How the NHS backlog is transforming occupational health
Pressure on the NHS means employers are using increasingly proactive occupational health services to fill the void and keep people in work.
The UK may have become the first country to transition from pandemic to endemic status but the impact on the NHS is nevertheless still all too apparent. According to our Health at Work Report, one in two employees (51%) have been affected by delays accessing the NHS, with one in ten extremely affected by operation cancellations.
The report also highlights the extent to which employees are now struggling with a range of issues. Over a quarter (26%) have clinical levels of anxiety or depression, one in four (24%) has musculoskeletal (MSK) issues, 8% have Long Covid and 7% have become drug-dependent.
With over five million people now waiting for support and many more being deterred from approaching an overburdened NHS, diseases ranging from cancer to diabetes are also going undiagnosed and untreated. In response, occupational health services are playing an increasingly proactive role, to fill the void and keep people in work, in the following ways.
Three ways occupational health services are evolving to keep people in work:
1. Prevention before cure
It’s long been known that the sooner employees can be supported to nip health problems in the bud, the quicker and less costly it is to help them recover. However, it’s taken the tipping point of the NHS crisis for employers to stop using occupational health purely to manage sickness absence in favour of proactively helping people to stay healthy, avoiding absence in the first place.
Many employers are now working with their occupational health providers to help employees avoid preventable diseases, such as cancer, stroke, diabetes and coronary heart disease. These non-communicable diseases (NCDs) have subtle, if any, symptoms in their early stage, meaning blood testing is often required to detect any sign of abnormality.
However, pressure on frontline NHS services from Covid meant a quarter of diabetes cases went undiagnosed last year. Instead of letting things slide further, occupational health providers are now stepping in, providing free health assessments and blood testing. Our sister company, To Health, has also been providing an hour-long private GP consultation to explain the findings and signpost employees to a 12-week course on how to reduce their health risks.
Not only does this extension of occupational health’s role reduce the risk and cost of undetected illness, but it also makes employees feel cared for and valued, and gives them access to expert healthcare support at a time when they might otherwise struggle to be seen. It’s designed to empower them to manage their health more effectively, especially if they have chronic conditions that need careful management.
2. Changing mindsets
Before the pandemic, if someone needed a knee operation and was struggling to work, they would typically get signed off work by their GP until after they had been treated and had some post-surgery rehabilitation. That might have been OK when they only had to wait six weeks, but it's unacceptable if it's going to be a year. Not least as there is a risk of financial hardship, and long-term absence has been shown to lead to lack of confidence, isolation and an increased risk of future worklessness.
Homeworking is often seen as a solution but can lead to increased inactivity which further exacerbates the issue and delays recovery from surgery. Instead, occupational health providers, and experienced OH MSK clinicians, use biopsychosocial models to help employees stay in work, by looking at the biology, psychological impact and social impact of their health condition. People’s experience of living with a condition can often be improved by finding ways to enable them to do more by reducing the psychological impact.
By working with the employee and their manager, occupational health can find ways to enable the employee to attend work, whereas previously there would have been a perception that they couldn’t or shouldn’t be in the workplace. If the employee can’t be rehabilitated to this extent, this finding can then be used by a clinically qualified OH professional to liaise with their GP, or other frontline services, explaining why if they don’t get help soon, they could be at risk of losing their job or developing mental health issues. This often generates good results once a fellow clinician makes the case.
3. Independent support
Another way occupational health services are continuing to keep people in work is by giving independent objective advice. In the past, if someone was struggling to work, OH might have been called upon to provide the independent advice needed to support a capability dismissal decision. Now, with an increasing lack of available talent, employers are more likely to look to OH to facilitate proactive and rehabilitative support to retain the employee.
Sometimes this might only require coaching to recognise symptoms and improve lifestyle management to optimise the condition. Other times it might require treatment, at the employer’s cost or via a private health insurance provider. Alternatively, where the NHS is the only option, the employee may be coached to push for a consultation or given guidance on what to say during their appointment.
It can also be about helping them to liaise with their manager about what they can and can’t do, so that reasonable adjustments can be made to keep them in work. It might simply be about giving them confidence that being in the workplace won’t to do them any harm or undermine the management of their condition. Simple advice, clearly stated, from OH, such as choosing a downstairs meeting room for a meeting to avoid the stairs helps both employee and manager to know what’s required and removes the need for any awkward conversations.
As simple as that sounds, it’s often difficult for employees to ask for what they need, without feeling guilty or inadequate. An independent third party guiding them to do this can make a huge difference to their ability to get past the awkwardness, ultimately staying in work by not doing the things that make them worse and reaping all the benefits that being in work provides to mental and physical wellbeing.
Quick Guide: How can I keep employees affected by the NHS backlog in work?
Download our quick guide to supporting employees affected by the NHS backlog, for five tips on how to support your people to stay in work.