SOM outlines proposals for universal occupational health access

At an online summit last month, the Society of Occupational Medicine (SOM) put forward a position statement outlining how it envisaged universal access to occupational health might work. Nic Paton looks at some of the key points.

In its position paper, SOM argues that universal provision of occupational health could be based on a mixed-model approach, combining access via the NHS with expanded access via employers.

First, the proportion of employers offering access to OH services and expertise would need to be increased from the current estimated 50%.

“Achieving this will require both greater support for employers and a clear obligation on larger employers to provider occupational health services for their staff,” SOM outlined.

At a practical level, it proposed the establishment of a centrally delivered advice service for smaller employers to improve their overall work performance through better working practices/conditions that support health and prevent occupational illness.

This could include email and telephone advice services, downloadable resources and workplace visits, and could be based on the existing Health Working Lives Scotland model, SOM suggested.

“Medium and large employers would be required to provide OH services, with penalties from the Health and Safety Executive if they do not. Existing regulations require that employers should have a ‘competent person or people’ to provide advice on meeting legal health and safety duties. New regulation/legislation may be required for HSE to enforce provision of OH,” SOM also argued.

The second strand of the model would be a ‘mop up’ OH service delivered through the NHS for those who do not have access through smaller employers (estimated to be around 16 million people) and self-employed workers (some 4.4 million workers).

Core OH services would be funded regionally and provided by existing NHS OH departments but also linked to a local direct referral offer via GPs. This could be coordinated by regional integrated care systems in England or equivalent bodies in the devolved nations (such as health boards in Scotland).

“Scaling up of NHS provision would require investment in a multidisciplinary OH workforce, particularly medical and nursing training, and the recruitment of case managers, as well as in the use of technology, for example for remote consultations.

“There would also be a need to engage with the whole medical profession to encourage referrals onto the programme, supported by marketing,” it added.

In sum, SOM argued the new service would be a mix of:

• Light-touch online and telephone assessment, referral via employer, Job Centre Plus or self-referral, with measures in place to determine whether clinical intervention is needed.
• Case management and advice via a confidential telephone service, with access to online physiotherapy and mental health support.
• A comprehensive NHS occupational health and safety service, encompassing referral from a GPs and other clinicians into NHS acute trust occupational health departments, with payment based on by person treated.

Scale and cost

The paper estimated that to achieve universal access would require 3,500 case managers and around 350 clinical professionals, including a mix of occupational physicians, OH nurses and associated health professionals.

“The need for training and recruitment of staff and the need to build up demand for the programme would mean a phased delivery would be required over a three-to-four-year timeline,” it added.

The total cost of delivering all this would be approximated £280m per year, split between £80m for the light-touch assessment service and £200m for the expanded NHS OH service.

There would also be a range of additional upfront costs, including recruiting and training all the new staff (approximately £350m); marketing to, training and engaging with employers, employees and the self-employed (£10m per year); GP fit note and referrals (£13m) and the cost of setting up a new Centre for Work and Health Research to co-ordinate and drive best practice and research (£7m a year).

But, SOM added, there would be a return on all this investment. “The programme has the potential to create cost savings for the DWP in low welfare spending, including on statutory sick pay, due to better job retention and less sickness absence.

“It also has the potential to save the NHS money by providing more appropriate and lower cost per head services that divert pressure away from more cost intensive services. £1 investment in OH services have been estimated to lead to £1.93 saving in absenteeism costs for employers or a £2.35 saving in medical costs,” it added.

Finally, any wholesale reform of this nature would need legislative changes. One change would be the need to enshrine in law the provision of OH to support both to NHS workers and those unable to access OH commercially. Mandating large employers to provide OH services would also likely require legislation.

The full position paper is available to view online here.