Countdown to a single occupational health body

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The launch of a body representing all occupational professionals and replacing the existing range of representative groups could be a step nearer reality later this year. Nic Paton reports.

By this summer, occupational health (OH) practitioners will have a clearer idea whether or not they will be represented by a single, over-arching college or organisation for occupational health, rather than the myriad of much smaller, more narrowly focused bodies and associations that now make up the OH, occupational medicine and wider workplace health “community”.

This new body has the potential to change the OH landscape – its profile, perception and influence – significantly. It will bring OH to a much wider audience by giving workplace health a much clearer, consistent representation and advocacy voice. Moreover, the new organisation could prove more ground-breaking if it eventually offers a viable alternative platform for representation, education and standards to challenge that of, say, the Nursing and Midwifery Council (NMC) or even the Royal College of Nursing (RCN).

It is perhaps unsurprising, therefore, that Dr Alastair Leckie, president of the Society of Occupational Medicine (SOM), called the creation of a single organisation “the biggest thing in my in-tray” when he took up office last summer. He argues that it would potentially “have a massive impact on the way we all operate”.

Unlike the launch of the Government’s Health and Work Service (HWS), which has been widely publicised, the new single organisation for OH – whether a faculty, a college, a society or a combination of all three – is a topic that has been more “under the radar”.

That is beginning to change. Dr Richard Heron, immediate past president of the SOM and one of the driving forces behind the change, outlined his vision at the Health and Wellbeing @ Work conference in Birmingham in March 2014. SOM, the Faculty of Occupational Medicine (FOM) and the Association of Occupational Health Nurse Practitioners (UK) also recently published a joint statement on their plans and aspirations for this new body.

The road ahead

So what will the new body be, what is its remit, membership and representation (and is there a risk of one voice dominating others), how will it be funded, how will it affect or change education and standards, and will it, ultimately, be able to take OH to a new level of influence and visibility?

According to Leckie the new body will, assuming it gets the go-ahead, mean the disappearance of both SOM and FOM, with an as-yet-undefined college of, or single organisation for, OH taking its place.

“It will have the statutory function of [FOM] in terms of setting the curriculum for occupational medicine and it will work on standards – for example, assisting the [General Medical Council] on revalidation,” he says.

It could have separate faculties within it, including one for OH nursing, and so could therefore take a leading role in defining and awarding qualifications in this area.

“The remit will be broadly what [FOM] and [SOM] do already, working to meet the health needs of the working-age population. But, by having a single voice and representing health professionals working in this area more widely, it will make it much easier for government and key bodies such as the CBI or the trades unions to deal with us, rather than having to go to a plethora of different organisations. At the moment, from the outside, it is cluttered and confusing,” Leckie explains.

The proposals are due to go to an extraordinary general meeting of FOM in May, followed by one for SOM in June. Assuming the proposal gets the nod, it will go to a formal vote of SOM and FOM members in August, with the intention being to create a new single organisation from August 2015.

One organisation “makes sense”

In many respects, a single body is a logical progression. Since 2012, SOM has opened its doors to associated healthcare professionals working in OH. More widely, the increasingly multidisciplinary nature and approach of OH means that not being open and collaborative in terms of representation is increasingly being seen as unsustainable and self-defeating.

Christina Butterworth is president of the Association of Occupational Health Nursing Practitioners, and sits on the steering group working on the new body, says: “When you look at the medical colleges, we are a very small group of people, so it makes sense that we join together in a single organisation, that we bring together our rank and file. It will help to set out our own curriculum and the specific needs of our profession.

“It is overdue and it is time we did this. The NMC understandably has to focus on risks to the public but, equally understandably, it is not really going to be able to focus on an area such as OH. So something like this is a definite opportunity.”

Mairi Gaffney, head of NSS Healthy Working Lives within NHS Scotland and a member of the RCN’s Public Health Forum, agrees: “There is no one place where you can go to have that discussion [about OH]. The RCN can speak for OH nursing, but the opportunity to have a broader discussion about health, and the opportunities and challenges there, that is something that is not there at that level of detail – and that is something that there is not enough of.”

Inclusive action required

As with any change, there remain suspicions and, to some extent, fears about professional factions and interests dominating. There is concern that one membership could end up drowning out another – especially as this will be an organisation created out of two well-established, doctor-led bodies. There will need to be a period of transition and an emphasis on building trust and ongoing dialogue.

Karen Coomer, director of OH consultancy KC Business Health, says: “It is a shame the catalyst for this appears to be that there are not enough OH physicians to keep both organisations going, rather than the fact that it is just a good idea. But, having said that, I do think it is a good idea; OH has moved in a more multidisciplinary way anyway, so it makes sense to have a single organisation that reflects that. Having one voice will also be much better for policy development.

“I think there will need to be clear guidance on the differences between the different disciplines. I would be supportive of the idea of having separate faculties within the single organisation. As long as the organisation is not dominated by one particular party it will be fine; but it has to be made really clear how it is going to work.

“Personally, I have always found [SOM] to be very welcoming and inclusive, but of course there is a danger of any new organisation being dominated by doctors. So we will need to work hard to ensure there is equality.”

