A core principle at the heart of the best occupational health (OH) care is that prevention is better than cure. OH is designed to promote and maintain the physical, mental and social wellbeing of the workforce. It involves fitting the person to the job and ensuring that work-related factors do not lead to ill health or injury.
The spin-off benefits from such an approach are significant. As Sayeed Khan, chief medical adviser at the EEF, explains: "At its best, occupational healthcare reduces costs and increases productivity."
Effective OH provides an impartial assessment of the workplace to identify the things that might cause accidents and injuries. Costs (resulting, for example, from absence, having to employ overtime/agency staff, and for insurance) are reduced by preventing accidents and injuries, and ensuring people are fit for their roles.
Lower compensation claims
Khan adds: "One of the other reduced costs is in terms of compensation claims. Having baseline data at pre-employment or at regular intervals showing, for example, that there is no increased detriment to lung function, or skin, or hearing, enables you to protect against unfounded claims."
OH can also employ health surveillance and screening to contribute to better productivity by identifying untreated medical conditions that are liable to hamper an employee's performance.
Cutting costs and boosting productivity are value-adding activities. However, good occupational health can also create value. Khan explains: "Workers with good attitudes and behaviours, creativity, drive, energy, and so on differentiate the happier, healthier workforces from those that aren't. These sorts of workers find solutions, they are energised and they are engaged in their work."
Managers who fail to take account of these considerations jeopardise their workforce, customers, visitors and members of the public. Risks can arise from placing someone with a health problem in the wrong job, or from physical and chemical hazards in the working environment.
That's a prime reason why it makes sense to consider having access to a professional occupational health service.
Traditionally, many OH departments have focused on providing a treatment service. One perceived advantage is that staff avoid the inconvenience of taking time off work to queue for treatment at a busy general practitioner's clinic. As well as dealing with minor symptoms, treatment-based services usually offer medical advice or counselling and first-aid, whether work-related or not, this being seen as a perk.
Stopping ill-health and injury
But beware. An occupational health service based on these functions alone is not an efficient way of dealing with the effects of health on work or, indeed, of work on health. True occupational health care is concerned with the wellbeing of the workforce by preventing ill-health and injury.
So, having decided to make use of an occupational health service, how do you go about introducing it?
OH services can be delivered in a variety of ways depending on the organisation's size and requirements. For example, you may decide upon:
- A full in-house occupational health service, often found in large organisations where internal OH requirements generate sufficient demand to spread the cost of the service.
- Partial in-house services, which tend to use regular part-time employees or contract for medical opinion as and when it is needed.
- Buy-in to another service via a service level agreement.
- Partnership (shared) services, which can be funded by charging pro-rata to the pay bills of the organisations involved.
- Using an external provider such as a local GP or specialist OH company. This is a straightforward commercial arrangement with a contract, defined service standards and agreed reporting/review mechanisms. It may be useful to discuss your requirements with companies that have experience of setting up their own occupational health provisions.
If you decide on an in-house service, you will need to take several steps:
- Identify OH needs – factors to consider here include the type of industry and the risks it presents, legislation and the need for its interpretation, and the number of employees to be covered. As a rough guide, a full-time occupational health nurse (who has the support of a physician, say, two days a month) should be considered for companies with more than 300 shopfloor employees. Companies with 3,000-plus people will need to employ a full-time occupational health doctor plus several nurses. Smaller companies should consider hiring the services of an outside agency.
- Talk to local factories and ask them who they would recommend. You can also ask the Society of Occupational Medicine – SOM (www.som.org.uk) – for a list of practitioners and look out especially for organisations that have Safe Effective Quality Occupational Health Service (SEQOHS) accreditation (www.seqohs.org).
- Occupational health services do not have to be certified or accredited, but taking advice from professional organisations like SOM and SEQOHS will help separate well-established operations from those lacking expertise.
- Consider commissioning a review by a consultant – this should take into account the type of industry, processes and chemicals involved, and the number and categories of employees. It should also suggest alternative services, provide costs and make specific recommendations.
- Think about equipment, data storage and support staff requirements for in-house OH, and ensure adequate provision of accommodation and finances – costs will include salaries, equipment and accommodation. Space must be made available for consultations, health assessments and medical examinations with adequate provision for privacy. Secretarial support is also needed. Since medical information must remain confidential, support staff will have to be selected with care.
