A report has suggested that enabling a much more “comprehensive access” to occupational health expertise in the UK could be the key to reducing the number of people who are unable to work due to illness.
Britain can also learn from other countries’ models, particularly in Europe.
The Commission for Healthier Working Lives published a report entitled Work & Health: International Comparisons with the UK. It looked at the workplace health of people with disabilities or long-term illnesses in the UK, and compared it to the provisions in 14 other European countries, and even further abroad.
This report was released to inform and stimulate debate about the recent Keep Britain working review on workforce health.
The commission was established by the Learning and Work Institute and Institute for Employment Studies, with support from the Health Foundation. The commission aims to create consensus about the steps needed to tackle the UK’s health and work challenges.
The report concluded that one fifth of UK workers (21%) reported health limitations. This gives Britain the highest rate of ill-health in Europe among adults of working age.
The UK has one of the largest employment gaps in the EU15 between those with and without disabilities.
Commission: In the UK, between 2018 and 2022, the likelihood that those 16-24 years old with health restrictions are not working will more than double.
Over this period, the UK saw a rise in the number of workers between 55 and 64 who were unable to work due to illness.
The report, which focused on occupational health, highlighted that OH models vary from country to country, depending on who provides them. There are different models, for example, that differ between internal or external doctors and whether employers have to provide them.
It added that “countries with more integrated policies around workplace health tend to be higher in OH coverage.”
In several European countries the statutory sick pay system is also linked to an employee’s wage, as opposed to the fixed rate in Britain. The report stated that “these models tend to provide higher rates of income replacement than the UK.”
The report highlighted that, in contrast to the UK, several European countries offer active support for workers to return to work after a sickness absence.
The report, which analyzed the models in detail, found that OH professionals are often included in national approaches for supporting health at work in many countries, including the UK.
The level of government funding and support varies, but employers play a key role in funding and administering OH Services,” the commission argued.
It was noted that there are different models not only within countries, but also between them, with mixed approaches being the norm.
They can include in-house OH, bespoke private provision and group models where employers pay a yearly contribution per employee.
Different OH models
In Finland, the Act on Occupational Health Services imposes a requirement on employers to provide preventive health care, which is provided by a specialist, such as a nurse or occupational psychology.
Comparatively, in France, large companies have been required for many years to employ occupational health nurses.
These tend to be in-house or at the group level. The commission stated that OH was funded by employers directly and in a Bismarck-style model by regional authorities through employer contributions.
The Working Conditions Act of 1994 mandates that employers provide OH in the Netherlands.
“During sickness absences, a gatekeeper protocols mandates tasks for employees, employers and OH doctors to support a return back to work. The commission stated that this includes referring the employee to OH to be assessed and drafting a plan for suitable work.
Commission for Healthier Working Lives: “There is evidence that OH can help employees who have health problems stay at work and facilitate their return, including for musculoskeletal and mental disorders such as depression and anxiety”
Japan has a similar law mandating that organisations with more than 50 workers appoint a dedicated OH doctor.
For smaller organisations, it is necessary to contract a part-time Occupational Physician. The report also stressed the importance of primary prevention legislation and mandated health checks for all workers in every workplace.
In Italy, the model is more similar to that in the UK, with occupational health services delivered by either certified-occupational physicians or by general physicians who have additional training in occupational medicine.
The report highlights that occupational health nurses, health visitor and other professionals may provide support to these physicians.
The commission said that the UK could learn a lot from countries with mandatory policies about OH services.
It said that although it was not known which OH programs were most effective, it was clear that they could help employees who had health problems stay at work and return to work – including those with musculoskeletal and mental disorders such as depression and anxiety.
Consultations with a psychologist in occupational health and problem-solving interventions can reduce absences among workers who have CMDs.
“OH services also reduce work-related ill health indirectly, in addition to helping workers deal with health issues directly.” The commission said that this could be achieved by encouraging healthier workplaces, improving lifestyles or by increasing the self-efficacy of workers and their ability to manage themselves.
It also warned against assuming that OH was a panacea. It said that “OH services cannot be guaranteed to work.”
Their impact is highly dependent on the type and target of the intervention. The report highlighted that OH services are more effective when tailored to workers at greater risk of illness absence or when complemented by a telephone service that allows earlier access to help.
The commission concluded that there are “good indications” that the UK could improve the employment prospects for people with disabilities and ill-health.
The result would be that more people could benefit from the employment market and actively contribute towards the economy.
“Change is needed across the board. However, younger workers are a priority due to recent trends, and the long-term effects of leaving the job market too early in one’s career.”
The improvements seen by many European peers suggest that this is achievable. The commission said that change is needed across the board. However, younger workers are a priority because of recent trends and long-term effects of leaving the job market too early.
There are many options available to us. “Policy interventions that address work and health differ in their delivery mechanisms and the scope of the population targeted. The UK government must carefully examine which changes will lead to sustainable improvements and should draw on the examples in this report”, noted the commission.
It also stressed that the effectiveness of policies and intervention in practice is influenced by the level and willingness of employers to engage them.
Attitudes toward ill-health and work are important. The commission argued that they would also help to de-stigmatize physical and mental ill-health in the workplace. They could provide comprehensive OH services which are tailored to the job requirements and do not become ‘over-medicalised.’ For example, focusing both on health promotion and illness, and reducing the under-reporting.
It concluded that “careful consideration” should be given now to which changes will most likely lead to sustained improvements for the UK. This would enable more people with disabilities or long-term illnesses to gain employment and actively contribute towards the economy.
The report included the following nations: Austria, Belgium (with Japan), Denmark, Finland, France Germany, Greece, Ireland Italy, Luxembourg, Netherlands, Portugal, Spain, Sweden and the United Kingdom.
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