In overall terms, the Review concludes that the current picture of Health and Work in Scotland is a relatively positive one. The economy is moving forward and there are high levels of employment. Significant numbers of employers continue to engage with initiatives such as the Living Wage, Healthy Working Lives and Working Health Services, and a Health and Work Pilot is underway to test a more joined up approach to health and work in Dundee and Fife.
The policy environment is also generally supportive, with recent policy initiatives in relation to Fair Work, Disability and Employment, and Health and Work in the form of this Review, which has been supported across policy portfolios.
There remain, however, a number of challenges that remain to be tackled, including closing the disability gap and the stalling, and indeed reversal of, measures of health improvement, including those relating to work. Moreover, three new challenges are emerging, all of which must be addressed and when taken together present a significant risk for Scotland:
- The nature of work is changing;
- The nature of the workforce is changing;
- The economic environment is changing.
This Review was not established, and nor does it purport, to provide all the answers to these challenges, many of which lie beyond the domain of Health and Work, though in proposing four policy themes and a series of specific recommendations for consideration by Scottish Government, it does seek to identify the interventions in relation to health and work can make a significant contribution.
In broad terms, the recommendations fall into three categories:
- Actions aimed at creating a more coherent approach.
- Areas for increased investment
- Actions to address issues that are not currently receiving focus.
In order to help provide a steer insofar as next steps are concerned, participants in the summative Health and Work Review Workshop held in May 2019 were invited to identify which actions they would like to see taken forward, with six emerging as priorities (figure 6).
2.2 Ensure adequate skills and capacity are in place to support employers improve their workplace health practice - both locally and nationally.
2.7 Ensure a robust regulatory, inspection and enforcement environment.
3.1 Improve the utilisation of the fit-note and the quality of return to work advice provided to employers and employees.
4.2 Fair and Healthy Work to be an explicit priority across all Directorates of Scottish Government and its national agencies.
4.3 Establish a single, integrated National Occupational Health body for Scotland.
4.6 Maximise the role of professionals in the wider health and social care system to consider how they can actively contribute to helping people access, remain in and return to fair and healthy work.
Figure 6 – Recommendations Prioritised at the Health and Work Review Workshop
Whilst taking action on these would be a helpful starting point, it is important to emphasise that improving the health of Scotland's working age population will require long term commitment and investment at a time when economic risks, such as the impact of Brexit, may make the financial environment a challenging one for Government. The economic gains to be derived from delivering Fair and Healthy Work for All make such investment all the more important, though inevitably there will be a lag in terms of seeing those returns materialise. The implications of not making such commitment will, conversely, result in a perpetuation of the adverse economic, social and individual impacts detailed within this report, and given the recent stalling and even reversal of the gains made prior to 2010, a likely exacerbation of these impacts over time. Maintaining the status quo is not, therefore, an option.