Could 2021 be the year occupational health seizes its moment?

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In her Christmas lecture to members of SOM, Professor Dame Carol Black urged occupational health practitioners to use the harsh spotlight that Covid-19 has thrown on to workplace health to “seize the moment”; to raise their voice and profile with government and employers and truly show the value OH can bring to the table. Nic Paton reports.

Covid-19 and the pandemic of 2020 put occupational health and occupational medicine in the spotlight as never before. It created challenges and complexities, especially around mental health and wellbeing, the scale of which are still only gradually becoming clear. But there is also an opportunity here for OH practitioners – carpe diem, or seize the day.

As 2020 drew to a close, this was the key message to SOM members – and call to arms for the profession – from Professor Dame Carol Black, doyenne of occupational health, author of the seminal 2008 report Working for a healthier tomorrow, and (among other titles) expert advisor on health and work to NHS England and Public Health England.

Dame Carol presented (virtually of course) the SOM (Society of Occupational Medicine) Christmas lecture in December, titled “Occupational health on the front line”. In a wide-ranging presentation, she looked at how OH has evolved (yet also stayed much the same) since the 1950s, the emerging themes and challenges as she saw them facing the profession, the scouring impact of Covid-19 on workplace health, and some thoughts and reflections on the way forward from here for practitioners.

Dame Carol opened her talk by expressing her gratitude and admiration for all that SOM members, and the profession as a whole, had achieved during an intensely difficult year. “I really want to start by congratulating you all and saying a big ‘thank you’ for your contribution to what has been going on with Covid. Because you have responded in an amazing way to the pandemic; you have really just shown your worth,” she said.

“What I want to say to start with, then, is ‘please seize this moment’. I’ve always felt, as many of you know, that occupational medicine and occupational health in general undersells itself. And we really have that moment to seize now; so please do that,” she added.

OH’s powerful position to influence change

Occupational health professionals, positioned as they are at that crossroads of the employer/employee healthcare interface, potentially are in a very powerful position to effect change, to be heard in government and the boardroom, she argued, a position of influence that has (at least in theory) been amplified by the experiences of the past year. “Covid has done many, many bad things, but I also think it has given you this opportunity to push for further recognition. Because you have shown how much you have supported individuals, organisations, and tried as much as you could to protect productivity and economic growth,” Dame Carol said.

“You have unique training and expertise; you understand that link between health and productivity; how to help the injured and ill and the ageing worker to remain at work and productive. You also have a very logical role in advocating for prevention-orientated programmes that really enable people to maintain their health and be productive citizens,” she added.

Dame Carol cited the influence on her of Donald Stewart’s 1950 BMJ article The future of occupational health when she was writing Working for a healthier tomorrow (when she was the government’s national director for work and health). Yet, his arguments – the need for more OH postgraduate educational facilities, for more OH consultants, for better integration between primary and secondary care and OH – also illustrated how much had not changed within OH in the past 70 years, let alone since 2008.

“I [within Working for a healthier tomorrow] did say there was a need for change. I wanted you to be more visible and more important, and more integrated into mainstream medicine. I wanted occupational health to plug into mainstream healthcare provision,” she highlighted.

Significant workplace health challenges

When it came to what she felt were some of the emerging dominant themes and challenges facing the profession, mental health and wellbeing – its extent and its associations – was top of the list, especially for younger workers, and that was even before taking into account the impact of Covid-19. Women’s health and musculoskeletal issues remained important issues as well, and both again had been amplified by the pandemic.

Presenteeism was a further, and growing, workplace health worry, Dame Carol argued. “People are often fixated by absence because it is easy to count. But, in fact, over the last I would say five or six years, there has been a rise in the number of people being at work but not really able to give it their best, perhaps because they are sick but don’t want to say so, or it may be that they are anxious or worried – it can be for a whole host of reasons – and people define it in different ways. There is some evidence, particularly the data from Britain’s Healthiest Workplace survey, that poor mental health is probably the biggest driver of presenteeism,” she said.

The ongoing lack of “good” work or a positive workplace culture for many employees continued to act as something of a drag on workplace health and wellbeing, and also worked to fuel presenteeism. This, again, had been amplified by the pandemic, especially with the explosion in home working during 2020 blurring the boundaries between home and work.

Financial wellbeing (or the lack of it), job insecurity, bullying and harassment, inappropriate managers, poor organisational culture – all of these remained important factors that continued to impact on and exacerbate poor health and wellbeing, especially mental ill health. Pour into this the impact from Covid-19, including the pressure of being a front line or key worker, working from home, increased alcohol consumption during lockdown, poor sleep, less exercise, bereavement, losing your job or being furloughed, or the anxieties of being asked to return to physical working, and it was clear there were huge challenges ahead for OH.

As she pointed out through one example: “I have worried a great deal that furloughing will have the same effect as being absent from work. We know from sickness absence data that when you have been out of work for six weeks, after that every week makes it less likely that you will return to the place of work.

“None of us knows where all this will settle and what will be the amount of remote working when we do eventually come through Covid and get out the other end,” Dame Carol added.

