Understanding the provision of occupational health and work-related musculoskeletal services

Understanding the provision of occupational health and work-related musculoskeletal services

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This report presents the findings from research commissioned by the Work and Health Unit (WHU), to map the current provision of occupational health (OH) in the UK and review work-related musculoskeletal (MSK) services in the NHS.

The research aimed to examine the available models of private and NHS service provision; how these are commissioned, resourced and accessed; examine the workforce of private and NHS providers; and investigate the commissioning of MSK and work-related NHS services. The research is intended to inform the ongoing development of policy relating to OH.

The definition of OH used throughout this research is: advisory and support services which help to maintain and promote employee health and wellbeing. OH services support organisations to achieve these goals by providing direct support and advice to employees and managers, as well as support at the organisational level, for example to improve work environments and cultures.

When the NHS was established, OH was not included in its responsibilities, but responsibility fell to the employer instead. In the experts’ view, the NHS’s traditional stance has contributed to employment outcomes being largely overlooked in studies of health interventions and a lack of leadership in OH, resulting in fragmented OH provision.

Experts reported that provision of OH has gradually shifted from an in-house function to an outsourced model, mainly due to employers seeking to reduce costs. However, they felt the training of OH professionals has not been taken up by out-sourced private providers to the same extent, and as a result the pool of UK OH expertise is perceived to be dwindling.

Weaknesses of OH provision identified by experts included uneven access to OH and work-related MSK services, a missing link between treating health problems and supporting individuals to work and OH not having been prioritised sufficiently by employers. Experts felt that key elements that contribute to effective provision include awareness that good quality work can lead to improvements in employee health and wellbeing, employers and managers with strong understanding of and belief in OH, multidisciplinary care and stratifying patients by severity of condition. The experts, and the evidence from literature, pointed towards some key models used in current delivery of OH and work-related MSK provision. These tended to fall within the domain of the employer, or the individual and their GP.

In the employer domain, Employee Assistance Programmes were felt by experts to be a relatively common pathway for referring employees to OH specialists. Also thought to be relatively common was employer-funded ‘basic’ OH provision to meet legal requirements, such as health surveillance. By comparison, a bespoke OH and MSK offer that is fully-tailored to the employer’s workforce, was felt to be comparatively rare.

The research is comprised of 5 main components, designed to capture a range of perspectives on OH and MSK provision:

- in-depth interviews with 8 experts in the fields of OH and/or MSK, and a literature review
- a semi-structured telephone survey of 103 OH providers (representing 32% of the sample built of private OH providers)
- a further semi-structured telephone survey of 156 private and NHS providers that sell OH services commercially (representing 36% of the sample built of private and NHS OH providers)
- a semi-structured telephone and online survey of 111 Clinical Commissioning Groups (CCGs, representing 58% of CCGs)
- 15 in-depth qualitative case studies with OH providers and employers that have used their services
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