There is no question that the occupational health profession is going through an unprecedented time of change. Nic Paton looks at how collaboration might help forge the profession’s future path.
Since August 2013, Occupational Health journal has been highlighting the workforce supply and demand challenges facing the occupational health (OH) profession. Specifically, we have looked at the Council for Work and Health’s work in mapping out possible solutions to some of the potentially transformational changes coming over the horizon and the question of whether or not OH – as an ageing workforce – is facing something of a retirement crisis in the future.
The third strand in this triangle of future tensions and challenges is the role and evolution of “non-OH” practitioners, defined as those that are not OH physicians or nurses, over the next five to 10 years – including the roles of OH technicians, ergonomists, wellbeing specialists, occupational psychologists and psychiatrists, occupational therapists, hygienists and so on.
How will their role, remit and involvement in OH (in its widest sense) change and evolve? How will changing notions and expectations of workplace health management bring new groups to the fore? How will different, complementary professions communicate and share knowledge and evidence? Where will governance and responsibility lie, and will there be areas of overlap? Who, in this changing environment, will “lead” OH? Will even the definition and very name of OH need to change?
Traditional models must change
“With an ageing workforce where people are having to work longer, there is an increasing demand on OH – both from employers and from self-employed people,” says Tom Stewart, founder of ergonomics consultancy System Concepts and president of the Institute of Ergonomics and Human Factors.
“The traditional model of OH physicians or nurses does not work for everyone, and probably most companies are not going to be able to afford that level of provision across the board or all the time. The patient journey is also changing, with more integrated healthcare, more online and workplace-based offerings, more dial-up facilities and so on.”
Ergonomists will have an important role to play in this fast evolving environment, Stewart says: “A lot of ergonomics is about prevention; creating a workplace environment that prevents ill health. Diagnosis and treatment are just part of the chain – when it comes to modifying the workplace, that comes back to the ergonomist.”
Professor Ivan Robertson, co-founder of business psychology firm Robertson Cooper, agrees: “A key issue is going to be links between professional groups. The narrow view of OH can too often end up overly focused on occupational ill health rather than OH. All sides therefore need to be working towards a broader definition. There is great potential for collaboration between groups, and when combined [they] can make a significant impact on the goals and success of an organisation.”
For example, talent management can be quite strongly linked to psychological wellbeing, for both mental and physical health. Achieving goals such as customer satisfaction can also depend to a large extent on how fit, engaged and competent people feel they are to do their job.
“But it is incredibly rare that anyone from the talent management side takes any interest in OH issues and vice versa,” Professor Robertson says.
“There is a need for occupational health to change a little,” agrees Jessica Colling, product director at wellbeing consultancy vielife. “I think multidisciplinary teams are a very good way forward for many people, especially where employees are now working from home or remotely more often and there are so many new ways of working.
“The services being offered have changed too, and cannot be delivered in the same way. There is definitely a case for having more individual self-help tools, more online and telephone-based offerings and a wider remit of support.
She adds: “It used just to be about people who were off sick. Now, it is about improving wellbeing for the whole population – so it is potentially very exciting. I think increasingly we will see external providers providing a variety of services.
“But this will still need to be managed, to be tied together by the organisations themselves – and that, I think, will be an increasingly important role for OH professionals going forward. OH practitioners will not necessarily be providing the services themselves, but they will be holding the providers to task; they will be tying together groups of solutions. OH will be the strategist and the driver of a culture of wellbeing within an organisation. So it may be doing more analysing of data, shaping the choice of service and making sure it can all be tied together.”
Contributions from related professions
Julia Skelton, director of professional operations at the College of Occupational Therapists, is of the opinion that allied health professionals across the board are likely to have a greater input.
“Occupational therapists do, of course, work within OH already – but the numbers at the moment are still quite small. I think things will begin to change over the next five to 10 years and allied health professionals, including occupational therapists, will be more self-evident within these services. I do think the relationship will evolve,” she says.
The college, for example, is working with the Council for Work and Health to raise the profile of its own allied health professions’ fitness to work note, which is separate from the GP fit note. There will also be an increasing need to share knowledge and best practice, Skelton says.
“It is going to be a huge change for the public as well, especially once we have the health and work assessment and advisory service up and running. Up to now, people have always just gone to see their doctor, but that will change. I think a lot of people, in fact, will welcome it, because most [of them] do want to get back to work,” she says.
“For OH nurses, it is going to be a case of realising and recognising how occupational therapists can help them and how they can contribute to ensuring people either remain in work or return to work more quickly – it is about understanding that we do have something to offer. OH has primarily been seen as the domain of the nurse or doctor and I do believe that is going to have to change.”
Safeguarding occupational health’s priorities
It is, however, imperative that in this changing environment important traditional priorities and needs do not become downgraded – not least the work of occupational hygienists, argues Roger Alesbury, former president of the British Occupational Hygiene Society (BOHS).
“I have been working in OH for 40 years, and [it] has always been multidisciplinary," he says. "People have started to look more closely at OH, often through the lens of the political imperatives related to Dame Carol Black’s report. But the elephant in the room is that there are still 13,000 people per year who die from occupational diseases related to the workplace and workplace environment.
