On 26 July, Hansard reported that “In the period July 2006 to June 2007, the Department [of Work and Pensions] spent a total of £3.147m on occupational health services.” With a workforce of 120,000, this equates to about £2 per month per employee, or 10p per working day.
It is extremely difficult for employers to decide what constitutes an appropriate investment in the health of the workforce, and there is limited data to guide them. Typically, blue-chip companies striving to attract the best from a small pool of highly skilled professionals invest heavily.
Their benefits packages include a well-resourced OH team, with nurses, doctors, counsellors, physiotherapists and assorted allied health professionals. Facilities often include an on-site gym or discounted membership to local clubs, as well as light, airy relaxing amenities in which to enjoy lunch, meet colleagues, and recharge batteries. Health promotion programmes are often sophisticated with personal health improvement targets set and measured. Access to external care is enabled through private medical and dental insurance schemes for the worker (and possibly dependents). Staff are attracted and then retained by a competitive health package. The perceived cost of this investment will not seem sustainable to many employers.
Small and medium-sized enterprises (SMEs) most often provide nothing. While they might feel it would be a good idea, it is too difficult, and perceived as bureaucratic and expensive. The chances of things going badly wrong (in terms of health management) are assessed as insignificant by comparison to the perceived cost of occupational health provision. The risk of investing nothing will seem acceptable to many employers.
Public sector employers tend to offer some sort of access to OH. It may be very limited and focused predominantly on sickness absence management, but at least it is available. Many private sector employers feel that managing attendance is a lesser priority.
Some public employers want to set an example, and some, such as the Department for Work and Pensions (DWP) and the NHS, have made this explicit: “The DWP Occupational Health Service is available to all employees and supports the department’s agenda of being an exemplar employer.” This is especially important.
The DWP is one of the UK’s largest employers. Figures from the latest report on sickness absence in the Civil Service suggest the cost of sickness absence in the DWP is about £90m per year. Knowing the DWP spent about 10p per day per capita on OH sets a unique benchmark. After all, the DWP has an added incentive to set the bar high. When other organisations’ workers are absent due to illness, it is the DWP, not them, that picks up the £12bn bill for incapacity benefit.
Caring employers can be reassured about the costs of OH services. Exemplar services cost about 10p per day. Lesser provision is presumably much cheaper. Litigation-conscious employers can also be reassured about the costs of providing expert health risk management. The Health and Safety Executive is, after all, part of the DWP. The investment in the health of those with the duty to enforce regulatory OH standards is only about 10p per day. And UK employers as a whole can be reassured that an exemplary OH service for all of working age could be provided for about 1/20th of the cost of either incapacity benefit or sickness absence.
The NHS also aspires to be an exemplary employer. Seven years ago, the National Audit Office found a relationship between investment in OH by NHS trusts, and improved workforce health. Trusts were investing two to four times what the DWP does now. Since then, the investment has increased through improved salaries and capital funding.
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The occupational health of UK plc is worth far more than just 10p per day. Other public employers should follow the NHS, stop spending money on services, and start investing in the health of the workforce. Then, and only then, can they claim to be an exemplar.
Dr Richard Preece is a consultant occupational physician
