Occupational health service needs a radical overhaul to address its wider remit

Black Review recommendation: an integrated approach to occupational health should be underpinned by:

• the inclusion of occupational health and vocational rehabilitation within mainstream healthcare
• clear professional leadership
• clear standards of practice and formal accreditation for all providers
• a revitalised workforce
• a sound academic base
• systematic gathering and analysis of data and
• a universal awareness and understanding of the latest evidence and most effective interventions.

Occupational health, as a profession, a service and a concept, will need to be fundamentally rethought and overhauled, with key challenges including OH's historical detachment from mainstream healthcare, its focus only on those in work and its uneven provision and inconsistent quality.

On top of this, there is the challenge of a diminishing OH workforce, a shrinking academic base and a lack of good-quality data.

"Its [OH's] practitioners must address a wider remit and embrace closer working with public health, general practice and vocational rehabilitation in meeting the needs of all working age people. This should be underpinned by clear workforce plans, clear standards of practice and formal accreditation of all providers," the report recommended.

This would require clear professional leadership from the OH and vocational rehabilitation communities "to expand their remits and work with new partners in supporting the health of all working age people".

At the same time, there would need to be a change in how services were commissioned.

"Government needs to ensure that commissioners of health services understand the importance of tackling working age ill-health, the needs of working age people and the interventions that are most effective in tackling the health conditions suffered by them," the report said.

An electronically-based fit note, could be closely linked to the new Fit for Work service.

"Drawing on the expertise of the Fit for Work teams proposed the 'fit note' can become a vehicle for providing practical advice to both the patient, and potentially their employer, about how a return to work can be achieved," the report said.

An electronic system would result in improved recording and analysis of certification, it added.

"There is a new and exciting opportunity for the OH specialty in Britain today to seize the initiative and lead a development that unites all those engaged in improving, safeguarding or restoring the health of all working age people.

"This would ensure a dynamic specialty into which it would be much easier to recruit new professionals who would have a rewarding role and a secure and exciting career," the report suggested.

Key conclusions of the Dame Carol Black report

• The economic costs of sickness absence and worklessness associated with working age ill-health are more than £100bn a year, greater than the current annual budget for the NHS
• The evidence base to support the business case for investment in the health and wellbeing of their employees is inadequately understood by employers
• Lack of appropriate information and advice is the most common barrier to employers investing in health and wellbeing, and this is particularly true for smaller organisations
• GPs often feel ill-equipped or ill-trained to offer advice to their patients on remaining in or returning to work
• The current sickness certification process focuses on what people cannot do, thereby institutionalising the belief that it is inappropriate to be at work unless 100% fit and that being at work normally impedes recovery
• There is insufficient access to support for patients in the early stages of sickness, including those with mental health conditions
• GPs have inadequate options for referral and OH provision is disproportionately concentrated among a few large employers, leaving the vast majority of small firms unsupported
• The scale of the numbers on incapacity benefits represents an historical failure of healthcare and employment support for the workless in Britain
• The detachment of occupational health from mainstream healthcare undermines holistic patient care
• A weak and declining academic base combined with the absence of any formal accreditation procedures, a lack of good quality data and a focus solely on those in work, impedes the profession's capacity to analyse and address the full needs of the working age population.

Key recommendations of the Black report

• Government should work with employers and representative bodies to develop a robust model for measuring and reporting on the benefits of employer investment in health and wellbeing. Employers should use this to report on health and wellbeing in the boardroom and company accounts
• Safety and health practitioners and, where present, trades union safety representatives, should play an expanded role in acting to promote the benefits of such investment
• Government should initiate a business-led health and wellbeing consultancy service, offering tailored advice and support and access to occupational health support at a market rate, geared towards smaller organisations
• GPs and other healthcare professionals 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 paper-based sicknote should be replaced with an electronic fit note switching the focus to what people can do and improving communication between employers, employees and GPs
• Government should pilot a Fit for Work service based on case-managed, multidisciplinary support for patients in the early stages of sickness absence, with the aim of making access to work-related health support available to all
• An integrated approach to working age health should be underpinned by: the inclusion of occupational health and vocational rehabilitation within mainstream healthcare
• There should be clear professional leadership, standards of practice and formal accreditation for all providers, a revitalised workforce, a sound academic base and systematic gathering and analysis of data.