Is it the end of occupational health as we know it?

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The Government’s proposals for an independent sickness review service could forever change the face of occupational health in Britain, says occupational health adviser Lindsey Hall.

“Fitness for work: the Government response to ‘Health at work – an independent review of sickness absence'” sets out the Government’s intention to establish a Health and Work Assessment and Advisory service (HWAAS).

Bizarrely, the second paragraph of the section on staffing needs claims that the UK currently has 65,000 nurses, 19,000 physicians, 9,000 physiotherapists, 4,000 occupational therapists, and 500 psychiatrists. There is no mention of OH advisers, unless they have committed that age-old cardinal sin of confusing us with occupational therapists again. My estimate has always been that there are between 3,000 and 4,000 OH advisers in the UK.

The HWAAS move will dramatically change the OH landscape. If the biggest part of your job is sickness absence, this means that the Government is about to provide the service to your customers and your employers for free. If you are an HR manager, business owner, finance director or manager and are considering signing a three-year OH contract, you may wonder if this is still worthwhile, as in about 18 months you can freely use the new service for all your absence needs.

I am sure that many of the larger OH providers are currently rubbing their hands in glee at the thought of winning the kind of contract that, in OH terms, will be the equivalent of running the Olympics – all year, every year. But the creation of the service raises huge issues.

Even OH providers Health Management, Serco and Atos are not capable of running such a mammoth service in-house unless they transfer a large portion of their client base over to HWAAS.

Even then, the prospect of possibly employing more than 20% of the OH workforce in the UK is daunting.

How could it work?

I can see three potential models:

1. One big provider with an employed workforce that is huge, in current OH terms. This business will have to:



  • get it right for its customers the first time, or the publicity for failure will be a hammer blow;
  • get it right for its employees or they will resign and put at risk the OH referral targets, as in the relatively small world of OH word will travel fast and nobody will want to take their place; and
  • have a substantial in-house training capability for new entrants to the OH profession, of which there will undoubtedly be a lot.

The problem with this model is that it could seriously damage competition in the market.

2. Three or four big providers. They will have effectively the same problems as one large one, in that they will still need a lot of staff and have to try to keep them, but at least there will be competition.

3. A register of a much larger number of local providers. The Commercial Occupational Health Providers Association has about 100 members, many of which are small local providers, offering a range of good services to their local area and beyond.






quotemarksThe huge unanswered question in all of this is whether or not those who are currently buying in OH services or employing their own in-house service will continue to do so at the same level, if at all.”


This could be a case of “the independent provider is dead, long live the independent provider”. It could also be the model for options one and two. If a large provider does not want to or simply can’t employ the required numbers, a subcontract network is the way to go – but that raises all sorts of questions about costs and charges.

The Government will want its pound of flesh and margins will be tight. What is ultimately paid to the person actually talking to the absent employee could be pretty small.

The huge unanswered question in all of this is whether or not those who are currently buying in OH services or employing their own in-house service will continue to do so at the same level, if at all. Whether you are Barclays bank with tens of thousands of employees, or Bloggs and Sons Builders with 10 employees, why would you, when a big part of what you are paying good money for is freely available?

Another concern is the narrow view of OH implied by the document. This is not about OH, this is about sickness absence and reducing the benefits bill.

It’s also about helping a lot of people get better quickly and return to work.

In recent years, a number of OH advisers have qualified from courses and think that OH is just about absence management – and some providers are just as bad. OH is about absence, health surveillance, pre-employment assessment, toxicology, workplace assessment and design, health promotion and much more. Above all, it’s about promoting health at work in a way that prevents the need for the above.

It could be argued that our ultimate goal should be to do ourselves out of a job – to help create such a healthy and well-managed workplace that we can walk away and let them get on with it. But none of that is in the document.

Don’t get me wrong – there is a lot to be applauded in the Government’s response and a HWAAS, free at the point of need, might just be the right way to go. It might also just be the end of OH as we know it.

Lindsey Hall is director of, and independent occupational health adviser for, Split Dimension Ltd.

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