A recent report by research company MBD has suggested the size of the OH market has grown by 9% in the past year and by 50% since 2000. At last it seems that many more in the UK workforce will be benefiting from occupational health provision. Surely this must be cause for celebration?
The numbers are not quite as encouraging as they might at first appear. Where does the data come from? Commercial providers probably provide about two-fifths of the market. They are unlikely to share their turnover figures. It is almost impossible to accurately estimate internal provision. Finally, there are no figures on total spend by the NHS on occupational health, although the NHS is both demanding of OH resource and is itself a large commercial provider.
Inevitably indications of market size are very rough estimates. Estimates of significant growth are even more unreliable – few if any providers have announced substantial growth in the past year that might explain a £30m increase in market size.
The best publicised source of market growth has been salary inflation. OH practitioner salaries have certainly increased by 50% since the millennium. When salary inflation is taken into account, at least all the suggested growth can be explained.
The Health and Safety Executive (HSE) reported surveys of OH provision in 1976, 1993 and 2002. It is difficult to make accurate comparisons between them because a different method was used each time.
All the surveys reported almost 100% provision to the public sector, a high level of provision to large manufacturers, a lower level of provision to the service sector, and almost no provision to small to medium-sized enterprises (SMEs).
During the period between the first and latest surveys, the employment market has changed considerably. Employment in the public sector and production (for example, mining) has fallen substantially. While the total workforce has grown, the proportion working in SMEs has increased. In short, the proportion of the UK workforce in industries well served by OH has reduced.
Impact on OH
The impact of this on OH provision can be estimated using the proportions of workforce provision in the latest HSE surveys (see table below). While this may only be another rough estimate, it is at least founded in the best available data.
The HSE survey data gives little reason to believe there has been an increase in OH provision over the past 25 years. On the contrary, the it suggests that the proportion of the workforce with access to OH support may have diminished.
So far, there has not been a concerted effort to demonstrate that provision has increased. But why not?
The evidence for real OH market growth is poor. Even when there is free access to OH, demand is weak – demand for Workplace Health Connect has been far from overwhelming, and those asking for health support are even more rare. When employers won’t even take help that is free, it is time to consider firmer approaches.
Put the champagne back on ice. A shrinking proportion of UK workers are being provided with quality occupational health. There is no certainly reason to celebrate progress in the past year.
Dr Richard Preece is a consultant occupational physician