COHPA 10 years on: transforming commercial occupational health provision

Since the launch of Commercial Occupational Health Providers’ Association (COHPA) a decade ago, occupational health provision has changed in many ways – and the association continues to make a valuable contribution to the sector. Nic Paton looks at its legacy so far.

When a close-knit group of commercial occupational health (OH) providers sat down at the Society of Occupational Medicine’s 2003 conference in Southampton, the two key items on the agenda were recruiting and retaining the right people, and the issue of training and standards. It speaks volumes, perhaps, that those items are still high on many agendas.

“To that extent, I suppose, not much has changed,” says Dr Mike Goldsmith, co-founder and honorary life president of the Commercial Occupational Health Providers’ Association (COHPA), the body that emerged from that nascent meeting on the south coast.

Nevertheless, as COHPA celebrates its 10th anniversary, it can look back with some satisfaction at what it has achieved and how it has changed the perception and influence of commercial OH providers (see Ten years of COHPA). From an initial 30 providers, it now has some 130 members, between them providing OH services for millions of employees and accounting for 70% of outsourced OH provision revenue and 45% of OH market revenue overall.

“It was exciting when we got together; there was a real sense this was an opportunity to share our experience, our views on important issues such as standards and simply to regularise what we were doing,” recalls Goldsmith.

“We felt it was important – and remember this was pre-SEQOHS [the Safety Effective Quality Occupational Health Service accreditation scheme] – that we looked at ways we could work together to demonstrate to people that when they were purchasing our services, they were purchasing a set of common standards. That, at the time, was quite new. More widely, simply the exchange of different views has been invaluable, as has been gaining perspectives on the problems we all faced which, in many cases, were very similar.

“I think if we have achieved anything it is that we have helped bring together a lot of the various strands that went into the development of SEQOHS. We have also had an influence in shaping the changing landscape around health and safety, particularly in helping to meld together occupational health and safety practice,” he adds.

The association’s original mission statement was:

• to be a forum for providers to enhance occupational health;
• to promote occupational health to government, key bodies and UK business in all sectors;
• to be an information body for employers seeking to access occupational health; and
• to offer every provider a voice that is heard.

Arguably, as founder director Geoff Helliwell points out, it has managed to stay true to these aspirations: “Our main achievement, I think, is simply being there at the table, representing the voice and concerns of commercial occupational health providers.

“OH at the time was a bit of an alphabet soup, with the FOM [Faculty of Occupational Medicine], SOM [Society of Occupational Medicine], BOHS [the British Occupational Hygiene Society] and so on. But OH providers were not there. So simply getting us noticed has, for me, been our major achievement.

“COHPA was born out of my frustrations at the number of business obstacles there were for organisations such as ours. It was also a realisation we were all facing much the same industry and professional issues; so it was the classic situation where a trade body could make a difference,” he says.

Director of public affairs Neil Lindsay agrees: “One of the things that has always struck me about COHPA is that it is light on its feet; it is swift to understand changing issues because it is not bureaucratic. Another important point is that COHPA really does represent its sector.

“We represent everyone from large organisations through to one-man bands. So when government comes to talk to us – which it does on a regular basis – it can feel confident it is speaking to true representatives of the industry, not just big players.”

Communication roles

COHPA’s advocacy work and close ties with the Government saw Department for Work and Pensions’ (DWP) chief medical adviser Dr Bill Gunnyeon coming to the association soon after the publication in 2011 of the Frost/Black review of absence management to discuss the Government’s future thinking – which has led, in turn, to the development of the Health and Work Service.

The association was instrumental in developing the fit note, too, after its suggestion that there could be value in the development of an “Absence Advice Note” was taken up by the DWP. Health and Safety Executive chair Judith Hackitt also visited early on in her tenure to share her vision for the future of health and safety, recalls Goldsmith.

Other key strands of activity have been COHPA’s involvement in the development of the SEQOHS accreditation programme, plus its role in the formation of the Council for Work and Health.

