Last reviewed 28 October 2019

Vicky Powell looks at some potential solutions for understanding and accessing services in this rewarding and multifaceted area.

Work-related health is firmly on the agenda after decades of Cinderella-like status compared with occupational safety — and this can only be a good thing. However, successful management of work-related health risks requires effective navigation of the complexities of its close relative, the field of occupational health. This can be daunting for many employers, raising all sorts of challenges in terms of financial constraints, lack of time and staff resourcing difficulties, for example.

Health risks, occupational health and wellbeing

Acas, the Advisory, Conciliation and Arbitration Service, defines occupational health as “a type of medical service for supporting employees and employers and helping wellbeing in the workplace, which can be used for both physical and mental health”.

Currently, occupational health provision is highly topical. At the time of writing the Government has a consultation document out on how to improve health at work, alongside proposed changes to improve statutory sick pay. The consultation document simply describes occupational health as “advisory support which helps to maintain and promote employee health and wellbeing”.

The various inter-relationships within the health at work arena have been helpfully explained by the British Occupational Hygiene Society (BOHS) as comprising three broad and overlapping spheres, namely:

  • managing and protecting workers from health risks created by the workplace, traditionally the responsibility of health and safety practitioners and occupational hygienists

  • caring for and managing the health of workers, traditionally falling to occupational health nurses and doctors

  • managing the wellbeing of the workforce by promoting healthier choices, often the remit of the HR department.

The three spheres above of course intersect significantly, creating areas of commonality and collaboration. In practice, responsibilities for their delivery, according to the guidance Occupational Health Management in the Workplace from the Institution of Occupational Safety and Health (IOSH) could fall to occupational safety and health practitioners, occupational hygienists, managers, employees, HR and occupational health practitioners, depending on the structure of the organisation.

Types of occupational health services

Earlier this year, in April 2019, the Government published research on occupational health services which listed the top 10 most common occupational health services as follows.

  1. Advice about workplace adjustments or return to work plans for ill or sick employees.

  2. Assessment of fitness for work for ill or sick employees.

  3. Pre-employment/post-offer of employment health assessments.

  4. Support with health risk assessments.

  5. Ongoing health assessments available for any employees (even if not ill or sick).

  6. Health promotion or healthy lifestyle schemes.

  7. Support with health surveillance.

  8. General advice on organisational policy or procedures to help with legal compliance and business objectives.

  9. Training, instruction or capacity building, eg for managers or leaders.

  10. Clinical interventions to manage health risks, eg vaccinations.

Other services included support such as sickness absence record keeping and data analysis as well as a wide range of therapies such as physiotherapy, cognitive behavioural therapy, workplace stress management, debt counselling and marriage counselling.

The challenges in occupational health

The NHS provides a range of health services to people to help keep them in work (eg physiotherapy) and GPs are often consulted on work and health issues.

However, occupational health is largely provided commercially and most support is bought in by employers through a well-established private market worth around £800 million a year.

Worryingly, commentators have described the occupational health workforce as “in crisis”. There is a tremendous current shortage of clinical occupational health staff, with 44% of occupational health providers reporting they are unable to fill clinical roles, typically those requiring nurses and doctors.

Currently only around half of employees in the UK have access to occupational health services through their workplace.

Furthermore, government research indicates that it is mostly large employers that are more likely to have the resources to offer wide-ranging health and wellbeing services to employees, including access to occupational health services.

Cost is a major barrier faced by smaller companies in purchasing occupational health services. Small employers are five times less likely to provide access to such services than large employers. Small employers often tend to stick to their legal statutory requirements in managing health and disability in the workplace, with the most common barriers cited by small employers including a lack of time, staff resources and capital to invest in expert advice.

Through its consultation, the Government is seeking views on ways to reduce the cost for SMEs through potential co-funding of occupational health, eg through a direct subsidy or voucher scheme, so that smaller employers can access the benefits of good occupational health advice and support.

