Look to the future

We talk to leading practitioners from the HSE and OH on their predictions
for the profession of the future

An employee calls in sick and goes off to see his GP, where he complains of
feeling under pressure and generally unwell. The doctor, who’s sympathetic,
listens carefully and, rather than signing him off there and then, suggests it
might also be a good idea to pop down the corridor to the walk-in occupational
health clinic.

Sounds fanciful? Get used to it, as it could be the way OH is going. In
February, the Health and Safety Commission (HSC) launched its new strategy for
health and safety in the workplace, designed to set out a blueprint beyond its
current Securing Health Together strategy.

What is clear from the document is that, just as the nature of the workplace
is changing, so OH and health and safety will have to change in the future.
Indeed, OH is likely to move much more centre stage as the workplace health
focus gradually shifts away from picking up the pieces after a chemical spill,
or dealing with a broken limb caused by a falling piece of heavy machinery.

The challenges of the future, according to the Health and Safety Executive
(HSE) and OH practitioners, will be much more around stress management,
musculoskeletal disorders (MSDs) and absence.

What the new strategy has done is to set out a number of key goals to help
improve workplace health and safety. These include requiring the HSE and local
authorities to target resources at the areas of greatest need, and to have the
confidence to be less active where risks are well managed. In these
circumstances, the emphasis will instead be on advice and support.

Similarly, there will be greater involvement of workers to manage risk
factors such as stress, employee well-being and rehabilitation. There will be a
requirement to make information more accessible, with clearer advice. There
will also be a need to build better, closer relationships between the health
and safety bodies, while emphasising that support does not necessarily mean

There is a huge commitment attached to the new strategy, argues Brian
Etheridge, head of the HSE’s strategy and intelligence division.

"This is something we are committed to deliver. We are committed to
five high-level programmes of activity, one of which is improving occupational
health and safety support," he says.

"The strategy is framed around the idea that the world is changing, and
we need to change to keep relevant. It is about looking forward and thinking
about ways in which we can remain able to address issues around the
corner," he adds.

The fact the strategy stresses occupational health and safety support is
important too, argues Elizabeth Gyngell, head of the HSE’s better working
environment division. "It is distinguishing it from the old service – it
is not just a medical route. It’s about providing whatever support that company
or individual needs, which might be ergonomic."

The new strategy takes Securing Health Together forward, stresses Colleen
Bowen, head of the HSE’s OH support policy team. At its heart is a focus on
proactivity – preventing risks before they happen. "It is not just about
putting plasters on injuries. We want to prevent the risk happening in the
first place," she says.

The construction industry is a good case in point. The HSE has been setting
up a support model, which should be rolled out across the industry later this

Similarly, when it comes to MSDs, the focus is on developing a more active,
case management approach, Bowen says.

The HSE is also in the throes of developing a management attendance tool to
help small businesses. "It is a long-term programme, and we haven’t got
there yet. But I think there’s going to be a snowball effect in industry,"
she says.

Another key area that the HSE is working on is developing more ‘gateway’
services, perhaps through telephone helplines or NHS Plus, which could be
accessed by employers and employees.

The main focus of OH in the future is going to be sickness absence
management and rehabilitation back into the workplace, predicts OH consultant
and ex-HSC commissioner, Cynthia Atwell.

"OH has been trying to do these things for years, but with all these
new strategies, it is almost as if OH is being reinvented. I can see OH being
provided through a lot of outlets," she says.

As GP surgeries expand their health-related activities, and bring in more
alternative services, such as those already provided by practice nurses and
complementary therapists, OH could be another service that fits into a primary
care, as appropriately as a workplace, setting.

This becomes particularly relevant when you bear in mind the push by GPs, as
part of their new contract, to get shot of sicknote certification. The idea is
to have made ‘substantial progress’ to moving certification out of GP practices
by 2006. And, back in April, pilots were due to start for examining the
practicality of OH taking on some of the responsibility.

However, it appears that the pilots have still, as yet, to get underway,
casting doubts over whether this sort of timetable is too ambitious, or even

Atwell believes OH could provide health advice and promotion through GP
practices, and could help deal with workplace health issues. What level of
practitioner would do this, however, is a moot point, as it is unlikely to be
the sort of thing a high-powered, specialist practitioner would consider the
best use of their time.

