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James McMeckan, head of clinical services (occupational health) for HCA Healthcare UK, asks whether occupational health can be part of the solution.
The recently published Milburn interim report focusing on young people who are not in education, employment or training (NEET) makes for uncomfortable reading, warning of a generation which will be lost unless the NEET crisis is addressed.
The headline figures alone are stark – there are almost one million young people aged 16-24 currently not in education or employment. That equates to one in eight young people, and the situation is estimated to cost the UK £125 billion.
Beyond those alarming statistics, the DWP-commissioned report – Young People and Work – further finds that unlike other peaks, the current crisis is “deeply interlocked with health and disability”. Health issues are now a primary driver in determining who becomes a NEET – and who stays a NEET, with many of those who fall into health-related inactivity still remaining in that pattern two years later.
While it does not make detailed proposals on solutions – the next phase of the Milburn review will focus on that, with the current interim serving as the diagnostic review – it signposts steps that can be taken.
A joined-up solution
It outlines a need for a joined-up solution between healthcare, business and individuals. Often considered just a reactive strategy, this need can be met by occupational health – which should be given the platform to play a proactive role within businesses and organisations, including education, helping to stop NEETs from falling into a cycle which could become future-defining.
An occupational health provider, through its team of nurses, doctors and advisors, can and should support on the entire journey, from the recruitment stage all the way to managing wellbeing throughout an employee’s career at a business. Within this, there are a number of practical steps and considerations which can be taken.
Milburn’s report states that there is a structural failure at play in this crisis, with the fit note being labelled as the “poster child” of this issue. His central argument is that fit notes can inadvertently act as a gateway into long-term welfare dependency and long-term NEET status for young people.
Employers say that even when “fit to work” is ticked on forms, they need of clearer guidance on workplace adjustments and realistic return-to-work timelines.
Rather than serving as a barrier, the fit note could in fact be used as a trigger for occupational health intervention, working with the business in proactively referring patients through a pathway giving access to multidisciplinary teams of specialised occupational health doctors, nurses and therapists to assess patients and develop tailored return-to-work plans that are revisited regularly.
It can provide actionable suggestions that employers say are currently lacking from fit notes: real-world recommendations for appropriate adjusted duties, achievable work patterns and roadmaps for phased returns.
The aim is to meet the employee realistically, at a level where their functional capacity to engage in work is.
Supporting wellbeing from day zero
There is a clear opportunity for organisations to start their support for an employee’s wellbeing earlier – even ahead of an employee actually starting work with a business.
Occupational health teams should be on hand to create tailored pre-assessment questionnaires for new joiners to identify any adjustments that may be needed to help employees thrive. These reports should be clinically reviewed – with any medical information staying strictly confidential – and can provide practical advice to employers where appropriate.
It presents a proactive opportunity for employers to make the working environment supportive and inclusive to the individual. Pre-employment checks are not a legal requirement – they cannot be used by a business as a reason to prevent employment.
Day one absence intervention has been found to be effective at managing employee health and reducing absence, with one solution coming via technology.
Systems can be put in place that require employees to call an automated line to report sickness, which is geared up to share recommendations with employers to support the individual back to work when needed.
The automated system takes the responsibility to follow best practice and signposting to support available away from managers – and on to occupational health experts. This opens another window for expert knowledge and support to be provided, again from an early stage.
If health outcomes are to be based on participation in work, then occupational health can, and should, act as a bridge between healthcare, employers and patients to provide a supportive and achievable return to work for young people and prevent long-term detachment.
This shift could help improve health outcomes for the wider workforce – and provide vital services in preventing a lost generation.
