Field of dreams? Why the government needs to rethink how occupational health is delivered

“Build it and they will come" said the protagonist in the film Field of Dreams. But the fact they didn't for the Fit for Work service means the government may need seriously to rethink how occupational health is delivered. Shutterstock.

The government will need to widen its focus beyond traditional occupational health if it wants to build support for its reforms among smaller employers and avoid repeating the history of Fit for Work, writes Dr Syed Zakir Abbas.

“Build it and they will come.” These words echoed in the ears of Kevin Costner’s protagonist, Ray Kinsella, in the Hollywood film Field of Dreams, leading the novice farmer to flatten his corn crop and build a baseball diamond in the middle of the Iowa countryside. Only, instead of welcoming an all-star team and crowds of adoring fans, he sits alone – watching intently a game nobody else can see.

When Fit for Work was introduced as a national scheme, envisaged to solve workplace health, the low uptake resulted in a similar disappointment. Just like Ray Kinsella’s baseball field, nobody came. In fact, when the contract for the assessment service was terminated early, referrals were running at less than 2% of government predictions.

About the author

Dr Syed Zakir Abbas is chief medical officer at Unum UK

The failure of Fit for Work and its attempt to solve workplace health through a national scheme contracted from Whitehall poured cold water on ambitions for even greater state provision – policymakers envisaged eventual “integration of occupational health into primary care” as recently as in November 2017’s Improving Lives.

But we could yet be in for a resetting of the agenda, with the government in July publishing its long-awaited consultation on workplace health provision and support.

The ins and outs of that consultation process have been written about elsewhere but what is clear is that, while the government’s good intentions are undeniable, turning good intentions into good policy can be extraordinarily challenging.

As any policy is made – documents published, stakeholders assembled, commitments made and reiterated – it builds a sense of momentum that can make it difficult to slow, stop, or steer.

Policy can quickly be sent forward by this inertia into a land of unforeseen consequences. In Fit for Work’s case, promising pilots led to an ambitious green light for a service that hadn’t won the hearts and minds of employers.

We, of course, cannot know what the findings of the consultation will bring or what the government will then propose to do. We’ve had some hints, such as last year when the then minister for disabled people, health and work admitted that the government had not ruled out mandating employer purchasing of occupational health services.

Many assumed this could mean reforms similar to those found in the Netherlands or the Nordic countries. But the Work and Health Unit also told a conference in March that its approach would be more “nudges” than “Netherlands”.

What if policymaking inertia were to send the government careering towards the conclusion that simply saw employer provision of occupational health as a panacea, as the goal in itself?

Strong industry representations and policymakers’ understandable desire to deliver at pace might lead them to see occupational health as virtually the only answer to the problem of sickness absence management.

Alternative models

This in turn could force them to spend their available research funding on standing up that case, with little time left to explore alternative models that might prove just as valid.

Of course, managing sickness absence well is not the exclusive domain of traditional occupational health providers. The team I lead at Unum provides employers with group income protection access to early intervention and support services, active case management, and initiatives designed to prevent absence in the first place.

Unum’s economy of scale allows any employer to have access to its team of doctors, psychologists, nurses, and vocational rehabilitation consultants whenever necessary – without any need to procure this expertise themselves.

This is combined with financial support for employees, enabling employers of any size to manage the cost of absence and – crucially for policymakers – with the insurance premium element providing an economic incentive for the employer to partner with us to support a sustainable return to work.

We know this is an effective model from the number of those using our rehabilitation support services that successfully return to work. Key to delivering this success is working so closely with employers and, often, change the way they view sickness absence altogether – from an unknown and unavoidable cost to something that can not only be managed but even prevented.

It is this culture change that should now be the starting point for the government’s plans – supporting employers to invest in workplace health before someone falls ill, guiding them to explore all the expert help and support available, and rewarding businesses when they reintegrate staff who might otherwise have left altogether.

Only by giving employers true ownership of this task can we achieve the change needed for success.

Constructing a prescriptive and impossible policy ideal may well turn off smaller employers entirely – leaving officials to maintain another pristine baseball field with very few visitors.

Improving lives: the future of work, health and disability, 30 November 2017, Department for Work and Pensions and Department for Health and Social Care, (pp. 45),

Occupational health services and employers, 2 April 2019, Department for Work and Pensions and Department for Health and Social Care,

Private providers of occupational health services: interim report, 2 April 2019, Department for Work and Pensions and Department for Health and Social Care,

Government ‘not ruling out’ making occupational health mandatory for employers, says minister, 28 June 2018, Occupational Health & Wellbeing,

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