Senior health official Jean King was careful at the SOM annual general meeting last week not to pre-empt the government’s response to its Health is everyone’s business consultation, which she indicated will be published ‘shortly’. Nevertheless, her presentation did give some indicators as to where the government’s thinking is going and what we might be able to expect. Nic Paton reports.
The expression of thanks and gratitude last week by senior health official Jean King to occupational health practitioners for their contribution to tackling the pandemic will undoubtedly have been welcomed by most, if not all, practitioners.
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King, deputy director of the Work and Health Unit at the Department of Health and Social Care (DHSC) and Department for Work and Pensions (DWP), told the annual general meeting and one-day conference of the Society of Occupational Medicine (SOM), how “incredibly grateful” she was for the way OH providers had responded to the challenge of the pandemic. “I do want to take that moment just to thank all of you for the really important work you have carried out in the pandemic and that you continue to do so,” she said.
Given that many practitioners have felt their expertise and ability to help the nation, and NHS, in its time of crisis has been largely overlooked by the government over the past 18 months, King’s words will have been timely, overdue even.
King’s hints that the government’s long-awaited response to its 2019 consultation Health is everyone’s business may be seeing the light of day “shortly” will also be welcome, even if its arrival is now a full year later than originally anticipated.
Focus on chronic health conditions
To recap, the consultation was one of the last-gasp actions of the Theresa May administration but, laudably, prime minister Boris Johnson’s administration has remained committed, at least in principle, to bringing forward reform within workplace and occupational health.
The consultation covered a broad range of ideas but, from the OH perspective, was notable in proposing:
- Overhauling statutory sick pay (SSP) and improving advice, including amending the rules to enable an employee returning from a period of sickness absence to have a flexible, phased return to work.
- A possible SSP rebate incentive for small and medium enterprises (SMEs) to encourage more return-to-work activity.
- A national, multi-year workplace health/return to work communications campaign particularly targeted at SMEs and the self-employed.
- The possibility of some form of co-funding subsidy scheme to better enable SMEs to purchase OH advice and support, perhaps through a direct subsidy or voucher scheme.
- Creating an enhanced OH workforce that is less reliant on clinical staff and improving the data and evidence for OH interventions.
While King in her presentation was careful not to pre-empt any formal announcement, it was possible to glean some hints as to where the government’s thinking may be going in this area.
King indicated, first, that one of the government’s ambitions post-pandemic will be around narrowing the disability employment gap and ensuring more people with disabilities or chronic health conditions are able to remain in work.
“Helping disabled people and those remaining with those health conditions staying in work has got the potential to make a really positive impact. And occupational health plays an absolutely critical role in this,” she said.
“We see it as something that increases economic output, can potentially reduce demand on the NHS, can help reduce sickness absence, and it can really promote inclusivity. Access to occupational health and its varied range of interventions can prevent those really long spells of sickness absence progressing into job loss and can absolutely support those returns to work. Early intervention is very much about how we are looking at this agenda; early intervention to reduce health risks to individuals and the population, reduce pressure on the NHS, is absolutely where we see a vital role for occupational health.
“It is so important that people have that occupational health access to prevent them falling out of work and then needing to move into welfare and then longer term having those co-morbidity and co-issues,” she added.
Access and capacity challenges
As ever, however, access and capacity remain key stumbling blocks, as King conceded. “The policy challenge we have got is how we increase access to quality occupational health services. We know there is a really good case for this, and government is absolutely committed to it. However we really recognise that, despite its many benefits, not everyone currently has access to OH services provided by their employer.”
Within this, the challenge remains as to how a relatively small (and ageing) specialty and profession can be scaled up to meet demand. “In terms of workforce, we do recognise the shortages in the OH workforce, particularly shortages of clinical staff and there are some risks around the limiting of the future capacity of the markets to deliver the services,” King said, highlighting last year’s research by the unit suggesting that 44% of providers say they are unable to fill vacancies, particularly clinical roles such as nurses and doctors.
King appeared to hint there may in future be more of an onus, or expectation, on private providers to support and fund training but also, perhaps, that there needed to be a long, hard look at how OH workforce planning works more generally.
