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The National Director for Health and Work, Dame Carol Black has published the first ever review into the health of the working age population - Working for a Healthier Tomorrow.
In her report, Dame Carol proposes radical changes to work-related health services so that people who are in work remain so and remain healthy, and those who do fall ill get the help they need to return to work. More than 30 recommendations were made, including that the role of safety and health practitioners and union safety representatives should be expanded to ensure they are at the heart of pushing through proposed reforms to health provision for Britain's 36.6 million workers.
According to Dame Carol, the historical separation of occupational health from mainstream health care has resulted in an inability to provide holistic support for patients of working age. Henceforth, she said, OH will need to address a wider remit and attract more numbers to what is currently a dwindling profession.
Dame Carol also states that the key to reducing the cost of ill health to the economy - estimated by the report to run to £100 billion a year - as well as the "considerably larger" human cost is to intervene early enough to ensure people are properly treated before they spiral downwards into long-term sickness absence.
The BOHS view
However, the BOHS is critical that the review does not adequately address the need to prevent ill-health actually being caused by work activities and the importance of occupational hygiene in prevention. The report's emphasis on getting people back to work and reducing benefit payments hides the fact that there is still an intolerable burden of ill health caused by unsatisfactory conditions in the workplace. The impact of work-related ill health simply cannot be ignored. Over 7,000 deaths from cancer and 13,000 new cases of cancer per year are caused by working conditions. Exposures to fumes, chemicals and dusts at work also account for around 4,000 deaths each year from chronic obstructive pulmonary disease (COPD). "There has simply not been enough attention paid in this report to serious, irreversible occupational health diseases," states Steve Bailey, incoming BOHS President.
Fit for work
To prevent that downward spiral, Dame Carol is proposing a 'Fit for Work' service to be piloted for patients in the early stages of sickness. This would be based on a case-managed, multidisciplinary approach in which treatment, advice and guidance on not just health issues but also financial and housing concerns, would be provided. The service would also benefit GPs - the first port of call for the majority of people - who would have quick and easy access to the help and advice they need to understand how to treat their patients effectively.
Early intervention ought to be about changing the workplace so that the person does not become a patient in the first place." continues Bailey. "We must ensure that workplaces are safe. We cannot wait for tomorrow's occupational diseases to emerge. We need to monitor conditions in workplaces and intervene early to prevent serious illnesses".
To solve these sorts of problems it is important to tackle both occupational and non-occupational risks in a coordinated way. BOHS believes that the Health and Safety Executive (HSE) needs to play a leading role in strengthening links between occupational, public and primary health communities, because the NHS does not have the resources, skills or focus appropriate to workplace interventions. The government's Health Work and Wellbeing initiative could provide a vehicle to achieve this but it will need some vision to look beyond simply reducing sickness absence. BOHS does not consider that such a vision has been demonstrated in this review.
The challenge
The challenge now lies in not only deciding what should be done in response but who is best placed to deliver on the various elements. HSE will be keen to underline the role it plays in prevention of injury and ill health due to work."
Dame Carol Black’s report stems from the wider Health Work and Well-being strategy, focusing on the needs of the working age population. Health, work and well-being is a cross departmental partnership between the Department for Work and Pensions, the Department of Health, the Health and Safety Executive, the Scottish Executive and the Welsh Assembly Government. The programme aims to help reduce health inequalities and social exclusion by demonstrating clearly that work helps people maintain and possibly improve their overall personal health and well-being.
A copy of the full report can be found on the Working for Health website
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