How pandemic has put the spotlight on OH accreditation

Since its launch more than a decade ago, the SEQOHS accreditation scheme has become the gold standard by which an OH provider evidences its quality of delivery to clients and customers.  But the pandemic has brought into the spotlight other accreditation models that can also be of value to OH practitioners, as one leading OH nurse has found. Nic Paton reports.

When you think about ‘accreditation’ in the context of occupational health, most practitioners, quite understandably, will probably jump straight to SEQOHS, the Safe, Effective, Quality Occupational Health Service accreditation scheme run by the Faculty of Occupational Medicine (FOM).

Since its launch in 2010, the scheme has rapidly become something of a gold standard for providers to show clients and customers that they are working to a high level and can, effectively, deliver what they say on the tin. Being able to demonstrate SEQOHS accreditation has become pretty much a mandatory requirement for providers tendering for contracts within the public sector, for many large private sector organisations and for local and national government in particular.

Indeed, the government’s response to the Health is everyone’s business consultation over the summer highlighted that SEQOHS is central to its thinking in terms of ensuring providers can show they are delivering services of sufficient quality, especially those delivering services under its proposed OH subsidy model.

As the response document said: “Government believes linking quality requirements to a provider’s eligibility to deliver subsidised services could incentivise providers to continue to offer a good standard of service, and support quality improvement in the market.”

Making access to OH services more widespread and accessible could “lead to a rise in demand, and potential new customers of OH will require support to ensure they are not purchasing inappropriate or low-value services”, it cautioned. Government therefore intended to explore the “potential of outcome-linked measures to support providers to improve and innovate”, including “piloting outcome-linked metrics with OH providers and employers which could be used to support continual provider improvement and improve employer choice.”

Ongoing SEQOHS review

Alongside this, the government in its response highlighted FOM’s ongoing review of SEQOHS, saying that it had “expressed its interest in the review exploring opportunities for SEQOHS to introduce stronger links with outcomes, and to increase engagement with employers and smaller providers”.

An update on that review was recently provided by Dr Robin Cordell, chair of FOM’s SEQOHS Review Steering Committee, at the NHS Health at Work Network’s 2021/22 annual conference in Kenilworth, Warwickshire in September.

Dr Cordell highlighted that the review will be “an upgrade” to the 2022 standards, with the aim being to “build on the value derived from the current standards, with further emphasis on clinical outcomes and measures of effectiveness.”

Key challenges (and, conversely, opportunities) included the need to introduce and demonstrate stronger links with outcomes and better engagement with employers and smaller providers, he outlined. This was likely to mean a need for better collation of data, caution around using absence data as a metric on its own, and consideration of how the standards can be better tailored to the needs of specific sectors, for example the NHS or construction. Then, overlaying all this, there would now be the imperative of ensuring providers are able to demonstrate that they are meeting the standards required to be included within the proposed subsidy model.

This is all well and good, of course, and in fact positive in terms of continuing to raise the quality and profile of OH provision within the UK as we gradually move (hopefully) to more of a post-pandemic footing.

Rise of UKAS accredition within OH

Yet it also needs to be recognised that SEQOHS is not the only accreditation game in town for OH providers. As we reported over the summer, the myriad pressures of Covid-19 are leading some to question whether the tick-in-the-box of becoming SEQOHS-accredited will continue to outweigh the cost (financial and time) of jumping through the various accreditation hoops to get there.

Equally, Covid-19 itself is driving change. For example, in December 2020 it became law that all private coronavirus test providers have to be accredited by UKAS, the UK Accreditation Service. Accreditation to ISO 15189, for running medical laboratories, is required to be listed as both a UK government test service and for international travel testing.

One practitioner who has gone through becoming ISO-accredited is Su Chantry, who runs an independent OH service, SKC OH, along with being the in-house occupational health nurse manager at Formula One team Williams Grand Prix Engineering.

She is now ISO 15189 accredited (with an extension to the scope of accreditation to include ISO 22870, the standard covering point-of-care testing). Alongside this, she is now working to accreditation for ISO 45001 and the new ISO 45003, which respectively cover occupational health and safety management systems and occupational health and safety management, especially psychological health and safety at work.

“You cannot present yourself as a Covid testing service unless you are ISO 15189-accredited,” Su explains to OHW+. “That is for PCR tests and laboratory testing, and that is both the lab’s responsibility and the clinician’s responsibility. I have ISO 15189 because I offer Covid swabs for travel; in the context of the Williams race team there is, naturally, a lot of international sports travel.

