Whatever the outcome – hung Parliament, David Cameron triumphant in Downing Street, or Gordon Brown finally trouncing his critics – the forthcoming General Election looks as if it will be one of the closest-fought in years. And for occupational health (OH) practitioners, there is a lot riding on the result.
Labour, of course, as the ruling party, is the known quantity here. Should it be returned to power, it will probably be quite straightforward for OH in that the substantial reforms already in place or being piloted – the fit note, the fit-for-work service, the helpline for small and medium-sized enterprises and so on – will simply run their course until 2011, after which the tough decisions will need to be made.
Nevertheless, with Labour firm in its pre-election “not immediately” approach to cuts to reduce the ballooning budget deficit, it may well be that by 2011, those decisions could be being made against an extremely difficult public spending backdrop. In that context, even with a Labour victory, it is still not 100% certain that the landmark reforms related to OH that we have seen over the past few years have become fully embedded.
The Conservatives have, as yet, only given hints about what their future direction is likely to be in regard to OH. The clearest picture was outlined back in January in a paper published by shadow health secretary Andrew Lansley which, if not formal policy, sets out a clear tone and focus for the future, and in fact could be a seductive message for many OH practitioners, particularly those working in the commercial arena. The central message of the Healthier Nation Green Paper was that a future Conservative government would look to bring in tax breaks for employers that invested in workplace health and OH.
Lansley, through his Public Health Commission think-tank, has also floated the idea of using the tax system to remove “existing financial disincentives to physical activity for both people and employers”, the reduction of VAT on healthcare provision that makes people more physically active, and the removal of tax liability from employers that encourage employees to be more physically active, so removing its current status as a benefit in kind. Lansley has also suggested that a Conservative government could offer matched funding for businesses that spend capital on promoting health improvement.
One of the more intriguing elements of what Lansley has been saying is how it chimes with the current government-backed Marmot Review of health inequalities, which in February suggested that employers needed to be encouraged or incentivised “to create or adapt jobs that are suitable for lone parents, carers and people with mental and physical health problems”.
As for the Liberal Democrats, they could yet turn out to be powerful “king-makers” in any hung Parliament or minority government, and therefore have much more political clout than normal. Their document in February – Protecting and Improving the NHS – while not exactly heavy on detail, does provide at least a taste of what we might be able to expect from a LibDem government or, more realistically, the party’s influence in a coalition.
It said it would tackle the “burden of repeated assessments and requests for data” within the NHS by ensuring that no one organisation can ask a hospital or health trust the same question. Strategic health authorities would be abolished and replaced, with local NHS trusts within a region being allowed to act together to commission tertiary services.
Incentive payments to health boards and GPs would be reformed to ensure there was a closer link to health prevention, particularly in relation to alcohol, smoking, obesity, poor diet and sedentary lifestyles. There would be “better help and advice” for people with long-term illnesses or disabilities through the piloting of a network of “patient advocates”.
Finally, the party has stressed that employers, as much as individuals, families, schools, the NHS and local government, all have a shared responsibility to encourage people to adopt healthy lifestyles.
“Part of the solution is getting people to take a more active interest in their health, so they will start living more healthily. We will give patients greater control of their own health records, so they’re able to take a more active role in managing their health,” it recommended.
Scottish National Party
The Scottish National Party, while not making any specific commitments about OH, has prioritised a number of public health initiatives, including working to create a smoke-free Europe and developing a healthy National Food and Drink Policy to promote health and wellbeing.
Finally in Wales, Plaid Cymru pledged last year, as part of its ‘One Wales’ coalition agreement with Labour, to look at the possibility of setting up a statutory OH service.
Ultimately for OH professionals, whatever the result, the key is going to be the extent of a new government’s long-term commitment to the reforms we have seen over the past couple of years, suggests Graham Johnson, OH nursing development manager at Bupa Wellness.
“I would be hopeful that at this point any governing party would now continue what the Department for Work and Pensions has started in terms of the Dame Carol Black reforms,” he says. “For OH’s sake, too, now that we have finally arrived, it would be a shame for it to be taken away.”