Policing is changing. The police uplift program aims to recruit 20,000 police officers over three years. The Police Covenant places health and wellbeing at the centre of police support. There are opportunities for police occupational health services but can they (will they) respond?
Why is police occupational health more important than ever?
Oscar Kilo, the National Police Wellbeing Service has launched Foundation Occupational Health Standards for Police Forces – a set of Occupational Health standards to ensure that health and wellbeing of officers and staff is better supported and there is more consistency across UK policing.
Following the financial crash of 2007-8, UK Government-funded departments felt the cold wind of financial austerity. Police forces had to manage substantial cuts to their budgets. Inevitably, this led to reductions in the numbers of police officers and police staff. The BBC reported a fall of 21,732 police officers between 2010 and 2018. Similarly in 2019, the GMB reported that 23,500 police staff jobs were lost from 2010. The Government response to this was the announcement, in 2019, of a commitment to recruit 20,000 police officers.
May you live in interesting times - Chinese proverb.
Prior to this announcement, the impact of what might be considered to be a perfect storm of insufficient staffing, increased demand on forces and ever-challenging work content had taken its toll. A Police Federation survey of 17,000 officers in 2016 showed an alarming set of statistics around mental health of officers, with 39% seeking help with mental health issues. Subsequent surveys have reinforced these findings and have highlighted the need to address psychological trauma on mental health. The Home Office Front Line Review was scoped around four themes, one of which was wellbeing. The subsequent report comprehensively portrayed the many complex issues affecting wellbeing in the police. It was illuminating (and of concern) that forces' occupational health services were perceived to be reactive. The report indicated that the respondents considered welfare departments, occupational health and counselling services, whether provided within-force or externally, to be often inadequate, in terms of access, timing, level of provision and expertise of practitioners. A proposed response to this was a view that, whilst occupational health services are generic, they should be specific to the demands of policing.
Health and wellbeing AND occupational health?
The launch of Oscar Kilo and the National Police Wellbeing Service is, in part, a response to the findings of the Front Line Review. The need to address wellbeing and, in particular mental health, was evident. The live services being delivered by the NPWS are predicated on improving mental wellbeing in the police. There are, however, opportunities for police occupational health services to demonstrate their worth and value to police forces. The national approach to police wellbeing represents an opportunity to show the importance of a suitably configured occupational health service as part of a holistic and multidisciplinary approach to wellbeing. The NPWS has raised awareness that wellbeing at work is not just about addressing individual wellbeing issues, although they are clearly important. Organisational factors such as culture, leadership and management styles, policies and procedures and the work environment all contribute to a sense of wellbeing. Occupational health is, perhaps, unique amongst clinical specialties with its two-pronged focus on both individual wellbeing and that of working populations. An effective occupational health service operates as a preventative function through primary, secondary and tertiary prevention. This means promoting good health and working with health and safety colleagues to prevent ill health occurring at work, intervening early, where risk assessment deems this important, to identify signs of illness and providing support as well as assisting with the rehabilitation of people who become unwell with impaired work ability. This also means that police occupational health cannot be effective if it operates at the margins of operational command structures.
Police occupational health for the 2020s
2020 and 2021 have presented new challenges for the police, as for society, in general. The COVID-19 pandemic has introduced concerns about infection control and new ways of working. As a clinical specialty, occupational health has assisted forces in developing COVID-secure workplaces, testing regimes, guidance on isolation of the workforce and on issues, such as Long COVID. The concept of COVID age for medical risk assessment and guidance on risk assessment in the workplace have come from the occupational medicine community. Occupational health services have continued to support the Police Uplift Program, despite the restrictions imposed by the Government, by adapting and working flexibly. Questions about consistency in assessing fitness of police officer recruits have arisen and further work will be required to address them. Effective and efficient models of clinical assessment have ensured that the increased workload of the Uplift program has, in the main, been absorbed. Many forces now proactively monitor the psychological wellbeing of officers and staff, as part of a psychological risk management program. Self-assessment of and compliance with the Foundation Standards will provide the foundation that services need to ensure that they are appropriately set up to function effectively and to address the issues highlighted in the Front Line Review. 2021 saw the launch of the Police Covenant, which will enshrine in law a duty for the Home Secretary to report annually on progress made with respect to health and wellbeing in the police. There will be a requirement to extend wellbeing support to former and retired members of the police and to the families of police officers and staff. Occupational health services will have to develop effective working relationships with other healthcare professionals, such as primary care.
It's life Jim, but not as we know it
The Growing OH initiative was launched in the NHS in 2021. NHS England and NHS Improvement has launched a strategic occupational health (OH) program aiming to grow and deliver OH services and support NHS colleagues leading on occupational health. The vision for this exciting new program of work is to support the health and wellbeing of NHS people by growing NHS delivered OH services and NHS OH people as strategic, integrated and proactive organisational partners. The program is underpinned by various service improvement drivers, and the principles of collaboration and co-design by working with the OH community to grow the service, and OH people together.
The challenge for police occupational health is to mirror the approach taken by the NHS. It can be argued that the police are no less weary than their NHS colleagues. Notwithstanding the success of the Uplift program, there is much anecdotal evidence locally of the strain being felt by police officers and staff, as a consequence of the past 21 months, which followed the effects of austerity on the police. Pressure on primary care and NHS waiting times have led to people seeking alternatives for treatment. There is increasing pressure on forces to fund private healthcare in order to maintain their resilience, particularly with respect to mental health services. Clinical occupational health services will have a key role to play in providing timely access to clinical assessments of fitness for work and in facilitating access to healthcare. Services must position themselves strategically within forces and investment will be required in training and in implementing effective processes, including investment in IT. A regional collaborative approach seems to be inevitable in order to effect economies of scale with a suitable distribution of clinical expertise. A new vision for occupational health is vital to meet the needs of the police over the next decade and to attract and develop the next generation of occupational health practitioners in what is an increasingly competitive market. Many of the recommendations of the review by Dame Carol Black for occupational health remain relevant today. In 2008, the challenges facing occupational health were:
Detachment from mainstream healthcare
Limited remit
Uneven provision
Inconsistent quality
Diminishing workforce
Shrinking academic base
Lack of good quality data
Image and perception
A new ambitious collaborative approach across the public sector is required to support our essential public services.