On 9 May, Lord Darzi published the latest part of his review of the NHS Our NHS Our Future: NHS Next Stage Review – Leading Local Change.
Darzi has made it clear that change is necessary, but has given five pledges:
Change will always be to the benefit of patients – whether in terms of clinical outcomes, experience, or safety.
Change will be led by clinicians and based on the best available clinical evidence.
All change will be locally-led.
Those affected will have the chance to have their say and offer their contribution. NHS organisations will work openly and collaboratively.
Existing services will not be withdrawn until new and better services are available.
These pledges provide a standard for future change in health provision that will be applied to the NHS. While they are directed towards primary care trusts (PCTs), they provide a new benchmark for others that provide health services to the public sector. These pledges are given by the government, not suggestions made to government. They constitute another opportunity for occupational health.
OH in the NHS is usually the only clinical service that sits in a non-clinical directorate (HR). Although OH units increasingly provide clinical care and support beyond their own trust this situation has persisted. Some of us have believed for some time that hosting OH services in HR is unhelpful, stifling evidence-based practice, investment, and impeding the move of OH into the mainstream of clinical care (recently highlighted in Dame Carol Black‘s report). Darzi’s latest report provides additional impetus for changing the host directorate for OH units.
Where PCTs are considering changes to their OH provision, they should acknowledge that we offer a clinical service and meet Darzi’s pledges. The change should be clinically-led, open, collaborative and based on evidence. The need for change is acknowledged, but a new process has been set out.
Most PCTs outsource, albeit mostly to local acute trusts. They should no longer change the form of their provision without taking account of the five pledges. OH providers, that deliver clinical services for PCTs, should ensure as they change they also fulfil the pledges.
OH is a clinical service. It will not be considered mainstream health care, and benefit from commitments on clinical care, until it resides within the clinical domain. In the NHS it should usually sit in a clinical directorate.
It should change and as it changes fulfil Darzi’s pledges. His report is only 16 pages – it is important reading for OH managers and should be compulsory reading for directors responsible for OH service provision. Send your director a copy and the five pledges today.
Richard Preece is a consultant occupational health physician.
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