Make occupational health fit for purpose

Employers and providers are working to update occupational health and make it an integral part of the drive to improve staff wellbeing.


  • Occupational health (OH) is becoming more of a holistic service aimed at improving general health and wellbeing.
  • Good communication among all the benefit providers is important because early intervention will help employers manage risk and costs.
  • Technology is playing a crucial role by telling employees what the OH service can do for them as well as speeding up the referral process.

Ever since Dame Carol Black published her influential review, Working for a healthier tomorrow, in 2008 and described occupational health (OH) as being detached from mainstream healthcare, she has been banging the drum for bringing the service more up to date.

Richard Jones, head of policy and public affairs at the Institution of Occupational Safety and Health (IOSH), says: “IOSH would like to see more multidisciplinary working on OH, with an enhanced role for trained health and safety professionals. We also advocate more training in OH awareness for managers and GPs, a better appreciation of the business case for good health and safety, and use of the supply chain to extend good practice to smaller firms.”

Slowly but surely, employers and providers have been changing their approach to OH, which is starting to meet the changing needs of business and is being used as part of a more holistic approach to boosting workplace health.

Kirsty Jagielko, head of product management at Cigna Healthcare, says the change has been forced by a shift away from industrialised and risk-based industries to more office and service-based industries. Current challenges include increased mental health problems, fewer line managers handling more staff, and the greater need for robust absence management policies, she says.

Proactive approach

“OH needs a much more proactive approach, ensuring there are triggers in place to identify problems early on, and that there are slick referral mechanisms to appropriate support services,” she says. “There needs to be good engagement with other benefit providers, such as group income protection (GIP). Early intervention between such services will help manage risk and costs for employers. OH needs to educate line managers and employees to encourage people to take responsibility for their own health and wellbeing. Communicating with, and engaging, employees will be key.”

Employers and providers agree that using technology more effectively will speed up improvements. Cigna offers a telephone service to help employers manage staff health and productivity across multiple locations. It also supplies a toolkit for line managers to get the most from the provider’s OH services, as well as booklets on how to understand and manage certain chronic health conditions. “The aim is to build line managers’ confidence in managing employee absence and performance,” says Jagielko.

Kim Strugnell, director, healthcare, at Xafinity Consulting, says employers want to do the right thing by their staff, but the difficulty is often persuading the board about costs. She suggests the first step is to audit the spend on OH, including examining absence rates and the hidden costs they create. “Some employers look at OH just as a compliance issue, doing all the things they have to by law,” she says.

But knowing how to deal with a health issue can be more problematic. Strugnell adds: “The line manager won’t always know where to go, whether to the employee assistance programme (EAP), the medical insurer or GIP provider. These services often work in silos with a lack of communication between them.”

Lengthy clinical referrals

Dr Steven Iley, medical director for occupational health at Axa PPP Healthcare, says traditional OH methods that include lengthy clinical referrals and reports, which can take months to compile, are another key area for change. “This doesn’t work in the fast-paced working environment of today,” he says. “Employers need advice quicker than that.”

Axa has been working to speed up the report phase and has introduced a flagging system that allows a faster response to cases. Iley says: “The employee might benefit from cognitive behavioural therapy, for example, and since the NHS waiting list for this might be 12 weeks long, the employer can then decide whether to use other means to get the employee back to work, such as funding it themselves or using private health insurance or an EAP.”

Axa, like Cigna, believes technology is crucial to help OH move forward. Iley adds: “In primary care, telephone consultations have been used for many years. OH has been slow to embrace that because of fear of misunderstandings and a belief by line managers that it may be easier to hide information by phone. But it is growing in usage and most providers use it or offer it.”

Video-link consultations

Although Skype has yet to break into OH as a tool, its day cannot be far off, says Iley. “We follow the rest of medicine with developments and you are starting to get video-link consultations in medicine,” he adds.

Axa’s system enables managers to make referrals online and access support material, as well as giving access to rehabilitation services. Strugnell also highlights the importance of technology in OH services’ success. “Employers that do well in this space are those that use the intranet, have procedures and practices in place and promote employee wellness,” she says. “These days, employers want employees to be responsible adults and help manage their own wellness. We help create portals that build depositories of information. Employers can get a lot of management information from that.”

The modernisation of OH is moving slowly, but Strugnell is optimistic. “We are seeing a few early adapters,” she says. “They are forcing insurers to develop systems and processes. Once insurers come in with more standardised propositions, it will also raise the standards of the third-party service providers they use.”

Glass offices


Improving the image of occupational health

Sara Turner, head of reward at accountancy KPMG, is working on improving the ‘sometimes negative image’ of occupational health (OH) among the workforce by using technology to improve communication.

“If someone is referred to OH, they can sometimes feel they have misbehaved in some way,” she says. “We have altered the way we position it to be a health and wellbeing benefit. We use communications through the intranet to explain that it is less about what is wrong with an employee, and more about improving their ability to work. It is about helping the employee.”

Turner says the employer can help with various interventions, such as allowing someone who has had an injury to travel outside the rush hour so they do not get jostled on the Tube, and allowing more flexible working so staff can work at home more. “Or it could be by referring them to one of our partner services, such as Axa PPP Healthcare, which will report on what to do next,” she says. “If you don’t do these things, it is a cost to the business and it is no good for the individual just to be left sitting at home.”

KPMG switched to Axa as its OH partner in April 2012. Turner adds: “If an employee hits a trigger, they get referred to Axa. We don’t have self-referrals because the line manager has to do it, although an individual can approach their manager about being referred.”

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If an employee has musculoskeletal problems, for example, KPMG might call in a third party to assess the employee’s needs at work, or if there is a clinical need, the company might turn to private medical insurance (PMI).

KPMG used to self-insure for GIP, but, in January 2013, began a scheme with Unum working in partnership with Axa. Turner says: “For the first year, we will use our broker Aon Hewitt to manage claims. So we have three organisations providing a holistic approach. We want a good OH service so that we don’t get the claims. We want them to work together and collaborate, rather than operate in the dark.”

Graph 43
Source: Labour force survey, Offi ce for National Statistics, May 2012