’Tis the season to be jolly as Black’s review comes to town

Close your eyes for a moment, and imagine the eminent physician Dame Carol Black with a cushion up her top, a red pointy hat, and a big white beard. Doesn’t really work, does it? But in many ways, the national director for health and work’s consultation on the working health of the nation is an early Christmas present for OH practitioners everywhere, and certainly a once-in-a-generation opportunity to present a Christmas wishlist to the government.

Black’s “call for evidence” announced in October has a wide remit, covering issues around how to keep people healthy at work, how to get them back in to work after being off sick, the rise of mental ill health in the workplace and, crucially, the future role of OH within all this (see below).

As Black herself said at the launch of the process: “People who work are healthy, wealthier, and live longer than the unemployed. The benefits to the individual are clear but employers also have much to gain. A motivated and engaged workforce is far more productive and efficient. It also dramatically cuts the cost of unnecessary sickness absence – which is no better for the individual than it is for business.

OH investment

“Ultimately, investment in workplace health will yield multiple returns. But why don’t more employers invest in this area? Do GPs provide the right advice to patients? What support should the government provide? And what are the true costs of ill health – to society, business, and individuals? I will be seeking answers to tough questions like these over the coming months,” said Black.

What’s more, for a government-led process, it all appears to be moving remarkably quickly. The deadline for submissions was the end of last month and, it is thought, Black will present her conclusions early in the New Year, possibly as early as January.

There has also been a flurry of activity in other quarters. November saw the first of six events designed to bring together health practitioners and business leaders to discuss Black’s core questions.

The event, held in Sheffield, was hosted by the Sheffield Occupational Health Advisory Service, and consisted of a number of round-table discussions. Afterwards, Black also attended a lunch briefing with small businesses – still largely an occupational health black hole – hosted by the engineering and manufacturing organisation the EEF.

Government plans

Black’s evidence-gathering also comes against a backdrop of plans by the government, led by surgeon turned health minister Lord Darzi, to make it easier for people in employment to gain access to primary care.

Lord Darzi’s interim report into the NHS has recommended that at least half of GP surgeries should open during the evenings and weekends, and that there should be 150 easily accessible health centres open seven days a week from 8am to 8pm.

At the same time, the government has said it will invest £170m to create a network of centres offering mental health and psychological therapies for people either off or out of work with anxiety and depression. The idea is to roll out psychological therapies to 20 areas, with the aim of covering the whole country over the next few years.

With most health and certainly most OH organisations submitting individual responses, Black will not be short of material, even given the tightness of the deadline. And, if last month’s meeting of key ‘stakeholder’ organisations is anything to go by, the key message coming from the profession is not likely to be a particularly new one.

The meeting saw representatives from NHS Plus, the Ministry of Defence, the Royal College of Nursing, the Commercial Occupational Health Providers Association and the Association of Local Authority Medical Advisers, all trying to thrash out a consensus viewpoint to present to Black.

And, as anyone who has even scratched the surface of debates about workplace health will well know, it is perhaps hardly surprising that the size and capacity of the occupational health profession was one of the key areas of debate, as was whether the current OH training structures are sufficient to cope with all this increased demand and expectation.


There was, and is likely to be going forward, much discussion about the role of technicians, GPs, physicians and nurses where the links should be, and where responsibilities should start and end.

Another issue of concern was the fact that OH is an ageing profession – with the majority of nurses, physicians and other OH staff now aged over 40, as made clear in the workforce mapping survey carried out by the Commercial Occupational Health Providers Association (Cohpa).

In fact, the Cohpa survey, part of a much wider Department of Health investigation into the OH workforce (and surely set to be a key part of Black’s review), illustrates very clearly why workforce and training are such concerns.

On education, the report made it clear that many on the commercial side of the profession believe training programmes for specialist practice is difficult to access, and often inappropriate or irrelevant to the OH setting.

As the report stated: “Current training is encouraged on a full-time academic basis, which neither the nurse nor the employer can practically afford. This leads to insufficient nurses wishing to become OH specialists and, consequently, universities fill courses with those wishing to focus on community nursing… The resulting courses are therefore heavily biased towards nursing in the community rather than the workplace.”


What Cohpa suggests is that more people need to be encouraged into OH at the initial stage of their specialist training, supported by standardised Nursing and Midwifery Council qualifications, and more people encouraged into OH as a career immediately after registration to bring more young blood into the profession.

It has also called for the creation of a National OH Technician grade, with recognisable qualifications in both the NHS and commercial sectors.

Moving back to Black’s review, another key message likely to be coming from the profession is the need to make employers part of any solution. What needs to be made clear, almost everyone agrees, is that it is as much down to bosses, managers and employers to look at what they can do to make a difference as it is to healthcare professionals.

Financial incentives

Finally, there is likely to be the thorny issue of whether the review should recommend financial incentives for employers who invest in health and wellbeing – again, something that prompted debate during the stakeholder meeting.

This is something many in the industry, perhaps unsurprisingly, are keen on but up to now the Treasury, again perhaps unsurprisingly, has been adamantly opposed to. In many respects, this is likely to be a political call that will need to be made by Black and her team.

She will need to judge whether putting her weight behind the idea would mean it is taken more seriously, or would risk ministers throwing their hands up in despair.

There is a wider financial question here, too. Is not just about whether there might be money for incentives for employers, but also whether the government, having heard what the profession has to say, is prepared to put sufficient (or indeed, any) financial clout behind what Black recommends.

As so often in politics, ultimately, it is money that will decide whether Black’s review ends up as a document that effects real change or, like so many before, is quietly filed away in a dark and dusty corner of Whitehall.

For most of us, of course, the fevered excitement of the run up to Christmas gives way to a lean, belt-tightening January. Let’s hope for the occupational health profession that Black’s pre-Christmas festivities do not lead to a New Year hangover.

Blacks’ core questions

The questions posed by Dame Carol Black were:

  • How can we keep working-age people healthy, and how can the workplace be used to promote health?
  • How can people be best helped to remain in or quickly return to work when they develop health conditions including chronic disease or disabilities?
  • How does the age of the person affect the support that is needed?
  • How can government encourage action to improve employee health?
  • What underlies the apparent growth in mental health problems in the working-age population, and how can this be addressed?
  • What constitutes effective occupational health provision, and how can it be made available to all?
  • What would be the impact on poverty and social inclusion of a healthier working-age population?
  • What are the costs of working-age ill health to business, and what are the benefits to companies of investing in the health of their staff?

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