The financial fallout from Covid-19, with businesses and OH providers likely to be under intense pressure, means that costs will be being interrogated like never before. In such a climate, Victoria Tait considers whether we might get to a point where the expense of becoming SEQOHS-accredited could begin to outweigh its reputational benefits.
Over the past year, during the Covid-19 lockdowns, many Chartered Quality Institute online branch meetings have steered away from topics of compliance or root cause analysis and instead focused on the topical subjects of health and wellbeing in the workplace and returning to work.
Many attendees to these meetings have been brave enough to open up about their own personal experiences surrounding their mental health as well as encounters with their companies’ occupational health departments.
As Occupational Health & Wellbeing highlighted in December, the SOM (Society of Occupational Medicine) Christmas lecture by Professor Dame Carol Black urged OH practitioners to use the harsh spotlight that Covid-19 has thrown on to workplace health to “seize the moment”, to raise their voice and profile with government and employers and truly show the value OH can bring to the table.
Dame Carol Black’s seminal review of the health of Britain’s working-age population, Working for a healthier tomorrow was published back in March 2008. Among its recommendations was the need for clear standards of practice and formal accreditation of all providers who support people of working age. The government’s response to her review, Improving health and work: changing lives, endorsed that recommendation.
In response to this, a broad stakeholder group led by the Faculty of Occupational Medicine (FOM) developed standards and accreditation for OH services. The first set of standards was launched as “SEQOHS” in January 2010 and FOM commissioned the Royal College of Physicians to develop and manage the scheme, which was launched in December 2010.
In July 2019, the running of SEQOHS was brought in-house to FOM’s new premises in Greenwich, south London, which also provides onsite training facilities (and currently remote online training).
Understanding SEQOHS accreditation
Although SEQOHS as a standard and accreditation process will be familiar to many OH practitioners, it is worth recapping what it is and what it entails.
It stands for “Safe, Effective, Quality Occupational Health Service” and is a set of standards and a voluntary accreditation scheme for OH services in the UK and beyond.
Since its launch, the SEQOHS accreditation scheme has rapidly become an integral part of the occupational health service landscape, accepted in both the public and private sectors as the recognised industry standard. Indeed, NHS Employers and NHS Health at Work guidance underpins the need for all NHS OH services to be accredited to SEQOHS standards.
SEQOHS accreditation is the formal recognition that an OH service provider has demonstrated it has the competence to deliver against the measures in the SEQOHS standards.
The standards are categorised into six domains: business probity, information, governance, people, facilities and equipment, relationships with purchasers, and relationships with workers. There is an additional clause for NHS services that are accrediting.
Striving towards quality and customer satisfaction is, of course, the mission of every modern company and various clauses within the domains of SEQOHS standards resonate with the international ISO 9001:2015 standard.
This includes the same requirements for mandatory documents. In the case of the ISO, these are: monitoring and measuring equipment calibration records (ISO clause 188.8.131.52); records of training, skills, experience, and qualifications (ISO clause 7.2); criteria for evaluation and selection of suppliers (ISO clause 8.4.1); and characteristics of service to be provided (ISO clause 8.5.1).
Further mandatory documents required are: records about customer property (ISO clause 8.5.3); record of conformity of service with acceptance criteria (ISO clause 8.6); record of non-conforming outputs (ISO clause 8.7.2); monitoring and measurement results (ISO clause 9.1.1); internal audit programme (ISO clause 9.2); results of internal audits (ISO clause 9.2); and results of corrective actions (ISO clause 10.1).
How to achieve SEQOHS accreditation
To achieve SEQOHS accreditation, an OH service needs to demonstrate it deals fairly and ethically with purchasers, as well as being customer-focused in its relationships with purchasers. Many big providers of occupational health services have chosen to achieve ISO 9001 certification as well as SEQOHS.
Critically, accreditation should be a supportive process involving self-assessment and external peer assessment against accreditation standards; it should be a process of establishing and promoting a culture of continuous quality improvement.
When a service registers for accreditation, it shows it is committing to an ongoing annual programme of quality improvement, assessment, and maintenance.
By going through the accreditation process, services demonstrate that they have been assessed by a team of peer reviewers and have met the SEQOHS standards.
So, how does the process actually work?
A team of assessors, normally consisting of, for example, independent OH practitioners and OH management consultants will be led by the most experienced SEQOHS assessor (the quality lead and interim clinical lead). The lead assessor has been on the assessment team since the accreditation scheme was set up.
An assessor must attend a bespoke training programme and team meetings to ensure their practice remains consistent and independent and that the confidentiality of the services they review presents no conflict of interest.
Accreditation is awarded to a service for five years, subject to successful completion of further annual assessments.
A service is required to demonstrate it has an active audit cycle and has maintained the same standards on an annual basis (it does this by completing an annual renewal assessment evidencing this, among other factors). It must be able to show that quality improvements and feedback is ongoing and continual. It must formally reaccredit once the five-year cycle is complete.
Understanding the benefits of SEQOHS accreditation
SEQOHS accreditation, ultimately, is a recognised badge of quality in the delivery of occupational health services.
