Why providers need to get more worried about employer ignorance of OH

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Many employers remain woefully ignorant about what occupational health can do, its value (versus its cost) and the benefits it can bring to the workplace, government analysis has suggested. And OH’s own lack of marketing and advertising savvy may, in part, be to blame. Nic Paton reports

For occupational health practitioners it is often the profession’s lack of capacity, or what we might term “boots on the ground”, that is perceived to be the key barrier to spreading the word about, and access to, occupational health.

Simply put, with occupational health historically a relatively small specialty, there are just not enough OH practitioners to meet demand from employers that want to access support, let alone those “hard to reach” corners of the workplace such as small and medium-sized employers or self-employed workers.

But, as is made clear by two recent reports from the Department for Work and Pensions and Department of Health and Social Care, cost, concerns about value for money and a lack of knowledge about what OH involves are other significant barriers that prevent employers from investing in occupational health.

However, alongside this, occupational health providers may be doing themselves few favours by adopting a laissez faire (at best) approach to marketing their wares to employers and individuals or educating the wider public about the value of their expertise.

The reports – Employers’ motivations and practices: a study of the use of occupational health services and Understanding private providers of occupational health services: an interim summary of survey research – from the two departments’ Work and Health Unit (WHU) were published in April.

The complementary reports are, of course, very timely, what with the WHU leading the government’s ongoing review of occupational and workplace health, and with the industry keenly awaiting the government’s proposed consultation on occupational health, which is expected (Brexit turmoil permitting) to be announced any day.

Both also feed into the wider ongoing debates within government and the profession around the state and role of occupational health provision in the modern workplace, both within the NHS and in terms of what (if anything) employers should be expected to fund or contribute towards maintaining a healthy workforce.

Indeed, as Dr Richard Heron, chief medical officer at BP and former president of the Society and Faculty of Occupational Medicine, commented in response to our online news story on the Employers’ motivations and practices report, the findings underpinned “the need for a nationally organised and available service for healthy workers, employers and economy”.

Basic understanding of OH

So, what did the WHU find on both counts? This analysis intends to provide a snapshot of the conclusions but both reports are freely available to view on the government’s website (and see the references at the end).

Taking the Employers’ motivations and practices survey first, WHU through research firm Ipsos MORI conducted 35 in-depth telephone interviews with employers during October and November 2018. Participants were business owners, office managers, or HR representatives.

Employers, this concluded, had a shared, albeit basic, understanding of occupational health services. “Fundamentally, they understood the benefits of consulting a qualified expert for situations they felt unable to handle alone, either through lack of expertise or due to a need for an independent third party.”

Situations for which OH support was commonly used, included:

  • To support staff with mental or physical ill health
  • To supporting a return to work
  • To attract and retaining talent
  • To investigate under-performance or poor conduct
  • To verify medical statements or health surveillance

OH services commonly used for these situations included:

  • Counselling
  • Physiotherapy
  • Workstation assessment
  • CBT (cognitive behavioural therapy)
  • Physical health screening or assessment

Employers by and large split into three types of purchasers. First, “reactive”, or where the employer was simply seeking ad hoc support, commonly piece work without an ongoing contract. Second, “proactive in office-based environments” with an ongoing contract in place. And, third, “proactive in manual environments”.

Employers provided access to OH services for three broad reasons. First: to comply with legal and regulatory obligations (or what the survey called the “legal” reason). Second: to reduce costs and improve business efficiency (or “cost”). Third: to support and improve employee health and wellbeing (or “moral”). “Whilst one of these motivating factors was a priority in certain cases, in general they were usually interlinked,” the research added.

Misconceptions and lack of knowledge

Where employers did not have occupational health but yet engaged in other health and wellbeing activities, the key barriers to making the leap to purchasing were financial, attitudinal and because of a lack of knowledge or misconceptions as to what OH involved. Similar reasons were given by reactive purchasers for not having permanent contracts.

As the research stated: “Whilst all employers recognised the cost of sickness absence, not all employers understood or had considered the benefit of providing OH to reduce or prevent sickness absence. Employers were largely positive about their OH providers, and relied heavily on them to recommend services or treatments that should be a part of the package they received.”

Such employers (especially reactive purchasers), the report made clear, still relied heavily on the NHS – both primary and secondary – to support employees back to work. They often thought solely in terms of meeting “the legal minimum” when it came to health and safety, and did not understand or appreciate the wider organisational benefits that could come with making this sort of investment.