One possible model could be the development of nurse assistants in the NHS,
who would work alongside the qualified nurses, believes Atwell. Some sort of OH
assistant providing general advice and first port-of-call support, and with the
ability to recognise when a referral to a specialist practitioner or GP is
appropriate, could be a workable solution.

"You could have healthcare assistants or OH technicians who might do
relatively basic things such as audiometry or lung function checks. Then the
qualified OH nurse could interpret those findings and suggest a best course of
treatment," she suggests. "But they would have to be working under
the supervision of an OHN."

Even in big companies that employ fully-qualified OH nurses, there is often
testing that could just as easily be done by someone with fewer qualifications,
she argues, freeing up the specialists to do what they do best.

Of course, such ‘blue-skies thinking’ is all very well, but where are all
these new practitioners going to come from? There is already a shortage of OH
nurses, advisers and specialist practitioners. And even if there was an
expansion of NHS Plus, it would be unlikely to have the resources, capacity or
expertise to provide the necessary numbers.

Atwell suggests that, if people are being used in different ways, then
perhaps there needs to be a long, hard look taken at entry routes into the
profession and levels of training. Similarly, there will probably need to be a
growth in the number of independent OH consultants.

In an ideal world, when you start a business, going to see an OH
practitioner to make sure people are employed in the right way should be on the
same list as going to see the bank manager, believes Graham Johnson, business
development manager at Interact Health Management.

"At the moment, OH is a cog in the wheel, but we are still not seen by
employers to be needed as part of the development of new companies," he

It should be the case that insurers specify an OH consultation for a new
business as a matter of course, he adds.

Too often, OH and health and safety are thought of as something threatening,
and only to be called in when things have gone really wrong. So there needs to
be an education process. "If you did a Mori poll of 1,000 people asking
them what occupational health was, you would see a lot of blank faces,” says
Johnson. "We have a reasonable idea about what a nurse does, but not OH.
There are so many different ways of providing OH, and so many models," he

OH will increasingly be an advocate in the workplace, a bridge between
management, HR and employees, and as such will need to work evermore closely
with all sides, suggests Sharon Horan, director of OH nursing services at Aon
Health Solutions, and chair of the Society of Occupational Health Nursing.
"We will be looking at a whole new range of issues, psychological and
musculoskeletal. There will be more involvement of workers, too, in asking how
we can do things better," she says. "There is still a big educational

As OH becomes a more high-profile issue within the workplace, so it will
need to become more visible and prevalent, agrees Judy Cook, president of the
Association of OH Nurse Practitioners.

"We need to be clear what OH is. Up to now, we have been quite focused
on safety. I think in the future we will need to become more focused on
occupational health and occupational ill-health, as well as safety. The world
of work is changing, and our role within it needs to be clarified," she explains.

OH will probably become more multi-skilled, she adds. "In 10 years’
time, we will probably have better identified what needs to be done and who
needs to be trained. "There are an awful lot of people out there still
sticking on plasters because it is what their employers want. But just because
their employers want it, does not mean it is the right thing to do. So there is
an element of educating employers about the role of OH."

Employees, too, will probably become much more involved. Much like Atwell,
Cook believes there may be a move towards a new tier of OH nurse, who carries
out more basic functions and has fewer qualifications than their specialist
counterparts. "There may be a move towards simplifying risk assessment.
Employees could be doing a lot of risk assessment themselves," she

Reducing sickness absence will also be a key challenge for the public
sector, she believes. The effectiveness of the NHS OH service will be critical
to this. There will need to be an increased awareness among employers, both
public and private, about for what purpose they want OH.

Bizarrely, considering how much employers are talking about absence and
sickness management, one of the biggest challenges facing the service may be in
creating demand, suggests the HSE’s Bowen. This is not because there is not
enough to do but, again, because there is not enough understanding about how OH
and health and safety can help.

"People want it once they have got it, but often they do not know that
it is out there. So there is an element of creating a demand for the
service," she argues.

If the HSE is successful, the profession could find itself severely in
demand in years to come.




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