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The Health and Work Service: confusion may reign

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The British Medical Association believes that the Department for Work and Pensions (DWP) description of the new Health and Work Service (HWS) as providing ‘occupational health advice and support’ is unhelpful and confusing. Occupational health is a broad specialty with an emphasis on protecting and promoting the health of people at work, working with colleagues including safety managers. The mainly telephone-delivered HWS offers case management of ill employees, which is only one of many functions of a comprehensive occupational health service (OHS); prevention and promotion being more critical success factors in matters of health and safety.


The Frost/Black review of sickness absence recommended a new Independent Assessment Service (IAS), and the DWP has not created value by changing the name to one less fitting (HWS). By definition ‘health’ is the absence of illness, yet users of the HWS must be ill; there is no preventive element. Confusion risks damaging existing OH provision and diluting support to workers by replacing advice and support from providers who understand intimately the hazards and jobs in workplaces. The economic climate is already pressurising employers to cut costs and OH is an easy target. Some employers are already questioning the need for their current provision of genuine on-site OHS because of DWP’s confusing communications about the mainly telephone-based HWS.

Dumbing down occupational health through messages that it is only about getting ill people back to work won’t help when recruitment into occupational medicine training posts is at an all time low; such messages risk accelerating the decline of the speciality. 

On a more positive note, HML – who won the contract to provide the HWS – have advertised for ‘healthcare professionals responsible for carrying out bio-psychosocial assessments, looking for both occupational health professionals, and healthcare professionals from other disciplines’. This is in the spirit of the IAS proposed by Black and Frost. It recognises the true nature of the assessments and the fact that the service should be provided by a range of health professionals with diverse and relevant skills.

Dr Paul J Nicholson is chair of the British Medical Association’s Occupational Medicine Committee

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