Guest blog by Dr Paul J Nicholson OBE
The SOM report Occupational Health: The Value Proposition (OHVP) collates the evidence to substantiate the business, financial, legal and moral imperatives for providing employees with access to occupational health services. This broad approach to ‘value’ is driven in part by the substantial challenges presented by economic analyses; publication bias and low-quality research. Often occupational health interventions such as health surveillance are just one element of a multifaceted prevention programme, making it difficult to determine cost-effectiveness of one component.
Ironically, some of the best OH advocacy data comes from organisations that get it wrong rather than those who do it right. The OHVP discusses the quality management term the cost of non-conformance (CONC) – the cost of failing to deliver a quality product or service. CONC is well understood in industry supply chains, as is zero defects i.e., the principle of doing it right first time. Examples of cost increases could include scrapping or re-working a manufactured item and re-testing employees in a health surveillance programme because equipment wasn’t calibrated.
A recent Employment Tribunal Mr V Filipovich v East and North Hertfordshire NHS Trust: 3327833/2019 evidences one element of CONC, here the award of £101,906.50 in compensation to a doctor who suffered from post-traumatic stress disorder after serving in Bosnia and who was dismissed from his job. The Tribunal found the Trust was at fault for breaching its own ill health and sickness policy by not seeking an up-to-date occupational health report and for failing in their duty to offer an alternative role instead of dismissing him. The Tribunal found that “no other reasonable employer …. would fail to investigate this further by way of seeking a report from their own occupational health department, particularly when the Respondent is an NHS Trust, and we find that on this issue alone it meant the investigation fell outside the range of reasonable investigations of any other employer”.
The compensation award of £101,906.50 is only one avoidable tangible cost. The OHVP includes a table that describes various tangible and intangible employer costs that can be eliminated by providing employees with access to an effective occupational health service. The Trust’s legal costs would have been substantial since it deferred to legal opinion rather than seek an OH report and was represented at the Tribunal by counsel. The costs of management and human resources time spent on the case and the Tribunal would have been significant and could be quantified. Intangible costs include the impact of the doctor’s health, employee relations and corporate image. It would seem to conservative to suggest that the total CONC was at least double the amount of compensation. Conversely, in contrast, the cost of seeking an up-to-date opinion from the Trust’s own occupational physician would have been trivial.
The recent case should remind us all that employment tribunals and HSE prosecutions can provide useful CONC data that we could use to help further the case for the value of occupational health. Individually, as SOM members we could do our bit to help strengthen the case by forwarding to the SOM office any cases that come to our attention including anonymised personal cases that you know from your own practice. I encourage everyone to help build the database as much as they can.