A document from the Society of Occupational Medicine explains the occupational health value proposition for potential purchasers of services. Nic Paton looks at the key messages, and suggests how the report might be used by OH providers to win contracts.
If you wanted to distil the “problem” of occupational health down to three words, you probably wouldn’t go far wrong with: “evidence”, “access” and “capacity”.
In a nutshell, too often employers don’t feel there is the hard-and-fast, cold-light-of-day, return-on-investment evidence to justify spending their precious cash on OH. This, in turn, means only a minority of employees end up having access to OH, creating something of a “well if they don’t offer it, why should I?” vicious circle.
How the report makes the case for OH
Occupational health: the value proposition has a simple goal at its heart. Its aim, as it articulates right at the beginning, is to synthesize “the evidence from the scientific and wider literature to help illustrate and publicise the benefits that occupational health services provide to employers, workers and to the economy.”
In essence, the report aims to demonstrate that there is a rounded business case for investment in occupational health services and, beyond that, to define this “value proposition”. Importantly, while it does look at the business and financial drivers behind investing in OH, it also tackles some of the more intangible reasons for making this decision, such as the moral business case.
The report is divided into eight broad areas: making the business case for occupational health; then the legal, moral, business and financial imperatives for investing in OH; then the evidence for investing in both occupational safety and health and workplace health promotion. Finally, the report looks at the evidence for investing in OH services.
To give a flavour of how the report works, the chapter on the legal imperative, for example, emphasises the need for employers to appoint one or more competent persons to assist them in meeting their legal duties and to take into account the size of the undertaking and the risks at the workplace.
Occupational health doctors and nurses need to be competent/suitably qualified to enquire about symptoms, inspect or examine employees. Companies and/or directors can be prosecuted for breaches of health and safety law and face significant fines and potentially imprisonment. Litigation risks company reputation which can threaten businesses.
By comparison, when it comes to the moral imperative for OH, this is more about highlighting and recognising that employee health and wellbeing contributes to successful business performance and that highly effective companies commit to a culture of health. Wellbeing strategies, it adds, “must extend beyond health to encompass the work environment, culture and interpersonal relationships”.
When it comes to analysing the evidence for OH intervention, the report concedes that “studies are difficult to locate in electronic literature databases because of diverse study types, low numbers of cost-effectiveness or cost–benefit analyses and poor methodologies”. Indeed, measuring benefits from OH services is “inherently difficult”.
It can also sometimes be the case that, where programmes are legally-mandated (such as health surveillance) there is little motivation to gather evidence because there is no perceived need to justify the programme.
Nevertheless, it is possible to demonstrate that some occupational health interventions are more “profitable” than others.
As the report argues: “It is suggested that active OH care aimed at prevention and rehabilitation is more profitable than a focus on treatment. A systematic review of different types of intervention identified musculoskeletal interventions (in certain sectors) and return-to-work/disability management interventions as usually worth making from an economic point of view.”
And even when employers do recognise the value and business case of investing in OH, there’s the fact OH and occupational medicine are both ageing specialities and in short supply, as the Council for Work & Health warned last year.
To try to tackle at least the first two of these core challenges, the Society of Occupational Medicine (SOM) has published a new document, Occupational health: the value proposition. It follows on from the society (along with the Faculty of Occupational Medicine) last year launching a campaign, “Why Occupational Health?” designed to make the case for investing in and having access to occupational health provision.
This latest document is a bringing together of the available evidence to show why OH stacks up: the business case, the financial case, the legal case, even the moral case. It also makes the argument for investing in occupational safety and health and health promotion.
Evidence base for occupational health
As SOM chief executive Nick Pahl explains: “As a profession, there has for a long time been a feeling that we do not have the evidence, the evidence base, even though we believe there is a strong business case to be made for occupational health.
“Alongside the business case, there is also a moral imperative for investing in occupational health. It is simply the right thing to do, both for employees individually and for the business. A lot of businesses, too, are concerned about their supply chain; if something hits or interrupts the business, it can be catastrophic,” he adds.
When you read the document, it is clear it is not primarily aimed at a professional OH audience, in that the vast majority of its contents will already be well-known and understood by that audience.
“The audience is mainly HR professionals, commissioners of occupational health services, managers and employers. It is simply about showing to people what occupational health can do,” says Pahl.
“It is going to be a valuable document for employers primarily, but it could also be useful for policymakers to see what they can do in terms of any legislation or guidance or evidence-based best practice. It is simply about gathering together the information that will allow people to make the best case for occupational health to their employer or organisation or potential customers,” agrees report author Dr Paul Nicholson, a former Society president and chair of the British Medical Association’s occupational medicine committee until his retirement last year.
“The primary intent of the document is to assimilate the available evidence out there about investing in occupational health. One of the challenges around occupational health generally is that we do not have a particularly good handle in terms of accurate figures; the majority of the evidence available is from relatively small surveys. And this is not helped by the fact that often ‘occupational health’ as a term is itself not very well defined,” he adds.
Making the occupational health value proposition
But that’s not to say OH practitioners and occupational medicine specialists shouldn’t make use of a document such as this, far from it, in fact.
“This document could be useful for OH practitioners when they are bidding for work or commissioning. For example, as an employer, if you’re worried about mental health and stress, is an EAP going to be too ‘lightweight’ for what you need compared to what occupational health can provide?” explains Pahl.
“Occupational health, too often, does not grab the stage. But this document can show people what occupational health can do and the role it can play; the value it can bring,” he adds.
“It is about being able as an OH practitioner to say ‘this is not just us looking for a new income stream – it is because there is good evidence to support investing in occupational health, which this SOM document shows’,” agrees Dr Nicholson.
Access to occupational health
As well as articulating the case for investing in OH, the report provides an illuminating snapshot of the OH landscape, including an analysis of the common reasons why organisations invest in this area, and the burden and cost of sickness absence.
It also outlines the current state of play when it comes to access to OH services in the UK, synthesizing a number of different reports and evidence.
This includes highlighting research from 2011 for the Department for Work and Pensions suggesting that just 13% of employers reported providing access to occupational health services, and even here the term “occupational health service” had not been defined.
Similarly, the document cites research for the Health and Safety Executive (admittedly 15 years old, which in itself highlights the challenge here in terms of evidence) that defined “comprehensive” occupational health support as encompassing hazard identification, risk management, provision of information modifying work activities, providing training on occupational health-related issues, measuring workplace hazards, and monitoring trends in health.
Using this definition, just 3% of UK employers provide access to comprehensive occupational health services, the report concludes.
Finally, the document has received an array of high-level endorsements from, among others, former home, health and work and pensions secretary and now SOM patron Lord Blunkett, the Chartered Institute of Personnel Development, the Institution of Occupational Safety and Health, The Royal Society for the Prevention of Accidents, the What Works Centre for Wellbeing, and former director for health and work Dame Carol Black.
As Ian Lavery, chair of the All Party Parliamentary Group on Occupational Safety and Health, has put it: “Given the huge number of workers who are being injured or made ill at work we need to work towards every employee having access to an occupational health service.
“This report makes an important contribution by summarising the available evidence to persuade employers and policy makers that there is an indisputable case to provide workers with access to good quality occupational health services.”
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The report was formally launched in early May, at the Royal Society of Medicine. It is available online through the Society website, www.som.org.uk, plus through the combined Society and Faculty “Why Occupational Health?” website, http://www.whyoccupationalhealth.co.uk and via Twitter.
Accompanying the report are mini printed leaflets available for employers/HR professionals, company directors and commissioners of services. Through an agreement with the TUC, there is also a summary leaflet for workers and their representatives.
