Guest blog by Dr Paul J Nicholson OBE
Recently, it is has become commonplace for some organisations to state that only around half of the UK workforce has access to occupational health services; however, the underlying data is unreliable and I propose that access is likely to have been overestimated and that this is attributable to small sample size and a definition of occupational health that is sensitive but not specific.
In 2020, a Department for Work and Pensions and a Department of Health and Social Care research report stated “A couple of the experts estimated that OH services only have 50% population reach currently (this is backed up by DWP research that has shown that 51% of employees have access to OH services provided by their employer currently ”. Data that is based on the estimates of “a couple of experts” sounds rather slapdash; even published peer-reviewed expert opinion being the lowest quality evidence in most evidence hierarchies. What then of the DWP research? This is based on a single survey that deployed a random digit dialling approach to supposedly select a nationally representative sample of 2,013 employees plus 358 employees who had been off work sick for more than two weeks . This is out of a workforce of currently more than 28.3 million, in other words a 0.007% sample. Apart from being a small sample we need to examine how access to occupational health services was defined. Respondents were informed and asked the following: “An occupational health service provides advice and practical support about how to stay healthy in the workplace and how to manage health conditions. To the best of your knowledge do you have access to an occupational health service through your employer?” Considering that occupational health is a poorly understood term, how many respondents might have misunderstood the question and might have confused occupational health with health and safety?
What then of external and internal consistency? Previous research has estimated access to occupational health services (OHS) as being much lower; it being inconceivable that access has improved since. In 2002, an HSE contract research report estimated that around 14% of workers in the UK benefit from comprehensive occupational health (OH) support; defined with greater specificity as “hazard definition and measurement, risk management, health and safety information and training and monitoring health” . Subsequent estimates have suggested that 30-34% of the UK workforce has access to specialized OH care . Interestingly, this level of access is more consistent with secondary data in the DWP report which notes that of employees who were unlikely to use Fit for Work 37% had access to occupational health services at work. The lack of internal consistency (37% vs 51%), albeit based on different samples, should raise additional concerns about the reliability of the estimates. Overall, organisations are best placed to avoid repeating the estimate that around half of the UK workforce can access OHS; it is likely to underestimate the extent of the problem and the urgency to put it right.
- Understanding the provision of occupational health and work-related musculoskeletal services. Research report no. 985 London, DWP/DHSC. May 2020. https://www.gov.uk/government/publications/understanding-the-provision-of-occupational-health-and-work-related-musculoskeletal-services/full-report-understanding-the-provision-of-occupational-health-and-work-related-musculoskeletal-services
- Health and wellbeing at work: a survey of employees, 2014. London, DWP. 2015. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/447127/rr901-health-and-wellbeing-at-work.pdf
- Pilkington A, Graham MK, Cowie HA, et al. Survey of Use of Occupational Health Support. Contract Research Report 445/2002. Norwich. HSE Books. 2002. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/447127/rr901-health-and-wellbeing-at-work.pdf
- Carder M, Money A, Turner S, et al. Workforce coverage by GB occupational physicians and disease incidence rates, 2014;64: 271–278.