Why a Brexit-fuelled government collapse may be bad news for occupational health

Theresa May arrives for the most recent EU summit in Brussels
Olivier Matthys/AP/REX/Shutterstock

Whatever you may feel about Brexit, there is an argument that occupational health practitioners should be willing and hoping Theresa May’s warring government does not completely collapse over the next year to 18 months.

Why? Well, irrespective of our future direction of travel within or outside Europe, the government appears to be making (so far) positive and sensible noises around the wholesale reform of occupational health provision in this country.

In June, Sarah Newton, the minister for disabled people, health and work, provided the profession with an update on its plans to review occupational health, as revealed last December in its response to its Work, Health and Disability: improving lives green paper.

Led by an expert working group, this review is looking at the evidence base around OH, including new funding models and “where responsibility for OH support should fall”. It is due to report next year, hence the need for practitioners to be keeping their fingers crossed that the political landscape does not get thrown totally up in the air between now and then.

Future role of occupational health

What was clear from Newton’s speech to the Society and Faculty of Occupational Medicine’s annual scientific conference was that she is taking a careful, considered and evidence-based approach to this review. Moreover, access to occupational health appears to be central to her thinking around meeting current and future workplace health challenges.

Indeed, the government is even “not ruling out” the idea of making it mandatory for employers to provide and invest in occupational health.

Newton also indicated there is an assumption that the now-scrapped Fit for Work service will need to be replaced by something, even though it is early days yet on the detail of what this might look like.

More broadly, in her speech Newton recognised that occupational health – and the expertise of OH practitioners – needed to be at the centre of the government’s workplace health reform agenda.

“If we want all employers to be the best employers we need to ensure they have the right, expert advice and support to create healthy and inclusive workplaces as well as excellent, common-sense support to manage sickness absence. And this is why occupational health is at the heart of our reform programme and our whole-system approach. We know that occupational health has a vitally important role to play in supporting people to stay in employment,” she said.

Occupational health is at the heart of our reform programme and our whole-system approach. We know that occupational health has a vitally important role to play in supporting people to stay in employment.”

“But unlike in some other countries where provision is much more widespread, in the UK many workers have no occupational health support in their workplace and access other services can be patchy and confusing. So we want to change this, and that’s why last year we set out our intention to develop proposals for truly transformational change in occupational health.

“We can’t deliver the kind of widespread access to good quality occupational health provision we want to see by working on policy in isolation in Whitehall. Working with experts like you is so important to getting big reforms like this right,” she added.

Fit for Work replacement?

In many respects, however, it was the question and answer session following the formal speech – “The Thackrah Lecture” – that was the most revealing.

For example, Dr Richard Heron, chief medical officer at BP and a former president of both the society and faculty, asked: “Many of us are this year celebrating 70 years since the NHS was set up. But in 1948 occupational health/occupational medicine was put outside the NHS. Is that something you’re considering as you look at this nationally-available occupational health access service?”

To which, Newton replied: “We are driven by the evidence, we are doing huge amounts of testing and learning and we haven’t come up with any prescribed views at all. This is why I am here today, this is why I’m inviting you into the conversation, to help us get this right. We will not be able to sit in Whitehall with bits of paper and design a system; we need to be talking to and listening to you; inviting you to help us get this right.

“You’re quite right, right from the outset occupational health did sit outside the NHS. But I think that, as I mentioned in my speech, it’s got to be a whole-system approach and to finding how we can help people to be healthy, to live healthy lives; to make sure that, as far as possible, they can avoid acquiring long-term health conditions and, when they do, to ensure the support that they need to manage those conditions as best they can is there to ensure they can continue to play their part in society, including work.”

Importance of OH education

Professor Anne Harriss, course director at London South Bank University and this publication’s CPD editor, pressed the minister on the lack of funding for OH nurse education, to the extent that Newton replied, to applause: “I have listened very carefully, and I have received that message loud and clear!”

Dr Steve Boorman, chair of the Council for Work and Health, described what he was hearing as a “truly a really exciting time in this agenda”. But he added a note of cautionary scepticism (again to applause). “How can we be sure that this time it is different? Because, when you specified the Fit for Work service, there were a number of experts who actually highlighted to you the problems with the specification that you were letting, which unfortunately have come true. How can we be sure that you will actually listen to the experts this time round?”

Newton replied: “I wasn’t involved back then, so I can’t say why those decisions were made and neither have I looked at the evidence about what actually happened. I suppose, why will it be different this time? Because we have set out very, very clearly in our command paper a whole series of actions.

“You have seen the level of commitments and resource we are putting behind this, not just in terms of the officials within those departments to work with you as experts to get this right, but actually the amount of money that we have put into all the testing and learning investment that we are already making, and the randomised control trials that we are committed to evaluating all of that.

“It is specified as a ten-year plan, which is well-resourced. So I think it is different than before, and I understand that, until you see the fruits of your work and you start to see those changes, you will remain sceptical. My job is to show you that commitment with those actions,” she added.

In the current febrile political atmosphere, 10 more years of Theresa May’s administration may appear optimistic, of course. And, as ever, the proof will be in the pudding as and when the review reports. But for occupational health practitioners it does appear there is, quite possibly, all the play for over the coming months.

One Response to Why a Brexit-fuelled government collapse may be bad news for occupational health

  1. Tony Williams 7 Jul 2018 at 10:37 am #

    This is not a problem with Occupational Health, it is a problem with society. We are overmedicalising on an industrial scale, then expecting our social problems to be solved by doctors and medicines. Having applied a completely inappropriate medical diagnosis, the assumption is that the person is no longer fit for work or needs unnecessary adjustments.

    Occupational health is about applying common sense to this whole process. It will only work if society accepts common sense, and if the new practitioners needed have enough common sense and the confidence to use it.

    GPs need more time with patients to explain why they don’t need a prescription. Society needs to appreciate that the great majority of mental health symptoms are normal, don’t represent a disease, and talking therapies are the mental health equivalent to visiting the gym. Patients need to understand that the only effective treatment for most chronic pain conditions is exercise.

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