Interview: Rethinking Work, Health, and Upstream Intervention

I recently sat down with Insight Workplace Health Director Chris Terry to discuss current policy changes in work and health. We talked about occupational health as both the tip of the iceberg and a key part of the upstream solution.

The interim Milburn report was published last month and demonstrates the scale of the challenge surrounding almost one million 16-24 year olds who are not in education, employment or training, with disability a contributor in almost 50% of cases. This is deeply concerning given the potential long-term consequences for health, employment prospects and economic participation throughout the life course of this cohort, and possibly those that follow.

Here are a few highlights from our conversation.

Work and Health Support: Progress and Complexity

LS: Over the last few years, there’s been increasing policy focus on supporting people with long-term ill health and disability to stay in or return to work. The latest thinking on this involves upskilling non-clinical professionals in a tiered approach to be able to broaden access support with occupational health oversight and escalation pathways. How does this sort of model match up to what are you seeing in occupational health practice on the ground?

CT: There’s definitely been a lot of policy interest and change in this space in recent years. And it’s all progress as far as I am concerned. Ultimately, we want more people who need it to have access to work and health support. It remains the case that in the UK, work and health support is employer dependent and that therefore many unemployed people cannot access work and health support at all.

On the other hand, the more I see in my occupational health career, the more I have come to understand that work and health is an incredibly complex challenge. One that starts far upstream of the occupational health clinic.

Health beliefs and how people relate to work while living with long-term ill health or disability are deeply shaped by psychosocial circumstances. These aren’t always recent factors either, they can trace back to the circumstances in which people grew up.

LS: That maps to what we know about the social determinants of health, a theme that was mirrored in the interim Milburn report. And suggests the issue goes well beyond healthcare services alone?

CT: Absolutely. These challenges sit at the intersection of multiple systems, healthcare, welfare, and employment support. These systems impact current service users. Beyond this, the services that were offered to the adults and caregivers in their lives while they were growing up have an impact too.

So there’s the constantly evolving state infrastructure trying to provide the right support, whether through healthcare services, benefits systems, or schemes designed to match individuals with employers.

By contrast, interventional work and health services, whether delivered by clinicians through occupational health or non-clinicians (as we are seeing through some of these new pilots like WorkWell), tend to come in relatively late in the work and health journey. By the time someone requires extended time off work, their functional capacity has often already been significantly affected. The issues all accrue the longer they wait for this support, which is, I suppose, where the government is coming from in trying to achieve earlier access to work and health services.

Why Occupational Health Often Arrives Too Late

CT: We do try to intervene earlier. For example, services like our day-one sickness absence product are designed as time critical to prevent escalation. We speak to an individual within the first 24h of sickness absence. But even then, we’re still operating downstream of function that has deteriorated to the extent that the individual is no longer working.

The broader public sector infrastructure such as the fit note system isn’t particularly robust, which also means that an individual’s work and health challenges typically escalate before they receive specialist support. The fit note system in England is undergoing a trial of reforms, but it is still unclear where and when OH support will be offered, if at all, in the pilot services.

I’d really like to see occupational health principles embedded much further upstream, in public services and even in education.

LS: So in many ways OH and other work and health support is a late stage intervention. Do you think organisations that have access to occupational health are using OH to get upstream of work and health issues within their own workforces?

CT: We do have some examples of this, which is encouraging.

Some clients are starting to understand that occupational health can be used proactively, not just reactively. We’re seeing organisations come to us with ideas around health promotion, like educating their workforce on skin health in the sun, or asking for input before an office refurbishment to make sure changes are aligned with the OH evidence base on noise, light and other factors.

That said, this shift isn’t consistent across the board. We have data that shows that even when organisations purchase occupational health services, the support is often underleveraged.

Many stakeholders still see occupational health primarily as a compliance function, rather than something that can actively enhance workforce health and productivity. As a result, recommendations in reports are frequently not implemented.

Ironically, this can come full circle, because failure to act on advice in a timely way can create compliance risks later, including in tribunal cases.

The Opportunity for Upstream Intervention

LS: So if OH services come in relatively late in the work and health journey, where do you think the biggest opportunity for improvement lies? And what can OH services offer upstream?

CT: I believe a big part of the solution is education, particularly for the professional colleagues who interact with occupational health, like HR teams and managers that come across work and health issues in their day to day roles.

There’s a clear disconnect, and we need to bridge it. That’s why we’re investing heavily in providing practical, accessible resources, whether that’s top tips for HR professionals, deeper guidance on hot topics like reasonable adjustments, or even forward-looking content on areas like lighting and office design.

So occupational health definitely has a role in education at organisational level. But I believe OH also has a role in education far before these issues emerge at the work-health interface.

It would be great to see OH professionals brought into schools, health and welfare services and other upstream public services to support people to learn about the relationship between work and health, and the importance of seeking early support where required.

Maybe that would be a way of getting resources to young people before they face issues with dropping out of education, employment or training due to long term ill health and disability.

As well as providing bread and butter occupational health services, Insight Workplace Health is working to address these gaps in the bigger picture.

Education, Prevention and Work Design

LS: I agree it would be great to find ways to connect with more people earlier on in their work and health trajectories, from a primary care perspective as well as an occupational health perspective. This also fits with the NHS agenda of shifting from treatment to prevention. What do you think about upstream intervention with your ergonomics hat on?

CT: One aspect of ergonomics that is relevant to prevention is work design. Some work is designed so poorly (think monotony, lack of control, inefficiency) that people do not enjoy their work or value their role.

I think, in practice, this interacts with the threshold for sickness absence, possibly via work-related stress as a connecting factor. Someone with a poorly designed role may be experiencing work-related stress as well as low job satisfaction, which could translate to a lower threshold for sickness absence and greater obstacles to return to work.

LS: So maybe improving work design is another upstream intervention opportunity at organisational level.

Key Takeaways

Thanks Chris! Here are my takeaways:

• Work and health support is currently mainly reactive rather than proactive.

• Current policy change is geared at expanding reactive support services.

• To really make an impact, stakeholders need to pivot to upstream investment and acknowledge the relationship between the social determinants of health and work and health outcomes.

• At an organisational level, this could look like education for HR and managers as well as thoughtful work design, workplace design and health promotion.

• At a national level, basics about the relationship between work and health could be better integrated into public services such as education and healthcare.

• This could provide individuals with a foundational understanding they can lean on should they experience issues at the work-health interface in future.

How Insight Workplace Health Can Help

Looking to take a more proactive approach to workforce health?

Occupational health can do far more than manage sickness absence. From manager education and health promotion to ergonomic advice and early intervention support, our team helps organisations create healthier, more productive workplaces.

Whether you're looking to improve employee wellbeing, reduce sickness absence, support managers, or create a healthier work environment, Insight Workplace Health can help.

Get in touch today to explore how occupational health can support your workforce before issues escalate.