Should Occupational Health become a part of the NHS?

Proposal to incorporate OH into the NHS

Occupational physician Ian Torrance and Faculty of Occupational Medicine president Richard Heron recently suggested in BMJ editorial that ‘integration of the clinical specialty of occupational health (OH) into the NHS is long overdue’. Their argument was based on a viewpoint that current OH provision in UK puts employees of smaller companies and the unemployed at a disadvantage.

Poll: 76.4% of OH community disagreed

Occupational Health [at Work] journal polled its readers in the OH community about this proposal in June and July 2017. Three quarters of respondents disagreed with the idea of incorporating OH into the NHS.

One respondent said: ‘I believe that employers should pay for this as they have a duty of care to their employees under law, and to expect an already stretched NHS to fund this would be inappropriate and criminal.’

‘It is important that OH remains independent and able to make important decisions about the workforce without any hint of concern about other factors involving an overarching organisation,’ said another.

Some would welcome better focus on the link between work and health

Some respondents could see benefits of a fully integrated NHS OH specialty. ‘At long last people’s work is starting to become an essential aspect of today’s healthcare,’ said one respondent. ‘It is therefore only right that OH should become an integral part of the mainstream NHS to reflect this improvement in person-centred care. The link between health and work was identified a long time ago, but we in the NHS are only just starting to acknowledge its importance.’

Another added: ‘If we do not integrate OH into the NHS, it will always be perceived as an optional extra.’

Alternative framework approach

The editor of Occupational Health [at Work], Dr John Ballard, proposes another way to improve access to OH services. “An alternative strategy would be a framework whereby employers shared the responsibility with government – thus underscoring the link between work and health. The framework, phased in over several years to allow time to train specialists, could comprise: a requirement that all employers above a certain size, and all those in specified hazardous sectors, appoint or retain an OH service (in-house or outsourced); the creation of OH centres of excellence in NHS teaching hospitals to provide expert referrals, with accredited specialists; and all larger GP services and health centres to have a nominated permanent or visiting practitioner with training in OH.

“The government has declared its commitment to reducing the huge gap between the employment rates of disabled and non-disabled people, and to providing support for working-age people with long-term health conditions. A framework approach would have greater chances of success than trying to solve all the problems through the NHS. It would require major investment – but the cost of doing nothing is the £100 billion a year that working-age ill health already costs the economy.”