In July 2013 Occupational Health looked at the Council for Work and Health’s interim report “Planning the future: delivering a vision of occupational health and its workforce for the UK for the next 5-20 years”. The updated report, published in May 2014, covers a lot of the same ground. Nic Paton investigates.
The council’s ongoing project to map out a blueprint of future workforce need and demand illustrates that the workforce challenges facing occupational health (OH) are severe.
The challenges of lifestyle diseases such as obesity and diabetes, the UK’s ageing working population and the increasing prevalence of chronic and long-term diseases would be challenging even if the OH profession was expanding and attracting new blood. However, as the report makes clear, OH as a profession is facing its own challenge of declining numbers and an ageing of its own workforce.
As chair of the council working group Professor John Harrison puts it: “[The report] is setting the scene around where we are now and what is going to be happening in the future. It is really just highlighting the fact the working world is changing and OH is changing with it.”
Harrison is also clear that there are significant opportunities, too, for the profession.
“I think there will be more work that needs to be done around refining what it is we have to do. But what is clear is that it is potentially an incredibly exciting time for occupational health.
“We know there are major issues out there around succession planning and bringing through the next generation and developing our capacity, but there is also a fantastic opportunity for us to look into the future and make sure our people planning processes match the opportunities there for OH,” he explains.
- The Health and Social Care Bill has brought significant changes to the commissioning of services by the NHS. Clinically led commissioners will therefore “require significant guidance from occupational health leaders regarding the needs of populations over the next five to 20 years if they are to make informed occupational health purchasing decisions and occupational health, in its widest sense, is to become a mainstream component of healthcare”.
- Employers have “a collective responsibility and a business need to contribute towards the health and wellbeing of the working population”. Yet most employers, particularly smaller firms, do not use workplace safety or health specialists. “Commissioners of healthcare, including occupational health, will need to consider how partnership working with the private sector might address this.”
- While there is, and will be, an ongoing need to create safer and healthier workplaces, workplaces are also becoming places where “the lifestyle factors that contribute to the future burden of public health can be addressed as a sine qua non for keeping people economically active”. Within this there is increasing recognition of the need to address mental health at work and of the association between poor physical health and impaired mental health. To that end, it will be important to ensure strategists and commissioners “are aware of and understand the contribution that the workplace has to make with regard to prevention of ill health and in supporting people with health conditions”.
- The ageing of the UK’s working-age population will mean the way long-term conditions are perceived and managed will become increasingly important determinants of employability. With people working for longer, and staying healthier for longer (but also more likely to be “carrying” long-term health conditions), it will be important to “gear workplace health and wellbeing initiatives to prepare working people for productive lives well into their seventies”. OH professionals will have “a pivotal role” in advising employers and employees “what good work looks like” and creating the evidence base “for defining what physical and mental capabilities are required to deliver it”.
- Yet, at the same time, fewer physician trainees are entering occupational medicine and there are similar challenges for nurses and the allied professions. “The funding for training is unsustainable, the research base is diminishing and affordable access to comprehensive occupational health services for the majority of the UK’s working-age population is limited or non-existent.” Long-term resource planning over the next five to 20 years will be “as critical as the evidence-based pathways for managing work-health issues for the delivery of a healthy workforce, and a healthy economy.”
Council chair Professor Diana Kloss agrees that now is not the time for practitioners to be wringing their hands.
The fact the report has brought together so many elements of the profession bodes well for the greater focus there will need to be on the development of collaborative, multidisciplinary working. Initiatives such as the new National School of Occupational Health, though at present confined to physicians, and the creation of a single body or (probably) college for OH are also expected to be useful steps forward.
On top of this, the council is planning to hold a meeting specifically to discuss training and research which will take place in Manchester in early 2015.
“Problems of recruitment of skilled professionals are acute,” concedes Kloss. “My personal view is that we are more likely to attract experienced health professionals, particularly from primary care, than students fresh out of university. This makes it all the more important that we have training courses available to allow them to acquire OH qualifications.
“However, we should not be despondent. There is a definite wind of change blowing through occupational health, and also signs that government is coming to recognise the importance of the workplace in improving the health of the working-age population,” she adds.
The increasing “mainstreaming” of OH is going to be very important for the future health and wellbeing of the UK economy, agrees Harrison. But it will also be important to look at what is being tried, and what is working, in other economies and other health systems around the world, and that is part of the work the council is now doing.
The answer to the profession’s workforce lies in better training and recruitment pipelines and better awareness of OH within the health community. But it will also need to focus on spreading the workplace health message to those outside healthcare, Harrison argues.
“I think it is going to be about upskilling a whole host of people so that there is a greater awareness of occupational health issues as well as a degree of competence to do something about it. So it could be GPs and hospital specialists, clinicians and non-clinicians; managers, too, will need to be trained. But I think there needs to be more of a recognition that, actually, occupational health is about everyone in the workplace,” he says.
“Within that I think a lot of occupational health needs to be demedicalised. There are aspects of it, of course, that are medical, and you will need people that are appropriately trained to be carrying those out. But a lot of it, really, is not medical – and we have to start using language that people understand in this context,” he adds.
Working group member Leonie Dawson, of the Chartered Society of Physiotherapy, agrees. Although we are now seeing far more joined-up working between practitioners, GPs, employers and employees, it is, and it is increasingly going to be, about engaging employers and the public as well as simply getting GPs and other healthcare practitioners to have a better understanding of, and make better connections between, health and work.
