More words or an ambitious programme for action?

A new government strategy to improve the health of the working population seeks to break the link between ill health and economic inactivity. But is it just more words on paper?

The government says that its new health, work and wellbeing strategy¹, and the appointment of a new national director for occupational health, are a crucial part of delivering its commitment to improving the health of the working population.

This commitment is a central element of a wider welfare reform agenda and is designed to help implement other government and agency initiatives, including the Health and Safety Executive's (HSE) strategy.

The health and wellbeing strategy is described as "an ambitious agenda" by its two sponsoring government departments, the Department for Work and Pensions (DWP) and the Department of Health (DH). It is, they say, "far more stretching than any commitments of previous governments and more wide ranging", placing responsibility with employers, individuals and healthcare professionals, in addition to government.

The strategy aims to break the link between ill health and economic inactivity, to advance the prevention of ill health and injury, to encourage good occupational health management and to transform opportunities for people to recover from illness "while at work" (presumably government shorthand for "while still in employment but perhaps on sick leave").

The government believes that, although lots of good work is already being done in this area, a strategy is needed to bring it all together. The strategy's implementation will be led by a new director for occupational health, whom the DWP and DH hope to appoint by early 2006, and will include the creation of a national charter for health, work and wellbeing by next summer. This will set out the contribution of all stakeholders in delivering what the government sees as a "transformation" in occupational health.

A joint DWP/DH ministerial group has been set up to coordinate the delivery of the strategy. This group is already looking at a number of key parts of the strategy, including improving access to services for the management of common mental-health problems, and engaging GPs to transform culture, attitude and practice in the management of workers' health. It is also examining ways of narrowing the gap between treatment and return to work, and ensuring that the NHS and other public sector employers are exemplars of good occupational health practice.

The aims of the strategy, and the benefits the government hopes it will bring to individuals - including swifter treatment and better access to occupational health support - are familiar ones, and in some cases are already being addressed by other strategies, initiatives and pilots launched over the past two years.

Engaging stakeholders

The DWP and DH will create a National Stakeholder Council to support the strategy and will hold a stakeholder summit early in 2006. A charter for health, work and wellbeing will also be published, to which key stakeholders will be invited to add their names, setting out their role and contribution towards health and wellbeing at work. The charter, which will be published by spring 2006, will incorporate a detailed action plan to encourage progress.

The government also plans to initiate a national debate and support the creation of local stakeholder councils, the members of which will act as champions for services targeting the health and wellbeing of workers. Work is already taking place to define a healthy organisation framework that can be built into the Investors in People standard in line with the government's public health white paper commitment.

Improving working lives

NHS Plus, a scheme under which NHS occupational health units sell their services to other employers, is set to expand as a result of the new strategy. The government's Choosing Health public health white paper sees NHS Plus working more closely with the HSE to provide health, safety and return-to-work advice to small and medium-sized enterprises in particular. Creating healthy workplaces is central to improving working lives, and the strategy outlines a range of plans in this area:

A new service called Workplace Health Connect will be set up to provide smaller employers with access to free advice on health, safety and return to work, supported by regional services offering free workplace visits. This service is to be delivered in partnership with the HSE, which has already announced the contracting of such a service.

The government has also announced that it intends reviewing the medical statement for Statutory Sick Pay purposes to make it more "user-friendly" for GPs and to ensure it provides enhanced advice for patients.

The government has reiterated its previous statements that public sector employers should lead by example in the provision of occupational health support to employees. It will define quality standards for occupational health in the public sector and promote its take-up of the HSE stress standards. The strategy also states that public sector employers will develop employment policies and practices to make a better, healthier public sector workforce.

Healthcare for workers

The part of the strategy dealing with healthcare for people of working age will focus on improving services for people with common mental-health problems, providing work-focused treatment in the NHS more generally, vocational rehabilitation and the training of healthcare professionals.

Improving the supply of NHS services for the increasing number of workers with common mental-health problems is key. But reducing delays and waiting times for appropriate psychological therapies has significant resource implications, and there is no sign that these will be forthcoming from the Treasury.

Indeed, one of the overarching principles of the new health at work strategy is that it must be delivered "within the current financial resource constraints". This means that there is likely to be little new money for any of the initiatives contained in the strategy, placing the onus on employers and other partners and stakeholders to fill the gap. The government sees its role as an enabler and leader, promoting collaboration between others, but not actually bringing forward the resources to tackle the fundamentals of workplace health - for example, by providing workers with quick access to NHS physiotherapy and counselling.

¹Health, work and well-being - caring for our future, DWP, DH and HSE, 2005, www.dwp.gov.uk.

This article was written by Sarah Silcox, a freelance writer and trainer on employee health issues, sarahsilcox@waitrose.com. www.sarahsilcox.com.