As the new academic year gets underway, shock new statistics have revealed that university occupational health courses are down by nearly half this year – 43% – compared with September last year, at the same time as demand for OH expertise is greater than ever. So what is going on? Nic Paton investigates.
“I recently applied to Wales uni, went through all the process then received a phone call to tell me the course was no longer being offered.” So complained a member of the UK Occupational Health Practitioners Facebook group back in June.
While it was unclear precisely what sort of course she had been applying to, her experience is not uncommon and, if anything, likely to become more commonplace if latest data from National School of Occupational Health (NSOH) is anything to go by.
Its research has concluded there has been a massive 43% decline in university occupational health courses available from this September compared with September 2017.
As NSOH deputy head Mandy Murphy tells Occupational Health & Wellbeing: “As a specialty, the numbers within occupational health may be small, but the perceived value of it as a specialty is quite high. So the fact courses are disappearing like this is worrying.”
One of the latest casualties is the flagship occupational health course at London Southbank University (LSBU), overseen for many years by this publication’s CPD editor, highly respected Honorary Fellow of the Faculty of Occupational Medicine and Queens Nurse Professor Anne Harriss, a loss that Murphy describes as “another real blow”.
Harriss emphasises that, technically, the LSBU course is not closing. “We are supporting the current cohort of students to complete the course, which is only right. But we have closed recruitment for this year, September 2018/19. It is important, however, to stress the course is only not recruiting from September. And I am encouraging the dean of our school not to withdraw our NMC validation,” she explains.
“The government’s Work, health and disability: improving lives strategy document has made it clear occupational health is an important part of its thinking, and so there may be a requirement for more OH nurses in the future; the landscape may in two years’ time be very different.
“I am, of course, disappointed. But I can see why the university has made the decision, and it is solely about money. It is simply the fact any OH course totally focused on OH pathway-specific modules such as the one we deliver as LSBU is, increasingly, becoming too expensive for universities to run. There are, for example, complexities with regards to practice placements and practice teachers,” explains Anne.
So what’s going on? Given that, if anything demand for occupational health expertise is growing – and that the government has recently even suggested it is “not ruling out” the idea of making provision of occupational health a mandatory requirement for employers – why are universities shutting their doors in this way? And what impact is this likely to have on the profession and occupational health nurse education?
Cost of SCPHN OH courses
One of the answers lies in the nature of Harriss’ course at LSBU, particularly the fact it is an NMC-validated Specialist Community Public Health Nurse (SCPHN) occupational health course. As Anne’s comments illustrate, in an increasingly tight financial climate for higher education institutions, SCPHN OH courses, with their requirement for students to undertake placements supervised by practice teachers, are both expensive to run and onerous to administer.
“We had more than 40 students studying on our course this year. But what also has to be recognised is that there are far fewer funded training posts for OHNs than there are for, say, school nurses or health visitors. Budgets are tight for employers and they are not wanting to spend money on trainees; they want to be employing people who are already fully qualified,” explains Harriss.
“Then there is the fact that, across the UK, fewer people are applying for pre-registration nursing courses generally. The fees from these courses are often used to support the funding for those courses, like occupational health, with fewer students. It all comes back to budgets and money. There is simply less money to go around.
“There are fewer SCPHN courses across the UK. Some courses that have been validated are only taking small numbers of students or sometimes only run for a few years. I think SCPHN courses are all under pressure. Some universities, such as Robert Gordon, have dropped SCPHN altogether. The MSc occupational health course at Birmingham, for example, is brilliant but has never sought NMC approval, and so does not confer SCPHN(OH) registration upon graduation. Part of the problem is the cost and difficulty of getting practice teachers and running and supervising placements,” Anne reiterates.
This, naturally, is creating challenges for nurses wanting to make the transition into OH. Marie Crozier, for example, decided she wanted to do an OH course about a year ago. “But when I started drilling down into it I realised there were not that many courses out there and what there was was very varied; it was completely apples and oranges,” she says.
“I decided the LSBU course would be the best one for me – I have been a qualified nurse for 25 years and have done a variety of things within the occupational health arena for the past two years. So it would have been perfect for me.
“But now of course it is being stopped too, so it is very much a question of watch this space. I have put in an application for the new Robert Gordon BSc. That course, however, is not SCPHN and so what it does not do is confer Part 3. But now that is not so important to me anyway. Why choose a qualification that is probably not going to be available in a couple of years, and will probably be out of date?” she adds.
Crozier’s comments highlight the fact that underlying any debate about the current specific decline there are a series of much broader questions. What does and should occupational health education need to look and feel like? And how should it be delivered, both now and in the future, to make it “fit” for the workplace health challenges of the 21st century and beyond? And her “out of date” comments refer to the NMC’s ongoing review (since 2016) of both pre-registration and post-registration nursing education and standards.
NMC review of Part 3 of the register
The NMC is at pains to emphasise that this review is still very much at an early stage. Any reform to Part 3 of the register, where SCPHN is located, will only happen in 2020 at the very earliest, stresses an NMC spokesperson.
“It is going to be a long process, most likely into 2020. Hypothetically, if new standards were needed, I think the very earliest we would be looking at – and this is ambitious – would be in 2020. If we got there by, say, April 2020 that would, actually, be quite fast,” the spokesperson says.
Nevertheless, when you speak to OH nurses there a broad consensus – assumption, even – that SCPHN as we know it is unlikely to continue long term in its current shape or form.
Another factor coming into play in this febrile atmosphere is the launch this month of the Faculty of Occupational Health Nursing (FOHN). Clearly, as a new body it will need to find its feet and establish itself, but the long-term impact it could have on OH education – and the sort of role it could have – are very an area of ongoing discussion.