“The opportunity for promotion and health rehabilitation has received a massive amount of attention. What is interesting is that the aspects related to prevention due to chemicals, dust and noise in the workplace have received amazingly little attention.”
Dealing with change
And what of OH practitioners themselves, both nurses and physicians?
“I find it all very exciting and do not feel threatened at all, but there are many who do feel threatened,” says Anna Harrington, regional director for the Midlands for the Association of Occupational Health Nurse Practitioners and founder of OH consultancy Harrington Enterprises.
“We need to be very clear about what our strengths are, especially around the issue of our medical and research background and our ability to manage the more complex cases."
She adds: “We are going to need specialists in a lot of areas, not just medical or health. As the working population ages it may be, for example, that we need to be able to use people who are specialists in the needs of carers or managing caring responsibilities. Or it may be that we will need to make more use of people who can help with debt or financial management or, if people are managing long-term or chronic conditions, with lifestyle change.
“Any one of these non-traditional partners could, I feel, take a leading role as long as they have the skills and knowledge to do so – it does not just need to be the medical professionals who do that. One person, of course, will need to be leading a unit, but I do not necessarily feel that will need to be a traditional OH nurse or physician."
Harrington also says that it will be very important that individuals are clear on what their roles are, without falling into "role silos”.
Creating a powerful voice for occupational health
The creation of a single organisation bringing together the Faculty of Occupational Medicine (FOM) and the Society of Occupational Medicine (SOM) will create a valuable forum for leadership and knowledge sharing, but it will need to be just a first stage, believes Richard Heron, chief medical officer at BP, president-elect of FOM and immediate past president of SOM.
“If we can bring together those who provide that interface between health and work we really have the potential to concentrate the influence and leadership of OH into a single, powerful organisation,” he says.
“We already have physiotherapists, ergonomists, OH nurses and others within the society. But I see it as just the beginning of the journey to representing a much wider membership. My vision is something that is much bigger than that, an organisation that can be a champion for the working-age population and address the needs of both employees and employers. It will, of course, have to be truly representative rather than just saying ‘come and join us’."
The intention is to bring FOM and SOM together by around the middle of 2014, and then to start thinking more about creating a broader organisation that can potentially represent OH in all its facets.
“We can really start to think much more broadly about how we can shape something that is a truly representative multidisciplinary organisation,” Heron says.
Key topics of discussion are likely to include what this organisation might be called – or, indeed, whether or not OH as a profession will need to change its name to something more accessible as has been debated on and off over the years.
“Finding the right name will be an important part. It needs to be understandable to the wider stakeholder organisations, and be simple and inclusive,” Heron says. “We have the momentum and this is something on the stocks that people are aware of. We need to harness and drive that momentum. It may be a multi-year journey to bring all the organisations under one roof, but we are committed to it. The intent is way beyond the current membership of FOM and SOM.
Dr John Harrison, non-executive chairman of Syngentis, the not-for-profit social enterprise spun out of NHS Plus, and clinical director of organisational health and wellbeing at Imperial College Healthcare NHS Trust, agrees: “I think the future has to be a combination of the clinical and the non-clinical. We’ll need to focus on health, work and wellbeing, which is what I think it will be. People just do not know what the term ‘occupational health’ means, but they can easily identify with ‘health, work and wellbeing’ as it covers a variety of different backgrounds.
“It is quite clear to me the future is going to be about looking at the clinical aspect of health, work and wellbeing, but also about recognising that there are many non-clinical aspects too. There’s going to be HR, health and safety and ergonomics, not to mention line managers. It’s going to be more about managing relationships and upskilling managers.”
He adds: “When it comes to leadership, my personal belief is that it is necessary for clinicians to drive it forward, simply because there is no one else to pick it up. But there is also a broader multidisciplinary vision where it could be any number of people who might be leading things. As long as we do not lose the clinical discipline, it may be that this could be something driven by non-clinicians, who may have more clout because they are grounded in organisations and commissioning.”
A wider remit for occupational health services
Dr Anne De Bono, chair of the NHS Health at Work Network and consultant physician at University Hospitals of Leicester NHS Trust, predicts that the core OH workforce, whether in-house or externally provided, will become wider than the traditional nurse or physician service.
"For the NHS, particularly, this is an exciting thought for the future,” she says. “There is a wider recognition of the importance of work in terms of health and the importance of looking at the work dimension in all healthcare, not just OH practice. It is, for example, bizarre that people can be referred to all sorts of services within the NHS but not for OH advice.”
De Bono says that there will, of course, need to be agreed protocols and procedures, and there will need to be a lot of bridge building between different services and professions – but, she adds: “It is important that the particular strengths of OH, the discipline of practising OH medicine and nursing, is retained. The special expertise we have in terms of assessing the workplace and fitness to work should not be lost in a fuzzy wellbeing agenda.”
Clearly this is a challenging future vision, and it is one about which OH must not bury its head in the sand.
However, as Dr Harrison argues, it is already generating real engagement and debate – with more to come: “There is recognition at high levels that there needs to be engagement on this. We need to be looking beyond the old familiar ways of working; we cannot afford to be precious about these things.”