The Council for Work and Health has followed up its 2014 report on the occupational health future workforce with a second study. It outlines far-reaching proposals on how sufficient numbers of practitioners can be delivered.
It may not be the answer to life, the universe and everything, but hold the figure 41,708 in your mind. It’s the number of occupational health specialists the Council for Work & Health has estimated the UK is short of now to effectively meet the health needs of its workforce – let alone the number needed for the future.
The figure is a combined estimate of the number of specialist practitioners currently working within occupational health, across a range of disciplines, versus what the council has argued is in fact required to “provide an equitable service for workers”. The figure subtracts the current estimated number of practitioners from an estimate of the number currently required to arrive at the shortfall.
The figures come from the council’s second landmark work-force planning report, Planning the future: the implications for occupational health, delivery and training, published in March and the follow-up to its 2014 report, Planning the future: delivering a vision of good work and health in the UK for the next 5-20 years and the professional resources to deliver.
Six key recommendations of the Council for Work and Health report
One: That mainstream healthcare provision should be extended to include the integration of occupational health – from commissioning and outcome measurements, through improved knowledge and understanding of clinical healthcare teams in hospital and general practice settings, to maintenance of work ability, to the referral of patients across the NHS/private interface to occupational health services.
“Detaching occupational health from mainstream healthcare undermines holistic patient care.
The maintenance of work ability (a person’s capacity to do the work tasks they are required to do) and return to ‘good’ work should be a key clinical outcome for all care pathways formulated for people of working age”.
Two: That the Government should create incentives to encourage investment in healthy workplaces and the uptake of occupational health and wellbeing initiatives.
“There is scope to remove the tax liability for a wide range of occupational health and wellbeing interventions aimed at preventative workplace health risk management, promoting work attendance and effective rehabilitation back to work,” the report suggests.
“Employers currently have to wait for 28 days to refer to Fit for Work and there is the potential to reduce this so that they can have rapid access to the government service. Insurance companies should be encouraged to work with employers to promote workplace health and wellbeing.”
Three: To ensure that employers understand the return on investment in occupational health and have access to the right professionals to create healthy and productive work and workplaces. Also, to ensure that the risk of harm from badly designed or managed work and workplaces is reduced.
Four: To develop competency frameworks to ensure capability of multi-professional occupational health workforce through quality assured training.
“We need an occupational health workforce with a distributed range of knowledge, skills and competencies. A multi-agency approach is required to holistically address health and wellbeing in the workplace, advising employers and delivering the full range of preventative activities to ensure a working environment that is conducive to good health”.
Five: To develop models of delivery and workforce planning capability. The planning of occupational health workforce needs is complex because of a number of factors, including:
- the proposed changes in future occupational health provision to deliver cost- and workforce-effective tailored services;
- the breadth of models of delivery for the disparate needs of UK businesses and
- a lack of workforce intelligence from the respective professions.
“There is a need for a methodology to predict the match between requirements and supply”.
Six: To attract and train the required number of high-calibre occupational health practitioners to meet predicted occupational health needs.“We must ensure that there are clear attractive career pathways to attract high calibre applicants in each of the professions in the future. The current shortfall must be addressed urgently,” the report emphasises.
Within this, there is a need to:
- promote occupational health as a career to attract candidates for specialty training;
- encourage the training of non-specialist professionals for deployment into supervised roles;
- explore fast-tracking of specialist training; and deliver occupational health in a tiered approach, optimising the roles of experts and specialists and increasing the opportunities to deploy generic practitioners.
The table, in itself, is not a recommendation for future recruitment, emphasises Professor John Harrison, who chaired the working group that drew up the report. Nevertheless, it neatly illustrates the stark workforce crisis facing the profession.
“In terms of recruitment, there is a very acute message that if we do not do something pretty quickly we’re not going to have a specialist occupational health workforce because of not being able to recruit enough people and because of the ageing demographic of our respective disciplines,” he explained.
The report sets out six key recommendations, encompassing areas as diverse as commissioning, training and education, skills, the delivery of services and the role of Government, employers, the NHS and providers. It also argues for the creation of a new body, a commission for occupational health, that could bring together key workplace health stakeholders and “promote good occupational health practice in organisations – in particular, extending this to SMEs – and provide guidance for organisations wishing to procure occupational health services.”
Alongside this, the council makes the case for employers to be offered a greater range of incentives to invest in, and commit to, workplace health and for greater “credentialing” of occupational health services to improve the effectiveness of commissioning and procurement.
“When it comes to incentives, the Government will, naturally, point to the Fit for Work service and its £500 tax break, which have been helpful, a good start. But the service is primarily for SMEs rather than bigger employers and there is much more to do. When it comes to things like referring workers for physiotherapy or psychological support, the NHS, really, is not delivering what employers want,” said Harrison.
“Around credentialing, I think we really need to bring things into the 21st century. Nowadays when you want to buy something you go on to, say, Amazon and you look at the product, its specification and customer reviews, and that all influences your decision. Why should we not be able to do the same when buying occupational health?
“We need something that can show employers the parameters of a good OH service, with client testimonials. Often employers know they need something but do not know precisely what they need or how to access it. We need a vehicle that explains what they need to know and how to find it,” he added.
Christina Butterworth, deputy chair of the council and past president of the Association of Occupational Health Nurse Practitioners, agreed: “This report is a really collaborative work, with lots of people looking at lots of areas of the workplace, and all pointing to how the workforce is changing. It is about making sure we are providing what is needed in terms of workforce.”
“It is very much an in-depth study; it is not tinkering around the edges. But I also think the recommendations it is making are realistic,’ says Butterworth. “There are a lot of valuable resources that work within the workplace health and wellbeing arena, so it is about making sure those resources are being used appropriately.
“If people are really committed to the workforce they are going to have to put money into targeted policies and interventions. The council is trying to gauge what the workforce needs to look like, how we get there and how we attract, train and educate the right people,” Butterworth added.
“The main point that came out of the report for me is that occupational health needs to be relevant to current and future working populations. To do that, both from a clinical effectiveness and continuity of care and a workforce capacity point of view, it must link to mainstream healthcare,” said Jenny Nissler, professional adviser and lead on fitness for work at the Chartered Society of Physiotherapy. The society was also represented on the working group.
Parity of access
“A second important point is that all people of working age can benefit from access to fitness for work support – and so to be effective, there needs to be parity of access to advice and treatment. For those without access to occupational health, more support is being put into place, such as the Fit for Work service. Healthcare support also needs to be able to adapt to where and how individuals work both now and in the future,” she adds.
The council intends there to be a third and final Planning the future report that will look at the relationship between the various OH functions, the requisite skills required, numbers of practitioners, workforce planning needs, access to information, workplace practices, the composition and function of OH teams and the role of specialist practitioners, among other areas.
Professor Harrison admitted that the final report could take a similar two-year timeframe to collate. But he said, the second report is a valuable, weighty and authoritative contribution to a difficult and challenging debate with no easy answers.
“One of the things that makes this report different is that it brings together the voices of so many of the different disciplines that work under the occupational health umbrella; it is a consensus view about the way forward and a clear message about what needs to be done,” he said.