Written evidence submitted by The Society of Occupational Medicine (RTR0141)

Submission by the Society of Occupational Medicine (SOM)

This submission responds to the following two questions in the Terms of Reference:

• What are the principal factors driving staff to leave the health and social care sectors and what could be done to address them?
• What should be in the next iteration of the NHS People Plan, and a people plan for the social care sector, to address the recruitment, training and retention of staff?

Key points

• Occupational health (OH) is a multi-disciplinary approach to maintaining the well-being of those employed in a workplace, preventing and removing ill-health and developing solutions to keep staff with health issues at work.

• SOM has been working to extend access to occupational health. This has included making the case for all NHS staff to have access to suitable OH services and the long-term goal of universal access for all UK workers.

• Full access to occupational health services for NHS workers could reduce the number of staff leaving due to health reasons, reduce staff absences due to sickness which results in increased pressure and stress on the remaining workforce, and be cost-effective.

What is Occupational Health and what are the benefits?

Occupational health (OH) is a multi-disciplinary approach to maintaining the well-being of those employed in a workplace, preventing and removing ill-health and developing solutions to keep staff with health issues at work. The most common OH problems are mental health and muscular skeletal.

Among many other duties, OH professionals provide independent advice on staff unable to work due to long-term or short-term intermittent health problems, and organisation wide steps to reduce sickness absence. This includes advising employees and their managers on any adaptations they may need to their workplace or routine to enable them to continue at work. They also:

• Develop health and well-being related strategy and policies and can provide health advice to employees.

• Carry out pre-employment or pre-placement health assessments.

• Carry out statutory health surveillance (e.g., when workers may be exposed to hazardous substances or noise).

• Assess fitness to work regarding ill-health capability dismissal or ill-health retirement.

• Advise on compliance under the Equality Act 2010 (including disability or age discrimination) and temporary or permanent changes to the work or workplace ('reasonable adjustments').

Numerous occupational health interventions have been shown to help people with disabilities and long term conditions find and stay in work and increase productivity across the workforce. Studies have also found that £1 investment in OH leads to £1.93 saving in absenteeism costs or a £2.35 saving in medical costs.[[1]]

There is strong endorsement by Government of the importance of OH services. The Government’s response to the ‘Health is everyone’s Business’ consultation states that:

“Government believes OH has an important role to play in supporting job retention, and enabling staff to thrive in work.”[[2]]

Ill health in the NHS workforce

Physical and mental ill health is one important factor causing staff to leave the health and social care sectors, either as a primary or additional reason. NHS and social care workers face health risks at work and have dealt with unprecedented pressures during the Covid-19 pandemic, exacerbating what was already an intense and pressurised working environment. Ill health also causes increased staff absence, which in turn leads to increased pressure, dissatisfaction and burnout on other staff.

Data published by HSE in December 2021 shows that there were an estimated 253,000 work-related ill health cases among those working in the human health and social care sectors, of which 49% were due to stress, depression or anxiety. This was around 5.7% of workers in the sector, and was statistically significantly higher than for workers across all industries.[[3]]

Statistics from 2017/18 detailing precise numbers of leavers among NHS staff and their stated reasons for leaving showed that 3,835 out of 117,463 (3.3% of the total) gave ill health as their primary reason. This is likely to significantly understate the full extent that physical and mental ill health has on reasons for leaving, however, since leavers can be reluctant to offer this information and it can be a contributing factor to other stated reasons for leaving.

Research by the General Medical Council published in October 2021 into why doctors are leaving practice found that GPs showed particularly high levels of burnout and were also less likely to return than other doctors once they had left practice. Only 9% of GPs were found to be likely to return compared to 25% of specialists and 32% of trainees.[[4]]

Current access to occupational health services for NHS and social care staff

The NHS provides access to occupational health services for the vast majority of staff in acute trusts, however, the range and quality are not consistent. There is far less provision in primary and community care settings. This means that key parts of the NHS workforce, such as GPs, practice nurses and pharmacists, lack full access to OH services. This has implications for the retention of NHS staff including in areas of staff shortage.

The existing provision of OH services in secondary care are in part due to legal requirements around safety, for example checking for blood borne viruses in advance of performing surgical or other procedures which could potentially pose a risk to patients from an infected clinician. This is important, but full occupational health provision is needed to ensure staff have the support they need to continue at work, with accommodations made as necessary, in the case of physical or mental ill health.

Prior to the Health and Social Care Act 2012 Primary Care Trusts had an important role in supporting the provision of OH. However, coordination of OH services in primary care has suffered since the abolition of PCTs. Some funds previously allocated by PCTs in support of OH services were diverted to the Practitioner Health Programme (PHP)[[5]] which provides mental health support for NHS staff. While a valuable service, the PHP is not a replacement for specialist OH services which are able to work with both the employer and the employee and so have a greater focus on supporting staff retention.

However, there is a new, positive focus on increasing the provision and quality of OH in the NHS with the rolling out of the ‘Growing Occupational Health’ programme. Growing Occupational Health is a new, national, long-term initiative by NHS England and NHS Improvement designed to grow all NHS delivered OH services and NHS OH staff to reach their potential and to better support the health and wellbeing of those who work in the NHS. It’s aims include an increased focus on proactive and preventative care.

This programme is strongly welcomed by SOM, although it does not include rolling out OH services across the whole NHS workforce. 

Recommendation for the NHS People Plan

We believe Occupational Health provision should be extended to all NHS and social care workers to minimise avoidable staff losses, for example in cases where extra support and adaptations could have prevented a worker from leaving their job due to health reasons, and support the well-being and retention of the workforce.

This measure will not fix the issue of ill health in what is an extremely stressful and physically demanding occupation. However, OH has been proven to have an impact on staff retention and well-being and ensuring coverage across the full NHS and social care sector would:

• make a positive difference to the workforce, enabling staff to get access when they need it to high quality advice, including on what measures or adaptations could be made to enable them to stay in work;

• be achievable in light of the existing investment in the Growing Occupational Health programme;

• be aligned with the endorsement of the value of OH by the Government[[6]] and in the NHS Long-Term plan;[[7]] and

• be cost-effective, since £1 investment in OH leads to £1.93 saving in absenteeism costs.[[8]]

Nick Pahl | CEO  
 

Feb 2022