“Then, if you’re doing point-of-contact rapid testing as a swabbing service, you have to be accredited to ISO 22870. How people often get around it is by using a third-party supplier; if you’re not doing the test or are offering it as a self-test, then you do not need that accreditation.

“But, for me, it was also about me applying a model of quality assurance and audit. What I wanted to demonstrate was, yes, it was a big financial and time commitment from a business model point of view, but I think it actually reaps its benefits in the longer term,” Su adds.

Challenging process

The process to gaining accreditation was quite challenging, however, with a lot of detail required to be met around administrative, clinical, business and marketing standards. “When, in January, the government issued the qualifying criteria for ISO 15189I and I saw the amount of work I was going to have to do and hoops I was going to have to jump through, it did feel overwhelming,” she concedes.

“But probably that a good thing. I had naively thought, ‘oh I can just put a few bits together’. It soon became very apparent that, to do this seriously and to be audited by a government-level standard, it is really important for occupational health to realise how rigorous that is,” Su tells OHW+.

Su Chantry (standing at back) conducting a hearing test at Williams

There were three stages to the process. Stage one was the application and collation of basic documentation. Stage two was the development, gathering and collation of that evidence into a framework that aligned with the standards. Stage three was then an assessment process carried out by UKAS.

“UKAS was incredibly supportive. The team recognised there were a lot of people needing guidance and started webinar training sessions as well as some module training with the support of the Department of Health and Social Care,” says Su. Once assessors had been assigned, they advised and guided her through preparing for the stage three process, she adds.

“It is about putting in place systems that are recognised from a quality audit point of view. Because, I have to be honest, within occupational health I don’t think we’re particularly good at that. SEQOHS has tried to bring us up to it, but almost to the point where it is exclusive.

“I’ve now got a quality accreditation that is an internationally recognised accreditation but, because I don’t have SEQOHS, does that make my service any less valuable? So, maybe it is about challenging people’s thought processes. It is about the journey,” Su says.

“Whatever numbers or letters you acquire at the end of it, the process, fundamentally, is the same. It is about showing you have the ability and capacity to deliver good-quality occupational health management, whether you are a big provider or a single-service occupational health practice.

“When I did the accreditation, for example, I found what I had thought was really quite a good standard of documentation was really not yet at the level needed. So, you have to recognise where your strengths are but also your vulnerabilities. I realised very quickly into my ISO journey that I needed a quality audit service.

“I was lucky to collaborate with a chartered quality professional and lead auditor, Victoria Tait, who is very familiar with healthcare and the OH process and a range of quality standards (ISO/CQC/SEQOHS). Qualitait was able to advise and oversee a review and refresh of my management system and was an incredible font of knowledge, advice, and support during the ISO accreditation process.”

Victoria Tait tells OHW+: “Quality assurance is more than just a process, an audit or system being in compliance to a standard.

“Su wanted to think about the future of SKC OH, with sustainable skills, experiences and resilience, and have a quality management framework to inspire her future employees to work in a proactive, healthy quality culture that will have a lasting benefit. I try to offer a service as close to being an in-house service and working with companies and clinicians like Su, who are so dedicated to their profession but also willing to see scope for improvement within their business and because they want to and not because they must, is a very refreshing and rewarding role for myself.”

“Being ISO accredited has really made me up my game. It is a rigorous assessment process to go through,” Su adds.

“But even a simple thing like my website, has had to be taken to another level because the government drills down through that to make sure I’m doing what I’m saying as part of their evaluation. It has raised my profile within the local industry but also internationally. I’m now getting enquiries from Australia, China, America, Canada, Finland, throughout the world, for Covid testing,” she says.

“It has also made a massive difference within my cohort client base, which is predominantly sports travel, motor sports particularly of course. I was successful in being awarded the contract for the W Series motor racing championship Covid testing service. Obviously, the fact I am in-house at Williams was a factor – a lot of it is about the networking – but being ISO 15189 accredited certainly was a factor, that’s not a bad shout for a single nurse-led provider.

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“More widely, certainly within motor sport, the profile of occupational health has just gone stratospheric during the pandemic. My occupational health team is now a high-profile department within Williams; I am getting shout-outs at track on documentaries and on commentaries about the value that occupational health is bringing to Williams particularly, and that is fantastic.

“I think this aligns very much not only with current occupational health best practice but also where the future of occupational health is going. It is not about the numbers, it is about the quality, that for me is the key piece for occupational health,” Su says.