Although occupational medicine can trace its history back to the middle ages, the last 10 years have seen a revolution in its role within the workplace. In part, this has been driven by the change in the UK from a manufacturing to a service economy. There have also been profound changes in employment demographics with a reduction in the number of large employers and the growth of the SME sector. This change has been further accentuated by the increase in the proportion of women in the workforce and other trends towards part-time work and home working. This has all created a much more complex mix of employment practice and the attendant challenges arising from these changes.
So where does this leave the role for benefits consultancy within this area? It is probably helpful to look at the various purchasing drivers for occupational health services and how consultancy can add value to clients. The three key drivers are legal compliance, performance and absence management and wellbeing programmes. These should not be viewed in isolation as they will often co-exist.
Legal compliance centres upon the delivery of appropriate health surveillance programmes. These are driven by risk management assessment and control. They are not well person screening medicals. Health surveillance programmes should understand where there is a known exposure at work (e.g. paint sprayers and isocyanates), how this can lead to a specific occupational disease (e.g. asthma) and how this can occur despite appropriate controls (i.e. individual sensitivity). A well-tailored programme with early diagnosis will improve outcomes, such as preventing progression to severe asthma, and will allow employers to validate risk control measures (management information reporting).
This will achieve compliance with legislation (COSHH regulations) and is a requirement for employer’s liability insurance purposes.
As can be seen, this is a relatively technical area and it is clearly important for any consultant to work with the appropriate expert support, whether occupational health or health & safety, to ensure that the client has the right advice. Despite the move in the UK economy towards service provision, health surveillance programmes have expanded as research has identified new problems such as the more widespread occurrence of Hand Arm Vibration Syndrome.
The focus on attendance and the role of occupational health in supporting performance and sickness absence management has increased dramatically in the past ten years, and is an area where informed consultancy can bring major dividends.
So what has driven this increased focus? There are four main factors to consider.
Firstly, the increased tendency of society towards litigation has been further spurred by a more prescriptive legal framework for employment. The introduction of the Disability Discrimination Act and the onus it places on employers has made it more important than ever that employers should have access to high quality occupational health advice, especially as there is no cap on awards made at employment tribunals for claims brought under discrimination legislation.
The second factor is recognition of the cost of absence. This has been a consistent theme in both the CBI and CIPD’s annual absence survey. These costs were also highlighted in Dame Carol Black’s paper “Working for a healthier tomorrow”, which also led to the introduction of the “Fit note” in April 2010.
The third factor concerns direct and visible costs. Whilst few organisations show the cost of absence on their P & L, other costs of absence are highly visible. This takes two main forms – the costs of litigation and court awards and the costs of absence-related benefits. Examples of the latter are GIP/PHI/LTD schemes and ill health retirement provision. Although these costs are often relatively small against the overall silent costs of absence, their visibility allows for an effective consultancy opportunity, irrespective of whether these are insured or self funded.
For consultants getting into the OH arena, the key is to recognise the complexity of the services from a technical perspective, know what services to buy, know how to use and manage what you have bought, know how to benchmark the best value and understand how to drive the corporate healthcare integration agenda.