The All Party Parliamentary Group on Occupational Safety and Health has produced a report highlighting the short and long terms issues in occupational Health in particular focusing on Occupational Health Physicians (OHP) in the industry and the growing shortage of OHP’s now and the concerns for the future – They go as far to call it a crisis and with these numbers it’s hard to disagree – 64% are over 50, and 50% will likely retire in next 10 years (without adequate replacements).

Interestingly Apart from the UK and Ireland, in most European countries employers are obliged by law to establish or use an OH Service (OHS). In other European countries OHS are either incorporated into national health and social services for all working people or are statutorily required through risk based insurance levies on employers, who are obliged to purchase comprehensive occupational health, rehabilitation, and compensation services from independent providers. Examples of where provision of OHS is compulsory include Belgium, Finland, France, Germany and the Netherlands

The report goes onto say the UK’s working population is 31.7 million people and this is more than at any other time, including 1.2 million workers aged over 65 and 3.7 million more workers aged 50 – 74, compared to 20 years ago. Yet the numbers of occupational physicians is falling. In 2008, the report ‘Working for a healthier tomorrow’ found that the proportion of the workforce with access to occupational physicians varied from 1% in agriculture, forestry and fishing to 43% in health and social services.

Changes in UK employment structure and use of occupational health services has changed over the last 15 years as in the past, most large employers provided in house occupational health services. However, small and medium sized enterprises (SMEs) now account for the vast majority of all UK private sector businesses and employ 15.6 million people (60% of private sector employment).

It is not practicable for SMEs to employ their own occupational health specialist. Instead, SMEs who are aware that they have a need may contract for a service from an independent OHS provider; this outsourced model is also now the most common arrangement for larger employers.

A recent Council for Work and Health report highlighted the critical state of occupational health in the UK, the ageing occupational health workforce, and the lack of training opportunities. It noted that employers of OHS already report difficulty in recruiting suitably qualified practitioners and that the shortfall must be addressed urgently.

In conclusion the report said that good occupational health services are central to the effective management of workplace health and it is clear that while few UK workers have access to multi-disciplinary occupational health services; even fewer have access to a doctor who is specialised in occupational medicine.

The following recommendations are proposed to address the issues highlighted in this report:

• Health Education England, and the equivalent bodies in the devolved administrations, must fund a model that meets the requirement for occupational medicine training posts to meet the level of demand now and in the future
• Government and insurers should explore how to best incentivise employers to provide workers with access to multi-disciplinary occupational health services
• Employers of occupational medicine specialists within the NHS Occupational medical workforce crisis
• The need for action and private sector should have incentives in place to retain existing occupational medicine professionals as they consider retirement
• The NHS in each of the nations within the UK must ensure that occupational medicine physician posts are part of safe, effective, quality assured multi-disciplinary occupational health teams
• The GMC and the Royal Colleges must ensure that occupational medicine forms part of the core curricula – so that all medical undergraduates and doctors in postgraduate training understand the importance of work as a clinical outcome

Read the report in full here – https://www.som.org.uk/fileadmin/user_upload/Office/eAds/OM_Workforce_Crisis_2016_pdf.pdf

If you are a Ltd company and work via a recruitment agency and / or health care provider and the third part client is a public sector organisation then you must read this and be aware that big changes are afoot.

HMRC made it abundantly clear in recent months that they would tackle the use of Personal Service Companies within the public sector.

The following changes will come in to effect from April 2017:

Recruitment agencies will have to assess the IR35 status of all contractors working in the public sector who are paid via their own limited company (as it stands with OH Staffing all PSC’s are within IR 35 and it is unlikely this will change).

If the agency determines that they are Inside IR35, the agency must deduct full PAYE and NIC before paying the PSC – Read that line again and absorb it… Basically if you work on a recruitment agency contract as a Ltd company then by default you are likely to be inside IR35 and because of this the recruitment agency WILL BE RSPONSIBLE TO DEDUCT YOUR PAYE and NIC BEFORE PAYING YOU.

Should the occupational health agencies wrongly assess someone and pay them without deductions, the tax debt will be payable by the agency rather than the limited company.

The result of these changes means:

From a contractor perspective there will be virtually no benefit to working through a PSC if they are inside IR35 and contracting in the public sector.

From an agency perspective this will result in more administration, greater risk and potentially higher costs as a result of the levy.

Watch this space for more information and how it will work logistically.

Indulge me for a minute – Take a leap forward 20 years and how will Occupational Health in the UK look in 2036.

I have no doubt that it will be more accessible, wide ranging and more recognised than it is today but also streamlined – meaning almost entirely remote (phone based) – even online… type in your symptoms and let the computer give you the answer and advice.

I hope I am wrong and as a recruiter it’s what I worry about most.

I fear this as breaking into the occupational health industry for a Nurse or Physio or Therapist is very difficult.

I speak with many of these candidates every year who have good skills, some transferable, that want to get into Occupational Health but cant.

The reason is that there are very few trainee opportunities as the large employers do not have the time to do this. It would be great if the biggest employers could set up trainee integration programmes for students and to be fair some have but on a small scale.

The recruitment industry has the same problems now that we have had for the past 20 years – lots of occupational health vacancies – not enough candidates and unfortunately this issue has not been addresses in that time – without relevant training by employers for new recruits who do not have OH experience the job roles will become harder to recruit for.

There has been a recent paper published by Public Health England called “Educating Occupational Health Nurses” see here – Educating OHNs final Oct 2016.

Which for an OH professional is worth reading and hopefully will impact onto employers and the way they look at OH over the next 20 years.