Buyer’s Guide to occupational health

Impending government measures are helping to focus employers’ minds on the need for efficient occupational health services, says Sam Barrett

Occupational health is fast becoming one of the most desired workplace tools, with take-up now extending far beyond its traditional market of large companies and manual workforces.

Wayne Pontin, business development director at consultancy Jelf Wellbeing, says: “We are seeing a lot more interest in occupational health. Many of our mid-to-large corporate clients are keen to look at how occupational health can help their business.”

One possible reason for this is the government’s focus on occupational health, driven by Dame Carol Black’s review of the health of the working age population, Working for a Healthier Tomorrow, published in May. Alex Marshall, national sales manager for occupational health at Norwich Union Healthcare, says: “This highlights the cost of absence and ill health to employers, and the advantages of having a structured occupational health strategy in place.”

The review put a figure of £100 billion a year on the cost of ill health to the country and set out a series of recommendations to reduce it. These included a Fit for Work service to deliver work-related health support in the early stages of illness, and making occupational health a more mainstream part of healthcare.

Another factor is the Health and Safety (Offences) Bill, currently going through the House of Lords, which Dr Jenny Leeser, Bupa’s head of occupational health services, says could boost employers’ take-up of occupational health. “If this bill becomes an act, it will be much easier for an employer to be fined or imprisoned if they don’t take health and safety responsibilities seriously,” she says.

In its current form, the bill proposes to increase the maximum fine to £20,000 in the lower courts and to introduce a prison sentence as an option for most health and safety offences. Whatever happens, occupational health providers are getting ready for an increase in demand. Charlotte Bray, specialist consultant in occupational health at Aon Consulting, says: “We are seeing lots of product development at the moment, especially in the area of online occupational health.”

Online developments include pre-employment health screening, health assessments and case management services. Many wellness tools, such as health information, advice and coaching, are also available online. “It’s much more cost-effective to deliver a service online, for example, an online pre-employment health screening costs about £9 compared with £20-£25 for a paper-based one. The technology also allows questions to be customised,” says Bray.

Telemedicine, where a consultation is conducted by telephone or, possibly, through videoconferencing, is also growing in popularity. Simon Dickinson, director of business development and national clients at Capita Health Solutions, says: “This is so much more flexible than requiring an employee to go and see an occupational health specialist. The call can be at a time and place that’s convenient and there’s no need for the employee to take time out of work to travel. It also means that the occupational health practitioner can have more clinics in the day, which is cost-efficient.”

Dickinson has also seen an increase in teleconsulting, where a case can be triaged over the phone and referred to the most appropriate specialist or service. “There is a shortage of occupational health specialists and this targeted approach ensures their time isn’t wasted seeing healthy people,” he adds.

But offering such technology-based services is not always appropriate, says Dr Wolfgang Seidl, executive director at Validium. “Some assessments need to be face to face. Although much of occupational health doesn’t need a doctor, there is a danger that employers will lose some of the benefits if they shift all services online,” he says.

Another key trend is the emergence of full healthcare propositions, as more insurers bolster their product ranges by acquiring occupational health providers. This is the case at Bupa, Norwich Union and HSA’s parent company, Simply Health, among others. “We are seeing the market develop into one where the focus is on total wellbeing rather than just insurance,” says Jelf Wellbeing’s Pontin.

Although this might seem as if the insurers are wising up to the wonders of cross-selling, they claim this broader approach can help to manage costs. “Rather than seeing premiums escalate for risk-based insurance products, such as private medical insurance and income protection, employers are using occupational health products to help control these costs by reducing claims,” says Marshall.

But although the profile of occupational health may be at an all-time high, with products being adapted for the mass market, a significant stumbling block remains in the way of widespread take-up. Gary Gear, director of occupational health services at Atos Healthcare, says: “There is a battle still to be won when it comes to proving the value of occupational health.”

Return-on-investment figures are hard to come by, but this is changing. “The London School of Economics put together an independent report, The Value of rude health, for the Royal Mail Group. It looked at its occupational health strategy between 2004 and 2007, and found it had reduced absence from 7 percent to 5 percent and saved more than £227 million in direct costs. More of this type of evidence, especially in the current economic climate, will help employers see the value of occupational health,” concludes Gear.†

Focus on facts

What is occupational health?

According to the World Health Organisation, occupational health “promotes and maintains the physical, mental and social wellbeing of all staff”. To achieve this, it uses a number of tools, such as screenings, risk assessments, counselling and health education.

What are the origins of occupational health?

Occupational health can trace its roots to industry, originating in sectors such as the railway, power stations and manufacturing back in the 19th century. It has since developed, with support services now provided by in-house departments and external healthcare companies.

Where can employers get more information and advice on occupational health?

The Commercial Occupational Health Providers Association represents occupational health providers. Its website offers a service to help employers find a provider:

The Faculty of Occupational Medicine, a professional and academic body for practitioners, can also help. Its website is at:

The National Health Service (NHS), through its network of occupational health departments, NHS Plus, can also provide information about local units at:

Nuts and bolts

What are the costs involved?

Costs vary depending on the services used, but as a guide, employers can expect to pay between £15 and £20 for a paper-based pre-employment health questionnaire or about £9 for an online service. The cost of sickness absence management services vary from about £8 a year per employee for an automated service to £20-to-£25 a year if a person answers the phone, to as much as £6 a month for a fully-supported service.

What are the legal implications?

Occupational health services can help employers meet a number of statutory responsibilities, especially health surveillance requirements. The discipline is becoming more pertinent in employment tribunals, as judges increasingly regard occupational health physicians as specialists.

What are the tax issues?

Occupational health is not strictly an employee benefit, so is not subject to P11D taxation, but employers must be careful. To avoid a tax charge, they should ensure that only work-related injuries are treated. Likewise, if an employer offers health screening, they must ensure it is made available to all staff.

In practice

What is the annual spend on occupational health schemes?

In 2007, £394 million was spent on occupational health schemes, according to Market and Business Development’s UK Occupational Health Market Development report.

Which occupational health providers have the biggest market share?

The market is dominated by two providers, Atos Healthcare and Capita Health Solutions, with Atos pointing to revenue as evidence that it is the largest player.

Which occupational health providers increased their share the most over the past year?

Providers are cagey about sales figures, so it is tricky to gauge which has increased their market share the most. Atos Healthcare is certainly in the running, having won 17 large contracts in the past year. Serco also increased its market share by acquiring Grosvenor Health, while other fast-growing players include Axa Icas, Bupa and Norwich Union as they integrate their occupational health services with medical insurance products.