How the NHS reforms will affect occupational health

With the NHS reforms poised to jump into full swing, Nic Paton looks at how occupational health practitioners will be affected by the organisational changes.

If you haven’t already done so, look at that crisp new 2013 desk diary, turn to April, and put a big, fat circle around the first of the month. That’s because 1 April 2013 is the day when, without wanting to sound overly melodramatic, the new NHS is born – the day when the coalition Government’s controversial NHS reforms go “live” and strategic health authorities and primary care trusts are formally abolished, with GP-led commissioning groups and a new NHS Commissioning Board stepping into their place.

NHS OH practitioners will also be affected by this revolution sweeping through the NHS, not least because of significant changes being made in the organisation and structure of NHS OH services.

The most notable of these changes will be the formal ending of the NHS Plus “project”, a brand that has become familiar to NHS OH practitioners since it was launched by the Labour administration back in 2001, but which from April 2013 will, as NHS Plus director John Harrison put it, “slowly fade away”.

The reason why is simple enough: last year, NHS Plus moved from being an entity supported and funded centrally by the Department of Health to one that has moved into the brave new world of “self-funding”.

Self-sustaining structure

The challenge, as Andrew Gilbey, former associate director (operations) for NHS Plus, explains, has been “to set up a structure to allow us to continue, and carry forward, all the work that has been done”.

quotemarksMoHaWK has fantastic potential, but it needs to reach a tipping point with the number of people using it.”

John Harrison, Syngentis

The result has been the creation of two new organisations: the NHS Health at Work Network and Syngentis, the trading name of the new Health at Work community interest company (CIC).

The NHS Health at Work Network is, as its name suggests, the practical network of NHS OH teams – 95% of OH teams are part of it – with a threefold mission to:

  • help to develop the NHS as a model employer;
  • deliver services to other public-sector bodies and smaller businesses; and
  • support the development of quality OH practices.

As Gilbey points out, this is likely to remain the visible face of NHS OH for the majority of practitioners: “NHS Plus will disappear, and NHS nurses and doctors will be represented through the NHS Health at Work Network and board, chaired by Dr Ursula Ferriday.

“The NHS Plus website is being rebranded to NHS Health at Work, and there will be a change in that there will be more of a focus on evidence-based guidelines and audit tools and resources.”

Syngentis, by comparison, is a different type of entity. It will be carrying forward various specific strands of NHS Plus work as well as working in partnership with the network.

As a CIC, it is a not-for-profit entity and, importantly, has an “asset lock” within it to ensure it is established for its specified community purpose and that all profits are dedicated to this purpose. Its founding directors are Harrison and Gilbey, along with Keith Johnston, NHS Plus managing director, and OH consultant and Occupational Health columnist Dr Richard Preece.

So, what is it and what will it do? And, although this may not be the most important question in the scheme of things, what’s with the name?

“Part of the reason we chose Syngentis as the trading name is that there are so many organisations with the words ‘health’ and ‘work’ in their name it can get confusing,” explains Gilbey.

“Syngentis will have a big piece of work in communicating that NHS Plus has gone, but it has been replaced by a combination of the network and Syngentis.”

Four key areas

From April, the organisation’s work will be split into four main areas.

First, it will manage the Department for Work and Pensions’ free online and telephone-based Health for Work Adviceline service for small and medium-sized businesses in the UK.

Second, it will oversee and manage the MoHaWK clinical online benchmarking tool for occupational health (Occupational Health, April 2012, pp.14-16).

Third, it will offer a consultancy and support service to the NHS, public-sector and other organisations, including central government and NHS Employers. This will focus on providing organisations with board-level strategic OH advice as well as helping them with the tendering and commissioning of services. A recent example can be seen in the work Syngentis, although not yet formally “live”, has undertaken with the NHS Commissioning Board around the establishment of an OH service (see case study 2).

Finally, it will work in partnership with the NHS Health at Work Network, and in particular will be helping to support it administratively.

Only the beginning

All this, Gilbey and Harrison hope, will just be the starting point, with the company’s work gradually expanding over the next two to three years.

For example, the Health for Work Adviceline work has already been taken forward and developed into a standalone service for Constructing Better Health, the OH service for the construction industry (see case study 1).

quotemarksIt is about making sure that OH provision is fit for purpose, helping organisations procure the right service.”

Andrew Gilbey, Syngentis

Both Gilbey and Harrison are also optimistic that a tool such as MoHaWK might, in time, be attractive as a proposition to OH teams outside the NHS – given that it potentially has the ability to enable OH teams to benchmark their performance against others, improve clinical delivery and share best practice.

As Harrison says: “MoHaWK, I feel, has fantastic potential. It needs to reach a tipping point around the number of people actually using it, but once it has got there I am sure it will just run.

“I can see it being of immense value to many organisations, not just NHS ones, and not just within the UK either. I think it does have international and perhaps even global potential over the next three to five years.”

Similarly, especially for NHS trusts, outsourcing to a CIC such as Syngentis might be seen as somehow a more attractive half-way house than going out wholesale to the private sector.

“We have the knowledge and expertise of working with the NHS already, after all, and hopefully will be seen as less ‘threatening’ to the NHS than the private sector,” says Harrison.

