Guest blog by Dr Paul J Nicholson OBE, Chair, APPG Report Writing Committee
Throughout this decade our professional bodies have repeatedly expressed concern at the falling numbers of occupational medicine specialists. In 2006, the number of OM trainees peaked at 154 (compared with 129 in 2000). The Faculty’s Annual Report for 2018 shows that numbers have continued to fall, being 72 in 2018 compared to 83 in 2017. The Faculty notes obstacles such as limited HEE funding, changed models of service delivery and declining numbers of specialists able to train trainees. The problem persists despite raising these issues repeatedly in the last decade. The Faculty influenced various parties to provide encouraging words. In 2011 the Centre for Workforce Intelligence (CfWI) reported that there were significant recruitment issues and in 2014, the Chief Medical Officer (CMO) England recommended that the numbers of doctors being recruited into occupational medicine should be extended; but to no effect. The BMA Occupational Medicine Committee (OMC) wrote to the CfWI and CMO at the time. In 2015, Health Education England (HEE) committed to the OMC to examine the costs of fully-funding OM training posts, as it had done for palliative care. Colleagues at the Faculty had heard it all before. So, in 2016, OMC approached the All-Party Parliamentary Group (APPG) on Occupational Safety and Health to highlight the facts that half of OM trainee posts had disappeared while two-thirds of specialists were aged over 50 and approaching retirement. The APPG agreed to publish a report and OMC recruited a cross-organisation writing team comprising ALAMA (Geoff Denman), ANHOPS (Blandina Blackburn), BMA (Paul Nicholson), FOM (Richard Heron), HEOPS (Nigel Wilson), RSM (Lisa Curran) and SOM (Robin Cordell & Nick Pahl). On 18th October 2016 the APPG published Occupational Medicine Workforce Crisis. Among other actions the report recommended that HEE and its equivalents fund a model that meets the requirement for training posts and that government and insurers explore how to best incentivize employers to provide access to OHS. In November 2016 the APPG Chair, Ian Lavery MP (Labour, Wansbeck) tabled a question to ask what steps government intended to take to ensure the OM workforce meets future demands. The response that HEE would consider reports such as the one produced by the APPG felt like going around in ever decreasing circles.
One would have hoped that the APPG report would have triggered a succession of parliamentary questions, but all was silent until this year. Perhaps government has been paralysed by the outcome of the 2016 Brexit referendum, purdah and the 2017 general election; indeed, one is hard-pressed to identify concentrated focus on anything in Westminster other than Brexit. A series of pertinent written questions were asked in March 2019. Martin Vickers MP (Conservative, Cleethorpes) asked six questions relating to plans to require employers to contract OHS and the potential costs to business; assessments of the quality of (a) OHS and (b) SEQOHS; the average cost to an employer of contracting a physician-led OHS; the potential growth of the OH market should all employers contract an OHS; financial incentives to encourage employers to invest in services to facilitate return to work; and the contribution of OHS to the economy. Ben Bradley MP (Conservative, Mansfield) also asked two questions in March 2019 regarding what estimate DWP had made of the current shortfall in the number of OH professionals and what steps the Government was taking to encourage employer uptake of OHS. The responses to all questions indicated that DWP had commissioned research to better understand OH provision and that proposals would be set out in a consultation exercise in 2019. Ben Bradshaw was also advised that the APPG and the Council for Work and Health (CfWH) highlighted the need to address OM workforce capacity in reports in 2016. In May 2019, Norman Lamb MP (LibDem, North Norfolk) and SOM Patron asked when DWP planned to launch this consultation and was advised it would be later this year – but notably on measures to encourage and support employers to retain and reintegrate employees who are struggling with their health or who are off sick.
The consultation Health is everyone’s business: proposals to reduce ill health-related job loss has been published. As the title suggests its focus is on taking action to reduce ill health-related job loss. The consultation acknowledges the APPG and CfWH reports concerning OH workforce shortages which risk limiting future capacity to deliver services. Its own interim research reported that 44% of OHS are unable to fill roles, typically clinical roles such as nurses and doctors. Clearly, we still have to do more work to apprise government departments of the broad services provided by OHS. Is it likely that ministers will be more receptive to this and other advice going forward? It doesn’t seem likely given the current state of UK politics. With the prospect of further purdah at some stage even current initiatives might flounder. Faced with such adversities it has never been so important that everyone pulls together and focuses activities on defending and building the specialty. This will need a raft of measures; which should include finding ways to engage more OH professionals in activities to promote OH where they live and work. To take words from JF Kennedy’s inauguration address “ask not what your professional bodies can do for you - ask what you can do to protect and grow your specialty”.