New Health and Work Service needs a multi-provider vision

The Government’s new Health and Work Service is beginning to take shape, but occupational health adviser Lindsey Hall has a few suggestions to make sure it is the best that it can possibly be.

It was clear from the conference Westminster Employment Forum: Health and Wellbeing – the future for sickness absence policy – which took place in November 2013 – that there are still more questions than answers about the Government’s proposed Health and Work Service. In the glow of its response to the Black/Frost report, the Government set itself an ambitious target of establishing this service by the start of 2014, giving GPs the task of referring all those whose absences have reached four weeks for an occupational health assessment.

Like most others who attended the event, I am not against the broad concept – but currently see more negatives than positives. Concerns also seem to be weighing on those responsible for bringing in the service, as they realise that perhaps this is not quite as easy as they first thought. It now looks like a national service will not be in place until April 2015.

At least they have decided to start using a simpler name. The Health and Work Assessment and Advisory Service was becoming a bit of a mouthful and saying “hwarse” wasn’t doing it for me either – so get ready to start hearing about the Health and Work Service or “HWS”, as it will almost certainly become known.

The biggest concerns remain about the lack of suitably qualified and experienced occupational health (OH) advisers and the liberal use of telephone assessments. The synergistic effect of that combination could lead to an over-generation of poorly templated advice that is no use to anyone. So, below is my proposed solution.

More than one provider is required

Do not give this service to one big provider. If the Government thinks that yet another big one-off contract will do the job… it won’t.

It will crumble under its own weight and bureaucracy, and no one organisation will be able to take on the number of people it needs. And if it does, it will have a massive impact on the rest of the profession and the OH business.

It will be a route to nationalising and monopolising absence management and any services that are generated from the initial referral. Far better to allow GPs and clinical commissioning groups (CCGs) to work with local providers, large and small, to engage with absentees and local businesses.

Register of providers

Instead, set up a register of providers that GPs and CCGs can use. Quality will be key, so ensure that SEQOHS accreditation is the way onto the register. This will rule out a number of good independents. SEQOHS is far from perfect, but it is better than having a register without accreditation. There will inevitably be some subcontracting and/or consolidation of independents into accredited businesses.

Establish a Faculty of Workplace Health under SEQOHS

The recently linked up Society of Occupational Medicine and Faculty of Occupational Medicine will be the ideal choice organisation to establish a Faculty of Workplace Health. Give this organisation SEQOHS to manage – possibly in conjunction with the Commercial Occupational Health Providers Association (COHPA).

Get all of the OH and allied professions involved

Invite OH nurse advisers – most of whom are currently rather disgruntled with the Nursing and Midwifery Council – to join. Then ask other allied practitioners such as physiotherapists, occupational therapists, psychologists, vocational rehabilitation consultants and others with a healthcare qualification who are involved in workplace health and wellbeing to join as well.

The effect will then start to be a multidisciplinary body of motivated professionals and businesses, collectively suited to the task of providing a national service.

Keep it small

Prevent large organisations with established OH services from using the Health and Work Service for two years to allow the service to become established and to prevent a flood of referrals by businesses simply wanting to save themselves a chunk of cash. Get the GPs to refer straight to the employer’s own service, where there is one.

The messages from the team that conducted the National Sickness Absence Review are rather contradictory on this point. On the one hand, there is a stated intention not to duplicate the work of existing OH departments, yet on the other, there is a clear statement that it is open to all employers and might actually be encouraged as employees may open up more to an independent service than their own (I find this last comment of great concern as an OH adviser practising under the auspices of the Nursing and Midwifery Council’s code of conduct). But let’s be clear on the economics of this in straitened times: days of absence and government money will not be saved by duplicating work.

Competition means quality

With a multi-provider model, GPs and CCGs will be able to choose who they wish to work with. There will be competition in the market, which will ensure quality is maintained and prices kept reasonable. There will need to be some central coordination from the Department of Health, but this way the profession will grow, OH businesses will continue to grow and innovate and the long-term result will be far better, with meaningful engagement with a wide range of OH services to the benefit of all.

Lindsey Hall

About Lindsey Hall

Lindsey Hall is director and independent occupational health adviser at Split Dimension Ltd.
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