“SCPHN courses are tedious for universities to administer and run, and there is a lot of insecurity. I do think we are at something of a watershed. Historically the focus has always been on SCPHN. But I think the world is changing, and education is changing,” agrees OH nurse Sarah Holling.
Holling worked in HR for 15 years before deciding she wanted to go into nursing, and then into OH. She graduated from Surrey University in 2013 and this past academic year has been involved in supervising the learning of a student at LSBU. “We all need to be thinking more holistically, thinking about how people can gain the experience they need in different ways. We need to recognise that it is possible to gain competency via different routes.
“But within that we also need to understand what constitutes ‘competency’, and this where a body like FOHN may be able to provide a lead. It is not just about learning, it is about the experience on the job that enables you to be competent as a practitioner,” Holling argues.
Development of OH apprenticeships
There is, too, the question of the impact of new training pathways into occupational health, primarily the rise of apprenticeships. As this publication highlighted earlier this year, there are plans being worked on to develop a Level 7 apprenticeship standard and pathway for SCPHN OH nurses being led by the healthcare elearning body Skills for Health, as well as the NSOH and others.
Furthermore, there is the argument: do OH courses (and OH nurses) even need to be SCPHN anyway? As both Crozier and Harriss have highlighted, there are good OH courses out there, such as at Robert Gordon University in Aberdeen, that are not SCPHN-validated. Another innovative facet of the Robert Gordon course is that it is delivered solely by distance learning.
Lynda Bruce, lecturer in occupational health at Robert Gordon, points out that the university ceased to offer the SCPHN OH course in 2016 for a number of reasons. “Primarily it was because there were challenges in meeting the NMC practice standards due to a lack of suitable practice teachers, which is common across the UK in all higher education institutions,” she says.
The new BSc in occupational health at RGU – the one Crozier has enrolled on – which launched in September 2017 has already proved popular, she argues. “RGU has a new cohort of students commencing in September 2018 and the commencement numbers for autumn stand at just under 50,” she says.
“The new course includes new modules focused on mental wellbeing in the workplace and leadership and management in occupational health. The students can see the value of graduating with an award that includes management skills to suit their career progression. The RGU course is totally distance learning, which suits many practitioners who have busy lives at work and at home. RGU distance learning students are encouraged to communicate with each other digitally using social media,” adds Bruce.
The other side of this coin, however, is the risk that the quality of courses becomes diluted. Anne Harriss, for one, expresses disquiet at the rise, and growing popularity, of short, courses designed for nurses holding a SCPHN qualification to move from one field of practice into another. “Although it incorporates 10 weeks (50 days) of gaining experience in OH, I feel strongly it is not a course in OH nursing,” she points out.
Commitment to education
However, it also has to be emphasised that some universities are remaining firmly committed to offering full-blown SCPHN OH courses. One such is Brunel University in London, where OH nursing lecturer Marjory Fish points out the course is taking around 25 people this autumn. “London Southbank closing is definitely a blow as, really, it only leaves Brunel in the south east of England. But our course is continuing,” she emphasises.
“Should people be SCPHN or not? You can work effectively within occupational health while not being SCPHN, but people do learn differently,” she points out, though adding that SCPHN as a qualification does often offer higher employability chances and tends to be easily understood by employers.
“In the long term things may well change. For me, it is about educating employers so they know what different qualifications actually mean. Covering the material required in order to deliver effective occupational health nursing practice is the most important aspect,” Fish adds.
“There is a misconception that you have to have SCPHN-qualified nurses to get SEQOHS approval,” agrees Harriss. “But you don’t – you just have to have an ‘appropriate’ qualification. I would much rather as an employer have someone who knew what they were talking about, had experience and an appropriate qualification in occupational health, than someone who all they had was SCPHN. But for many employers, especially in the south east of England, all they want is people with SCPHN qualifications.”
“I think it is a really good time and moment to reflect on where we have got to within OH education and what it is that employers actually need,” suggests Mandy Murphy at NSOH.
She points out that FOHN, for one, is working on developing voluntary education standards for OH nurses as well as a guide for employers, a document that is expected to build on Public Health England’s 2016 document Educating Occupational Health Nurses: an approach to align education with a service vision for occupational health nurses (see panel below).
“We need to rethink our education methods and really think about whether we are meeting the needs of the specialty,” Mandy says.
“There are still some really good programmes out there that are NMC-approved. But the NMC is not necessarily the be-all and end-all; it is cumbersome and it can be hard work for people to get approval. So perhaps it is time to have a conversation about redesigning OH education based on need – the needs of employers, employees, universities and students – and having a discussion be about what is it that universities require to make courses financially viable?” Murphy adds.
Public Health England’s document Educating Occupational Health Nurses: an approach to align education with a service vision for occupational health nurses was published in November 2016 and aimed to set out, as it put it, “the recommended approach for nurse education going forward”.
The paper articulated four principles that, it argued, should “underpin the OH nursing approach to their working practice”, namely:
- the search for health needs
- the stimulation of awareness of health needs
- the influence on policies affecting health
- the facilitation of an awareness of health needs
It also outlined “the requisite ‘theory, knowledge and skills’ that must be included into education programmes to ensure excellent, high quality OH services”.
These it split into six broad topic areas: public health, the effect of work on health and wellbeing, the effect of health and wellbeing on work, research and evidence-based practice, leadership and management, and professional practice.
The full document can be accessed at: https://vivbennett.blog.gov.uk/wp-content/uploads/sites/90/2016/11/Educating-OHNs-final-Oct-2016-FinalNB071116.pdf