Enabling much more “comprehensive” access to occupational health expertise could be one of the keys to reducing ill health-related worklessness within the UK, a report has argued.
Britain could also learn important lessons from the models used in other countries, especially in Europe, and particuularly models where the provision of OH by employers is more of a mandatory requirement.
The report, Work and health: international comparisons with the UK, from the Commission for Healthier Working Lives, looked at workplace health for people with long-term ill health or disability in the UK and then compared that with the provision in 14 other European nations, as well as further abroad.
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It was published to help inform, and generate debate around, the recently launched Keep Britain Working review of workforce health.
The commission has been established by the Learning and Work Institute, Institute for Employment Studies and Royal Society for Public Health, supported by the Health Foundation. It aims to build consensus on the actions needed to address the UK’s work and health challenges.
The report concluded that a fifth of UK workers (21%) report health limitations, giving Britain one of the highest rates of ill health among working-age adults across Europe.
Moreover, the UK’s employment gap between people with and without health limitations is among the widest in the EU15.
The likelihood of those aged 16-24 with health limitations being out of work more than doubled between 2018 and 2022 in the UK, the commission said.
For workers aged 55 to 64, the likelihood of being out of work because of ill health decreased for most EU15 countries over this period, yet increased for the UK.
Focusing on the discussion around occupational health, the report highlighted that OH delivery models, naturally, vary by country in terms of who delivers them. For example, there are models that vary between in-house or external physicians and whether employers are mandated to provide them.
However, it added: “Countries with a more integrated policy framework around workforce health tend to have higher OH coverage.”
Equally, on sickness pay, in several European countries, statutory sick pay is linked to an individual’s wages, unlike the UK’s fixed-rate system. “These models tend to provide a higher rate of income replacement than in the UK,” the report argued.
When it came to rehabilitation and workplace adjustments again, unlike the UK, “various European countries provide active support to help workers transition back into employment after sickness absence”, the report emphasised.
Drilling down into the analysis of the different models, the report highlighted that, broadly, OH professionals commonly feature in national approaches to supporting health at work, including in the UK.
“The level of funding and support from government varies considerably but employers consistently play a central role in both funding and administering OH services,” the commission argued.
There are differing models, not only between countries but also within them with mixed approaches to OH provision being common, it highlighted.
These can include in-house OH services, bespoke private provision, group models in which employers make a yearly financial contribution per employee, social security models, and community-based health centres.
Different OH models
In Finland, for example, the country’s Act on Occupational Health Services imposes a duty on employers to fund preventive health care for employees, provided by a relevant specialist, for example a nurse or occupational psychologist.
In France, by comparison, large organisations have long been required to have occupational health nurses.
“These tend to be either in-house or group-level provision. OH is funded directly by employers and, in a Bismarck model, by regional authorities via employer contributions,” the commission said.
In the Netherlands, employers are legally mandated to provide OH under the Working Conditions Act (1994).
“During sickness absence, a gatekeeper protocol mandates tasks for employers, employees and OH physicians to support a return to work. This includes referring employees to OH for an assessment and drafting an action plan to provide suitable work,” the commission concluded.
There is good evidence that OH services can help employees with health issues stay in work and facilitate their return to work – including for musculoskeletal disorders and common mental disorders (CMDs) such as anxiety and depression” – Commission for Healthier Working Lives
Extending an aspect of Dutch policy, Japan also has a legal mandate for organisations of more than 50 employees to appoint a dedicated OH physician.
“For smaller organisations, a part-time occupational physician must be contracted. There is also an emphasis on legislation on primary prevention, and all workplaces are mandated to provide health examinations for their workers,” the report said.
In Italy, the model is more similar to that in the UK, with occupational health services delivered by either certified-occupational physicians or by general physicians who have additional training in occupational medicine.
“These physicians may be supported by occupational health nurses, health visitors and other professionals,” the report highlighted.
Overall, the UK “may learn something” about OH service provision from countries with mandatory policies, the commission emphasised.
“Although it is not clear which regimes are most effective, there is good evidence that OH services can help employees with health issues stay in work and facilitate their return to work – including for musculoskeletal disorders and common mental disorders (CMDs) such as anxiety and depression,” it said.
“For example, among workers with CMDs, absence can be reduced by consultations with an occupational health psychologist and interventions based on problem-solving.
“Moreover, as well as helping workers address health issues head-on, OH services reduce work ill health indirectly. This could be by fostering healthier workplaces and improving lifestyles; or even by increasing workers’ self-efficacy and ability to self-manage, thus reducing anxiety due to working in complex organisations,” the commission added.
However, it also sounded a cautionary note about assuming OH is therefore a panacea solution. “OH services are by no means guaranteed to be effective,” it said.
“Their impact depends significantly on the type of intervention and the target population. For example, OH services can be more effective when they are tailored and targeted at workers who are at higher risk of sickness absence, or when they are supplemented by a telephone-based service giving earlier access to support,” the report emphasised.
In conclusion, the commission argued there is “good evidence” that the UK can improve the employment prospects of people with ill health and disabilities.
This, in turn, would enable more people to benefit from employment and actively contribute to the economy.
Change needs to happen across the board, but younger workers should be a particular priority, given recent trends and the long-term consequences of being out of the labour market early in a person’s career”
“Improvements seen in many European peers suggests that this is possible. Change needs to happen across the board, but younger workers should be a particular priority, given recent trends and the long-term consequences of being out of the labour market early in a person’s career,” the commission recommended.
“Policy interventions addressing work and health vary in delivery mechanism, and scope of population targeted, so there are a range of options at our disposal. The UK government should carefully consider what changes are most likely to lead to sustained improvements, drawing on examples illustrated in this report,” the commission noted.
The effectiveness of policies and interventions in practice will inevitably be affected by the level of awareness and the willingness of employers and other actors to engage with them, it also emphasised.
“Attitudes towards ill health and work will be influential here. They will also be instrumental in de-stigmatising physical and mental ill health in the workplace, enabling comprehensive OH services that are relevant to job demands and not ‘over-medicalised’ – for example, focusing on health promotion as well as illness – and in reducing under-reporting of ill health,” the commission argued.
“Careful consideration should now be given to what changes are most likely to lead to sustained improvements in the UK, enabling more people with long-term ill health or disabilities to benefit from employment and actively contribute to the economy,” it concluded.
The nations included in the report were: Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, Netherlands (with Japan alongside), Portugal, Spain, Sweden, and the United Kingdom.
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