupational%20Health%20(OH)%20professionals,OH%20workforce%20with%20clear%20leadership
Meat plants – a new front line in the covid-19 pandemic (2020). BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m2716
O’Connor S. Leicester’s dark factories show up a diseased system. Financial Times July 2020. Available at: https://www.ft.com/content/0b26ee5d-4f4f-4d57-a700-ef49038de18c
Williams N. Different perspectives on telephone consultations (2019). Occupational Medicine, volume 69, issue 6, pp.396.
Returning to the workplace after the Covid-19 lockdown: a toolkit. SOM (2020). Available at: https://www.som.org.uk/Returning_to_the_workplace_COVID-19_toolkit_FINAL.pdf
Health is everyone’s business: proposals to reduce ill health-related job loss (2019). The Department for Work and Pensions and Department of Health and Social Care. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/815944/health-is-everyones-business-proposals-to-reduce-ill-health-related-job-loss.pdf
ESA expenditure by reported medical condition and phase of claim, 2000/1 to 2015/16 (2017). Department for Work and Pensions, London.
Elms, J et al (2005). The perceptions of occupational health in primary care, Occupational Medicine, volume 55, issue 7, pp.523-527.
Annual Report and Accounts, Faculty of Occupational Medicine (2010). Available at: http://www.fom.ac.uk/wp-content/uploads/2010-annual-report.pdf
Occupational health: the value proposition (2017). SOM. Available at: https://www.som.org.uk/sites/som.org.uk/files/Occupational_health_the_value_proposition_0.pdf
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