Lara Shemtob academic clinical fellow in general practice and occupational health physician, Kaveh Asanati professor in occupational health and consultant in occupational medicine, Shriti Pattani president of the Society of Occupational Medicine and consultant in occupational medicine
Shemtob L, Asanati K, Pattani S.
Why occupational health should be universally accessible
BMJ 2023; 381 :p1291
doi:10.1136/bmj.p1291
Genuine Occupational Health, Yes! More of the Same White Satanic Mills, No!
Dear Editor
I am concerned that Shemtob et al have effectively made an argument for more government funding for private provision of Occupational Health (OH) services.
Due to policies of the Faculty of Occupational Medicine that restrict the supply of ‘accredited’ specialists, and given higher pay and perks offered by private industry, many NHS organisations are unable to recruit ‘Consultant’ OH Physicians (OHPs) for their own staff. I therefore wonder how Shemtob et al hope to realise their aspirations for widespread OH provision to the public. Interestingly enough, labour shortage is not the only ill that afflicts the specialty. There is a pressing need for a version of the Clean Air Act for the moral environment in Occupational Health.
When William Blake penned the hymn 'Jerusalem', popularly recognised as an alternative English anthem, he is unlikely to have had any contemplation that the negative externalities of smoke and grime from manufacturing industry:
“And was Jerusalem builded here,
Among these dark Satanic Mills?”
would be supplanted by a white collar version of negative externalities, a little over two centuries later.
Nowadays, the greatest occupational hazard faced by UK employees and their trade unions, is the moral hazard of claims for sickness absence against their overly generous employer-provided sickness absence allowance (6 months full pay, 6 months half-pay) policies. In response to the demand for this paid leisure time, a corresponding moral hazard has been imposed on managers who see OH as merely an administrative convenience to rebrand employee absence claims as genuine. To add to the unwholesome mix, Occupational Health entrepreneurs have cashed in, exploiting the total lack of government regulation to set up medical (Occupational Health) report mills that crank out reports by the thousands each day. Interestingly enough, due to another corruption-friendly device, such OH companies even have their own ‘Responsible Officer’ to create paperwork attesting to ‘professional integrity’.
In my 10 years of working in the Occupational Health industry, I have found that often, an OHP or Nurse (OHN) denies an employee claim, to their own professional detriment. In an abuse of the complaints process, employees - often hand-in-glove with their unions - attack the personal and/or ‘professional reputation’ of anyone who does not play ball. I have had the unpleasant experience (and know of other doctors with similar experiences) of being forced out of/let go from jobs after raising concerns about such perverse business practices.
In my experience, the liberal issue of sickness-absence-validating OH reports leads to a sense of injustice and poor morale among staff who cannot bring themselves (due to religious/ethnic/moral values) to make such claims. The brunt of the sickness absence burden therefore falls on ethnic minorities who deem it beneath themselves to claim ‘aches’, ‘pains’ and ‘anxiety/depression/PTSD’ as reasons for staying off work. Due to the ill-treatment - via the complaints process - meted out to OHPs by employees and their unions and upheld by ‘commercially aware’ Medical Directors and Responsible Officers, the befouled moral work environment for OHPs in UK private companies is the very embodiment of the 'dark satanic mills' for our times.
The Society of Occupational Medicine (SOM) and Faculty of Occupational Medicine (FOM) are in dire need of reform not only to introduce some genuine diversity of opinion, inclusiveness and leadership among their ranks but also to introduce integrity into unregulated ‘Responsible Officer’ led Occupational Health companies.
As always, I am available to advise the SOM/FOM/UK Department of Health on measures to address the issues that I have highlighted.
Competing interests: Dr Chind is a paid employee and director of Proshen Consulting, a consultancy that offers policy advice based on sound principles of economics and law, to client organisations. He is a campaigner for the introduction of integrity into the commercial assembly-line style provision of 'occupational health' services by UK commercial companies. Until a few months ago, Dr Chind was serving as a ‘Locum’ Consultant Occupational Physician at an NHS Trust, under precarious work conditions.