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- Employers are working with occupational health to meet legal working requirements.
- Occupational health services can help an employee manage sickness absence and mitigate health risks.
- Technology is being increasingly used for management referrals and remote consultations.
There are generally three types of occupational health model: outsourced remote services led by an occupational health provider; onsite where services are offered through a provider or the HR and benefits team; or a combination of these two approaches.
Broader remit
While occupational health is still required to provide traditional services such as help and support, reasonable adjustments to work and pathways to help, trends are emerging that are broadening its remit. Dr Philip McCrea, managing director of BHSF Occupational Health, says: “Employers also want specialist impartial advice and guidance that is compliant with legislation such as the Equality Act and the Health and Safety at Work Act. More importantly, they want a realistic action plan: what are the next steps to getting someone back to work as quickly as possible?”
Manage sickness absence
Employers are also using occupational health to explore whether work has an impact on an employee’s health, or if the health of an employee affects their ability to carry out their role, and if any measures need to be put in place to address this. Dr Yousef Habbab, health services medical director at Axa PPP Healthcare, says: “Examples of this would be to understand whether an employee’s sickness absence or performance issues at work are linked to an underlying health problem, whether that health problem is work related, and if the employer can implement any measures to help support the employee and mitigate the risk of the problem in the workplace.”
This insight can help an employer plan how to manage thehealth and wellbeing of employees moving forward. Occupational health can help in this instance by providing impartial advice to both the employer and the employee. “This helps to protect the employee’s right to medical confidentiality while advising on the support that could help them maximise their effectiveness at work, but, at the same time, provides an approach that should enable the employer to meet its legal obligations,” says Habbab.
Integrated wellbeing services
A further trend is to integrate the traditional occupational health services into a wider employee wellbeing approach. Joanne Anderson, senior consultant at Towers Watson explains: “That manifests itself in looking at things like early intervention, musculoskeletal and psychiatric pathways, and really trying to get occupational health to integrate with all the other services, benefits and provisions within the organisation.”
Onsite versus offsite provision
While the size of an organisation will usually determine the extent of its occupational health services, many employers find that having an adviser or physician onsite will bring greater engagement with the service and result in a better understanding of the employer’s culture and workforce for the healthcare professional. “The costs of employing clinicians and keeping an appropriate and fit-for-purpose governing process in-house has led many employers to outsource their occupational health provision,” says Habbab. “Many employers request that their outsourced occupational health service provides set clinician days onsite to deliver services such as health surveillance activities and risk assessments if needed.”
Technology and occupational health
Occupational health services are making use of technology where appropriate, although the importance of providing help and guidance in person, particularly in complex or sensitive cases, cannot be replaced. “In a price-sensitive market, employers can look to get the best value by having services such as new starter health screenings and telephone consultations conducted remotely,” says McCrea. “This also has the added advantage of reducing the overall length of time to complete a referral or intervention.”
Providers are also using technology to provide a smoother process for both employee and employer. For example, Axa PPP Healthcare offers managers access to an online portal through which they can refer an employee electronically, track the progress of their referral and then view management advice.
As technological advances increase, there is a danger that occupational health will become more impersonal, so employers and providers need to ensure that what is being provided to employees is best suited for the culture, workforce and individual circumstances.
Cafcass integrates occupational health into wider wellbeing strategy
Family support service Cafcass has integrated its occupational health provision within its wider health and wellbeing strategy.
The organisation took measures to use its health and wellbeing spend more effectively after recognising that it was investing across a number of different providers, with a lot of reactive rather than proactive services.
Cafcass launched a health cash plan in April 2013 and consolidated many of its health and wellbeing services into one provider. For example, an employee assistance programme is available through the plan, as well as an eyecare benefit, both of which were previously provided through separate means.
With a view on operating as efficiently as possible, the organisation uses occupational health selectively. For example, if an employee has a condition that may be deemed a disability under the Equality Act, it will seek advice from its occupational health provider.
The organisation’s senior HR manager Daryl Maitland says: “We tend to work in partnership with our occupational health provider. We’ve done briefings with the physician team to help them understand the work of Cafcass. When it advises us on the reasonable adjustments, it’s important that it understands what the role is and the nature of the organisation. It signposts to resources we have in-house. It knows about our health plan so it knows they can signpost [employees] to get physiotherapy or a massage.”
Yorkshire Water uses occupational health to create a healthy workforce culture
Yorkshire Water gave its occupational health provision an overhaul to ensure that it helps to support a healthy workforce culture for its 3,000 employees.
The organisation’s approach is to refer staff to occupational health on day one of absence. As is the case with many organisations, the majority of absences are musculoskeletal or mental health conditions so it fast-tracks employees for counselling or physiotherapy, and makes use of an external psychiatrist when necessary.
In 2012, the occupational health department consisted of one internal adviser and two external physicians, but the service was underused. In 2013, the service was remodelled to include two internal occupational health specialist practitioners and an external supporting physician. There were 170 referrals in 2012, but in 2014 this rose to 926.
Yorkshire Water’s employee health and wellbeing manager, Susan Gee, says: “There has been a shift in culture of how occupational health is perceived. The profile of it has been raised and, arguably, one could say because we’ve put policies in place that are mandatory and direct managers.”
Gee explains that her plan behind the changes to occupational health included making sure that managers were confident in referring employees. “The barriers to effective management of attendance and monitoring of health, and getting the wellbeing piece going, is that managers can be timid when it comes to referring people.”
The organisation implemented directives that gave managers clear instructions on how to manage attendance. Key to engagement is to have transparency, consistency and fairness, says Gee. “To me, this is one way of changing that culture because everyone gets the same opportunity and it reinforces the message that occupational health is there to support helping people to remain in work, whatever their health status,” she explains. ”We can be confident that we’ve done everything possible to retain that employment and that that person feels valued.”
Viewpoint: Occupational health can support the changing needs of employers
Occupational health services are changing to meet the evolving needs of employers, employees and UK businesses. The dynamic nature of the workplace, people staying in work at an older age and new technologies are just some of the drivers for the repositioning of occupational health.
We know good work is good for health. Occupational health professionals help businesses become more productive and save money by preventive measures, for example, advice on maintaining a healthy workplace, and early intervention to assist those absent through sickness to return at the optimal time. There is a myth that full recovery is needed before return to work. In fact, returning to the right time, perhaps on a phased basis, aids rehabilitation. This proactive approach benefits the employer, and the individual, because being out of work is associated with poorer health and wellbeing, and the economy.
Musculoskeletal problems, such as back pain, remain the leading cause of the 131 million days lost a year through sickness absence, according to the Sickness absence in the labour market report, published by the Office of National Statistics in February 2014. However, mental health problems are close behind. Occupational health professionals can advise on how to reduce risk to mental health. As set out in the Health and Safety Executive’s Management Standards, attention to the demands of the workplace, the degree of control people feel they have, support, good relationships, clarity of role and good change management will not only reduce the risk of workplace stress, but also help support people with mental health problems stay in valuable work.
The major change this year has been the introduction of the government’s Fit for Work service. Using modern technology, Fit for Work provides generic advice on health and work, and assessment for individual employees who have been on sickness absence for four weeks or more. This will particularly benefit employers and employees in small and medium-sized enterprises, which currently have little occupational health provision. Full occupational health services, for example, advice on prevention, health surveillance and specialist occupational health, will continue to be provided by existing occupational health providers.
Robin Cordell is president of the Society of Occupational Medicine