Indeed, SEQOHS clinical lead Dr Sally Coomber recalls that COHPA’s sometimes robust input to the development of the standards back in 2011 proved invaluable. She says: “I had been in the role for perhaps three weeks and presented to their annual conference. They had some fairly strong views and were quite prepared to share them with me.

“Before that, COHPA had not really been on my radar at all, because I had been working tucked away in the NHS. But it was hugely supportive and was able to raise a lot of valuable issues that were of concern to OH practitioners. The feedback we got through COHPA around the SEQOHS questions and evidence required was very useful. I’ve always found COHPA to be a really useful source of information.”

Council for Work and Health chair Diana Kloss agrees that COHPA is a “valued” member of the council and has been particularly active around the work it is doing on workforce issues under the chairmanship of Professor John Harrison. “It has been generous in supporting the work of the council,” she says.

SOM president Dr Alastair Leckie concurs: “The Society of Occupational Medicine congratulates COHPA on 10 years of successful activity in improving standards in commercial OH provision, and helping to create additional resource in this, the fastest growing sector of occupational health provision.”

Current COHPA chair Geny Foster says: “There are so many things I am proud about when it comes to COHPA; it has been a touchstone for so many projects. One of its strengths, I think, is that it always takes a balanced, objective view of occupational health.

“One of the things that has come out of the past 10 years of COHPA is showing the commitment that commercial OH providers have to improving standards across the board. That, too, is one of the reasons why we are supporting the Health and Work Service, because it will touch people who have not had contact with OH before; it will expand the scope of what occupational health does.

“We represent an incredibly diverse membership, from one-person organisations right up to the biggest companies. But, even with this diversity, we do recognise that there is none so wise or so wonderful that they can never learn from anyone else,” she adds.

The next decade

So, what of the future? The launch of the Health and Work Service during this year and 2015 and the moves afoot, led by SOM and FOM, to create a single representative body and college for OH highlight just how fast the landscape is changing for OH. What role will an organisation such as COHPA have, and continue to have, moving forward?

“COHPA is now the place of choice for HR professionals to come if they want to tender for an OH service but do not know who to go to. We are completely neutral and simply link HR people with our network. I think it is a fantastic organisation; I am very proud of what it has achieved,” says Goldsmith.

“There is still going to be a need for an organisation such as COHPA,” agrees Helliwell. “Attracting, recruiting and retaining people, establishing competencies – these were all problems when COHPA was formed and they will continue to be so. We are in a situation where demand is increasing while supply is decreasing. So there needs to be proper pathways to bring people into the profession. I expect workforce will be a big issue for the next 10 years ahead.

“I am sure COHPA will continue to have an important role. One of the big challenges for OH for the future is going to be workforce. If OH is going to meet the ambitions the Government has set out for it, then it is going to need to have a better supply of qualified healthcare practitioners coming into the sector. There is going to need to be a real step change in supply,” he adds.

“There is still going to be a place for particular groups within the single body, for example there will be the voices of physicians and nurses, the NHS and the private sector; so I do believe there will continue to be a role for COHPA to play,” says Foster.

“There are a number of things that will become more important as we go on. Technology – for example, is becoming increasingly required, with clients wanting up-to-the-minute management information and reports. The use of applications such as Skype, too, are changing the way occupational health works. So, from there, data security becomes more important and standards such as ISO 20001. There will, too, I think, be more integration with different forms of accreditation.

“I still think there will be a place for very small organisations when it comes to dealing with the future needs of the working population; those organisations need to be represented. There are a lot of exciting opportunities out there,” she adds.

Ten years of COHPA

2004-2005

• COHPA formed.
• Health secretary Alan Milburn publicly endorses COHPA and speaks at its “Stress in the Workplace” conference.
• Acts as a key adviser to the Health and Safety Executive’s (HSE) “Securing Health Together and Better Health” pilots.
• Launch of VAT campaign, highlighting how the VAT regime potentially disadvantaged commercial OH practitioners.
• Meets with senior Department for Work and Pensions (DWP) minister Lord Hunt to promote importance of occupational health.
• Named by DWP, Faculty of Occupational Medicine (FOM) and Society of Occupational Medicine (SOM) as primary source to find outsourced OH provision.
• Launch of bespoke insurance facility for members, provided by broker Brett & Randall.

