The latest developments in Occupational Health

The past couple of months have seen a surge in activity from the UK Government and various other organisations in respect of reviewing and managing economic inactivity and long-term sickness absence.

On 19 July, the Work and Pensions Committee summary report on the UK Government’s ‘Plan for Jobs and employment support’ Inquiry was published. This report reviewed the UK’s current employment support offering and set out recommendations for the Government to help people who are economically inactive to move into work. Proposals include further integration of mental health and employment support services, particularly for young people, after the COVID-19 pandemic. It also recommended improvement of existing schemes such as the Disability Confident Scheme and Access to Work.

Immediately following this, on 20 July, the Department for Work and Pensions launched a consultation – ‘Occupational Health: Working Better’ (the Consultation) seeking views on proposals aimed at increasing employer use of Occupational Health (OH) services. On the same date, HMRC and HM Treasury launched a joint consultation on how the tax system can support employers to increase provision of OH for their employees. The intention is that these consultations are read together and that responses to both will inform the Government’s approach to supporting OH provision in the future.

The Government’s thinking appears to be that increasing access to, and ensuring provision of OH services will help to drive their ambitious economic growth plans by making work more accessible for those with long-term health conditions.

What is the current state of play in the UK?

The underlying need for this wholesale review was cemented by the Office of National Statistics’ (ONS) report ‘Rising ill-health and economic inactivity because of long-term sickness’ which was published on 26 July. The report considers statistics from 2019 – 2023 and shows that there are 2.5m people who are economically inactive due to long-term sickness – an increase of 400,000 people since the start of the pandemic. This makes long-term sickness the main reason for people of working-age to be economically inactive.

Of those who are inactive because of long-term sickness, 42% report suffering from five or more health conditions, suggesting increasingly complex health issues are preventing people returning to the labour market. The most prevalent health conditions reported by the working-age population in general were depression, anxiety or bad nerves. More than half of the economically inactive reported suffering from these conditions.

What does OH do?

Occupational Health is a specialist branch of medicine which focuses on the health of employees in the context of their work. An employer might refer an employee to OH if they are struggling with a physical or mental health issue which has an impact on their job. OH will assess the employee and make recommendations to the employer about how the employee’s condition can be managed at work, for example, if reasonable adjustments might be required, or if specialist medical treatment is advised.

OH is described in the Consultation as a ‘critical enabler’ to help reduce work-related illness, avoidable sickness absence and movements out of work into ill health-related inactivity. However, not every employer has access to OH services.

While many employers already invest in the health and wellbeing of their people, individual capacity to do so varies. For example, 92% of large employers provide some form of OH, compared to only 18% of small employers. Averaging this out, only 45% of workers in Great Britain have access to OH services. This is significantly less coverage than in other countries, for example Poland is suggested to have nearly 100% coverage.

What does the consultation suggest to improve the UK system?

“Good work is good for health and good health is good for work” is the first sentence of the Consultation.

The Consultation itself is in three chapters: chapter 1 sets out suggestions for a clear baseline for quality OH provision; chapter 2 examines international OH models; and chapter 3 then sets out the proposals to develop the existing OH workforce capacity and develop a longer-term, sustainable multidisciplinary strategy. The overall aim is to better support businesses by seeking to establish an agreement and partnership between Government, employers and OH providers.

The Government seeks views on its proposals which include:

• defining a ‘simple and clear baseline’ for quality OH provision for all employers;
• creating a national health at work standard and employer accreditation scheme (with funded support from the Government to enable businesses to adhere to guidance);
• legal requirements to provide OH services;
• automatic enrolment-style access to OH for eligible employees;
• increasing recruitment into OH services themselves;
• developing a multidisciplinary OH workforce by identifying a balance of clinical and non-clinical professionals from a mix of healthcare disciplines; and
• further extending the list of professionals who can provide fit notes.

The Consultation references the Government’s review of the fit note scheme, the guidance for which was published on 6 October 2023. The document is lengthy but broadly explains the rules of the fit note, what different fit note assessments mean, how to support employees to stay in, or return to, work as well as common questions, an employer checklist and example case studies.

Acas has also recently published a toolkit which aims to give employers and employees support on how to manage and record staff absence while they are off work and on their return to work. It includes information and guidance on matters such as checking holiday entitlement and sick pay, fit notes and proof of sickness, creating absence policies and absence trigger points.

What does all of this mean for employers?

Whether these proposals end up being adopted (or are considered feasible) will depend to a large extent on the responses that the Government receives to its consultation. However, the Government has not been shy about its desire to get people back into work (see our previous blog here about the return of retirees to the workforce), so the move towards improving the OH offering (and any tax incentives to do so) is perhaps a logical step.

It will be interesting to see whether and which of these proposals are adopted. In particular, an improved quality baseline to OH reports, better awareness of OH services and when to use them, and financial support to enable employers (particularly smaller employers) to do so would seem to be the most effective proposals to bridge the disparity of OH provision in the UK and assist those with long-term health conditions to remain in, or recommence, work.

What about the Fit for Work scheme?

The Fit for Work scheme was a DWP assessment service introduced in September 2015. It gave employers and GPs the power to refer employees for a free occupational health assessment when they had been absent from work for a period of four weeks or longer. It was quietly scrapped in 2018 due to ‘low referral rates’. The scheme was referred to as ‘flawed’ (particularly in respect of supporting those suffering with poor mental health) with healthcare professionals accepting that it was difficult for them to determine what an individual could cope with work-wise or where their threshold for stress at work lay.

Access to Work

What does still exist is the Access to Work Grant scheme. This is a publicly funded employment support programme which can pay for practical support for employees who have a disability, health or mental health condition to start working, stay in work, move into self-employment or start a business. How much you are eligible for depends on your individual circumstances.

As part of Access to Work, and particularly valuable given the ONS statistics on mental health issues, is the Able Futures Access to Work mental health support service. This service is funded by the Department for Work and Pensions and provides advice, information, support and tools to help support staff with mental health conditions. Guidance can be offered to individuals themselves, employers or apprenticeship providers. More information on this can be accessed here or by calling 0800 321 3137.