If you read nothing else, read this … Some 18% of organisations now have an on-site occupational health department, while 3% offer it as a core benefit. How an employer chooses to deliver a service will determine its cost-effectiveness. London Underground saved over £76,000 in a year by introducing a physiotherapist on-site. The Employee Benefits/HSA Healthcare Research 2004 revealed an increase in the number of organisations offering health benefits outside of standard medical insurance, with 18% of respondents boasting an on-site occupational health department. But how cost effective is this? On-site occupational health services can encompass everything from a part-time peripatetic nurse who assesses risk, to full-time specialists such as dentists, opticians, or physiotherapists. A good return on investment, however, depends on tailoring the service to suit an organisation’s needs. John Dean, managing director of Gissings Advisory Services, says: “People use on-site occupational health in different ways. Sickness absence management – or making sure that employees are fit to work – is real occupational health. But sometimes this gets mixed up with executive medicals, which is more of a perk benefit. It is a question of whether a company adopts a ‘nice to have’ or ‘need to have’ approach.” Our research shows, for example, that 3% of organisations now offer an on-site physiotherapist as a core health benefit. For some companies, such as London Underground, this is far from being just a perk. Working with System Concepts, the transport company introduced an on-site physiotherapist who places specific emphasis on the jobs that people do, and recommends exercises and postural advice. Four years on, data shows that employees return to work an average of 12.6 days quicker than before, which resulted in savings of over £76,000 for London Underground in the first year alone. But as Dean explains, how on-site health services are delivered is also crucial to cost-effectiveness. From paper-based systems that involve the employee being assessed on paper and referred off-site for any treatment, to having specialists on site five days a week, different approaches will suit different organisations. “Sainsbury’s have shops all over the country, and while some have hundreds of staff, the smaller stores might have five. A mobile unit is probably more cost effective because the specialists can travel around stores, maybe spending one day a month at each site,” he says. Paul Ashcroft, senior consultant at Mellon Human Resources, adds that the nature of the industry can also affect which form of on-site healthcare proves most cost effective. “If you are in manufacturing, workers may need statutory health surveillance, so having a full-time specialist on site to do fork lift truck driver medicals or skin tests, will often be most economical.” Another important point to consider is whether to employ an on-site specialist directly or through a provider. “It is cheaper if you do it yourself, but you do then have the responsibility for ensuring the specialist has the latest training, and so on. The lowest risk approach is often to outsource to specialists,” says Gissings’ Dean. Organisations that employ shift workers, meanwhile, are advised to think carefully. Dudley Lusted, head of corporate healthcare development at Axa PPP healthcare, says: “Some employers provide too much for their shift workers, having a full-time nurse on-site to provide first aid for example. Employees are often trained to provide first aid and if it is anything more serious the injured party will need to go to hospital anyway. It isn’t cost-effective.” So while on-site health services have the potential to reap cost savings, detailed research is key.