Occupational Health – the value proposition

1. Occupational Health – the value proposition For the EAPA - Nick Pahl, CEO June 2018

2. Aim of talk • About the SOM • The value proposition of OH • Working together with EAP – discussion

3. SOM Membership • Multidisciplinary membership – includes doctors, nurses, physios, psychologists etc • New OH technicians group - produced scope of practice and starting salary survey • New Disability assessment group • OH Nurse and GP connect e newsletter • Academic Forum • New corporate supporter offer Join at www.som.org.uk ….”Group” membership available

4. UK and global advocacy • Member of OH expert group, chaired by deputy CMO • Fit for work service scaled down • Involved in evidence collation, changes in fit note, Statutory Sick Pay, pilot site work..”Challenge fund” to be launched soon… • Responded to “Thriving at Work” report • Patrons – Lord Blunkett and Norman Lamb • Advocacy toolkit with IOMSC and advocacy to WHO world health assembly. DG video Question - what is the future model of occupational health e.g. direct access to OH teams, workplace coaches etc?

5. SOM Membership benefits • Occupational Medicine Journal • Regional Groups • Nurse and Dr insurance • Legal helpline • Job recruitment service • Golden Jubilee Travelling Fellowship • Peer support • Appraisal services • Reports e.g. value of Occupational health UK and Globally – on our website and free to access • E news • Reduced costs for attending events

6. Website - Why occupational health campaign Raising awareness of occupational health

7. Events Occurred this year: • HAVS - with RSM • Essentials in OH – RCGP • Regular webinars e.g. on global value of OH Coming up: • OH Industry meet - July • MSK and workplace health summit • Careers fair – 24th September • RCN event – 30th November

8. Working with our journal, encouraging interest in research • Special issues on Global occupational health • Sector level evidence reviews • Pod casts

9. Global Occupational HealthVirtual Issue Editorial by Will Ponsonby Chair of the International Group, Society of Occupational Medicine To read this virtual issue please visit: academic.oup.com/occmed/pages/global_occupational_health

10. Background – what is OH • OH supports employers to: • Improve employee health • Help prevent work-related illnesses • Provide early interventions for people who develop a work-related illness • Reduce sickness absence and presenteeism • Increase the efficiency and productivity of organisations

11. www.whyoccupationalhealth.co.uk/

12. Information sources A report based on 146 references: 50 systematic reviews and meta-analyses 37 studies 17 research reports 42 other publications Nicholson PJ. Occupational health: the value proposition. Society of Occupational Medicine. London. 2017. https://www.som.org.uk/sites/som.org.uk/files/Occupational%20health%20-%20the%20value%20proposition.pdf

13. Occupational Health – the global value and Evidence • Produced by Professor Lode Godderis and team and launched last month.. • Global cost of workplace ill health – 4% of GDP

14. Quality of the evidence • Some reviews fail to appraise quality • ~10% of studies are high rigour • ROI inversely related to study quality • Best evidence sources: • Cochrane, HealthEvidenceTM, CRD York

15. The ROI • Many papers, posters and lectures claim high ROI e.g. 4:1 (but provide little detail re: interventions) • Interventions range from single-focus activities e.g. smoking cessation to broad programmes

16. Making the business case Need to market: • Compelling and transparent reasons to buy OH • ‘Value’ in the broadest sense • Investment drivers • Legal • Financial • Moral • Reputation

17. Drivers - legal & reputation • Employers must appoint one or more competent persons to assist them in meeting their legal duties, taking into account the size of the undertaking and the risks at the workplaces • Companies and / or directors can be prosecuted for breaches of health and safety law and face significant fines and potentially imprisonment • Litigation risks company reputation which can threaten business

18. Drivers – moral & financial • Protecting and promoting employee health is integral to corporate social responsibility • Good workplaces, employee engagement, wellbeing and productivity are inter-related • Poor employee health is associated with significant costs to employers (2-16% of payroll)

19. Employer costs of ill health * additional costs for work-related ill health

21. RTW barriers • Anxiety • Depression • Co-morbidity • Job strain • Older age • Lower education Gragnano A, et al J Occup Rehab 2017

22. Occupational health services

23. Sickness absence • Short-term • Self-limiting conditions (‘colds’, gastroenteritis) • Long-term health problems (asthma, migraine) • Long-term • Common mental health problems • Degenerative diseases • Cardiovascular • Musculoskeletal • Cancer

24. The arguments for managing RTW Nicholson PJ. SOM 2017

25. Musculoskeletal disorders What works: • Back schools • Cognitive behavioural approaches (back + neck pain) • Advice booklets (mild low back pain) • Graded activity intervention (non-specific low back pain) Nicholson PJ. SOM 2017

26. Musculoskeletal disorders What works: • Early assessment and early rehabilitation • Work / workplace adjustments • Employer support for modified work, work organisation and working environment • Multi-component programmes are the most successful and cost-effective interventions Nicholson PJ. SOM 2017

27. Common mental health problems • Few economic evaluations • Most are of low methodological quality, or evidence on effectiveness is lacking • Only tentative conclusions can be drawn Hamberg-van Reenen HH, et al. Occup Environ Med, 2012

28. Common mental health problems • CBT is effective in reducing psychological ill-health and sickness absence in those: • Absent from work1 • In depression, sickness duration is reduced by adding: • CBT • a work-directed intervention2 1. Hill D, et al. TSO 2007 2. NieuwenhuijsenK, et al. Cochrane 2014

29. Other health conditions • Most studies included in systematic reviews involve musculoskeletal problems • The evidence is strongest for those disorders, and is less direct for other health issues Nicholson PJ. SOM 2017

30. Overall Strong evidence: • Supporting disability management interventions • Work disability duration is reduced by: • Work accommodation offers • Communication between healthcare provider and workplace

31. Overall Moderate evidence that: • Early contact between the worker and their workplace reduces work disability duration • Graded activity interventions reduce sickness absence

32. Benefits provided by OHS

33. Conclusion Employers should: • Understand barriers and facilitators to RTW • Be familiar with what they should do • Provide access to competent RTW support including Occupational health services and EAP • Remember £500 tax and NI exemption

34. Coming up for the SOM …documents on: - the “Value of OH specialist” - a “career in occupational health” -”hosting a trainee” - “commissioning an OH service”

35. Question: How can EAP and SOM/ occupational health work together more seamlessly?