This article is a shout-out for growing Occupational Health and Wellbeing (OHWB). We must broadcast the narrative to our teams, networks, and peers. There is nothing more powerful than people spreading the word. As Carol Chorleton said 30 + years ago when starting OH Today, “the more voices that shout, the louder the noise!”
What is it all about and why on earth does it matter?
Dr Anne De Bono put the “Why” very simply in her recent talk on Growing OHWB at the Trent Occupational Medicine Conference (October 2022) as being
- not enough OH professionals,
- key drivers
- evidence of OH effectiveness
What does this mean?
Point 1. OH, has been a shrinking speciality (DWP 2019) for some years now due to an ageing workforce but also because OH is not part of the NHS. This means OH is funded by employers as opposed to the government (compared to all other healthcare), therefore falling outside of the usual pathways of training in most cases. OH is not part of the general Doctor, Nurse and Associated Health Professional (AHP) (e.g. physiotherapy and Occupational Therapy) undergraduate education and consequently, awareness of OH as a potential career option has been small, with most people falling into OH as opposed to deliberately choosing it as a career.
Point 2. What are the key drivers for this move to Grow OHWB? At some point, it was noticed that hundreds of thousands of people were moving into worklessness each year and on to benefits! Several publications demonstrated the positive effects of good work on health, culminating in the DWP 2013 evidence and research. This focused attention on the need for a healthy and safe work environment for all individuals, including those with health conditions; how could they be enabled to remain in work? Creating a more equitable society, enabling those with differing abilities (DWP 2016) to access and remain in work, reducing health inequalities (Marmot 2010) and supporting those who become ill, to return to work timely, were major factors. All evidence points to a 90% chance of worklessness after a year of absence. In 2019, a consensus statement on health and work was published (CWH) supporting the need for healthy and safe working environments for individual health and the well-being of colleagues, as well as work as a health outcome.
There is nothing like a pandemic to highlight the importance of health at work and those who protect it! We don’t need to go into the detail of the bearing the pandemic had on people and the work arena, especially frontline workers, as we all know the effects were substantial. Mental health, general health, well-being, and chronic health conditions became significant workplace concerns, not forgetting the risks within the workplace. We’ve always been aware of workplace health risks, but COVID brought these to the top of everyone’s thinking. People were, and are still to some extent bruised and dented, with a new way of life being experienced by many.
Point 3. Those of us working in Occupational Health have always had a conviction that the service we deliver is essential for people, organisations, and wider society, including the economy. Workplace health and well-being, including the influence of OH, had been a strong topic in Dame Carol Black’s 2008 “Working for a healthier tomorrow” and the “Boorman review 2009”, driving health and wellbeing. After all, OH looks after the holistic health of people in the workplace, “how health affects work and work affects health”, alongside population and public health. We can be the whole package, especially with the use of a multidisciplinary team, a positive consideration for preventative workplace health, identified as far back as 2001 (Kopias). The business case for OH was made quite clear in SOM’s The Value Proposition 2017 and substantiated within 31 mentions in the DWP 2019 “Health is everyone’s business” report, the government proposal to reduce ill-health-related job loss where we were identified as a key driver in reducing sickness absence.
Pre-pandemic OH had been identified as a key part of “expert-led, impartial advice to help employers provide workplace support to employees”. Post-pandemic, it gives us an enormous sense of pride when OH is cited as having played a critical role in supporting the COVID-19 response. OH excelled, devising, and delivering new and appropriate services at record speeds, working with highlighted risks like ethnicity, and chronic illness and not forgetting the social aspects of vulnerable family members, like never before. Flexible, agile, responsive, and providing independent and impartial advice, OH demonstrated leadership and strategy that we know organisations appreciated and, in some instances, (anecdotal) saved millions. We have demonstrated our worth and this has been recognised.
The ONS report that 75.4% of the population aged 16 to 64 are in work, with a significant rise in the number of those aged over 65 also working. Covid risk assessments, undertaken by OH during the pandemic, identified individuals still working in their 90s! That is a lot of people within a large range of the population, demonstrating the potential impact OH could have! However, evidence suggests (SOM 2021) that only 30 to 37% of those in work have access to OH support via their employer, a figure, the government in their 2021 response to the “Health is everyone’s business report”, wishes to address. They realise that employers who invest in the health and well-being of their employees have fewer sickness absences, increased productivity, and a lower staff turnover. OH support employers and management with a preventative approach, healthier workplaces and individualised care.
OH has brought about a wealth of good to organisations and people, especially notable over the COVID period. We need to ensure the momentum persists to expand the workforce and ensure quality and leadership development. Early in the pandemic (Personnel Today 2020), it was identified that there was a need to promote the value of OH and invest in training. Fortunately, this was picked up in the Government response to Health is everyone’s business (2021).
Why OHWB in the NHS?
The NHS is the biggest employer in Europe and was probably the hardest hit in the pandemic for obvious reasons. Improving performance and capability alongside an improved experience for patients (NHS Long-term plan) is, therefore, a priority. Steve Boorman in 2009 put NHS people at the forefront of achieving these objectives, backed up by the 2022 People plan, Health and wellbeing framework In July this year, MP’s in a 2021 report cited understaffing as being a serious risk to patient safety. The obvious answer is to train and employ more staff, but NHS England’s People plan saw beyond that. They could see that investing in health and wellbeing would go a long way to retaining staff, improving productivity and morale, and therefore improving patient safety. Taking the long view, they prioritised
- “Looking after our people with quality health and well-being support for everyone”
- “in a compassionate and inclusive culture by building on the motivation at the heart of our NHS to look after and value our people, create a sense of belonging and promote a more inclusive service and workplace so that our people will want to stay”.
