Dr Richard Preece draws readers’ attention to the fairly quiet launch of the Quality Accounts Regulations.
Two things happened in October 2010 that should change occupational health (OH). One has been headlining all year but the other has barely registered.
OH practitioners have been preparing their practices to take account of the Equality Act 2010. A great deal of thought has been put into refinements to pre-employment assessment.
Less thought is being given to changes of post in employment but the same (legal) principles should apply. Employers and OH practitioners should reflect thoughtfully on whether they offer employees alternative posts, promotions and redeployment before asking questions of fitness for that post. The procedural rigour of pre-employment assessment is often not applied to internal job changes.
The Quality Accounts Regulations 2010 have crept quietly in. These require the publication of Quality Accounts from all providers of NHS services, including independent practitioners and private sector organisations contracted to provide NHS services. Small providers are exempt only if their annual revenue from NHS contracts is less than £130,000. Even small commercial providers delivering OH for the NHS will quickly exceed this threshold.
In the past, a great deal of health-related legislation has not applied to OH. Notably, the Private and Voluntary Health Care Regulations 2001 specifically exempted providers of health support to workers from the quality requirements from which all other patients benefited. This is not the case here – there are no exemptions for providers of healthcare contracted to the NHS.
Quality Accounts are public documents that aim to improve the public accountability of services and involve boards in quality improvements. Quality Accounts should help service users understand the following.
What an organisation is doing well – OH providers have not been very good at publicising achievements. Some enter awards and share case examples but most do not. Quality Accounts are an opportunity for all OH providers to promote their contribution to the public health of the workforce (and do so alongside all other healthcare providers).
Where improvements in service quality are required – OH providers have long embraced clinical governance (Preece, 2006). The central themes of this are accountability and continual improvement. The publication of Quality Accounts all in a similar format in one place will be a welcome opportunity for current and potential service users to consider whether or not providers are contributing as much to improving occupational health as their rivals.
What the organisation’s priorities for improvement are for the coming year – the contribution of independent providers to the development of the specialty and more widely to healthcare is considerable. By annually reporting targets and achievements in Quality Accounts it will be much clearer who is and who is not really contributing.
How the organisation has involved people who use its services, staff and others with an interest in their organisation in determining these priorities for improvement – the engagement of service users is at the heart of future provision. Workers don’t often get a say in the OH service that is provided (or more often they don’t get a service). As providers report this, we can hope that users everywhere recognise its importance and the demand for excellent OH support expands.
Managers, workers and their representatives have long deserved access to regular reporting on the quality of care. The new Safe Effective Quality Occupational Health Service standards make it clear that customers must be able to understand “what they can expect from the service” [Standard E2.2] and “must consult and involve workers or their representatives regarding the provision of OH services” [Standard F2.2]. If Quality Accounts are the model for other health services they should be a benchmark for all OH services and not just a requirement for those doing a significant amount of NHS work.
All Quality Accounts are published on the NHS Choices website. They are uploaded quickly, so those from OH providers contracting with the NHS should have been published by now. Organisations that might reach the threshold for NHS work, and whose Quality Account should be published on the NHS Choices website soon, include: Atos; Capita; Healthwork; Team Prevent; and People Asset Management.
The Equality Act and the Quality Accounts Regs are not that different from each other. Each aims to make sure that people are treated appropriately and organisations are held to account for this.
Dr Richard Preece is a consultant occupational physician.