Gilbey agrees: “The key market for Syngentis is, of course, the NHS – but we will also be looking to work with other organisations, especially public-sector organisations, with a focus on really helping organisations at a strategic level to identify what their OH requirements are.

“It is about making sure their OH provision is fit for purpose, helping organisations to commission and procure the right OH offerings and find the right provider for them and for their service needs.

He adds: “Syngentis is a new business, but it is finding its feet. We need to make sure it is providing the services people want, but also that it is doing this as well as it possibly can.”

Growing demand

On the consultancy side, Syngentis has already had a number of approaches from organisations that know they need OH services and that they are important, but want to make sure that they are getting the best value for money from their service, says Gilbey, adding: “I can see that growing going forward – I can see demand growing.”

He continues: “The key message for NHS OH practitioners is that they will continue to get excellent support, so they need to be sure they are getting the maximum benefit from being a member of the network.

“For non-NHS practitioners, as well as NHS, the message is that there is a new, not-for-profit expert OH company out there that has been set up to help them improve the quality of the OH provision within their organisation.”

Harrison adds: “What we have tried to do is to capture the network and leader-ship aspects of NHS Plus, while also working to address the quality issues of NHS OH services.

“For NHS practitioners, their interface will be mainly with the NHS Health at Work Network and it will still feel very much like NHS Plus. There will also be an interface around MoHaWK because they will be asked for impact data twice a year. Their interface with Syngentis will probably be more restricted.”

He concludes: “The focus of Syngentis will be primarily on the NHS and the public sector, but certainly not exclusively.

“More widely, it will have a remit to work to support the whole agenda around health and the management of sickness absence and rehabilitation. It will promote scholarship, education and training and produce guidance.”

Case study 1: Constructing Better Health

Syngentis has been behind the development of a construction-industry-specific OH advice line for the construction industry’s OH service Constructing Better Health.

The line, called the National Construction Adviceline, was launched in September 2012 and is in the process of being evaluated and the results fed back to members, explains Michelle Aldous, chief executive of Constructing Better Health.

But feedback, so far, has been extremely positive, she stresses: “The take-up is good even though, for us, it is still early days.”

Constructing Better Health’s relationship with Syngentis is not a new one – in fact, the service has worked closely with NHS Plus for a number of years.

“It has not been a quick in-and-out relationship. Even in the early days of NHS Plus, it was clear there was a passion for the small and medium-sized enterprise sector and, within that, for construction,” says Aldous.

So the fact that Syngentis is already running the government-funded Health for Work Adviceline for small and medium-sized businesses meant it was an obvious fit for the development of a construction-industry-specific variant.

Syngentis was therefore tasked with creating a bespoke version of the advice line, under the Constructing Better Health brand. This resulting National Construction Adviceline offers employers advice on:

  • getting an employee back to work after long-term sickness;
  • managing the impact on their business of an employee taking time off work because of ill health;
  • supporting an employee and benefiting from their abilities if they are at work with health issues;
  • encouraging and supporting an employee who is off work yet wants to return and contribute to the business; and
  • developing a working culture where illness is less likely to occur.

The advice line uses the same “interface” as the Health for Work line, meaning it costs a lot less to develop and deliver.

Different levels of service can be accessed, with options including one-to-one case management, online live chat with advisers and a question-and-answer facility.

“There is no difference in the front-end stuff, it is just about getting a quicker, easier access to the OH information,” says Aldous. “We are incredibly happy with what we have got. We have got a consistent, coordinated approach to how we respond to small and medium-sized businesses.

“It gives you a central point that is collating the questions coming through – the hot topics. We have got one central portal and that is absolutely key to managing OH going forward.”

Case study 2: NHS Commissioning Board

The NHS Commissioning Board is a new special authority, set up by the Government as part of its NHS reforms, with responsibility for leading the design and implementation of the Government’s new commissioning structures for the NHS. This includes agreeing the method for establishing, authorising and running clinical commissioning groups. It also has a remit to develop the NHS’s business functions.

Although it will not take up its full statutory duties and responsibilities until 1 April 2013, it was formally established as an independent “arm’s-length” body back in October 2012 and, as part of this, it was decided that an OH service was needed that was both cost effective and “fit for purpose” across the 40 locations it operates from in England.

To this end, Syngentis was asked to review the existing contract for the provision of OH and wellbeing services for such government arm’s-length bodies. The original contract had also been set up under a framework agreement put in place before the publication by NHS Employers last April of new commissioning guidance for OH services. The outcome of the consultancy work was the creation of a detailed report reviewing the OH needs of the NHS Commissioning Board, an assessment of the current contract and recommendations for changes, which are now being considered by the board’s directors.

But the key, argues Ali Mohammed, director of HR and OD (service design) at the board, is that now the directors have a much better “line of sight” when it comes to making effective procurement decisions around OH.

Given the big changes afoot for the NHS, particularly around the shift from targets to outcomes, staff health and wellbeing is going to be a huge agenda, he says – and in many respects, a commitment to health and wellbeing is going to have to become as mainstream as the sort of commitments we have long seen in the NHS to diversity and equality.

“It is really about mainstreaming the health and wellbeing agenda. It is about asking: what is it that makes us an exemplar employer?” Mohammed says.

“Fit, healthy and motivated staff are critical to the delivery of exemplary organisational performance. We now have the tools and confidence to procure a cost-effective, efficient and robust OH service for our staff.”

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