- Appoint someone to run the service – as already mentioned, most occupational health services in industry are headed by an OH in larger organisations. Smaller companies will have a senior nurse specialist in charge.
- Prepare procedures for operation of the service – draw up a document outlining how company staff can use the service. The emphasis should be on prevention of accidents and ill-health arising from the activities of the company, rather than on treatment.
- Make managers and employees aware of the service and how it is to be used – introducing the service to the workforce can be achieved via health and safety meetings and by circulating leaflets, posters or newsletters explaining the aims of the service and its availability. OH staff should be present at meetings to answer questions about the service.
- Review the operation of the service periodically – this ensures that it is working efficiently. An audit will typically cover the number of health-related queries which the OH department has dealt with and an analysis of sickness absence records, industrial accidents and/or hospitalisation rates.
The OH department must be perceived as independent, so its head must report to the highest level in the management structure. This avoids the possibility of the service appearing under too many layers of management control and thus being viewed, usually erroneously, as a management tool. Such a perception by the workforce makes the independent operation of an in-house OH service difficult and may hinder preventative programmes.
Service must be universal
The service must also be available to everyone in the company – managers and workforce – all of whom should be able to discuss their concerns with OH service staff in confidence. OH staff must remain neutral and should advise on the ability of employees to perform work safely as well as addressing concerns about chemicals, machinery or other hazards in the workplace. With a good OH service, its staff will be seen on the shopfloor, familiarising themselves with the workforce and its activities.
By cutting absenteeism and improving morale and productivity, an occupational health department has much to contribute to the health of your business and its workforce. But, remember, it can only work properly if it is considered and implemented with care.
The pros and cons of in-house occupational health
Advantages
- Ready access
- Lower operating costs than equivalent bought-in services
- Demonstrates your commitment as an employer to the health, safety and welfare of your staff
- Occupational health staff have the opportunity to become familiar with work processes and staff
- Staff in the OH department can respond quickly to day-to-day concerns. They can also provide regular input into the company's health, safety and welfare committees
- In-house OH does away with the need for a service level agreement (SLA). According to the EEF's Sayeed Khan: "It's almost impossible to get an iron-clad SLA, whether you are outsourcing finance, HR, OH, or whatever. The problem is that, since an SLA dictates how much you are paid for the service, by definition, if you go outside that service, it is not part of the function. That is the biggest loss versus employing an in-house person."
Limitations
- Large initial capital outlay
- Considerable initial effort needed to start the service
- Less feasible for smaller companies
- Professional time must be spent managing the service
- May be perceived as being less than independent.
Functions of an OH service
- Identification and assessment of workplace hazards
- Pre-employment health screening
- Periodic medical examinations of specific groups exposed to particular hazards
- Treatment for minor ailments
- First aid and emergency treatment
- Advice on compliance with health and safety law
- Statutory medical examinations
- Other statutory requirements like periodic checking of local exhaust ventilation and personal protective equipment
- Keeping records and collecting, recording and analysing statistics on occupational accidents and diseases
- Health education and promotion
- Counselling, consultation and advice on health hazards and immunisation
- Advice on the health implications of foreign travel
- Advice on rehabilitation, redeployment and job placement
- Advice on sickness absence.
The business case for OH
There are several solid business reasons to introduce occupational health cover. Besides the obvious safety considerations, an occupational health department can:
- Help develop policies for dealing with absenteeism, recognising that it is not always simply due to sickness
- Help managers meet their legal obligations, such as compliance with the Health and Safety at Work Act, the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations, and the Control of Substances Hazardous to Health Regulations
- Provide health, education and promotion, which will ultimately improve the general health of the workforce
- Demonstrate care for employees, thereby serving to promote loyalty and improve morale. By providing an occupational health service you, as an employer, are proving that you care about the workforce. This leads to an increased sense of belonging, which can result in significant productivity increases and a dramatic drop in absenteeism. This psychological effect was described in the classic Hawthorne experiment in the 1950s (http://bit.ly/19NdS8F), where increased productivity resulted from the interest shown by managers in the workforce at the Hawthorne Works, an electric company in Chicago, USA.
- Identify and recommend changes to working practices which could lead to ill-health or injury.
