Guest blog by Dr Lara Shemtob
The government have acknowledged the gap in occupational health provision (OH), in the Spring Budget. This includes a focus on digital solutions for MSK and mental health. Digital solutions could offer large scale prevention, employee monitoring and early therapeutic approaches to organisations. However, digital solutions are not a replacement for OH support.
Key issues are:
- The value of human-to-human discussion on complex issues. OH involves people discussing complex issues, which introduces a further set of variables around fitness to work and risk to self and others through work that digital technologies may be unable to safely manage. In most cases where ill health is affecting function to the extent an individual’s ability to work is affected, specialist nuanced decision making specific to that individual’s health and work circumstances is required.
- Do digital solutions have impact? Large-scale roll outs of digital employee wellbeing initiatives took place during the COVID-19 pandemic within the NHS workforce. Results of the NHS staff survey and sickness absence data published by NHS Digital suggest these did not materially help the health or productivity of the workforce, where there remains a 10% workforce deficit.
- Are digital approaches evidence based? While the National Institute of Health and are Excellence has a framework and process for evaluating health technologies, this has been developed and is being deployed with respect to health, rather than employment outcomes. Digital technologies in the work and health space need to be built with a way of negotiating and balancing health and work outcomes.
- Accessibility - Digital technology may not access those most in need.
- Ethical considerations - Information shared with OH services is treated as confidential. If digital technologies offering health interventions are collecting data that is being used for purposes outside the context of therapeutic support, for example for productivity monitoring, this may be unethical.
Here is a case study:
Steve is a 45-year-old man who works as an NHS healthcare assistant doing 3-4 12 hour shifts per week where there is occupational health (OH) access. Steve has another role, doing nights at a residential care home with no OH access.
- In a setting with OH - His NHS manager has noted a change in behaviour and refers to NHS OH. The OH clinician assesses Steve and realises he symptoms of psychosis and it may not be safe for him to be at work until his mental health improves. Working day and night is likely to have affected his mental health negatively. The OH doctor communicates with his NHS manager that Steve is not fit for work, and signposts Steve to his GP for a psychiatry referral.
- In a setting without OH but with access to digital technologies to support mental health at work - Steve’s manager at the residential care home also notes his behaviour has changed. She speaks to Steve who informs her he is going through a period of mental illness but he wants to keep working where possible as he needs the money. The residential care home is also short of staff so his manager cannot easily backfill his rota. Steve’s manager refers him to a digital technology for evidence based mental health support. Steve continues working at the residential care home, even though it may put him and his service users at risk while he is living through a period of psychosis.
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Comment from ORCHA
Digital health offers a huge opportunity to transform how we prevent and treat health concerns that are preventing people from working. The three most pivotal elements are:
- Choice of digital health technologies – There are more than 350,000 digital health technologies designed to support people. They are not all designed equally, the clinical safety, data security, and usability vary significantly. NHS teams need to ensure the very best-in-class products are commissioned. As both the market and products themselves are dynamic, there should be a continuous process to assess current digital health technologies and reassess those that meet defined standards and regulations, such as those outlined in the NHS Digital Technology Assessment Criteria.
- Putting the patient at the heart of the decision – There is no single mental, musculoskeletal or cardiovascular health app that will work for everyone. A national digital health formulary, echoing the British National Formulary for medicines, is required to ensure the right product is selected for each person, at the right time in their care pathway, to achieve the best possible outcome for them.
- Safe delivery and governance – Safety is paramount at every step of the process. From educating the staff who will be selecting a digital health product, such as an app, to electronic delivery of the recommendation, and tracking for product recall or providing supplementary information on its use.
The budget sounds like a big sum, but without these core elements, the impact digital health delivers will not be realised.
Liz Ashall Payne, CEO, ORCHA said: “We must ensure the right technology is given to the right person at the right time. There are more than 350,000 digital health technologies designed to support people, but only 20% meet quality thresholds, and there is no one app that will help everyone. Occupational health teams and the NHS need to establish the core infrastructure for digital health that has long been in place for medicine, including awareness, trust, access and governance.”