The good news, however, was the quality and quantity of the resources and toolkits that had been developed to help practitioners in the past year. Dame Carol highlighted some of the return-to-work and Covid-19 resources created by SOM, but also the Developing and evaluating workplace health interventions toolkit that had been developed by Public Health England, the Chartered Institute of Personnel and Development, and Northumbria Healthcare NHS Foundation Trust.

Chance to shine, and grow

As her presentation drew to a conclusion, Dame Carol returned to her theme of how occupational health needs to maximise the potential opportunity, along with the challenge, that has come its way from Covid-19.

“Covid-19 has given you the ability to shine and, I hope, to grow. I think you can become a really powerful lobbying organisation. There is very much a need for occupational medicine expertise within government; I think we would all agree that it is sadly lacking,” she said.

“Covid-19 has exposed the very close relationship between economics and health control; control of the virus and controlling the economy; enabling workforce physical and mental health and wellbeing, if you can do that you improve productivity and the economy.

“I think we should see Covid-19 as an opportunity to accelerate change, to make it [health and wellbeing] a high concern of CEOs, a boardroom issue, and a major KPI for managers. Take public health into the workplace and make OH a central part of that answer, and not an add-on; to my mind, that is extremely important.

“The pandemic has had so many bad things about it. But it has also shown the need for, and the value of, high-quality occupational health services,” Dame Carol argued.

It had emphasised the need for a better understanding of occupational and workplace health within government, both local and central. It had highlighted why occupational medicine input needed to be, and become, a valuable (and valued) part of strategic and organisational decision making. It had also illustrated why occupational health needed to be a voice at the boardroom table, perhaps in the shape of a board-level ‘corporate medical director’ role, although she recognised this would probably not be something viable or feasible within smaller organisations.

“I would say the future, in a way, is yours; we should have more of your expertise and leadership available to the population,” Dame Carol emphasised. “The world of work is going to be very different when we come through this; we are going to have to deal with, and understand much better, home working, for example.

“There are going to be great challenges of mental health and wellbeing. You have shown during the pandemic that you can deliver the wider health and wellbeing agenda to very good effect without losing all the really important other parts of your professional practice,” she concluded.

Need for leadership, voice and influence

The need for OH to have a leadership voice, role and influence was vital, agreed SOM president Professor Anne Harriss in responding remarks to Dame Carol’s presentation. “One message I want to take away is that OH should be heard at the boardroom table. It is so important. If we can make an effect at the very top and get that to filter down through the organisation, we will have done a good job,” she highlighted.

Harriss, who is also CPD editor of Occupational Health & Wellbeing, added: “This pandemic has certainly been horrific. But there are now bright shafts of light at the end of what has been a long, dark tunnel. Covid has brought workplace health to the forefront.

“We must continue to seize this moment. Never before has occupational health and occupational medicine been in the limelight like this. It is sad because it is Covid, but I guess it is an ill wind that blows nobody any good,” she added.

References
Developing and evaluating workplace health interventions: A toolkit for employers, Public Health England, CIPD, Northumbria Healthcare NHS Foundation Trust, available online at: https://khub.net/documents/135939561/286206066/Developing+and+evaluating+workplace+health+interventions+-+interactive.pdf/6995bde6-bdb8-b641-f76d-c11968a8b15b?t=1595346719766

Stewart D (1950). “The future of occupational health”, Br Med J 1950;1:156. Available online at: https://www.bmj.com/content/1/4646/156

“Working for a healthier tomorrow: work and health in Britain”, Department for Work and Pensions, 2008, https://www.gov.uk/government/publications/working-for-a-healthier-tomorrow-work-and-health-in-britain

Britain’s Healthiest Workplace, https://www.vitality.co.uk/business/healthiest-workplace/

“Nearly a third of UK public drinking more alcohol than usual during the pandemic”, Policy Institute, King’s College London, Ipsos Mori, May 2020, https://www.kcl.ac.uk/news/nearly-a-third-of-uk-public-drinking-more-alcohol-than-usual-during-the-pandemic; “UK still staying home and even coming to terms with lockdown”, May 2020, https://www.kcl.ac.uk/news/uk-still-staying-home-and-even-coming-to-terms-with-lockdown

“6 in 10 women finding it harder to stay positive day-to-day due to Coronavirus”, Ipsos Mori, Fawcett Society, May 2020, https://www.ipsos.com/ipsos-mori/en-uk/6-10-women-finding-it-harder-stay-positive-day-day-due-coronavirus

CIPD Good Work Index, June 2020, https://www.cipd.co.uk/knowledge/work/trends/goodwork

Napier J, Daniels K (2020. “Adding value: The value of occupational health to workplace wellbeing,” Occupational Health at Work October/November 2020 (vol. 17/3) pp30-35, https://www.atworkpartnership.co.uk/journal/issue/17_3/contents/adding-value

“Fair Society, Healthy Lives” – the Marmot Review (2010), http://www.instituteofhealthequity.org/resources-reports/fair-society-healthy-lives-the-marmot-review

“Returning to the workplace after the COVID-19 lockdown – toolkits”, SOM, https://www.som.org.uk/return-to-work/