2006-2007

• COHPA “Health at Work” Congress significantly raises profile of OH, attracting more than 300 participants and including keynote speeches from three government ministers and the deputy director general of the CBI.
• Becomes a key adviser/stakeholder in the launch of the HSE’s Workplace Health Connect initiative.
• Following meetings with the DWP, the Department of Health (DH) and the HSE, signs up to the Health, Work and Wellbeing (HWWB) charter.
• Joins the board and supports formation of Constructing Better Health, the OH scheme for the construction industry.
• Undertakes an industry-wide workforce mapping project on behalf of the DH, the results of which feed into and form a key part of government response to the Dame Carol Black review into working health.
• Proposes the creation of an “Absence Advice Note” at the British Medical Association conference. This is later adopted by the DWP as new fit note.
• Submits a joint response to the Black review alongside FOM, NHS Plus, the Ministry of Defence, the Royal College of Nursing and the Association of Local Authority Medical Advisers.
• Advises HSE on public-sector tendering for OH.

2008-2009

• COHPA instigates and runs a series of stakeholder meetings and a conference to form a joint body. This later becomes the Council for Work & Health.
• Assistance to employers seeking OH services hits a record, with organisations employing a quarter of a million employees supported by COHPA, exceeding the achievements of the HSE’s Workplace Health Connect, which was terminated later that year.
• Secures a seat on Dame Carol Black’s select committee for OH.
• Backs the formation of the Council for Work & Health.
• Acts as an adviser to the DWP and feeds into the consultation process for finalisation of the fit note.

2010-2011

• COHPA is closely involved in helping to set up the SEQOHS accreditation standards.
• Assistance to employers seeking OH services beats previous record, with organisations employing half a million employees now supported.
• Culmination of VAT campaign, including the running of a survey that shows that the majority of COHPA membership and the industry now understands VAT rules on OH services.
• Introduces area representatives, meaning each member now has access to a dedicated board director.
• Invited to join a working party to discuss the implications of the abolition of the default retirement age.
• Works with the Cabinet Office to discuss future procurement policy.
• Establishes a working party to discuss training of OH technicians and public indemnity insurance; this leads to the creation and funding of a steering group looking to develop standardised qualifications for OH technicians.
• Launches UK’s first OH provider map on a new, interactive website.

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2012-2013

• Meets with senior DWP officials, including chief medical adviser Dr Bill Gunnyeon, regarding the Black/Frost absence report.
• Challenges the HSE on not employing more doctors.
• Runs a joint campaign with the Royal College of Physicians (RCP) to encourage participation in the Health and Work Development Unit’s (HWDU) quality improvement programme.
• Lobbies Chinese Government on the importance of wide-scale OH provision.
• Appoints a director of public affairs for the first time, a move that leads to high-level meetings with the CBI, the Institute of Directors, HWWB, SOM and central government.
• Begins process of holding regular meetings with FOM.
• Launches first biennial market review of occupational health.
• Negotiates on reduced insurance fees for providers with SEQOHS or other accreditations.
• Launches a Twitter feed and COHPA app.
• Works with FOM on standards for transfer of medical records.
• Becomes a key stakeholder to Council for Work & Health’s OH workforce steering group.
• Engages with new NHS Health at Work Network on workforce issues, GPs and OH and the MoHaWK clinical governance benchmarking tool.
• Promotes OH at the Institution of Occupational Safety and Health’s 2013 Expo.

2014

• Supports the DWP in development of its plans for a Health and Work Service.
• Works with broker Brett & Randall to develop COHPA’s bespoke insurance for OH providers, in response to impending Royal College of Nursing changes.
• Continues joint campaign with RCP on HWDU, with ongoing support for SEQOHS.
• Extends work on MoHaWK and begins work on plans to introduce COPHPA’s business standards to other types of workplace health providers.
• Lobbies Nursing and Midwifery Council over plans for revalidation of nurses.