The University Hospital of North Staffordshire is one of the busiest and biggest acute Trusts in the country, with an annual budget of more than £220m. It employs more than 7,500 staff and has over 1,300 beds. Each year, the hospital treats about 87,000 in-patients and more than 44,000 day cases. It sees 100,000 new referrals and deals with around 120,000 emergencies – 94,000 of which come through the accident and emergency department.
This Trust is the main focus for trauma in the north-west Midlands, with a full range of acute, clinical and non-clinical services, as well as an extensive range of speciality services. The Trust is also a designated cancer care centre, working in partnership with a network of West Midlands cancer units.
The hospital is based on two sites – the City General and the Royal Infirmary – with a central outpatients department in between. Both sites are less than a mile apart. The Trust is sectioned into six clinical divisions and has one non-clinical division, which incorporates HR and OH.
The OH team
The occupational health and safety department consists of an occupational health and safety manager, a nurse consultant, six nurse advisers, two clinical support workers and two administration staff. There is also an OH physician who works one day a week to assist in the management of sickness and absence.
The OH department is nurse led. As clinical support workers, we work as part of this team. We joined the OH department when the new role was developed in 1999, and have worked for the Trust for 14 years, gaining a wide range of experience and knowledge, from medical wards to trauma and orthopaedics.
The clinical support role was first considered in 1998, when a review was undertaken of the OH services provided within the Trust, including staffing levels and roles. Following this review, a business case was developed, put forward to the board, and subsequently agreed. The plan was to be phased in over several years, with the final part of the business case being the appointment of a nurse consultant in 2004.
Requirements for the posts included a Level 2 NVQ in Direct Patient Care, or to be working towards it. Although previous experience of working in OH was not essential (as training would be provided), a background in healthcare was needed. The posts were advertised through the internal vacancy bulletin.
The clinical support workers role within the department is relatively new and very different from the acknowledged role of support worker. Since joining, we have developed our knowledge, skills and experience to become competent, and have been working with a nurse adviser, who acts as a supervisor by providing support for us to complete a six-month training and competence programme.
We have keyboard skills and are computer literate, which is an essential part of our job. As our roles have developed, we have gained further skills. We now have certificates in venepuncture, First Aid at Work, lung function testing and smoking cessation. Between us, we also hold certificates in manual handling training and vision screening assessments.
An example of how we use these skills is in undertaking annual health surveillance. Working alongside the nurse advisers, we each undertake health surveillance within an identified area.
This year, we have been undertaking health surveillance within the division of anaesthesia and surgery, with any abnormal results reported back to a nurse adviser. We found staff and managers appreciate us undertaking health surveillance within the workplace. The NHS is changing to provide a better service. By working in partnership and with the support of our colleagues, we can provide better services for all of our staff.1,2
The role itself is very demanding and challenging. We need to be motivated, good communicators and maintain a high level of confidentiality at all times. Because we are provided with training and assessed to ensure that we are competent, many of the department’s duties can be carried out by a clinical support worker. And working within protocols and standards, we are able to clearly identify when we need to seek further advice and refer to a nurse adviser.
We undertake a range of duties, including pre-employment paper screening, which involves assessing medical questionnaires, identifying problems and taking the relevant action. We are able to identify what immunisation details are required for new members of staff and deal with sharps and contamination injuries.
On a day-to-day basis, we work with one nurse adviser within the department. On average, we carry out 200 pre-employment paper screens each month. First, we check the questionnaires for any health declarations. If any are declared, we write to the applicant for further information.
The second stage is focused on immunisation status. We will screen to different levels depending on what job they will be doing and where they will be working.
Working as part of the team
One of the busiest times in the OH department is the new doctor’s intake. The department has several intakes over the year – the biggest being in August, when we can have up to 80 doctors attending in the space of two hours. It is essential that every doctor be seen as promptly as possible, and that all immunisations are updated prior to them starting their new post.
Many of the doctors need to be seen by a number of departments on their first day, including medical personnel, payroll and communications. We provide a ‘one-stop shop’, with representatives attending from all these departments.
We also contribute to the undertaking of a pre-employment audit to ensure that we meet the national OH standards.3
The way in which we deliver OH services has changed radically. We now operate on a no-appointment basis. The open clinics work well for staff, as they can attend at a time that is convenient to them. We are also available at any time to deal with needlestick/contamination injuries.
We also deal with self-referrals and telephone calls from staff seeking help and advice. We have found that staff and managers are not always clear about the role of OH. For example, sometimes staff seek advice because they find it difficult to get an appointment with their GP. Depending on what is wrong with them, we direct them to a local walk-in centre, NHS Direct, A&E or their GP. If a manager has sent the member of staff to our department, we always follow this up with a call to the manager. We explain to the manager who we have referred the member of staff to and our role. This also gives us the opportunity to reinforce what they should do if a member of staff becomes ill at work.
Our roles have meant that the nurse advisers are no longer tied down in the department, undertaking day-to-day tasks. The work that we do enables them to devote more of their time and skills to other work outside the department.
Currently, the nurse advisers are responsible for developing health promotion programmes and initiatives, and we are keen to become involved and incorporate our smoking cessation training.
By working in partnership with the Health Promotion Unit (HPU), the department has identified local and national initiatives to promote health. With such a large agenda, we realise that we need to work with others. This can benefit the local HPU by giving them access to a high population within a relatively small area. Staff can also access events within the workplace that are convenient to them.
We have taken the opportunity to talk to Trust staff about what health promotion events interest them. One area of interest is regular blood pressure checks and support with dieting. We are aiming to work with the nurse advisers to develop and implement a well-being programme in 2005.
With excellent support from the Trust and our entire department, we have now begun an OH diploma course at Warwick University. This is a four-module course, which is run in four weekly blocks of tutorials over a period of 12 months. The modules are:
- Policy and legislation
- Safety and hygiene
- Health management.
We believe this will enhance our ability and skills within the department and develop our practices and competencies. Upon successful completion, we hope that we can bring back knowledge gained to enrich the services that we provide.
Alison Perry and Pauline Walton are clinical support workers based at the University Hospital Of North Staffordshire
1. Clarke M – Speaker argues case for using assistants. Occupational Health, May 2003
2. Harris A & Atwell C – Better by Degree? Occupational Health, 2004
3. The Effective Management of Occupational Health & Safety Standards within the NHS. Department of Health, November 2001