The Government’s proposed absence review service got off to a promising start, but clinical operations manager for PAM OH Solutions Janet O’Neill says that it seems have cut some of the key stakeholders out of the development process.
The Health and Work Assessment and Advisory Service (HWAAS) that the Government is planning to introduce by April 2014 is based on recommendations from 2011’s “Sickness absence review” for an independent assessment service for employees on long-term sick leave.
Unfortunately, OH professionals seem to have been sidelined from the development process. A key part of the recommendations – that of communication with the employer, which has a critical role in preventing entry into the benefit system and reducing cost, (Waddell, Burton and Kendall, 2008; National Institute for Health and Clinical Excellence (NICE), 2009) – was also not guaranteed.
To address this, a cross-sectional study of employer and OH views about the potential independent advisory service (IAS) was undertaken as part of an MSc for the University of Nottingham’s department of work and health. Employers were contacted through their Chartered Institute of Personnel and Development (CIPD) membership and word of mouth, and OH professionals were sourced from the JISCmail forum and other OH groups.
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Eighty-seven per cent of employers surveyed, including those with an existing OH service, felt that an IAS was a good idea for reducing sickness absence. But for this to be successful, 91% felt that it would be necessary to have an objective understanding of the role, the industry, the sector and the organisation, along with what accommodations are feasible. Some 93% indicated the need for an understanding of health and how this may relate to work and for clear and open channels of communication with the employer. They wanted easy to understand guidance on adjustments, timescales, relevant legislation and what support would be needed. The same percentage of employers (93%) wanted to be able to make capability decisions based on the information.
OH is the only profession that is trained to assess behaviours from both the employee and the employer, both factors that have been found to need consideration when advising on return to work (Higgins et al, 2012; Reetoo, Harrington and McDonald, 2005).
The HWAAS announced in January 2013 seems to take into account employers’ views, as it incorporates the good ideas of the IAS and improves on them. OH professionals welcome the fact it will be a government-funded service, perhaps in response to consultation with the Faculty of Occupational Medicine and the Society of Occupational Medicine (SOM, 2013).
The Government has recognised that OH is the specialist group trained to understand the employer, the workplace, public health and the employee (World Health Organisation, 2001), something most employers have already recognised.
Better engagement
In the University of Nottingham’s study, 71% of employers felt that it would be useful to be able to refer staff members when they or the employee have a concern in regards to their health at work.
Another positive point of the HWAAS is that if an employee chooses not to engage with the independent service assessing them, they will no longer receive a fit note – a change that will help employers and OH substantially in managing absence.
There is also a higher likelihood of employer engagement now that businesses will receive a report at the same time as staff, which will lead to much more engagement and communication between all parties. However, unless the referral is built into the fit note as has been suggested, this process will mainly rely on GPs supported by increased workplace education – something they themselves have requested (Fylan et al, 2011).
An employer-funded OH service has maximum knowledge of the organisation and is highly valued by the individual as well as the organisation (Hoefsmit et al, 2012; CIPD, 2011), but off-site OH is seen as a new direction (Shearn, et al, 2010).
Such an independent OH service that complements an in-house service or is used where the latter is not available should be effective when employers are also in agreement.
Aside from the assessment, simple work-focused treatments are needed, as current waiting times to accessing treatment are a major contributor in continuing absence (NICE, 2009). Some 80% of OH professionals and 69% of employers in the study indicated that early access to work-based simple treatments should be an essential function of the IAS.
But with no tax relief on work-based treatments in the HWAAS, they can only be discussed with the employer and GP and people “signposted to the appropriate interventions” (Department for Work and Pensions, 2013).
This could be an opportunity for OH to utilise its skills in making a business case for these services, which will be crucial in reducing absence.
Feedback from employers suggests that using the existing independent providers of OH services seems the ideal mechanism to provide the HWAAS.
These providers usually have multidisciplinary teams (Health and Safety Executive, 2000), are skilled in making business cases and provide both on- and off-site OH case management and rehabilitation, which can reduce the burden on the NHS – especially if tax breaks on employer-funded simple treatments are considered in future government budget reviews.
The client base of independent OH providers gives them in-depth knowledge of clients from different sectors, and therefore they have learned to be adept in providing specific-work focused advice for their customers.
Those providers with SEQOHS accreditation – especially with domain G, the NHS core service standard – are ideal as they are accountable and have improved services (Williams, 2012).
Seventy-eight per cent of OH practitioners in the study felt that a single validated tool for assessment would be useful, with 42% of OH and 90% of employers feeling that an assessment of workability for long-term outcomes would be a beneficial tool.
Perhaps the HWAAS will be the conduit for research and development of this.
Janet O’Neill is the clinical operations manager for the Midlands at PAM OH Solutions
References
Black C, Frost D (2011). Health at work: An independent review of sickness absence. Department for Work and Pensions.
Chartered Institute of Personnel and Development (2011). Annual research report 2011.
Department for Work and Pensions (2013). “Fitness for work: the Government response to ‘Health at work – an independent review of sickness absence'”.
Fylan B, Fylan F, Caveney L (2011). “An evaluation of the ‘Statement of fitness for work: Qualitative research with GPs'”. Department for Work and Pensions.
Higgins A, O’Halloran P, Porter S (2012). “Management of long-term sickness absence: A systematic realist review”. Journal of Occupational Rehabilitation; vol.22, issue 3, pp.322-332.
Hoefsmit N, Houkes I, Nijhuis FJN (2012). “Intervention characteristics that facilitate return to work after sickness absence: A systematic literature review. Journal of Occupational Rehabilitation; vol.22, issue 4, pp.462-477.
National Institute of Clinical Excellence (2009). Managing long-term sickness absence and incapacity for work PH19.
Reetoo KN, Harrington JM, Macdonald EB (2005). “Required competencies of occupational physicians: a Delphi survey of UK customers”. Occupational Environmental Medicine; vol.62 issue 6, pp.406-413.
Williams S et al (2012). “Measuring how well the NHS looks after its own staff: methodology of the first national clinical audits of OH services in the NHS”. Journal of Evaluation in Clinical Practice; vol.18, issue 2, pp.283-289.
Shearn P, Ford NJ, Murphy RG (2010). “An evaluation of an occupational health advice service”. Health Education Journal; vol.69, issue 1, pp.13-20.
Society of Occupational Medicine (2013). Occupational health welcomes Government response to sickness absence review.
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Waddell G, Burton AK, Kendall NAS (2008). “Vocational rehabilitation: What works, for whom, and when?” TSO; London.
World Health Organisation (2001). “The role of the OH nurse in workplace health management”.
