Working in an in-house OH team comes with challenges – especially in the NHS where there is often pressure to do more with limited financial resources. Kelly McClenaghan outlines the challenges and opportunities for in-house OH functions in the NHS and beyond.
The NHS Growing Occupational Health and Wellbeing Together strategy has helped increase the profile of occupational health (OH) in the health service, but the function is still not getting the recognition it deserves.
Having been the head of the occupational health and wellbeing service at two large NHS trusts for the past five years, I have experienced the many challenges it involves – but this has also led me to identify several opportunities for the NHS in-house OH function.
Some of the challenges and opportunities here will also be familiar to people working in in-house OH teams in other sectors.
Challenges
NHS occupational health CPD
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Finance
As with other areas of the NHS, finance is among the most significant constraints NHS occupational health and wellbeing services face. NHS OH departments must scrutinise what they do and adopt a value chain model, incorporating the biopsychosocial elements of health and wellbeing (Burton and Bartys, 2022). There is a need to change the delivery of in-house NHS services if they are to add true value.
Traditionally, OH services focused on responding to sickness absence and statutory health surveillance. While this approach aligns with the Safe, Effective and Quality Occupational Health Services framework (SEQOHS, 2023), this does not demonstrate the full value OH can offer an organisation. Employee health and wellbeing should be viewed as a positive and valuable commodity.
Working environment
In the NHS, the in-house OH service has to compete for space against clinical services. Most NHS services do not want an external venue for OH due to the time requirements for staff to attend appointments for immunisations, health surveillance and assessments following sharps incidents. Frequently, the space NHS OH services are allocated is not in the main hospital building and may have poor amenities and decoration, and less than adequate clinical facilities.
Having a voice at board level
Key to success for an OH service is the ability to influence change, but OH teams are often grouped with other support services that focus on recruitment or culture. Occupational health should have its own voice at board level, not to be drowned out by other workforce issues.
The wellbeing champion, if your NHS trust has one, can be a useful person to work collaboratively with, as will colleagues in health and safety and recruitment. But NHS OH teams also need to ensure senior leaders sit up and listen to what they have to say.
One of the biggest challenges for OH teams is to be viewed as integral to meeting the strategic objectives and values of their organisation. They should be seen as part of the foundations and culture, not as an add-on or ‘nice to have’ service.
The OH workforce
This is a challenge for any occupational health service at present, not just in the NHS, due to a decline in professionals entering the specialty. Recruiting for OH physicians in the NHS is particularly problematic due to the demand for consultants and the expectation to be integrated with other clinical leads.
The vision should be to invest in a skilled multidisciplinary team, offering an evidence-based service that encompasses all elements of employee health, including musculoskeletal, mental health, vocational, financial and disability-related needs.
One way to overcome the challenges of recruiting experienced OH professionals is to ‘grow your own’. NHS services should be looking to work with universities to offer placements for medical students, as well as nursing and allied health professionals considering a career change, to encourage more people to enter the specialty.
It is important to examine existing job descriptions and ensure knowledge, skill and competency frameworks meet organisational goals.
Integrated Care Boards
NHS services should be looking to work with universities to offer placements for medical students, as well as nursing and allied health professionals considering a career change, to encourage more people to enter the specialty.”
Integrated care boards (ICBs) should be setting the vision and direction of the occupational health service for their regions, but there remains a significant disparity between the services offered by different NHS trusts.
There should be collaboration with the ICBs and primary care providers to provide an external business model that supports other NHS and private healthcare providers, generating income that can be invested back into the trusts to enhance organisational health and wellbeing.
Health inequalities
Inequality within inner-city areas impacts both patients and the NHS workforce. The vision should be to provide a large, affordable service that offers evidence-based occupational health advice.
Due to financial constraints, an in-house NHS service may not be able to provide the full range of services required to address health inequalities, such as health MOTs, restorative musculoskeletal physiotherapy, or trauma support services.
A hybrid model should be considered to allow employees access to external services, ensuring any gaps in provision are covered. Public health services can address health inequalities such as high prevalence of communicable diseases, poor vaccine uptake, or high levels of obesity and diabetes.
Lack of data
Some NHS trusts do not have access to business intelligence units that produce meaningful data, or lack the expertise in their own teams to show the impact of their work on the organisation. They might also be constrained by their own IT infrastructure.
A dashboard that highlights the outcomes measures of OH and wellbeing initiatives would be desirable. Data is key to showing the value a well-invested occupational health service can have on staff retention, recruitment, sickness absence, culture and patient experience and safety.
Investment in research
This is essential for the growth and development of OH now and in the future. NHS services need to invest both financially and through their workforce in projects that provide evidence of the impact their interventions have on staff health. Consideration should also be given to quality-improvement initiatives.
Benefits and opportunities
Despite the significant challenges an in-house OH and wellbeing service can face, there are some obvious advantages to an NHS trust investing in this service.
Local intelligence
An in-house service will know the organisation inside out and can be available to attend meetings where their expertise will be useful. The NHS people plan outlined the plans for a health and wellbeing ‘culture’, of which in-house expertise is crucial.
Access to expert knowledge
Investing in in-house OH will help other functions enhance staff health and wellbeing. These include infection prevention and control, dermatology, psychiatrists, virology, public health, respiratory service for tuberculosis and sexual health clinics that specialise in blood-borne viruses. Collaborative working is essential.
Having an in-house OH team presents an opportunity for corporate services and clinical services to learn from OH professionals internally. The OH team can also collaborate with other experts externally on a regional and national scale.
Innovation
The diversity of the NHS workforce provides a great opportunity for innovation, while digital transformation will also change the NHS. Consequently, the skillset within OH services will need to change. As the administration burden decreases, clinicians will be able to be more proactive.
Staff development
The diversity of the NHS workforce provides a great opportunity for innovation, while digital transformation will also change the NHS. Consequently, the skillset within OH services will need to change.”
The opportunities to learn and grow professionally are often among the main reasons people decide to work in the NHS. The OH service can offer lots of opportunities for professional development and access to degrees, apprenticeships, leadership courses and the opportunity to shadow or access other specialities and learn from their expertise.
NHS trusts have access to experienced librarians and education academies, as well as improvement and development teams to implement change and innovation.
Priorities for NHS occupational healthÂ
For in-house OH services to survive in the NHS in the next five years, they must be flexible and listen to the needs of the organisation. They must adapt to ensure they are meeting emerging health needs.
One of the challenges for the profession is what it should call itself. Does the title ‘occupational health’ incorporate the whole self, or does ‘wellbeing’ need to be included as these concerns become more prevalent in the workforce?
If practitioners are unsure of who they are and what their role is, they will project this to their service users. There needs to be clarity around who we are as practitioners and what services we plan to deliver.
There are fantastic opportunities for OH services to influence strategic direction and help achieve overall organisational health. To do this, existing models must evolve. The traditional medical model for occupational health is no longer relevant in the changing world of work.
The Covid-19 pandemic gave OH teams a voice within the boardroom, and we must keep our seat at that table by offering a wide-ranging service that is inclusive and does not just focus on risk or compliance with health and safety legislation. We need to use this opportunity to influence how employers can create healthy workplaces.
References
Burton, K. and Bartys, S. (2022) The smart return-to-work plan Part 1: the concepts, Occupational health (at Work) 19 (2) pp. 22-27
NHS Improvement. (2022) Online library of Quality, Service Improvement and Redesign tools. A model for measuring quality care. (online). Available from: https://www.med.unc.edu/ihqi/wp-content/uploads/sites/463/2021/01/A-Model-for-Measuring-Quality-Care-NHS-Improvement-brief.pdf
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