Recent trends indicate that spending on outsourced services is growing faster than in-house services. This has been attributed to a structural change in the employment sector, with the decline of large manufacturing and former nationalised industries replaced by growth in medium-sized service companies.

Long-term sickness absence is estimated to cost private sector businesses in the UK a total of £4.17 billion a year, and is set to reach £4.81 billion a year by 2030. This makes it important for employers to work with staff to manage their return to work, maintain morale, and invest in their wellbeing.

In 2018, the UK market for occupational health provision is estimated to have grown by 8%, with the market projected to be worth £900 million.

This report covers the UK occupational health market and occupational health is defined as ‘healthcare provision provided in the workplace, and includes both specific health and safety care, and broader issues of health, fitness and preventative health care, often referred to as wellness’.

There remains much debate and confusion over the precise definition of occupational healthcare, and the boundaries of the sector remain vague. According to the joint International Labour Organisation/World Health Organisation Committee on Occupational Health, occupational healthcare is aimed at the following:

“The promotion and maintenance of the highest degree of physical, mental and social wellbeing of workers in all occupations; the prevention amongst workers of departures from health caused by their working conditions; the protection of workers in their employment from risks resulting from factors adverse to health; and the placing and maintenance of the worker in an occupational environment adapted to his/her physiological and psychological capabilities.”

The Health and Safety Executive (HSE) suggests “The term 'occupational health' conveys different things to different people. For some, it means simply the prevention and treatment of illness that is directly related to work, in which health education has no place. Others will emphasise fitness for work issues separately from health and safety. However the impact of any sickness absence on SMEs and their employees does not brook such fine distinctions. In those terms, it is of little importance whether the sickness is the result of an accident at work, long-term exposure to risk, or the conflicting demands of home and work. Only a holistic approach can make a difference to health inequalities.”

The HSE reports that occupational health can embrace:

• The effect of work on health, whether through sudden injury or long-term exposure to agents with latent effects on health; and the prevention of occupational disease through techniques, such as health surveillance, ergonomics, and effective human resource management systems;

• The effect of health on work, bearing in mind that good occupational health practice should address the fitness of the task for the worker, not the fitness of the worker for the task alone;

• Rehabilitation and recovery programmes;

• Helping the disabled secure and retain work;

• Managing work-related aspects of illness with potentially multi-factorial causes, such as musculoskeletal disorders and coronary heart disease, and helping workers make informed choices regarding lifestyle issues.

The CIPD defines occupational health as:

“Occupational health is a specialist branch of medicine focussing on health in the workplace. It is concerned with the physical and mental well-being of employees. Occupational health specialists can support organisations through advising on work-related illnesses and accidents, carrying out medicals for new starters and existing employees, and monitoring the health of employees.

Occupational health services are also used to assist organisations in managing absence situations – both short and long term. The opinion of an occupational health specialist might be crucial in determining how to manage a capability issue, and can be key evidence in a claim to an employment tribunal.

Only large organisations are likely to employ their own occupational health specialists. Most organisations will contact an external provider of occupational health services as and when they need it. In some organisations there will be an employed full-time nurse who has training in occupational health. This might be supported by a part-time doctor who comes to the organisation to carry out medicals and other assessments. Other organisations, particularly those working in hazardous areas, are more likely to employ their own doctor.

The level of provision is likely to be determined by the size of the organisation and the nature of the operation. An organisation that operates in a particularly hazardous area is clearly likely to need more occupational health support than other organisations.

The interaction of employees with occupational health will largely depend on the presence of the service. If there is a full-time service on site then employees are more likely to make ad-hoc use than if the service is only available at specified times. It is important that employees are clear about the nature of the service, and see the distinction between what is offered by occupational health and what they should refer to their own GP.”

As well as addressing issues that occur, occupational health services should also be proactive, aiming to reduce potential problems in the workplace. The activities of occupational health are therefore likely to include:

• Implementing policy

• Ensuring compliance with health and safety regulations

• Minimising and eliminating hazards

• Dealing with cases of drug and alcohol abuse, and advising on HIV/AIDS issues

• Offering pre-employment health assessment

• Maintaining relations with appropriate bodies and individuals

• Monitoring the health of employees after an accident, illness, and during and after pregnancy

• Managing clinic facilities, basic health checks and first aid

• Advising on medical severance and ill-health retirement

• Advising on ergonomic issues and workplace design

• Promoting good health education programmes

• Promoting healthy eating

• Monitoring symptoms of work-related stress

• Providing advice and counselling

• Working with special needs groups

The occupational health service is provided by a diverse range of practitioners, including physicians, hygienists, psychologists, ergonomic experts and occupational health nurses.

Occupational health is likely to work closely with HR and those responsible for health and safety in organisations. However, for occupational health to have the greatest impact, it is important that line managers feel able to approach occupational health advisers to discuss any concerns or issues.