One issue emerged as the hot topic at last month’s Health and Wellbeing at Work conference – the question of which is more important: the impact of health on work, or the impact of work on health.
National director for work and health Dame Carol Black put the case to delegates for making the workplace a key setting for tackling health problems and inequalities, regardless of whether these are work-related.
A few hours later at the Ruth Alston Memorial Lecture, organised by the Association of Occupational Health Nurse Practitioners, OH adviser Christina Butterworth and chief nursing officer Dame Christine Beasley led a debate on the issue. Butterworth said OH should focus on workplace hazards and Beasley supported the case made earlier by Black, while reassuring OH nurses that she would help raise their profile in the nursing profession in general.
Butterworth voiced frustration among OH nurse practitioners about the lack of understanding of their role. “I am so glad that the debate has shown that the government’s responses to Health, Work and Wellbeing [the strategy that has Black’s 2008 review of health and work at its core] has focused on the link between health and work, and has failed to recognise the role that OH specialists play in the management of work and health,” she said.
She pointed out that the future role of OH is still uncertain, and that only a small number of practitioners have been able to actively participate in the national strategy due to the pressures of providing OH care. She argued that OH nursing is not well understood by nurses in general, and that OH nurses have two masters: the individual health status and needs of the employee on the one hand,and the need to raise awareness of hazards for the employer on the other.
For Butterworth, the priority for OH nurses is preventing employee ill health caused by physical, chemical, biological, ergonomic and psychosocial health hazards through risk assessment, and monitoring of controls and promotion of health – for example, through hearing protection campaigns.
Black’s presentation earlier in the day argued that OH professionals need to extend their remit beyond workplace hazards to improving the health of working-age people, stressing the impact of an ageing population and lifestyle-related illness on the workplace. “OH professionals need to enhance their leadership roles and revitalise their services making them fit for current needs,” she said.
With an ageing population and the need to work until later in life, employers face increasing incidence of long-term conditions. At the same time, there is also a risk to employers from conditions starting earlier in life that are caused or aggravated by lifestyle.
The three main risk factors are tobacco, physical inactivity, and poor diet. “These risk factors provide a clear focus for business,” said Black.
If OH is to align its efforts with Black’s priorities, then practitioners need to support employers in offering flexible working arrangements, ensuring compliance with the Disability Discrimination Act, making reasonable adjustments at work, and giving line managers more information and guidance on conditions such as cancer, stroke, hypertension, coronary heart disease, diabetes, and rheumatoid arthritis.
Black also encouraged employee health checks, citing research that showed 91% of office workers and 84% of factory workers rated health checks as ‘very’ or ‘quite’ effective in helping them lead a healthier life.
She cited four recent studies which showed there was an opportunity for workplace interventions for those most at risk and hardest to reach, across a wide range of ages, with ease of monitoring effectiveness: Foresight, Mental Capital and Wellbeing; the Black Review: Working for a Healthier Tomorrow; Working our way to better mental health: a framework for action; and the recent Marmot Review.
So who is right? Employers must comply with the law to ensure the workplace is safe as far as is ‘reasonably practicable’ as laid down in the Health and Safety at Work Act 1974.
However, the belief that this means legal compliance and risk management are the most important priorities for OH practitioners can be challenged. In the April issue of Occupational Health, Dr Richard Preece questions whether a slavish compliance to employment law necessarily reduces the risk of work-related ill health, looking in particular at the ‘six pack’ of health and safety legislation.
It is also a debating point whether time-consuming health surveillance where incidence of hazards causing ill health is low is time better spent than interventions to support return to work or improving employee attendance.
If, however, it is a given that a basic level of risk management is a core OH responsibility, then the amount of OH capacity focused on the impact of health on work is discretionary. One argument is that while minimum standards are non-negotiable, the ‘health promotion’ part of the OH remit needs to be justified by cost benefit analysis. In other words, it needs to pay for itself through reduced absence costs or higher productivity at work.
But this does not mean OH nurses should focus only on risk management and on where they can use their clinical knowledge, usually in managing more complex referrals. If they do so, they will stay on the margins of the government’s health reforms and also risk making themselves irrelevant to employers and HR. The answer is for OH practitioners to look beyond managing workplace risk, and address employers’ objectives of cutting absence and raising productivity through a focus on the wellbeing and engagement of employees.