Dr Paul Nicholson

Dr Paul J Nicholson OBE considers the role of occupational health in supporting health and wellbeing in the workplace.

With factors such as unemployment and deprivation being familiar public health risks it is sometimes easy to forget that there are significant risks associated with people being in work. 

The risk to people in work may be underestimated because of the decline of heavy industry and the growth of employment in the service sector. Almost 32 million people are in work, so they represent a significant part of the UK population and ought not to be overlooked. 

Furthermore, the activities of those in work can impact upon the health and safety of the public; whether it is passengers on board public transport whose lives are in the hands of the driver or pilot; or communities close to a petrochemical plant or a nuclear power station. 

One of the many key roles for occupational health is to ensure that people in safety-sensitive roles do not present a risk to themselves or others. Another core competency is to monitor the health of workers who are at risk of exposure to hazards at work.

HSE’s latest annual statistics reveal that 1.3 million people who worked during the last year were suffering from an illness they believed was caused or aggravated by their work, of which 500,000 were new cases. A further 0.8 million former workers were suffering from an illness caused or made worse by their past work.

Despite the ongoing exposure to risks at work and the incidence of self-reported work-related illness (which has increased in the last five years) only a minority of the UK workforce can access an occupational health service. 

The occupational medicine workforce crisis was highlighted last year in a report published by an All Party Parliamentary Group. The number of trainee doctors has more than halved since 2006; whilst two-thirds of trained specialists are aged over 50; so, the medical support provided to people in work is severely challenged and set to get worse. 

Austerity in the public sector not only threatens the funding of occupational health service provision; it also affects the ability to provide training. In the private sector, global competitive forces cause employers to do more with less. 

Since providing access to occupational health services is not explicitly mandated by laws and regulations as it is in some other countries occupational health services, being regarded as a ‘cost centre’ rather than a ‘profit centre’ can be among the early casualties, further depriving the working population of specialist support.

In light of the crisis and being aware that we need to convince employers and policy makers that occupational health adds both tangible and intangible value, the Society of Occupational Medicine published a report Occupational Health: the value proposition. It is accompanied by lay summary leaflets for workers and their representatives, managers and HR personnel, and directors and commissioners of services. 

The report synthesizes the evidence from the best quality studies that are available to examine the evidence for the effectiveness of various health interventions and argues the business, financial, legal and moral imperatives for providing access to occupational health services. 

The main benefits that occupational health services provide are summarised in the table below.

Employees Employers Society
Protect and promote health Help reduce sickness absence Reduce NHS care costs
Help prevent work-related illnesses Improve business performance Reduce the cost of state benefits
Manage return to work after illness Avoid litigation Increase tax revenues
Maintain earnings Improve corporate image Revitalize the UK economy
Maintain quality of life    






By keeping people healthy and in work we reduce preventable ill health which not only reduces the burden on the NHS, it maintains people’s earnings and avoids business interruptions. Both optimise contributions to the state through increased tax revenues, which among other things are used to invest in health and social care and in public health programmes for the entire population.

Hence the value proposition derived from the body of evidence is that ‘occupational health specialists enhance employee health, workforce productivity, business performance and the economy’.