Tips for accessing occupational health help

Useful strategies for organisations contacting an occupational health supplier might be as follows.

  • Know the health hazards in your company, and how many employees are potentially exposed as well as your current control measures for the hazards.

  • Know what type of service your business may require.

  • Consider what experience and qualifications you need an occupational health provider to have, eg:

    • for doctors, Membership of the Faculty of Occupational Medicine (MFOM) or a Diploma in Occupational Medicine (DOccMed)

    • for nurses, registration with the Nursing and Midwifery Council (NMC) plus a certificate, diploma or degree in occupational health and ideally being on the specialist part of the NMC register.

  • Ensure the occupational health provider is able to supply information such as fees, any medical equipment required for the tasks and anonymous trend information which can be used to review risk assessments with employee representatives.

  • Before a contract is arranged with the occupational health provider, there should be agreement on issues such as fees, services, the number of site visits, processes and communication pathways (ensuring medical confidentiality).

  • It is usually worth obtaining two or three quotes from different occupational health providers. In addition, it is advisable to request the contact details of other similar companies to which the provider has delivered services so that references can be obtained.

The Health and Safety Executive (HSE) has also advised employers to:

  • share risk assessments with the occupational health provider

  • make sure they observe employees and the work they do by giving the occupational health provider time to do this

  • come up with a list together of red points (“must dos”), amber points (good practice) and green points (eg lifestyle issues not legally required or necessarily work-related)

  • set up front expectations from the service being provided in terms of communication, feedback of results and roles and responsibilities

  • agree a timescale for review.

The HSE has offered a series of tips for the chemicals industry for purchasing occupational health services, which may be helpful for that particular sector.

Furthermore, Acas advises that an occupational health policy should specify:

  • when an occupational health referral or assessment should be made

  • how, where and by who it is carried out

  • what both the employer and employee need to do

  • the next steps.

Where to get help on occupational health

When deciding whether to outsource occupational health or keep it in-house, employers will need to look at factors including cost, how quickly treatment is required and their in-house expertise.

Smaller organisations might not have an occupational health policy or scheme. In this case, Acas advises the employer to take the advice of both the employee and their doctor.

It should also be noted that research shows that even though occupational health services are largely commercially provided, nearly all interact with NHS provision in some way.

Useful routes for employers to find occupational health providers include:

In addition, it should be noted that referrals and assessments under the Government’s Fit for Work scheme (designed to provide occupational health and support on sickness absence for employers, employees and GPs), closed in spring 2018. However, employers, employees and GPs may still access its helpline, website and web chat service, which offer general health and work advice, as well as sickness absence support.

The value of successful interventions

Successful occupational health interventions can result in win–win outcomes for both the employer and employee, improving the health of working people, preventing work-related illness and absence, and raising productivity levels within organisations.

As a specific example, the company Occupational Medicals has described its work with a 30-year-old female call centre agent who was referred to them for a fitness-to-work assessment, having been absent from work with an acute episode of anxiety and depression related to a long-term medical condition.

She saw the company’s consultant occupational health physician, who concluded that she could return to modified work over a period of two to three months. It was recommended that she initially worked reduced hours four days a week for two weeks, gradually increasing to reduced hours five days a week for the following two weeks.

Following that she could be gradually phased back into full-time employment, and the physician was optimistic that she would be able to return to her normal contracted hours — a positive outcome all round.


The burden of occupational ill health within the working population is considerable. Fatal and non-fatal work-related injuries and illnesses worldwide equate to a cost of approximately €2680 billion, equivalent to 4% of the global GDP.

Commenting on the global value of occupational health interventions, Nick Pahl CEO of SOM said, “Work-related health issues are far reaching, through the impact on organisations, employees and their families and on the wider community and ultimately the economy. Effects are across industries and ailments, from the impacts of a bad flu season to accidents and injuries. Many of these issues are preventable or at least can be reduced, hence the enormous potential of occupational health programmes.”