All NHS staff deserve access to occupational health services

In the wake of the Mid Staffordshire hospital scandal, it is apparent that NHS managers need to deliver appropriate care and create a stress-free culture for their employees

Dr Paul Nicholson wrote a response to an anonymised “personal view” by a former NHS consultant OH physician, which was titled “After Mid Staffs: the NHS must do more to care for the health of its staff” and appeared in the March issue of the BMJ. The original article painted a damning picture of attitudes to OH and workplace health and wellbeing within the NHS, and made a link between the scandals at Mid Staffordshire NHS Trust and the potential for workplace pressure and poor management to “brutalise” staff. This is the text of Nicholson’s response to the article.

I read the anonymous personal view with great interest and welcome views being shared. On a similar note, I posted a pledge to the NHS Change Model website this week as follows: “I pledge to promote and protect access to specialist-led OH services for all NHS staff to help them be at their best each day.”

Employee health and wellbeing influences whether people are able to work at their peak and are critical success factors for both individual performance and organisational performance.

NHS employees need to be supported at work by programmes that protect and promote the highest attainable level of physical and mental health and wellbeing in order for the NHS to consistently deliver the highest quality care to patients.

OH services focus on enhancing and maintaining the health of people at work, ensure that they operate safely and the organisational effectiveness of enterprises by providing expert advice to management (Nicholson, 2001).

BMA policy

It is British Medical Association (BMA) policy that all employees in the NHS and elsewhere must have access to specialist-led OH services (The Occupational Physician, 2013).

The BMA occupational medicine committee has championed OH services for all NHS staff, being involved with the development of NHS good practice guidance. The latter states: “Providing a first-class OH and safety service for NHS staff and GPs and their staff is the responsibility of all who work in the NHS.”

In spite of this, GP OH services are in jeopardy as the NHS Commissioning Board reviews funding (Lind, 2013).

As to Mid Staffs, the Francis report (2013) noted that a Health and Safety Executive inspection report included at least one observation that might have had implications for the standard of care given to patients.

It was reported that staff in some departments were experiencing particularly high stress levels and felt poorly supported by the organisation. While OH services can help employees who experience stress, the responsibility for identifying and managing stress, for tackling the causes and for creating a stress-free culture rests with leadership. The report also recommends that an accreditation scheme should be considered for managers. Here, occupational health is an exemplar.

A professionally led accreditation scheme (Faculty of Occupational Medicine, 2010) was launched for OH services in 2010. More than 40 NHS OH services are accredited, with a commitment for all to be accredited.

OH services must be provided for all NHS staff and those services must be supported to deliver appropriate care.

Dr Paul Nicholson is associate medical director at Procter & Gamble. Competing interests: none declared.


Anon (2013). “After Mid Staffs: the NHS must do more to care for the health of its staff”. BMJ; p.346.

Nicholson PJ (2001). “Occupational medicine: new world, new definition”. Occup Med; 51: pp.423-424.

The Occupational Physician. BMA. London. 2013.

Department of Health (1998). “Management of health, safety and welfare issues for NHS staff”. HSC1998/064.

›Department of Health (2001). “The effective management of occupational health and safety services in the NHS”.

Lind S (2013). “GP occupational health services in jeopardy as NHS Commissioning Board reviews funding”. Pulse.

Stationery Office (2013). Report of the Mid Staffordshire NHS Foundation Trust public inquiry.

Faculty of Occupational Medicine (2010). Occupational health service standards for accreditation.

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