“We know that occupational health providers include a range of healthcare professionals, including specialist OH doctors, nurses, physicians, psychologists and others, but the majority of clinical training places are funded through the NHS. So, to an extent, private providers are reliant on those NHS-trained clinical staff,” King said.
“We also know lack of data makes it hard to make decisions on strategic workforce planning and so we are looking to understand more about how this data could be collated and how it might be used,” she added.
King indicated future delivery models would, almost inevitably, need to be more multidisciplinary and collaborative, ones where “all relevant professionals can play a role in supporting people back to work”.
She added: “We know developing and delivering it is not going to be easy, which is why we are looking at different opportunities to look at the leadership role within OH to support effective, strategic workforce planning and including training to help drive this agenda forward. And I hope that I will be invited back to talk a little more about what that could potentially look like in the future.”
Possible important ‘long Covid’ role
Intriguingly, and potentially positively, King indicated that the government did see an important role for OH in terms of managing ‘long Covid’ and rehabilitation back into the workplace following the virus.
“The Covid-19 pandemic, including the emergence of long Covid, has really brought new challenges for occupational health. It has also shone a light on the really important role of work and health,” she said, adding that the joint unit was working closely with the DHSC’s long Covid team to understand the emerging evidence and future challenges in this area.
“We are aware that occupational health and rehabilitation services do play a really key role in responding to the pandemic, and that is another route that we, and our colleagues in DHSC, are having conversations with, around those rehabilitation services and what could that potentially look like in terms of support?” King pointed out.
We are aware that occupational health and rehabilitation services do play a really key role in responding to the pandemic, and that is another route that we, and our colleagues in DHSC, are having conversations with, around those rehabilitation services and what could that potentially look like in terms of support?” – Jean King, joint Work and Health Unit
Alongside improving access and availability, improving education and awareness among employers of what OH can bring to the table was also high on the government’s agenda, King indicated.
“We know employers have got a basic awareness of occupational health; they really do need that expert advice to manage and support their employees and individuals who have those conditions in the workplace,” she said.
“We also know we need to do more to get employers to be actively looking and seeing recruitment and retaining of people with long-term health conditions and disabilities who already have them as people are just as valuable and just as productive and valuable to join their organisations as people who may not have those issues.
“We are doing a lot of work to support looking at how we get employers to think about and understand the value of occupational health for their business, and the value that you all really bring in terms of how they are able to have a really successful, really effective workforce,” she added.
Within this, innovation and research, being able to show clearly to employers an evidence base for what works, would likely be key, with King indicating the government was likely to move forward with the establishment of some form of centre or network to lead on and disseminate workplace health research, perhaps along the lines of the What Works Centre for Wellbeing.
Likelihood of more financial incentives
It also seems likely the consultation’s proposals for financial incentives to encourage investment may be taken forward, perhaps through some form of subsidy or co-funding model. As King put it: “We do recognise there is a difference in those levels of access between smaller employers, who are five times more likely to invest in OH services rather than those larger employers who have that higher capital.
“This [co-funding through a subsidy model] is something we are also looking at working through as another way that we can support your absolutely critical efforts on workforce to really drive that change,” she added.
Finally, in the concluding question-and-answer session, Professor Anne Harriss, now SOM immediate past president, asked King whether, given the difficulties many providers were having in filling clinical roles, more funding for OH training was on the government’s radar.
“We are looking at the different ways that that might be possible; a lot of that is about working closely with SOM, with FOM [the Faculty of Occupational Medicine], with the leads of the professions to understand what is needed. We are doing work engaging with both our DHSC and DWP colleagues about what is going to be trajectory of the workforce and saying we need to be part of that conversation,” King replied.
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“It is absolutely on our radar; it is definitely in there in the way we are looking at workforce. That is why, for us, it is as much about ensuring there are those places, ensuring there is a sustainability of the workforce, ensuring we are drawing on the expertise of those people who have been in this space for a long time and therefore have a really good understanding of what is needed and what we need to put in place in terms of that training.
“But also how we have that supporting leadership to really say ‘this is an important area; this is an exciting place to do your training, there are fantastic opportunities within occupational health and you can take it up as a profession’. It is about how we bring all of that together, but it is absolutely recognised and it is part of our considerations,” King added.
