Occupational health and the Comprehensive Spending Review

Will October’s public spending review mean longer waits for workers awaiting treatment? Nic Paton reports.

Before the election there was much talk about what a new Government would mean for occupational health and, in particular, national director for health and work Dame Carol Black’s reforms.

The general consensus was that, austerity climate notwithstanding, they were likely to be relatively safe, at least until most of the various pilots ended next spring.

Thereis still not a huge amount of detail about the coalition’s ambitions or intentions when it comes to workplace health. We know that budgets across the board (including within the NHS, despite ministerial assurances) are likely to be eye-wateringly tight in the wake of the October 2010 Comprehensive Spending Review. We know that the Government is heavily focused on slashing welfare spending and getting people off long-term sick leave and back into work, and we know that health and safety reform is an area of interest.

Hospital waiting times

Another, albeit indirect, change increasingly worrying occupational health (OH) professionals is the Government’s decision in June to scrap performance management targets that require hospitals to start treating patients within 18 weeks of their seeing a GP.

While data on hospital waiting times will continue to be published, and this year’s contracts between hospital and primary care trusts stipulating treatment within 18 weeks will remain, the system under which hospitals failing to hit the target faced weekly calls from the health department, with chief executives’ jobs ultimately at risk, will cease.

The move, announced by health secretary Andrew Lansley, was heavily “spun” at the time as not being an indication that longer waits for treatment would suddenly become acceptable.

Lansley argued that, in fact, greater patient freedom to choose where to go for treatment would make long waits even more unacceptable. “We expect providers to continue to make improvements, for example on referral to treatment times, and to provide this information to patients themselves, driving choice and competition in the NHS,” he said.

But OH and healthcare professionals are nevertheless concerned that, in reality, it could mean workers off sick waiting longer for treatment on the NHS at exactly the time employers feeling the squeeze (especially in the public sector) will be less prepared to pay for access to fast-track treatment, in the process undoing much of Black’s vision.

Absenteeism

“I think we could certainly find people are having to wait longer and therefore that absenteeism from work will go up, which of course goes against everything Dame Carol Black and the previous Government was wanting to happen,” says Cynthia Atwell, OH consultant and chair of the Royal College of Nursing’s Public Health Forum.

Scrapping bureaucratic targets is not in itself a bad thing if it means patients are treated more holistically, cautions Dr Sayeed Khan, chief medical adviser of the manufacturers’ body the EEF. But the 18-week wait target has been a useful one, he adds.

“The 18-week target in my view is better to have than not to have. Many employers say the limited capacity of the NHS is already a barrier to treatment. Having to wait 18 weeks is not good enough in itself, but not having an 18-week target would be even more dreadful,” he argues.

“Some hospitals will probably continue with the 18-week target, but others will undoubtedly relax their rules,” predicts Graham Johnson, clinical lead – nursing, Bupa Health and Wellbeing.

“Employers are already finding it very hard to sustain levels of sickness absence. It is well recognised too that individuals who are off for a long time may eventually suffer from anxiety, stress and depression, so compounding the issue,” he adds.

What, then, does OH need to do if absence rates start to creep back up as a result?

“OH should be saying to employers that this is on the horizon and they need to be aware of it and reiterate the importance of a referral to OH.

“They could also highlight the cost benefits of a fast-track private referral and the advantages of using a case management approach,” advises Johnson.

OH in these straitened times will simply need to ensure it is being even more proactive and working even harder to pick up people and health issues sooner, to ensure as few people as possible are forced to become reliant on the NHS for their return to work, argues Khan.

Chronic health problems

“Occupational health practitioners will need to be identifying and picking up chronic problems earlier and ensuring that where there are absence or performance problems, people are getting the right treatment and follow-up,” Khan says.

“What occupational health practitioners need to be doing is making sure they have their fingers firmly on the button and know exactly when people are off sick,” agrees Atwell.

“They will need to be doing even more to try to prevent people going off sick in the first place and trying to manage things in-house, perhaps through the use of more physiotherapists and occupational therapists,” she adds.

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