The government’s long-awaited consultation into occupational health and how government and employers can reduce ill health-related job loss was published in July. As Nic Paton argues, it is a golden opportunity for OH practitioners to make their voice heard on what could be potentially significant changes to how provision is delivered and managed.
So, finally, it is here. The government’s consultation Health is everyone’s business: proposals to reduce ill health-related job loss was published by the Department for Work and Pensions and Department of Health and Social Care at the end of July.
The consultation will run until 7 October and, naturally, is a golden opportunity for OH practitioners and the wider industry to get involved, have their say and give their views to government on what they feel should be the future shape and role of occupational health.
Of course, what happens next, given the fact we have a new prime minister bedding into office with a miniscule (if even existent) Parliamentary majority in a highly volatile political climate, and with Brexit continuing to loom heavily on the horizon is anyone’s guess.
Nevertheless, it is fair to say that, as a parting shot by Theresa May, this consultation has the potential at least significantly to change the occupational health landscape as we know it.
So, what is the government proposing? The full document – which is lengthy at approximately 24,000 words – is available on the government’s digital portal www.gov.uk and the full address is at the end of this article.
But, broadly, it is addressing three key areas:
- what needs to change to our legal framework to better clarify employers’ responsibilities towards their employees in the event of sickness or ill health (especially access to statutory sick pay);
- what needs to change to improve access to high-quality, cost-effective occupational health services for employers and self-employed people; and
- what needs to change to improve the advice and support employers need to understand, and act on, their responsibilities.
In this article we will look what the government is proposing in each of these areas but will focus on arguably the section of most interest to occupational health practitioners: the government’s suggestions around what needs to change in terms of the delivery of OH services and support.
Overhaul of statutory sick pay and improved advice
Taking the sick pay question therefore first, this was the element of the consultation that garnered the most headlines and interest within the mainstream media. The government’s argument here is that it believes “there is scope to strengthen statutory guidance to support employers to take early, sustained and proportionate steps to support a sick employee to return to work, before that employee can be fairly dismissed on the grounds of ill health.”
Statutory sick pay (SSP) currently is inflexible and does not reflect modern working practices, such as flexible working, it argued. Proposed reforms or questions for consideration within the document therefore include:
- amending the rules to enable an employee returning from a period of sickness absence to have a flexible, phased return to work
- extending protection to those earning less than the lower earnings limit (currently £118 per week) who do not currently qualify for SSP, as recommended in the Taylor Review of Modern Working Practices
- Where employers fail to pay SSP when due, fines could be increased
- Whether enforcement of SSP should be included within the remit of a new, single labour market enforcement body
- How the incentive of a rebate of SSP targeted at small and medium enterprises (SMEs) might work to support greater employer action in helping employees to return to work.
Although not a new announcement, the consultation reiterated the government’s intention to make access to a “day one” written statement (which would include details of eligibility for sick leave and pay) a right for both employees and workers.
Turning to improving advice and support to enable employers to better understand and act on their responsibilities in this area, the consultation makes it clear the government is “seeking views on improving the provision of advice and information to support management of health in the workplace and encourage better-informed purchasing of expert-led advice”.
This, it argues, could be via some form of national, multi-year communications campaign particularly targeted at SMEs and the self-employed.
On top of this, the consultation says: “The government is exploring the possibility of employers automatically reporting sickness absence through their payroll system, so that government has the data to be able to provide timely and targeted guidance to employers on how to manage sickness absence.”
Reform of occupational health provision
This for most OH practitioners will be the “meat” of the consultation document and what the government is looking to gain views on is indeed interesting.
The government, first, emphasises its hope is that the reforms that come out of this process will “result in more employers wanting to purchase OH services.” But the document recognises there are currently significant barriers to access, including cost, a lack of understanding of OH and what it can do among employers, and the ongoing lack of capacity within OH itself.
However, the document emphasises the government is not intending just to throw money at the problem. As it states: “The government recognises that there may be a case for smaller employers to receive greater financial support to purchase OH services, in order to overcome challenges posed by cost. The government is not committing at this stage that any financial support will be provided, but is interested in the strength of the case to do so.”
Equally, the document makes clear simply extending or building upon existing tax breaks, such as the Cameron-era 2015 exemption for recommended medical treatments of up to £500, is not the answer. “There is limited evidence that making the tax treatment more generous is the most effective lever to incentivise more employers to start offering OH provision, if the initial cost is the main barrier for them,” the document says, and therefore the government has “no plans” to make further reforms in this area.
However, one intriguing reform on its radar is a co-funding scheme to enable SMEs to purchase occupational health advice and support. As the document explains: “Under such a scheme, SMEs and the self-employed who choose to invest in OH advice could potentially claim, either through a direct subsidy or voucher scheme, a proportion of the cost of their purchase. Any scheme would need to be straightforward for employers to understand and respond to.”
The document proposes two models to consider for this. First, where the subsidy or voucher is claimed by the employer when it purchases OH services. This could be either upfront or after the point of purchase. Then, second, where it is claimed by the OH provider, so that employers pay a reduced rate when purchasing OH services. The provider would then be subsidised for the cost, so reducing the administrative burden on the employer.
Key further questions up for consideration include what this subsidy should cover (for example just advice and assessment or treatment too) and whether, say, it should be linked to purchasing OH of a particular set standard or quality.
Capacity questions and new delivery models
To respond effectively to (it is hoped) the increased demand for occupational health that will result from these reforms, the consultation is clear the capacity to deliver of OH as a specialty and profession will also need to be addressed.