It shows the outside world – peers, other providers and, of course, potential clients – that an independent, impartial recognition and an external validation process has been completed; that the service provider has objectively demonstrated its competence and met the required standards. As we have already shown, SEQOHS accreditation has become something of a prerequisite for operating in some areas, such as NHS OH.
SEQOHS accreditation also shows that a provider has developed cost-effective management guidelines and standardised care, is able to identify good practice so that it may be furthered and built upon, and, just as importantly, is able to identify sub-optimal practice so that it may be improved.
SEQOHS provides a robust governance framework, built on best practice, and a standard for all OH services to work towards to improve consistency across occupational health services for workers.
Does SEQOHS have a take-up problem?
Having said all the above, which is clearly positive, questions do remain about the future of, and appetite for, the standard. In an intensely challenging economic climate, as we are and will be post pandemic, will there still be the appetite among providers to pay for and go through all the hoops to get accredited?
Already we have been seeing some evidence of a decline in the numbers of providers working towards accreditation, although it is early days yet to be forming firm conclusions.
For example, five years ago most large contracts and principal contractors working within the construction sector insisted that occupational health providers were SEQOHS accredited. The SEQOHS standards were recognised as being crucial for good research- and evidence-based practices; without it the worker is less protected.
However, come 2021 and we have begun to see this trend changing. As of February 2021, there were 183 accredited services and 135 working towards accreditation. However, this compared to 212 services working towards accreditation and 242 services accredited back in 2017. In other words, the numbers indicate a more than 30% drop in interest.
Most services in the “system” when it comes to SEQOHS remain NHS foundation trusts, councils and private sector OH providers.
There are a few in-house service providers, and generally in-house occupational health services struggle to justify the expense to their senior management team. After all, they do not sell to anyone else, so why should they pay for SEQOHS accreditation to set their own comparable standards and audit compliance? There will often be a service-specific framework they can adopt, such as “Oscar Kilo”, the National Police Wellbeing Service framework that was launched in 2017. This is now used by police forces and Fire and Rescue Services across the UK to audit and benchmark.
That said, in-house OH services within Transport for London, the University of Glasgow and Walkers Snack Foods, to cite just three examples, have seen the benefits of being SEQOHS accredited.
Our feedback has been that the teams have found it an excellent experience to document their processes (whether that be as a formal document or as a process flow chart) and/or identify gaps in their processes and existing services. This has allowed these to be remedied as well as identifying the staff, associate clinicians and other resources required to deliver an effective consistent service.
They have found SEQOHS beneficial in ensuring clinical governance and competency, for driving audit and identifying areas for clinical training, and for the professional development of their staff.
SEQOHS has also been valuable it in terms of proving to senior management that the service is doing things to the highest and most appropriate standards as well as demonstrating the value each department brings to the organisation.
Could a ‘Covid crunch’ create a cost barrier?
The big caveat, however, especially for smaller companies, remains the fact that this sort of accreditation process is expensive. For a single-handed provider, the fees start at £250. Single-handed in this instance means any OH physician or practitioner who operates independently as a peripatetic service or services with offices, with access to an identified occupational physician listed on the GMC specialist register, including for advice or the escalation of cases and have administrative support.
However, as soon as you employ someone directly or contract any other clinical or technical staff you become classed by a SEQOHS as a “small service”, and the fees rise sharply.
For a small service, the stage one annual fee is £1,200 unless you have more than seven sites or are providing OH services to 145,000 or more workers. If this is the case, your service is upgraded to be considered a “large service”, at which point the stage one annual fee rises to £2,000.
Just to be clear on what “stage one” means, achieving this gives an organisation or provider access to one place on a mandatory stage B training day (per five years), the SEQOHS self-assessment tool, its action planning tool and knowledge management system, and all of the online SEQOHS web tool.
Stage two begins once a service signs off its self-assessment and is ready to be formally assessed by an assessment team. Once you progress to stage two, the annual fee rises to £2,400 for a small service or £3,300 for a large service. All figures, by the way, are quoted exclusive of VAT.
Finally, occupational health providers involved in sample collection and end-to-end testing of Covid-19 are also now being asked by the Department of Health and Social Care to UKAS (UK Accreditation Service) accredit against ISO 15189:2012 (and ISO 22870:2016 for point-of-care testing) or ISO 17025:2017. All these come with a starting cost of £1,500 plus VAT.
This, therefore, has simply added another additional cost to externally prove the quality of your service. And of course it comes at a time when many practitioners have been left facing financial challenges from the pandemic over the past 18 months, and this situation may yet be amplified by a likely tough ‘recovery’ climate post pandemic.
Many occupational health providers, we hear, are already asking what can be done to re-cost, re-energise or change the SEQOHS accreditation process so that more OH services believe it is a worthwhile investment for themselves and, ultimately, for the wellbeing of the workers which they assess.
Is Covid-19 creating a crunch point for SEQOHS? It is probably too early to tell. But, nevertheless, it is a conversation that, as a profession, we perhaps need to be having, both for the future quality of OH provision and, ultimately, the health and wellbeing of UK workers.