New Work and Health Service: A small step forward
Towards the end of this year the Government expects to start a “Work and Health Service” which means that everyone who is absent from work more than four weeks because of illness will be given an assessment which will indicate if there is anything that might help then return to work earlier. That report will then go to their employer who will be encouraged (but not forced) to provide the assistance needed. That may be a specific treatment such as physiotherapy, access to counselling, or changes to the workplace. By the middle of 2015 it is expected that this service will have been rolled out to every GP’s surgery in Scotland, England and Wales.
In principle it is a good idea, although ideally the TUC would want a comprehensive occupational health service provided through the NHS. We are also concerned about the fact that many employers will simply do nothing as there will be a cost to them of providing any assistance.
However a spat seems to have broken out between the DWP, who are developing the scheme, and the occupational medicine committee of the BMA, who represent many of the doctors who will be referring patients to the service.
According to the BMA Committee, the description of the service as “providing occupational health and support” is “unhelpful and confusing”. While I understand where they are coming from I am not sure that the issue is really about the name. For unions, the question is whether this is generally a step forward or simply another attempt to force workers back to work early.
On balance, although the aim behind it is to get workers back to work as quickly as possible, so long as that is done in a way that workers feel comfortable, and the outcome is to help a worker to get better (rather than force them back before they are able), then it is a positive move.
Most workers do not want to be spending their time at home watching daytime TV if there are options that could get them better earlier. After all we have often criticised GPs for leaving it far too long before they refer a patient to a specialist and by then the condition may have become worse. This is especially the case with some musculoskeletal disorders and also stress-related illnesses, where there is mounting evidence that early interventions can be effective. So any kind of early assessment is welcome – even if it is only “sign-posting the patient to a service. What we have to do is make sure that employers act on the assessments and pay for the treatment needed.
I suspect that what the real concern of the BMA occupational medicine committee is nothing about the name but relates to the effect on existing Occupational Health Services. That is a concern that many unions share.
There is a possibility that employers will turn round and say that we do not need to employ anyone to assess people who are off sick as this is being done by the new Health and Work Service. The result may be that some will get rid of existing provision. This is a genuine fear, but let us but it in context. The provision of occupational health by employers is “patchy” at best, with the vast majority of workers having no access to a comprehensives service. According to the TUC survey of safety representatives, even those employers that do have a current occupational health service only provide sickness monitoring and health surveillance, with only around a third of those giving a pathway to rehabilitation.
Even with the new service, employers will still need an occupational health service. Unfortunately they may not realise it, which is why the BMA warning is helpful when they say “It may damage existing provisions by replacing advice and employee support from providers who understand the hazards and jobs of particular workplaces.” That is something that chimes with the fears of the TUC and we need to work together to use the new scheme to promote the need for occupational health provision by employers in the workplace rather than seeing a state-run assessment and referral service as being the answer.
However for most workers that debate is academic as they have absolutely no occupational health provision in their workplace and even where they do, the service does not get involved until the person has been off work for some time. Having an occupational health assessment through the worker’s GP is certainly a step forward.
But it is only one step. In the long run we want every worker to be covered by a comprehensive occupational health service which is there to ensure that all workers are given the support and help they need, through the NHS, to get fit and healthy and at the same time seeks to ensure that, where a condition is work-related, workplaces learn from any illnesses to take action to prevent them happening again.