As the document states: “The government is concerned that the commercial market (which includes some NHS as well as private providers) by itself will not have the resources or processes to meet future workforce requirements. There may therefore be a role for government to support OH providers to meet this need. The government wants to ensure that NHS and private providers have opportunities to contribute to the development of a sustainable OH workforce.” The document argues this might involve:
- improved gathering of workforce data
- immediate action to increase the flow of OH doctors and nurses in training
- longer-term approaches to training and development and workforce models to reduce pressure on highly trained clinical staff, while supporting service quality
- clearer leadership of OH workforce strategy and development
The document adds that: “The government is interested in working with partners to encourage a significant increase in the number of OH specialists. In particular, this includes ways to increase the opportunities to undertake OH specialty training through OH providers, and opportunities which encourage more doctors to enter the specialty. This has the potential to support NHS and private providers to increase the capacity and quality of the service they provide.”
It also makes clear that the government is “concerned” at the limited opportunities for nurses to undertake appropriate OH training, “as well as a lack of awareness of the prospects of a career in OH”. It highlights the ongoing work of the National School of Occupational Health to develop an OH apprenticeship programme, adding: “The government is exploring ways to support training opportunities such as this programme, or existing postgraduate courses, to alleviate pressures on the workforce.”
It also potentially envisages an OH workforce less heavily reliant on clinical staff. As it states: “Reducing the reliance on clinically trained staff has the potential to increase the capacity of the OH market.” Adding that: “The provision of OH services may benefit from a workforce which has greater flexibility and adaptability.”
It adds again that: “The government could work with relevant bodies to scope, deliver, manage and promote an OH workforce model and training and development approaches. This could support providers to increase the capacity and cost-effectiveness of OH services, while maintaining quality.”
On top of this, the consultation sets out some ideas around new models for delivering OH services, especially if they can be made more accessible to SMEs and people who are self-employed.
As the consultation states: “New commercial models that enable the buying and selling of services at scale, or that deliver services more efficiently, could make access to OH services more affordable for employers. For example, these new models could explore innovative models of providing OH, focusing on areas such as early intervention and considering the current methods of payment, opportunities for selling alongside other mandatory employer products, the greater use of brokerage, co-ordinated purchasing or large employers offering OH services to supply chains.”
To that end, the consultation proposes that the government “could dedicate funding to the development and testing of new models of buying and selling services, testing and evaluation of new service models and ways to harness the potential of technology to support service provision.” However, as with funding questions highlighted earlier, there is the caveat: “While the government is not committing at this stage that any financial support will be provided, it is interested in the strength of the case to do so.”
Evidence and data-gathering
Finally, the document makes it clear that improved data and evidence is likely to be a critical part of this new landscape. The consultation therefore highlights that “the government is considering which new models would work best to support the necessary prioritisation, co-ordination and dissemination of working-age health research and development.”
This, it argues, “could take the form of a new Working Age Health Research and Development Network that would signal system-wide commitment to improve priorities and evaluate work and health research and innovation.”
This proposal has strong echoes of the Society of Occupational Medicine’s call in June for the establishment of a new Centre for Work and Health research hub for OH, and so it may be that SOM is pushing at something of an open door here.
Of course, as with all of these ideas and proposals, only time will tell. But now is the time for the profession to get involved and use the remaining time left of the consultation wisely to feed back to government and make your voice heard.
What will happen next?
The consultation will conclude at 11:45pm on 7 October and, the consultation document makes clear, will be one part of a wider evidence-gathering process. The government will, it says, carry out workshops during the consultation period “to further explore the proposals in detail”.
However, what will happen to all the feedback gathered through this process is, for now at least, somewhat opaque.
The consultation document simply states that: “The government will use the evidence and views gathered during this consultation to develop these proposals further and understand the impact of the changes on both employers and employees.
“This feedback will also help to determine what approach offers the best value for money and is affordable in the context of the next Spending Review.”
At the time of writing (in late July), it was not precisely clear when the next comprehensive spending review would be, given the rather volatile political climate at the moment. But it is anticipated the review will have to take place at some point during 2019 because the government will need to outline its spending plans for 2020/21 and ideally the next two financial years after that.
The likelihood therefore is that the comprehensive spending review will be revealed alongside whatever Budget is announced in November or December. However, as ever the ramifications of Brexit and whether we’re in or out of the European Union at that point and on what terms, remains a heavy caveat.
How to take part
The full consultation document, Health is everyone’s business: proposals to reduce ill health-related job loss, can be view in various formats here:
The questions posed by the consultation can then be answered online by going to
What the industry said
“We welcome these proposals to invest in occupational health. It makes sense to facilitate investment in occupational health for small businesses and we urge the government to invest in occupational health professionals to allow this scale-up to occur. We will continue to work collaboratively with the government with the aim of ensuring that new OH services are appropriately designed and funded.”
Dr Will Ponsonby, president of the Society of Occupational Medicine
“For the past few years, we have engaged in constructive dialogue with government as they developed plans for this consultation. We support the consultation’s emphasis on investment in training in occupational medicine, which is desperately needed to provide the quality OH offer to employees that our workplaces require. Employee health and wellbeing contributes to successful business performance and we know that highly effective companies commit to a culture of health.”
Dr Anne de Bono, president of the Faculty of Occupational Medicine
“The aim of incentivising phased returns is an admirable one, as in practice this is how many employees wish to reintroduce themselves to the workplace. The change may equally be welcomed by employers if it reduces overall absences.”
Daniel Parker, solicitor at Winckworth Sherwood
“Extending the eligibility criteria for lower earners to be able to receive statutory sick pay will no doubt help to relieve people from some of the financial strain at a time when they should be focusing on their health.”
Kate Smith, head of pensions at Aegon