Why welcome investment in OH needs to be backed by education

The government has put occupational health at the centre of its plans to reduce economic inactivity. But its welcome investment needs to be accompanied by education showing employers when it’s best to turn to OH and why, writes Imogen Cardwell.

In the Budget and ‘Transforming Support’ health and disability white paper, the government last week put addressing sickness absence and supporting people with health conditions to stay in work at the heart of its economic policies, investing £400m in occupational health.

But do the measures go far enough, when just one in two UK employees has access to OH, compared to 90% of German and French workers?

A key focus will be the rollout of a pilot scheme that enables small and medium-sized businesses to provide employees with an OH assessment for a fraction of the price. The supplier will then reclaim the rest.

This is to be welcomed, as previous attempts at keeping people in work, such as the Fit for Work Service and fit notes have become a gateway to long-term absence.

GPs alone cannot be expected to understand what someone’s workplace is like enough to say what they can still do. This means a third of fit notes end up signing people off for four weeks or more, by which time 20% never return.

Finally incorporating employers into the mix will allow managers to raise the referral and provide context on the employee’s role and workplace and how they’re currently struggling.

An occupational health clinician can then provide recommendations on what they can still do and reasonable adjustments that could be made to keep them in work. This means the loop between employer, employee and healthcare professional is finally being closed.

Impact of NHS waits

Nevertheless, although the Budget was billed as a ‘back to work’ Budget, the lack of any funding for onward treatment, at a time when more than seven million people are waiting for NHS treatment, won’t help those already off sick.

Individuals waiting for hip or knee operations, for example, will be living with pain and need help to manage the psychological and social consequences of that.

Those struggling with anxiety, burnout or depression may need counselling and other therapies to recover.

Used upfront, the new scheme could help employers to keep people in work. Not least as our own research into the benefits of early intervention shows 64% of absences can be prevented if people are referred into occupational health while they’re still in work.

However, if OH is something only used once the employee has been off sick for months, it will have very little impact. This is not because it appears so far to be just a transactional solution that only allows for a single referral and report on adjustments, with no rehabilitation support for the employee.

Another criticism is that occupational health is about much more than supporting people to stay in work.

Businesses working in partnership with an occupational health and wellbeing provider can also proactively help people to stay well, with data-driven risk assessments and culture change initiatives to keep people healthy.

Reducing work-related illness is important because there were 900,000 cases of work-related stress, anxiety or depression and half a million cases of work-related musculoskeletal disorders last year. That’s 1.4 million people who could have been helped to stay healthy in the first place.

Without ongoing dialogue between occupational health and employers, the likelihood of the underlying issues causing people to become sick in the first place is reduced.

Sarah Hughes, chief executive the mental health charity Mind, has criticised the lack of extra funding for people on waiting lists for mental health support. She said: “There was no funding to better support our NHS services that enable many people’s recovery when they’re in poor mental health.

“There were no measures that would help prevent people’s mental health from declining in the first place. And there was little to help employers create more mentally healthy workplaces, so work is something people can to get back to and stay well while doing.”

The chancellor himself, Jeremy Hunt, said he wanted to help people with mental health and musculoskeletal issues before they decide to leave their jobs.

Role of education and awareness

All of which means it is essential that education about the benefits of using occupational health services – before people become too sick to work – is also delivered as part of this package of reform.

Unfortunately, the smaller businesses that the subsidised solution is being promoted to only tend to use occupational health as a last resort.

They often don’t see the value in making the changes required to bring someone back into work in a reduced capacity. They think it will be easier to hire someone else, even when this typically costs more than supporting existing employees.

This is perhaps the reason that people working in larger companies are nearly seven times more likely to have access to occupational health services, compared to those working in micro businesses.

As to whether or not the government’s unprecedented investment in occupational health will pay off, what will be critical to its success will be educating employers about the business benefits of helping people to stay in work.

Even if someone can only return to 85% of their former capacity, this is still better than having a vacancy and many people can be helped to recover fully over time.

Seeking OH advice earlier could also reduce the risk of and shorten the length of any absence. Education on when a referral will add most value and learning from absences, to make changes that also protect others, will also be vital.