Long-standing professional barriers could well be an issue, agrees Gaffney: “To have somewhere where we can go that is a broad church, where everyone speaks the same language, that is more than we have now. We will need to ensure the mechanisms are in place to ensure there is proper debate, and we would be naive to believe the old hierarchies will not exist. So we need a framework by which we can access the right debate and comment. It will only succeed if people can see the benefit and the potential for wider debate.”

Nurses may fear that their voices will be drowned out by the doctors’ voices but, in fact, there is equal fear and trepidation among physicians. The concern is not a one-way-street by any stretch of the imagination, points out Leckie.

“The fear among doctors is that they are going to end up being dominated by nurses! There are four or five times as many [nurses] as there are doctors, after all. There is a fear doctors will be swamped by their nursing colleagues, but that does not need to happen at all. This is a genuine aim to attempt to create an organisation that all can join; where the sum will be greater than its parts,” he contends.

The new body will be funded by members, either individually or through their membership of existing bodies that become a part of the new organisation, Leckie explains. And one area where the new body could make a big difference is within education, he claims.

“Within education there are already significant overlaps between doctors and others; there is a lot of opportunity for joint training and education and so there should be a lot that is beneficial. There is clearly scope for improvement in education,” he says.

“Overall, this should be seen very much as an opportunity and not a threat by anyone within the profession. It is about taking all these different parts and coming up with something better. It is certainly not going to be any less effective than the current organisations, and it will not be more expensive than what people currently have to pay.”

Positive outlook

The general feeling among the practitioners that OH spoke to is that, yes, this is potentially a positive move. It could even in time be a very positive move if it ends up giving occupational and workplace health the recognition and influence it deserves. There was definite enthusiasm, too, about the prospect of being part of an organisation that understands, and is prepared to listen to, the concerns and priorities of those working within the profession.

“Certainly this is a body that could be in addition to the NMC, which would be positive, but could it perhaps even become instead of?” asks Anne Harriss, course director for occupational health nursing at London South Bank University.

“In many ways I would much rather see myself as allied to OH physicians and physiotherapists than as an adjunct of health visitors. So it might be that, in the long term, this organisation could even co-validate OH nursing, perhaps alongside the NMC.”

Lindsey Hall, of OH consultancy Split Dimension enthises: “The ambition is quite big, and it is in the right direction. I do not think the nurse voice will be lost. My vision would be that this is going to develop into a Royal College for Occupational Health or a Faculty for Health and Wellbeing or whatever it is called, and simply drag the workplace people in, the physiotherapists, OTs [occupational therapists], vocational rehabilitation specialists and so on.

“Occupational physicians are a powerful group, but they are still pretty small in terms of numbers. So it is up to the rest of us to make our voice heard. Nurses can sometimes be their own worst enemy in terms of sitting back and waiting for others to do stuff.”

Jeremy Smith, OH consultant at Occupational Health Services (South East), says: “I think it does have the potential to be positive. As nurses, what do we do when we look for evidence? We look towards FOM; for things like evidence-based practice it is really good. But I like to think it would not be doctor led; I’d hope it’d work as part of a team.

“It’s an idea that’s been batted around before. We do need a governing body that understands what we do, and the idea has been around now for a while. Doctors and nurses do work slightly differently, so it may be a case of waiting and seeing how it develops. I would love to be governed by a body that understood what I do.”

Joint response

As part of the move towards the creation of a new single body for OH, the Society of Occupational Medicine, the Faculty of Occupational Medicine and the Association of Occupational Health Nurse Practitioners (UK) (AOHNP), issued a joint statement in January 2014 outlining their position, their ambitions for the new body and the work so far.

This emphasised that the “ultimate vision” was the creation of a “body for all health professionals who address health needs in respect of work”.

Although the first part of this process was to liaise with SOM and FOM members – some of whom are, of course, nurses – a broader formal consultation with nurses, allied health professionals and other potential members would take place after a mandate had been obtained from the SOM and FOM memberships.

“However, we recognise that if the vision of a new single organisation that will address the health needs of people of working age is to be realised, then we need to ensure that other healthcare professionals involved in workplace health who may be part of the new organisation are broadly in agreement with our direction of travel,” the statement added.

To that end, SOM and FOM had been liaising through the Council for Health and Work and had enlisted the help of Christina Butterworth, chair of the AOHNP.

The statement also outlined what it argued needed to be the principles that underpinned any new single organisation. These were:

  • Address the health needs in respect of work.
  • Meet the needs of the current memberships irrespective of their background.
  • Have a collegiate framework to deliver and develop networking, education, and peer support both regionally and via special interest groups.
  • Represent the multidisciplinary OH professions and their skill sets.
  • Deliver a robust framework for revalidation.
  • Administer a robust and representative governance structure that stands up to public scrutiny.
  • Promote best practice through standard setting, education and training.
  • Stimulate research and evidence-based practice.

It added: “The provisional preferred model of the new organisation includes a ‘faculty’ of occupational medicine and potentially (if wanted) individual faculties for other professional groups such as nurses, physiotherapists etc.

“The faculties would be responsible for those areas that are specific to that professional group – for example, specialist qualifications, standard setting, revalidation and linking to regulators and relevant professional bodies.”

But the statement also recognised that much more work was needed. To that end a website has been set up that nurses and others can visit, as well as a LinkedIn discussion group. Practitioners are also being encouraged to get involved and submit ideas or queries direct via email.

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