OH reform: Unpicking the new health and disability white paper

With the dust now settling on this week’s health and disability white paper, what is it actually proposing for occupational health? Nic Paton reports.

It was heavily trailed, but the publication this week of a new health and disability white paper alongside the Budget has been broadly welcomed by the occupational health community.

Dr Shriti Pattani, president of SOM (the Society of Occupational Medicine), highlighted, for example, how OH expertise could be the “game-changer” that helps the economy to avoid work-related inactivity. SOM also reiterated its long-term call – and campaign aim – for the economy to have universal access to OH.

However, with the dust now settling on the long-anticipated publication of the Transforming Support white paper, what is it really proposing in terms of workplace health support and, in particular, the possible expansion of occupational health?

The Department for Work and Pensions’ (DWP) white paper, first, makes it clear that its proposals are part of a continuum stretching back to the 2021 Shaping Future Support health and disability green paper. The latest paper can as well be seen in the context of the government’s 2019 Health is Everyone’s Business consultation on expanding workplace health and subsequent response, as of course reported at the time in OHW+.

The paper also needs to be viewed against the backdrop of increasing concern within government circles at the numbers of people who have left the workplace, especially over-50s, during and since the pandemic, often because of long-term health reasons.

As the paper has stated: “Working with the occupational health sector, we will help more people remain and thrive in their job.” The paper highlighted that the government’s efforts will be focused on the following areas:

• Continue to work to expand which healthcare professionals can certify and issue fit notes.
• Work with the occupational health sector and employers to reform the market and improve access to OH services. Crucially (as we shall return to in more detail shortly), this includes testing a financial incentive and support model to help small and medium-sized businesses (SMEs) and the self-employed overcome barriers to purchasing OH services.
• Develop a new advice and information service for employers, now in national live testing.
• Publish a major conditions strategy. This will be developed by the Department of Health and Social Care, in consultation with NHS England and other departments, to “set out a strong and coherent policy agenda that sets out a shift to integrated, inclusive, whole-person care”.
• Provide mental health support to people in employment through the Access to Work mental health support service.

The paper highlighted feedback from the various consultations that government needs to go further in encouraging employers to support their disabled staff, including improving employers’ awareness of health conditions and disabilities.

While it is course up to employers to adopt good practice on sickness management, they also need to be made more aware of the advantages of retaining skilled and experienced staff who might have disabilities or health conditions, it pointed out.

Government, the feedback therefore urged, “should signpost employers to information and advice on disabilities and health conditions, provide support to improve the recruitment, retention, and progression of disabled people, and offer financial support for the most expensive adaptations.”

New Access to Work pilot

Access to Work support, while helpful, was still not widely enough known about, by both individuals and employers, and the application process is too complex.

Employees, the paper therefore highlighted, “should have greater access to Occupational Health (OH) support and therapy and more flexible work opportunities.”

As part of this, the paper outlined the piloting of a new enhanced Access to Work scheme for people who need more support. “We are for the first time testing whether providing support for employers who are willing to shape vacancies to accommodate an employee’s disability can make a difference and unlock employment opportunities,” it stated.

On access to occupational health in particular, the paper highlighted the ongoing disparity of access. For example, those working for larger employers are nearly seven times more likely to have access to OH services compared to those working in micro companies (69% versus 10%), it said.

“Cost and information are some of the biggest barriers preventing small and medium-sized enterprises and self-employed people from using OH,” it added.

New ‘innovation fund’ for occupational health

To that end, the highlight for OH providers and practitioners within the paper is confirmation that the government will test a new financial incentive and support model to encourage employers to purchase OH services.

As the paper said: “User-centred design has commenced, working towards development of a minimum viable product. This test will help us to determine whether to seek to expand the service nationally in the next Spending Review period should it prove effective and value for money in helping small and medium-sized enterprises and the self-employed overcome cost and information barriers to purchasing OH.”

This subsidy model will be called the Innovation Fund for Occupational Health, the paper revealed. It said: “The Innovation Fund for Occupational Health will stimulate innovation in order to improve access to OH for small and medium-sized enterprises and self-employed people through better use of technology and new models of buying and selling OH. We continue to work with stakeholders to improve the work and health research landscape.”

However, the paper remains somewhat vague about how, alongside this, the government intends to solve perhaps the biggest barrier to this expansion of access: OH’s historic capacity problem. Or, put simply, the fact that OH as a specialty is relatively small and limited in terms of practitioner numbers.

All the paper stated on this was that: “To tackle the declining number of OH professionals to deliver OH services, we are continuing work with the OH sector to identify ways to support development of the multidisciplinary OH workforce.”

New information and advice service

Turning to the new information and advice service, for those with longer memories this feels quite similar to the Fit for Work OH service piloted by the government back in the mid-noughties, and which then evolved into a website and telephone advice line.

The current plan is for a new digital information and advice service to help employers, and SMEs, to support and manage disability and health conditions at work. It will help employers to “self-serve” by walking them through common scenarios and signposting them to more detailed guidance.

“The new digital service and the non-statutory principle-based guidance are designed to feel seamless and will provide additional support to employers on managing health at work, with different formats available to be accessible for all employers, irrespective of size or digital capacity,” the paper said.

The paper then concluded by making it clear these proposals will feed into a new Disability Action Plan being developed during this year. This, the DWP said, “will set out the practical action we will take across government – beyond the health and disability benefits system – to improve disabled people’s lives.

“Ensuring the voices of disabled people are properly heard is a priority for this government. We will run a full public consultation on the plan later this year,” it added.