The NHS England’s Growing Occupational Health and Wellbeing Together Strategy (June 2022) supporting the NHS People Plan and People Promise of ‘we are safe and healthy, sets out a united vision and areas for action that can be achieved together based on four strategic drivers:
- Growing the strategic identity of OHWB
- Growing our OHWB services across systems
- Growing our OHWB people
- Growing OHWB impact and evidence-based practice
“This is an important moment for us as NHS OHWB professionals, as it:
- Unites us as a multi-professional family supporting the health and well-being of our NHS people, to enable them to pass good care onto patients
- Sets the national direction of travel for us as a profession, co-designed with us, and puts us in the driving seat to grow our services
- Acts as a strategic lever to encourage investment and collaborative action in us as a community and the services we lead”
This very much supports the importance of a healthy and safe working environment, advocated by the 2019 consensus statement and the Growing a Healthier Tomorrow with its overriding message of utilising Occupational health (OH) and health and wellbeing (HWB) in providing excellent support to health care staff so they can provide excellent support to patients.
To achieve this, NHS Health Education England (HEE) 2019 advocated occupational health be prioritised as a frontline clinical function with appropriate funding to provide ‘proactive, responsive support to all NHS staff’. The Growing OHWB Together strategy unites occupational health and wellbeing as a multi-professional family of job roles and services that collaborate to improve the health and well-being of our NHS workforce
This is all great work but if we look at the time lag between the Boorman report in 2009 to now, we know that we cannot just deliver a great document and leave it there. Short-term limelight can fade into the sunset. We must keep the momentum going and this means a strategy! July 2022 saw the publication of a roadmap to growing OH&WB, not only to shout out the message of OH&WB as an integrated, multi-professional family with a strong voice in organisational decision-making relating to health and wellbeing but to build on this with 4 key points:
Let’s look at these individually: –
Growing the strategic identity of OHWB is shouting out about who OHWB are, building on the momentum of the pandemic, and encouraging people to sit up and listen by becoming a trademark of employee health and wellbeing. Investing and uniting the multidisciplinary team looking after NHS employees into one integrated team, will enable us to be one, reliable voice who is listened to.
Growing OHWB services across systems is inspiring and fundamental in caring for the carers! It supports an inclusive service that is driven by need, is well staffed, has joined-up, collaborative services with clear pathways for access encourages quality and innovation and maximises the use of technology including digital ways of working.
Growing our OHWB people is incredibly exciting as this supports the development of a multidisciplinary workforce with attractive career pathways, recognising and encouraging talent. Made possible with accessible training, good quality education and leadership development. Leading in health and wellbeing includes upskilling all NHS managers to support the health and well-being of their teams. If anyone is interested in the NHS education and training opportunities within the Growing OHWB programme, please contact: firstname.lastname@example.org
Growing OHWB impact and evidence-based practice looks at data and research to drive quality and practice, demonstrate the impact and value of OHWB and therefore increase trust and confidence in the service but also drive the OHWB market.
In a nutshell, this is about being a multi-professional service that is trusted by all employees and NHS leaders by having attractive career pathways, credible education and training and empowering our OH and wellbeing leaders with the wider workforce to move from transactional to transformational with a voice at board level (Dr A Turner, Personnel Today 2022)
What about the National School of Occupational Health (NSOH)?
NSOH is part of Higher Education England (HEE), the education subsection of the NHS, but is also a collaboration with the Faculty of Occupational Medicine (FOM) a different way of working to other schools because OH is unique in the world of health and not funded by the NHS. The school is headed up by Dr Ali Hashtroudi and has a vision which supports the training of the OH workforce, i.e., the multidisciplinary team, to have the “capability and capacity to optimise the workability of the working-age population”. A significant focus is the quality of OH education and training, working with partners like Higher Education Institutions. As you can tell this vision fits in well with all the drivers we have already talked about, however, instead of just focusing on one sector, the school covers all sectors of OH delivery. For those who aren’t aware, OH, is delivered in two ways; – in-house provision i.e., paid for and supported by the employer and privately via OH providers. Some in-house OH departments also deliver privately externally such as in the NHS but also some private providers deliver to the NHS, local councils, and the private sector.
The school covers all OH delivery, as part of the 2021 Government response to Health is everyone’s business, including the need to grow the capacity of OH, i.e., workforce planning. This is an exciting time for the school, working as a strategic partner with the Department of Work and Pensions (DWP) Work and Health Unit (WHU) and other stakeholders such as the Growing OHWB together team, FOHN, SOM, Council of Work and Health, COHPA and ACPOHE, to meet the need of future workforce planning, not only to grow the OH workforce but to grow awareness of OH as a future career.
One initiative is the development of shadow opportunities for those interested in the inner workings of OH, facilitated by the Society of Occupational Medicine (SOM) (please email email@example.com for more information), as well as the development of placements for Nurse and Allied health professional undergraduate students within OH departments and organisations. We are actively seeking placement opportunities so if anyone is reading or listening to this and would like more information on what this involves, please contact Janet.Oneill@hee.nhs.uk.
The benefits of having a placement are numerous and include an opportunity to teach and supervise; upskill with exposure to best practice, knowledge, and skills; as well as obtain assistance with projects, audits, and service delivery. There is a small placement tariff that can be claimed for each student.
Janet O’Neill, Deputy Head National School Occupational Health (NSOH) (HEE) and Clinical Education Director, PAM Group
Victoria Small, Senior Project Manager Growing Occupational Health and Wellbeing, People Directorate NHS England