Research and analysis

Summary: Employers’ motivations and practices: A study of the use of occupational health services

Published 2 April 2019

Authors: Sarah Fullick, Kelly Maguire, Katie Hughes and Katrina Leary (Ipsos MORI Social Research)

Background and methodology

Improving lives: the future of health, work and disability outlined the role of good quality occupational health to help disabled people and people with health conditions stay, and thrive, in work, as well as preventing unnecessary sickness absence, presenteeism and health-related job loss.

The Work and Health Unit commissioned Ipsos MORI to conduct qualitative research with employers to understand their motivations and practices when using occupational health support and to explore:

• how employers use occupational health services
• why employers use occupational health services as they do
• why engaged employers do not purchase occupational health services

The Work and Health Unit is a UK government unit which brings together officials from the Department for Work and Pensions and the Department of Health and Social Care to lead the government’s strategy to support working-age disabled people, or people with long-term health conditions, to enter and stay in employment.

Ipsos MORI conducted 35 in-depth telephone interviews with employers in October and November 2018. Participants were business owners, office managers, or HR representatives and quotas were set on size and sector (see Appendix 9.1).

Main findings

What do employers think occupational health services are and when do they purchase them?

Employers had a shared, but basic, understanding of occupational health services. At a fundamental level, they understood the benefits of bringing a qualified expert into an organisation when a situation arose that they felt unable to deal with themselves, either through lack of expertise or because of a need for an independent third party. In practice, employers used occupational health services for a number of different reasons and services, including treatment.

The nature of occupational health provision was affected by a mix of size, sector and the working environment, and the research identified several typologies^{[footnote 1]}:

• reactive purchasers sought ad hoc occupational health support, without permanent contracts, their reasons for not having permanent contracts are covered in section 2.2
• proactive purchasers in office-based environments had permanent occupational health contracts and worked in sectors that did not pose major physical health and safety risks
• proactive purchasers in manual environments had permanent occupational health contracts in order to manage the health and safety risks associated with the nature of their work or workplace

Having permanent contracts in place meant that employers could respond quickly to new situations, as well as proactively support employees through access to services designed to prevent ill-health (such as 24-hour counselling and wellbeing and healthy living guidance).

Six interviews were conducted with employers who had not purchased formalised occupational health services, but in the past year had carried out a range of interventions to support employee health and wellbeing in-house.

What are the motivations for using different occupational health services?

Employers used occupational health to help deal with situations in which they were not sufficiently skilled, and were motivated to provide occupational health services for 3 reasons:

• to comply with legal and regulatory obligations (particularly important for employers in manual environments, where the nature of the work posed a risk to employee health and safety)
• to reduce costs and improve business efficiency (employers understood the costs associated with sickness absence and wanted to limit them)
• to support and improve employee health and wellbeing (employers felt they had a moral duty of care to their employees)

These 3 factors were usually interlinked when employers considered their motivations for using occupational health services. For example, employers who used occupational health services to mitigate health and safety risks did so in order to be legally compliant, but also to avoid (costly) sickness absences resulting from workplace accidents, and because they felt a (moral) responsibility towards their employees.

Whilst legal regulatory compliance may have initially formed the foundations of employers’ occupational health offers, those who felt they had a duty of care that exceeded their basic legal duties had expanded their occupational health offer to include wider health and wellbeing benefits in recent years.

In which situations do employers use occupational health services?

The diversity of situations that occupational health services could be used to support meant that, across the interviews, employers did not have a shared interpretation of what occupational health services could be used for in practice. However, across all the examples shared by employers, wanting to retain employees emerged as the main, overarching reason why employers sought occupational health support. The wish to retain employees encompassed all 3 of the motivating factors for seeking occupational health:

• cost (to avoid the cost of having to replace staff members)
• moral (because employers valued employees and wanted to keep them)
• legal (to ensure any actions they took were carried out in accordance with employment law)

Situations that employers used occupational health services for, and the specific services used

Situations occupational health support was used for:

• supporting staff with mental ill-health
• attracting and retaining talent
• verifying medical statements and health surveillance
• supporting a return to work
• investigating underperformance or poor conduct
• supporting staff with physical ill-health

Occupational health services used:

• Employee Assistance Programme
• counselling
• physiotherapy
• cognitive behaviour therapy
• workstation assessment
• physical health screening or assessment

Why do engaged employers not offer occupational health services?