“At the moment there is so much potential to increase health and wellbeing within the workforce and reduce sickness absence rates. We need to target small businesses especially and try to help them understand what OH can offer,” she argues.
“We have got to highlight the value and interest of occupational health so that people will be encouraged to join this specialism. We need, too, to look at the different competencies and whether we can develop common competencies that will encourage more multidisciplinary working,” she adds.
The council’s ambition, in essence, is simple: to look at what “UK plc” needs going forward and what is going to be the right mix of professionals to deliver this, says Christina Butterworth, president of the Association of Occupational Health Nurse Practitioners (UK).
“Once we have that in place, and we know what is needed, we are in a much stronger position to go to educators,” she points out.
“It is about asking ‘who are going to be the people we need going forward?’ But I do think the future is bright. Workforce is always going to be an issue but we have to make the most of the people we have and those more generally who work within the workplace,” she adds.
Drivers for change
The report identifies what it argues will be the three forces for change over the next 20 years: finance, demographics and chronic and long-term conditions.
Central here are the huge financial pressures expected on government agencies, including the NHS, as the country adapts to caring for an ageing population. Within this, OH will need to grasp the opportunity to position itself within mainstream healthcare.
“Work and the workplace can be used to promote health and wellbeing through healthy lifestyles, health risk management and supporting people with long-term conditions as part of integrated care pathways, in addition to the historical role of safeguarding workplaces,” the report argues.
It is, the report notes, “time for occupational health to be recognised as a key component of general healthcare and the maintenance of an active and productive working-age population”.
Connected to this challenge will be long-term demographic change, especially the ageing of the population and longer life expectancies, the growth of the population (with numbers expected to grow by eight million to more than 61 million by 2020), growing ethnic populations and more people living on their own.
Chronic and long-term conditions
Chronic and long-term conditions, especially the health issues arising from obesity and cancer (and increasing cancer survival rates), will be the third great challenge, the report contends, with workplaces and work cultures being increasingly used to address this. Musculoskeletal conditions (especially as the working population ages) and stress and mental ill health will be other core challenges. Dementia is likely to be a further issue, again becoming more prevalent as the population ages.
The report also predicts the growing impact of technology on workplaces, workplace health and how OH is practised. The rise of mobile technology will be a key component of this, both in terms of giving people more freedom in how and where they work but also in introducing new ergonomic challenges (such as work-relevant upper limb disorders caused by poorly set up workstations) as well as potential challenges around working hours and an “always on” culture.
Developments in areas such as biotechnology and nanotechnology will create new processes, materials and potential risks. Telemedicine and tele-health will also become more commonplace both generally and within the delivery of OH.
Education and training of future practitioners
The creation of Health Education England (HEE) and its Local Education and Training Boards will stimulate change in the current models of training in England, the report argues. Concrete change is already visible in HEE’s agreement to support a Faculty of Occupational Medicine-led initiative to establish a National School of Occupational Health, starting from August 2014 (see News).
Similar innovation is being seen within the allied professions in the training and development of occupational hygienists, the report argues.
But the training and qualifications system “needs to be expanded rapidly” in order to cope with the anticipated demand, it contends. “In particular, there is a critical need for more postgraduate courses and students creating an opportunity to integrate this into multidisciplinary occupational health training.”
Models of delivery and future competencies for OH professionals will be the focus of subsequent stages of the project, the report points out. However, it adds, “it is clear that strategic decisions about training the future workforce must have a wide focus encompassing the multidisciplinary nature of provision and the wide range of stakeholders in the workplace health and wellbeing agenda.”
Training, it continues, “must be adequately resourced and the recent decline in the numbers of training posts must be reversed to ensure future workforce capacity.”
Who is leading the process?
The council’s working group comprises Harrison as chair and:
- Richard Heron (Society of Occupational Medicine/Faculty of Occupational Medicine).
- Keith Johnston (Syngentis).
- Anna Harrington/Kate Kyne (Association of Occupational Health Nurse Practitioners (UK)).
- Leonie Dawson (Chartered Society of Physiotherapy).
- Julia Skelton (College of Occupational Therapy, specialist section for work and vocational rehabilitation).
- Tom Stewart (Institute of Ergonomics and Human Factors).
- Roger Alesbury (British Occupational Hygiene Society).
- Mike Goldsmith (Commercial Occupational Health Providers’ Association).
- Emma Donaldson-Feilder (British Psychological Society).
- Surinder Kumar (NHS Health at Work).
- Vanessa Hebditch (communications adviser).
However, the report has also been endorsed by more than 20 leading healthcare organisations involved in improving workplace health.
These include the Society and the Faculty of Occupational Medicine, the Royal College of Nursing, the Royal College of General Practitioners, TUC and NHS Employers, among others.
From its interim report published last summer, the council has now essentially completed stages one and two of its outline process: establishing the change management approach and creating the population definition and/or strategic environment.
The focus will now turn to stages three to five, for which the council has said it has laid the foundations, and which it hopes to complete within 12 to 24 months.
These stages are:
- design service delivery models;
- define knowledge, skills and competence levels; and
- define roles and future workforce.
Once these have been completed, future work will focus on a gap analysis, what the council terms a “reality check” and, finally, planning for implementation.
Alongside this, the report has recommended the council implements “a communications plan that has been developed in conjunction with this project, which engages key stakeholders and aligns our messages to promote a consistent vision of occupational health”.
It also recommends the council develops and implements “a marketing campaign for occupational health which promotes the demand for occupational health and ensures there is sufficient capacity of suitably trained and competent practitioners to deliver the demanded evidence-based interventions”.