Last week saw probably the most important document relating to health at work of the 21st Century so far. And it will be a while before someone tops it.  Fitness for Work: the Government response to “Health at work – an independent review of sickness absence”, sets out the Government’s intention to establish a Health and Work Assessment and Advisory service. (HWAAS) This will provide:

  • an occupational health assessment after 4 weeks of absence
  • appropriate interventions, advice and follow up help after the assessment
  • advice for employers, employees and GPs throughout the sickness absence process

Referral will mostly be from the GPs, who will continue to provide fit notes but employers can refer at 4 weeks if they wish. GPs will have the ability to seek advice at any time.

This estimated cost of the service will be £25 – 50 million. The estimated pay back of between £660 million and £1.34 billion will come from reductions in sick pay and benefit costs, increases in tax and NI revenues and increased economic output.  It is estimated that about 560,000 absentees will use the service every year and will require between 220 and 740 OH professionals plus another 240 – 1,300 healthcare professionals providing further interventions like physiotherapy, counselling etc.

Bizarrely, the second paragraph of the section on staffing needs claims the UK currently has 65,000 nurses, 19,000 physicians, 9,000 physiotherapists, 4000 Occupational Therapists, and 500 Psychiatrists.  There is no mention of Occupational Health Advisers unless they have committed that age old cardinal sin of muddling us up with OTs again.   A bit of an oversight really, but my estimate has always been about 3- 4000 OHAs in the UK – give or take.

Whatever you think of it, it will dramatically change the Occupational health landscape in the next 5 years. If, like me you are an occupational health adviser and the biggest bit of your job is sickness absence, this means that the Government is about to provide this to your customers and your employers for free.  This might be an over simplification but that is the ultimate end and that should get you wondering why your customers and employers will want to continue paying you when someone else starts providing a big chunk of what you do for nothing?

If you are an HR Adviser, business owner, Finance director or manager then you might start to consider whether that proposed 3 year OH Contract is really worthwhile as in about 18 months, you can freely use the new service for all your absence needs.

Tenders will be drawn up early this year and will be out by the summer. Contract(s) will be awarded by the end of this year. Now I am sure that many of the larger OH providers are currently rubbing their hands in glee at the thought of winning such a contract that in OH terms will be the equivalent of running the Olympics – all year, every year. But that raises huge issues.  My concern is that even Serco, Health Management and Atos are not capable of running such a mammoth service in house unless they transfer a large portion of their client base over to HWAAS (a better title or acronym someone please) and even then the prospect of possibly employing over 20% of the OH workforce in the UK is a pretty daunting one.  I can see three potential models:

1)    As above, one big provider doing the lot with an employed – and huge in OH terms – workforce.  This business will have to:

  1. Get it right for its customers or the large amount of publicity for failure will be a hammer blow
  2. Get it right for its employees or they will turn over too quickly to enable a reasonable pace to be kept with referrals.  In the incestuous world of OH, word will travel fast and no-one will want to take their place.  Some of the big providers have already had this problem.
  3. Have a big in house training capability for new entrants to the OH profession via this route – and there will undoubtedly be a lot of them.  The problem with this model is that it could seriously damage competition in the market.

2)    Three or four big providers. They will have effectively the same problems as one big one – needing a lot of staff and trying to keep them but at least there will be competition.

3)    A register of a much larger number of local providers.  COHPA has about 100 members (including associate members) many of whom are small local providers, providing a range of good services to their local area and a bit beyond.  Plenty more are springing up although some have disappeared, usually by acquisition or failure.  SEQOHS would almost certainly be a requirement for registration.  But at least the market gets bigger for everyone and has more structure.  This could be a case of “the independent provider is dead, long live the independent provider”.  It could also be the model of sorts for options a) and b).  If a large provider does not want to or simply can’t employ the required numbers, a subcontract network is the way to go but that raises all sorts of questions about costs and charges.  The Government will want its pound of flesh and margins will be tight.  What is ultimately paid to the person actually talking to the absent employee could be pretty small.  For anyone that has been subcontracted by an agency who has been contracted by a provider, you will know that your hourly rate is a small fraction of the charge at the other end of the contractual process.

The huge unanswered question in this is whether those that are currently buying in OH services or employing their own in house service will continue to do so at the same level if at all.  Whether you are Barclays Bank with tens of thousands of employees or Bloggs and Sons builders with 10 employees, why would you, when a big part of what you are paying good money for is freely available?

Another concern is the narrow view of occupational health implied by the document and all that has gone before.  This is not about OH.  This is about sickness absence and reducing the benefits bill. And ok, it’s also about helping a lot of people get better quickly and return to work.   What has scared me in recent years is the number of OH Advisers who come out of one course or another who seem to think that OH is just about absence management – and some providers are just as bad.  No.  OH is about absence, health surveillance, pre employment health assessment – yes, it’s still out there and necessary in the right circumstances – toxicology, workplace assessment and design, health promotion and much more.  And above all else, it’s about trying to promote health at work in a way that prevents the need for much of the above.  It could be argued that our ultimate goal should be to do ourselves out of a job – to help create such a healthy and well managed workplace that we can walk away and let them get on with it.  But none of that is in the document.

Don’t get me wrong. There is a lot to be applauded in the Government’s response and a Health and Work Assessment and Advisory service, free at the point of need, might just be the right way to go.  It might also just be the end of occupational health as we know it.  As a member of the Commercial Occupational Health Providers Association, I will be very keen to hear their views but yours will be just as welcome.