A small number of employers, who had not purchased occupational health, but were engaged in wellbeing activities, primarily stated they had tight profit margins and could not justify the expense of occupational health, preferring to signpost employees to free resources (such as the NHS or dedicated charities). Lack of knowledge or misconceptions were also evident; these engaged employers had a more limited understanding of what occupational health services actually involved.

Finally, attitudes around employers’ responsibility towards their employees also presented a barrier. Some, in particular small employers, felt that a formal occupational health service ran counter to their ‘family culture’, whereas others felt that providing for their employees’ health and wellbeing was beyond their remit, and that employees should be taking responsibility for this themselves.

Given the small number of these interviews, these findings should be treated as indicative.

How do employers choose an occupational health package or provider?

The personnel involved in these decisions varied depending on the organisation’s structure, and included:

• internal HR teams
• senior management
• external HR consultants

HR consultants were used by smaller employers who lacked the time or expertise to handle human resource issues.

For the most part, employers performed internet searches to choose their providers and, in some cases, the history of how or why they had chosen their occupational health provider was unclear or undocumented. Employers without a permanent contract in place often needed to find an occupational health provider quickly, and would make a shortlist of providers who offered the service(s) they required, were local and, all other factors being equal, chose the cheapest provider.

Reviewing occupational health provision was rare, and the examples were confined to large employers (section 5.1). The factors involved in choosing and keeping a provider were:

• expertise in resolving situations or finding workable solutions, understanding specific job roles and circumstances, understanding the nature of the working environment and any restrictions on adjustments, and producing useful reports
• cost and efficiency covering speed of initial response, efficiency and speed of consultation, and regular communication

In most cases where employers had a contract in place, they relied heavily on their occupational health provider to recommend a package of support. Business needs, whether this linked to compliance or broader business objectives such as productivity, often shaped the type, size and frequency of the package purchased. Where employers had seen increased disclosures of mental ill-health, they had looked to expand their occupational health products to include services such as counselling and employee assistance programmes.

How does the occupational health referral process work in practice?

The process of how an occupational health assessment (an assessment of an employee’s physical or mental health with a view to supporting employees to carry out their role to the best of their ability) worked in practice typically followed the 6 stages shown below^{[footnote 2]}. Employers reported some variation within these stages, depending on their size, relationship with their employees or whether they had an HR function, which are outlined in more detail in the main report (section 6.2).

1. Decision^{[footnote 3]} – the suitability of occupational health is discussed and employee consent gained.
2. Referral – could be self-referral or referral from HR or line manager depending on organisational setup.
3. Assessment – occupational health practitioner carried out an assessment of the employee.
4. Report – a findings report is written, with the level of detail shared up to the employee.
5. Action – any suitable changes may be made. Managed by HR or line manager depending on organisation.
6. Review – an informal or formal review is undertaken.

What do employers think about their providers?

Employers were broadly positive about their occupational health providers. As they used occupational health specialists for situations they felt they either could not or should not handle themselves, they saw their occupational health providers as a source of expert advice and guidance. When asked to consider improvements or tensions within the relationship, employers highlighted the following:

• slow turnaround or delayed responses
• vague or unactionable recommendations
• poor communication and information sharing

What policies do employers have in place?

Most employers did not have a dedicated organisational policy guiding their use of occupational health, rather it was included as part of a wider sickness absence, health and safety, or attendance management policy, reflecting the different uses of occupational health across different types of employers. The level of detail in employers’ policies was minimal (for example, when to seek occupational health support) and, as such, guidance for line managers was not prescriptive. Employers explained that this enabled their occupational health-use to be more tailored and adaptable on a case-by-case basis. For others, the use of occupational health was so infrequent that they did not see the need for a more detailed, formal policy.

Occupational health was often communicated through general all-staff channels. Some employers reported that line managers ought to have a greater awareness of occupational health policies than other staff members. This was because managers would need to know the policy to effectively supervise employees or the hazardous sites in which they may work.

Read the full report Employers’ motivations and practices: A study of the use of occupational health services.

1. These typologies are not intended to be a comprehensive segmentation of employers. They are subgroups emerging from the interviews, with similar characteristics affecting the nature of their occupational health provision. These typologies exist within the study population, and may not be representative of the wider employer population. ↩

2. This process was highlighted during the interviews, and is also a widely-used and accepted process (outside of the research findings). ↩

3. Steps 1 and 2 can be used interchangeably. ↩