As the BBC’s Chief Medical Officer Clare Fernandes says, the case for health screening can be made both ways. So that’s exactly what we’re going to do in this article….
Pros
It could lessen the burden on the NHS
“After Covid, there are massively long waiting times and it’s hard to see a GP or specialist. Employers by offering screening could take on part of that burden if they offered an end-to-end service,” says Fernandes.
Elizabeth Swanton “absolutely agrees” with this, as Chief Operating Officer, running a health screening company Qured, arguing that:
“Yes! Employers can reduce burden on the NHS, both in the short and the long term. Long term chronic illnesses like diabetes and cardiovascular disease are very expensive for the NHS to manage. It would be much better to prevent them happening in the first place. That’s where employers can help; in shifting to a model of preventative healthcare.”
It gives employees valuable information about their own bodies
We know employees are becoming more health conscious, especially younger generations. Offering health screening, then, could prove a very compelling benefit to attract and retain new recruits.
“As well as giving people clues as to what is going on within their body and encouraging them to make positive changes, it also gives employers the ability to see what is going on with the health of their workforce on an aggregated basis, which can directly impact the organisation’s productivity and ability to function sustainably,” says Nick Davison, health and wellbeing strategist and managing director at myadv1ce, who formerly held senior positions at John Lewis and Aviva.
Ignorance is not bliss when you’re talking about serious diseases like cancer
As was recently reported, the UK has the worst outcomes for treating cancer in Europe which is largely down to lack of, and late, screening. Employers could plug the screening gap and save lives, as well as costs, by identifying diseases much earlier, as well as reaping the obvious commercial benefits of keeping their employees in work and productive.
Anxiety about the future can be reduced if the information is delivered in the right context
As this previous article stressed, responsible companies will do screenings only when they can ensure the information is given to employees by experts who can answer all their questions and reassure them.
“Every result is reviewed by a doctor and most results, especially anything abnormal, is provided to the patient by a doctor,” says Qured’s Swanton, explaining how her company operates.
Employees can be assessed on an ongoing basis
Due to overload, the NHS can often struggle to consistently follow up and monitor test results leaving the onus on individuals to chase results and advocate for themselves. If employers set up a comprehensive health screening programme they take this worry away and take on responsibility for things like test reminders and follow up appointments.
“We sell annual plans and provide longitudinal testing. This means that if an employee is tested and has elevated cholesterol, for example, we book them in for a retest in six months and we manage that client, without them having to go to their GP. The same would be true for tests like vitamin D levels and iron levels. We can pick up important information that the NHS can’t and action can be taken earlier,” says Swanton.
Employees can access screening tests at an earlier age than via the NHS
For instance, the NHS provides bowel cancer screenings from 59 years and above (gradually expanding to those over 50). But companies like Qured can do this from 45, in line with other countries’ screening programmes, and even younger for those with risk factors.
It would help our aging population live longer, better
Many would argue there’s no point living longer if we are riddled with disease and not enjoying our lives. Swanton goes as far as to describe it as an “existential risk to our society that we are living longer” and she says “we don’t just want more years. We want healthier years.”
You can save lives and surely that is a worthwhile reason?
Swanton adds: “I am very pro the NHS. I’d love it to be doing all this preventative care that could be done. But it is overwhelmed, and as of today, it can’t. But employers can. So, you can think about the benefits in terms of NHS costs, but think about the impact on an individual employee. That’s massive. It’s a human life.”
Cons
Many employees might be turned off by health screening
“From diabetes to cancer, a lot of people are in denial, so they don’t want to think about these things and would prefer to avoid the topic,” says Davison. So, perversely, an employer runs the risk of investing in a programme and then receiving little employee engagement or return on investment.
Other employees might spiral into anxiety
There’s a risk – particularly with genetic testing – that you will cause significant anxiety if individuals receive ‘bad’ test results. As Davison says, there’s a risk that they feel hopeless and act recklessly with resignation in response.
As Swanton says:
“Genetic testing has a higher chance of causing anxiety because they test for things that may, or may not, come to pass.”
Companies which don’t provide adequate support for individuals could do more harm than good
Without the right support in place, they could create a huge amount of unnecessary anxiety, especially amongst the worried-well who are already doing everything in their power to better their health and wellbeing. In some cases, too, this may be completely unnecessary as there is still a high level of inaccuracy with some tests.
Arguably some tests, especially genetic, might not realistically add any value to a person’s life because they wouldn’t be able to take any additional preventative measures, but would be aware of a potential issue, which could prey on their minds. Ironically this could adversely affect their productivity rather than be a benefit which reassures them and boosts their wellbeing and, so, productivity.
Private companies out for profit might sensationalise results to justify costs
Given that health screening companies need to market their goods, and persuade people to part with sometimes significant amounts of cash to take the tests, there is concern around sensationalisation of results for effect. If nothing is flagged as important, there is the risk that individuals then believe the test had no added value.
Some tests – especially genetic tests – have issues around accuracy and regulation
A recent BMJ headline reads: “Call for regulatory crackdown on private health and genetic screening”. It went on to explain that some experts are demanding that there’s mandatory appropriate counselling before tests and that the government needs to review the “ethics of offering these tests and ensure all such services are registered and regulated”.
“We need to question – do these tests actually do what they claim to do?” says Fernandes. “If the test isn’t regulated and there’s a high false positive rate, for example, that creates more problems than it solves. And the consumer may not even be aware of the false positive rate. We need to know how good these tests are at picking up the diagnosis. Alot of work still needs to be done on these tests.”
It could increase the burden on the NHS
If companies create the ability for employees to test for certain conditions, but don’t offer ongoing support, then this could lead to a flood of patients waving their test results, out of context, to the GPs. This would create extra stress, as well as work, for medical professionals and is, arguably, unethical.
The BMJ recently quoted MP Samuel Parker on this matter who said: “It’s completely unacceptable for the private providers offering non-evidence based screening tests to expect GPs to interpret, explain, discuss or give feedback.”
Even if you facilitate employees gaining knowledge, this will not necessarily lead to them taking action
Humans are notoriously bad at changing their behaviour. Particularly when it involves sacrificing present moment pleasure for a better outcome in future.
“The big question employers need to ask is: can we affect lasting behavioural change in our people on the back of testing?” says Davison.
One off tests are often not helpful
Some companies offer one off tests for certain conditions but these can be problematic, and actually could be misleading. For things like measuring blood pressure or testing for prostate cancer, you need to be monitoring test results over a longer period of time. (For an explanation of why in relation to the latter, see this article here).
Blanket testing won’t suit all
People’s levels of risk aversion vary widely. Fernandes takes an example from her own life to explain this. When she was pregnant, she and her partner decided to have the ‘normal’ genetic test which showed the risk to their baby having a genetic problem was ‘very low’.
“I was very satisfied with that but my partner wanted another test which narrowed the probability down even more. People have different levels of risk and probabilities they are willing to accept. It’s the same with our workforce. I understand that many employees now want to know more but, as a doctor, I’m most concerned with: does the test actually do what it says it does, or could it lead to more problems in the NHS and burden on individuals?”
