Rammya Mathew: We can’t overlook the backdrop as Britain becomes “a sicker nation”
BMJ 2024; 385 doi: https://doi.org/10.1136/bmj.q956 (Published 30 April 2024) Cite this as: BMJ 2024;385:q956
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Dear Editor,
This is a welcome and insightful reflection on the increasingly important issue of economic inactivity, for people, employers and the economy. What should be done and why? The issue is complex, and expanding access to occupational health specialist advice is welcome; for those who can and want to work (many) personalised advice to help them and their employer is essential. However, many are struggling with physical and mental health challenges, and it is access to clinical interventions that are needed, not punitive sanctions that only increase presenteeism, and certainly do not contribute to productivity.
While making employers accountable for managing health risks from and to their work make sense, the issue of trust (who trusts who) and advocacy (who is advocating best for the individual) will only be resolved when there is a much closer relationship between health professionals in primary care and occupational settings, both lobbying for better work, and better access to care, for individuals, and workplace cultures that encourage engagement, offer fulfilment, enhance wellbeing and deliver the productivity needed to pay for it.
Competing interests: I am a past president of UK Faculty and Society of Occ Med and former VP Health for Bp plc
Dear Editor
The backdrop is a great deal starker than Rammya Mathew portrays it. Austerity measures from 2010 onwards effectively denied the NHS £500 billion in annual uplifts. Reducing the average uplift from 4.9% to 1.9% for 10 years, along with failing to provide any capital projects has eviscerated the health service and condemned millions to poor health and disability.
No other organisation responsible for the lives of individuals is allowed to function so desperately understaffed and under resourced. If Rolls Royce Aerospace does not have the requisite number of staff when building aircraft engines, it ceases work until it can proceed safely. Yet not so the DHSC, which has overall responsibility for ensuring safe working practices.
Why, I wonder, do our political leaders think it is acceptable to deny us good health? For what possible reason can that be tolerated? People’s lives are destroyed by pain and sickness. Is it really any wonder they are anxious and depressed?
If the Government wants to boost the country’s productivity to grow the economy, the answer is NOT to demonise those whose lives have been ruined by the political choices of that very same Government. Give back the missing £500 billion in one way or another - or enough of it to bring the NHS back up to functioning capacity.
To create wealth, you need a healthy workforce. To return the workforce to good health, the NHS must be funded to a degree which allows it to respond speedily and well. Only by repairing what has been broken will people get back to work.
No health - no wealth.
Competing interests: No competing interests
Medice, cura te ipsum (physician heal thyself) – Illness Might Lie in thine Eye
I read with interest and bemusement, Mathew’s opinion column [1] and Heron’s response [2]. While both point to the complexity of the situation, the elephant in the room, that work is a ‘bad’, i.e. the opposite of leisure, and is avoided where possible by players, fails to find mention, let alone cursory treatment. I disagree that this nation, with its heritage including the industrial revolution, that historically labelled its colonial subjects - ‘the natives’ - in far off lands as ‘lazy’, is currently severely afflicted with a genuine outbreak of illness within its shores affecting ability to work.
In my Occupational Health clinic, I find a surfeit of the same ‘causes’/’diagnoses’ among workers: aches and pain, ‘anxiety and depression’, PTSD and the new kids on the block, ‘autism’ and ‘ADHD’ day after (livelong/groundhog) day. When I started training in psychiatry in the UK in 2007, I was shocked at the sheer volume of ‘illnesses’ that have no counterpart in the third world. While serious mental illnesses (SMI) such as schizophrenia were the same as in India, worryingly, bad life choices, poor judgement and simply bad behaviour, were being conveniently labelled as one mental illness or another. Interestingly, social acceptance and celebrity endorsement of ‘mental health’ has led to rich pickings for the mental health-occupational health industrial complex, that claims to ‘diagnose’ and ‘treat’ the ever expanding ‘patient’ population. The fact that other first-world economies exhibit similar trends, does nothing to mitigate the curse of the current trend of physicians to bleat "baa" with the rest of the sheep. As a scholar and rational observer of such phenomena, I am inclined to say to myself, ‘bah, enough humbug’ and ‘industry-speak’.
Although a GP and an operative from the occupational health industry working closely as suggested, sounds nice on paper, my concern is that given social and industry pressures, both parties are liable to collude, to the detriment of the tax-paying public. Despite claims of efforts to support a return to work, in my experience over the past 12 years, the commercial Occupational Health industry actively assists employees in (over)claiming against their overly generous sickness absence provisions to protect their own revenue stream. Given such perverse industry incentives to ‘work the system’ [3] and corresponding disincentives for workers to work, I find that those with little/no thought to the societal consequences of their actions, self-select themselves into the specialty of Occupational Health (adverse selection). The ‘moral hazard’ of workers/Occupational Health providers, combined with ‘adverse selection’ involving workers and ‘commercially aware’ Occupational Health industry players, remains a deadly detriment to the nation’s economic health.
Turning to my favourite topic of work, I estimate that if I were to only turn up for work when I felt brilliant, it would perhaps be 2 days a year. It would come as shocking news to many, but professionalism includes doing things that you would sometimes much rather not. In my days working in concrete specialties such as surgery and intensive care, especially in the wee hours of the night, I performed procedures or prescribed medication, not because I was feeling wonderful to be awake at night, fighting sleep, irritability, tiredness and even headaches, but because someone needed my ministrations, so I needed to extricate myself out of the ‘me, me, and only me’ mode. I dare to believe that thousands of patients over the decades have benefited and continue to benefit from my ‘diagnosis’ of ‘presenteeism’ (yet another non-existent ‘disease’, YAND), and have the audacity to continue to believe, that people who are sufficiently safe to be at work, should turn up and contribute.
References
[1] Mathew R (2024) We can’t overlook the backdrop as Britain becomes “a sicker nation”. BMJ 2024;385:q956. doi: https://doi.org/10.1136/bmj.q956
[2] Heron R (2024) Closer relationship is needed between primary care and occupational settings. BMJ 2024;385:q1238. doi: https://doi.org/10.1136/bmj.q1238
[3] Chind A P (2023) Genuine Occupational Health, Yes! More of the Same White Satanic Mills, No! https://www.bmj.com/content/381/bmj.p1291/rr
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 including private/private sector and government departments. He is a campaigner for the reduction of inequality in training and employment opportunities for 'migrant' doctors and the introduction of integrity into the commercial assembly-line style provision of 'occupational health' 'services' by UK commercial companies. Thanks to existing policies on the recognition of professional competencies, Dr Chind works in the shadow economy of 'undocumented doctors' as an alleged non-specialist ‘Locum’ Consultant Occupational Physician at NHS Trusts and other organizations under precarious work conditions. As an incorrigible optimist, Dr Chind remains grateful for the abundance of study material for his research into the enduringly fascinating regulatory, anti-trust and labour market phenomena in the UK. As always, Dr Chind is available to assist His Majesty King Charles III, the UK government's Department of Health/Prime Minister's Office to address issues raised in the above.