By comparison, employers with long-term contracts (perhaps unsurprisingly) were more likely to “get it” when it came to understanding the value OH can potentially bring to the table. As the research concluded: “Overall, this suggests that examples of how OH services can be used, along with the potential benefits of investing in OH services, could encourage more employers to purchase OH or invest in a broader range of services.”

Tailoring services to employer need

The Understanding private providers research, meanwhile, was interim findings from a telephone survey carried out by IFF Research of 103 OH providers from a sample of 322. The WHU has said the research is part of a wider study about occupational health and musculo-skeletal conditions, including a survey of clinical commissioning groups about MSK services they commission and further in-depth case studies with OH providers, employers and employees. The full results of all this are expected to be published later this year.

However these initial conclusions were that OH providers, again perhaps unsurprisingly, offer a broad range of services and place considerable importance on tailoring their services to meet employers’ specific needs, even when delivering an “off the shelf” package. The most commonly offered services were advice about workplace adjustments and assessment of fitness for work for ill employees. The most commonly commissioned services were health surveillance and assessment of fitness for work.

Employers were the main commissioners of OH services, with almost all the providers surveyed (97%) saying they had been commissioned by employers. However, around half (54%) had also been commissioned by individuals, often self-employed individuals or those looking for work seeking mandatory medicals.

Line managers and other employer representatives were frequently involved in assessments of fitness for work and workplace adjustments. However, their involvement was often limited to the start and end of the process. As the research said: “OH providers noted the importance of involving the line manager in the process, and this was most successful when line managers had a good understanding of OH.”

Nearly all the OH providers sampled (96%) said their OH support interacted with NHS provision, most commonly recommending employees go to their GP or specialist treatment. Four in ten providers (39%) had capacity to support fewer than 200 individuals at any one time, and most had only a small number of employees (17% were sole traders and 43% had one to nine employees).

The majority of OH providers (82%) subcontracted to additional members of staff on a regular ongoing basis. On average, two-thirds (64%) of employed or subcontracted staff were medical professionals (for example doctors or nurses).

Skills shortages and recruitment worries

Eight out of ten (78%) felt they had the right balance of medical and non-medical staff. However, just under half (44%) conceded they had OH nurse or physician roles they were unable to fill, which they felt was because of a decrease in medical professionals with OH experience in recent years.

Worryingly, if anything this capacity issue is become more pressing as occupational health as a specialty ages and the numbers coming into it dwindle. As the report concluded: “A potential large threat to the future of OH provision is the reduction of qualified OH physicians and nurses in recent years, which has led to unfilled roles for approximately half of OH providers.”

Yet, arguably equally importantly, especially when set against the conclusions of the Employers’ motivations survey was the conclusion that, among many of the OH providers surveyed, perhaps because they were already so busy and in demand, there was felt to be little, if any, need to market or promote their services or expertise to a wider audience.

As the research report highlighted: “OH providers had limited need to use marketing to attract their customers. Targeted marketing to specific sectors was rare, and a substantial proportion of OH providers did no form of marketing at all.”

Overall, six in ten OH providers (63%) did some form of marketing, mostly to employers (97%). Three in ten (28%) marketed their services to individuals and “only a very small proportion” marketed services to clinical commissioning groups or health insurers (6% and 5% respectively).

Of the four out of 10 providers (37%) that did no form of marketing, many mentioned “they felt received enough business without it”, the report concluded.

References
Employers’ motivations and practices: a study of the use of occupational health services, Department for Work and Pensions and Department of Health and Social Care, April 2019, https://www.gov.uk/government/publications/occupational-health-services-and-employers/summary-employers-motivations-and-practices-a-study-of-the-use-of-occupational-health-services

Understanding private providers of occupational health services: an interim summary of survey research, Department for Work and Pensions and Department of Health and Social Care, April 2019,
https://www.gov.uk/government/publications/private-providers-of-occupational-health-services-interim-report

Is NHS occupational health at breaking point?, Personnel Today, 07 December 2018, https://www.personneltoday.com/hr/is-nhs-occupational-health-at-breaking-point/

Government ‘not ruling out’ making occupational health mandatory for employers, says minister, Personnel Today, 28 June 2018, https://www.personneltoday.com/hr/government-not-ruling-out-making-occupational-health-mandatory-for-employers-says-minister/

Cost and poor understanding discourage investment in occupational health, Personnel Today, 03 April 2019, https://www.personneltoday.com/hr/cost-poor-understanding-occupational-health-investment-barriers/

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