The UK needs to establish a national occupational health service alongside the NHS to help tackle, and support, the rising numbers of working-age people falling out of work because of ill health, a think-tank has said.
The Fabian Society has argued that a new regulated occupational health market could be funded by a growth, skills and health levy, much like the apprenticeship levy.
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“Occupational health services should continue to be delivered through private providers contracted by employers,” it recommended in its report Nye’s Lost Legacy: Towards a national occupational health service to keep people well in work.
The service would work through a combination of improving support through better occupational health provision and then putting in place new responsibilities “to ensure this support delivers for workers through incentives to engage with occupational health to keep people well in work.”
The call comes as the CIPD’s annual Health and Wellbeing at Work report, supported by Simplyhealth, found that the average UK employee took nearly two full working weeks of sickness absence in the past year, a record high and a 62% increase on pre-pandemic levels.
The Fabian Society highlighted that, since Labour was last in power, the number of working-age people reporting a disabling condition has increased by 4.3 million, while more than 300,000 people leave work with health problems each year.
“Healthy and inclusive work can help reduce the numbers leaving employment – and make it more feasible for others to return. But many are excluded from work because they cannot access the conditions or support they need,” it said.
There were 1.7 million cases of work-related illness in 2023-24, up 44% since 2010-11 – driven in large part by a 93% increase in work-related mental illness, it said.
Occupational health support is there – and growing, according to a recent analysis by the Society of Occupational Medicine – but still is not available universally, and access is inconsistent, it pointed out.
The government is also reviewing workplace health provision, through its Keep Britain Working review, which is expected to report this autumn.
The society has therefore proposed the establishment of a new national OH service, overseen by a new Occupational Health Authority, sitting within the Health and Safety Executive, to set standards and enforce compliance.
The service would be funded by a new growth, skills and health levy, “funded by a small number of the largest employers”, to incentivise and support employers of all sizes to invest in occupational health, it argued.
There would be tiered public sector provision coordinated by WorkHealth caseworkers, it recommended. “Integrated public services should step in where employers are unable to support workers, or where there is a public interest case for state involvement – for example, where someone is at significant risk of leaving work,” it argued.
A new ‘WorkHealth’ service of vocational caseworkers should be set up, embedded in NHS neighbourhood health centres, to “coordinate tailored, multi-agency support”, the society said.
“This service would be accessed voluntarily via NHS pathways, self-referral, and when someone has reached a specific sick leave threshold,” it added.
NHS occupational health referrals would come via an updated fit note, which would allow clinicians to recommend occupational health consultations as well as more medical interventions.
The Access to Work programme should be reformed, it argued. “Any registered occupational health professional should be allowed to conduct standardised screenings, with automated approvals and self-service procurement from preselected services where appropriate,” the report argued.
Alongside this, there should be more extensive HR support, with a service piloting HR support being made available to small and medium-sized enterprises investing in accredited occupational health services.
There should be sick pay reporting via payroll to allow WorkHealth caseworkers and the HSE to contact consenting workers and employers with offers of voluntary support, the society argued.
Workers, too, should have a ‘WorkHealth’ health record. This would: “Ethically integrate occupational health with the NHS and social care single patient record to facilitate joined-up care,” the society said.
It would also: “Let workers generate an adjustments’ passport with information selected from the record to support conversations with employers.”
The service should have a ‘digital front door’, the Fabian Society recommended. “Create an online portal to offer employers and workers practical routes to act early before turning to professional support, and to help them navigate and access available services and providers,” it said.
Alongside this reformed service provision, the government should put in place new rights and responsibilities to promote prevention, monitoring and support.
There should be incentives, it argued, for employers to prevent, monitor and address emerging workplace challenges – including through a national ‘good work standard’, reporting requirements on work-related illness and greater parity between protections for physical and mental health and safety.
Employers should be required to share a standardised questionnaire with new starters and introduce a new right to an accompanied ‘healthy work’ conversation.
New duties should be put in place for employers to consult with occupational health before refusing requests for support.
Statutory sick pay should also be increased to “at least” the same level as out-of-work benefits, the society said, ideally 20% higher, to improve incentives to stay in work.
Finally, employers should be incentivised to rehabilitate workers who have been off sick, through two new requirements: to consult occupational health under specific circumstances; and to write to the government at least four weeks before dismissing a worker for health reasons, the society argued.
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