“Dame Carol Black Report on Britons' health at work”

Working for a Healthier Tomorrow – Dame Carol Black’s Review of the health of Britain’s working age population 17 March 2008. Read the full report here: link

As reported in Personnel Today Online link, where the full text of these extracts from the article can be read, Dame Carol Black the head of Royal College of Physicians has publised her report to the DH and the DWP, and the national debate that it has generated, should provide an opportunity both to restructure the discipline, and determine where its future lies, and to address societal health issues that were first raised by Sir Douglas Black in his radical assessment of inequalities in health in the UK population in the 1980s.

The report is perhaps more cautious than the controversial, and takes account of more than 260 responses including Stand to Reason’s contributions. One of her specific reccomendations is that the government should encourage and support high-profile campaigns to tackle workplace stigma about ill-health and disabilities, particularly mental ill-health, and encourage employers to be more willing to employ staff with health conditions.

The report contains no prescriptive answers but clearly identifies weaknesses in the current arrangements in the UK. In particular, the separation of the occupational health system from the NHS and the lack of the cross-professional collaboration needed to tackle common health problems are identified as significant problems.

Key points

Supporting the health of working age people requires the co-ordination and integration of a range of professional disciplines
A new Fitness for Work pilot scheme drawing on the biopsychosocial model, to provide OH support under the NHS banner, is proposed by the Black report
Services would range from physiotherapy to counselling on matters such as debt and personal relationships
There has, to date, been no clear business case for wellness programmes in the UK
Demographic, societal and economic factors increasingly underpin wellness programmes in many leading UK employers.

The business case

While US employers have been encouraged to invest in employee health promotion and wellbeing schemes for some time, there is little good quality evidence relevant to the UK on the cost and benefits of such interventions, Carol Black says. That is one of the reasons that only pilot schemes and trials are being proposed in her report. However, one of three principal reports commissioned by Carol Black for her review (to be published as a supplement to the main report) is an analysis of the health and wellbeing interventions undertaken by 55 UK employers that provides strong evidence of the business case for investing in such interventions.

A report prepared by PricewaterhouseCoopers link, comprises a series of anonymised case studies and the development of a model for evaluating health interventions and their impact on organisational performance for example, how data on sick leave, absence, and staff morale can be used to demonstrate the value of health promotion activities.

PWC concludes that, although there “is no clear business case that demonstrates wellness programmes have a direct financial return” to a business, “demographic, societal and economic realities” increasingly under-pin wellness programmes in leading UK companies.

Pilot services

The Fitness to Work scheme would be an “early intervention vocational rehabilitation service” to help tackle long-term absence from work. If the proposal is accepted by the government, the scheme would run on a trial basis, providing case-managed, multidisciplinary services encompassing treatment, advice and guidance for people on long-term sickness absence and “could generate significant savings for the economy”, the report suggests. Services envisaged include:

Exercise and physical training and activity
Cognitive behavioural therapy and counselling
Educational elements, for example on back care
Physiotherapy
Occupational health interventions, including assessment of appropriateness of returning to work, for example, workplace risk factor assessment and modification
Debt advice and counselling
Relationship advice and counselling
Continuation of self-care and self management.
The role of GPs

Carol Black’s report believes that, if such services were widely available on the NHS, occupational health services could be available to all people of working age. Such an early intervention service would tackle the market failure that has resulted in limited access to high quality occupational health services that employees of smaller organisations typically experience. Individuals, employers and healthcare professionals must be encouraged to widen their traditional responsibilities and the public sector must set an example through its own policies and practices.

The review suggests that GPs should be able to refer working age people to services that not only focus on medical interventions, but also deal with the necessary non-medical interventions to enable a return to work, for example, liaising with employers over reasonable adjustments to jobs.

Carol Black accepts that this form of referral does not easily fit in the current NHS service framework but her recommendation is that consideration needs to be given to developing a new, broader speciality that takes on such responsibilities.

The government is expected to respond to Carol Black’s recommendations in the summer.