Musical chairs

It’s all change at the Department of Health as the latest reshuffle means
there is yet another new face responsible for overseeing workplace health
issues. Some argue that if this Government wants to make a real difference, it
needs to have a huge shake-up of how OH is managed and enforced, by Nic Paton

The surprise resignation of transport secretary Stephen Byers in May brought
about a much wider reshuffle of the Government than political pundits had been
expecting. Why this should be important to occupational health nurses is that,
yet again, it means a new face is dealing with workplace health issues in the
corridors of Westminster.

Ever since Labour came to power in May 1997, Occupational Health has been
pressing the Department of Health to agree to an interview with the minister of
state responsible for overseeing occupational health issues. We have argued –
and officials have agreed in principle – that Occupational Health would be a
perfect forum for the minister of the day to set out his or her stall to the

Yet despite having at least twice got to within days of sitting down for a
face-to-face chat, each time events or reshuffles – with the Byers reshuffle
being just the latest – have conspired to ensure it does not go ahead.

Rightly or wrongly, OH is one of the responsibilities considered appropriate
to be handled by a junior member of the Department of Health ministerial team.

Four ministers in five years

As a result, those picking up the OH baton will often be new ministers or
those destined for greater things. Since 1997, four ministers have had
responsibility for workplace health issues (see box) – nearly one a year.

On the plus side, it could be argued that Labour is putting some of its
brightest future stars in charge of OH issues. Indeed, the latest incumbent,
David Lammy, is Britain’s youngest MP and is widely tipped for higher office.

In many respects, too, the Government’s record on workplace health is not at
all bad. A central plank was the launch in 2000, with the Health and Safety
Commission, of its Securing Health Together and Revitalising Health and Safety
occupational health and health and safety strategies.

These 10-year strategies have set targets to reduce the incidence of
work-related ill-health, the number of fatal and major injuries and working
days lost to injuries and ill health.

NHS Plus

Another major initiative was the launch last October of NHS Plus. This saw
NHS OH units encouraged to outsource their services to the wider community, in
particular to small- and medium-sized enterprises (SMEs), through the use of a
dedicated website.

Politically too, the Government has made changes. Whereas once OH was simply
lumped in with public health, it has now become a ministerial area of
responsibility in its own right, and so rewarded with greater prominence in

Ministers have championed the introduction of better work-life balance,
shorter working hours (through the Working Time Directive) and, in the public
health arena, have tried to tackle levels of smoking and other pervasive public
health issues such as obesity.

But such is the revolving door now at the DoH, OH nurses are becoming
increasingly concerned that ministers do not have time to grasp the key issues
facing the profession before they move on. This, they fear, results in
short-termism, a lack of focus and an inability to push through change.

Carol Bannister, OH nursing adviser with the Royal College of Nursing,
believes relations between the Government and the profession are rapidly
approaching a critical point.

Substantial funding needed

Speaking personally rather than with her RCN hat on, Bannister argues that,
while ministers, superficially at least, are making all the right noises,
without extra cash to back their words it may as well just be hot air.

"The longer it goes on without any substantial new money spent, the
more reason there is for OH nurses to say nothing is being done," she

Strategies such as Revitalising Health and Safety are welcome but without
extra funding, can only achieve a limited amount, she suggests.

"The only money being spent, as far as I can see, is around vocational
training and rehabilitation. This speaks volumes about the Government’s
attitude towards saving money rather than protecting health.

"They have been talking about a strategy for occupational health since
1997 and have been trying to implement it since 2000. We are now fast
approaching 2004 – when they expect the 50 per cent targets to be met. It will
be impossible that those will be met if the Government does not put any money
into this strategy," Bannister emphasises.

"We are fast approaching the time where the Government is going to have
to evaluate what it has achieved with its strategy and ministers are going to have
to manipulate it because they have achieved nothing," she adds.

Civil servants complain the profession carps on about the fact there are not
enough OH nurses to cope, she says. Yet what the Government fails to grasp is
that, if it is left up to employers, whether NHS or in the commercial sector,
to fund OH training then it is just not going to happen at the levels required.
Government grants are needed towards training of OHNs, Bannister argues.

Crack-down on employers

The Government could do more, too, to crack down on errant employers,
suggests Anne Harriss, director of the BSc course in OH nursing at South Bank

The fact that providing an OH service for employees is not a statutory
requirement is a failure that has yet to be addressed by any Government, she
contends. "My personal feeling is that more could be done. It is
unfortunate that anyone can be a nurse with an interest in occupational health
and that the quality of OH nursing and provision is patchy," she says.

The Securing Health Together document was "a move forward" and
moves to get GPs and practice nurses more involved in OH, while laudable, are
not a solution.

"Where are they going to get the OH knowledge from? And it is sometimes
tempting for GPs to move into OH because it can be lucrative for them,"
she worries.

The idea behind NHS Plus was "excellent", she concedes, as long as
it does not result in an already stretched NHS OH service becoming even more

Angela Dunlop, OH nurse with Scottish Equitable, is more positive, arguing
that things are improving, even if there is still more that could be done.

But she adds: "Occupational health should be compulsory for all
employers. The Government is not putting its money where its mouth is. It is
expecting companies to fork out. For a lot of bigger companies that is OK, but
how do you make sure services are available to SMEs such as hairdressers, who
often have dermatitis or other skin problems?"

Tax incentives for SMEs could be one option the Government might consider,
she predicts.

Professional qualifications

Much like Harriss, Dunlop wants to ensure that, when someone goes to see an
‘OH nurse’ they know he or she will be a qualified specialist practitioner.

"It goes from the sublime to the ridiculous. You get individuals who
are essentially glorified first aiders right up to a pure occupational health
service," she explains.

Health ministers could also do a lot more to raise their profile within the
profession. When asked who the minister with responsibility for OH was, one
senior OH nurse, who wished to remain anonymous, had to think long and hard
before answering, "Yvette Cooper?".

When prompted, she admitted to recognising the name of Hazel Blears (who
took over from Cooper last year) because she had seen it on the bottom of
circulars, but she had certainly not yet heard of new-boy David Lammy.

Ministers poorly informed

Dunlop agrees. Few ministers in her experience bothered to come along to
regular nursing forums or make sure they understood the key concerns of the
profession. "What do they know about OH and what the job entails? When you
talk about occupational health they seem just to think about health
promotion," she says. OH nurses within the NHS are also sceptical about
the Government’s commitment to their profession. A senior NHS OH nurse, who did
not want to be named, believes ministers failed to take OH or workplace health
sufficiently seriously.

The arrival of NHS Plus was ‘over spun’, for instance. "That is
something that has been going on quite nicely at our trust for years and years.
We have had external customers for a very long time," she says.

Penalties for employers are not harsh enough, meaning organisations are too
ready to risk cutting a corner or two.

"There is very little penalty for employers who expose their staff to
risk. But I do think OH is enforced better within the NHS," she says,
adding that resources for NHS OH services are improving and trusts are doing
more to try to enforce standards.

Shake-up needed

"Over the years I have noticed there is more attention being paid to
OH, but if this Government really wanted to make a difference, it would do
something radical like a huge shake-up of the way OH is managed and
enforced," she argues.

Historically, the difficulty with OH has been that it is often seen as a
drain on resources, not a core requirement. With an increasingly transient,
mobile workforce this is ever more the case. Where is the incentive for an
organisation to offer a comprehensive occupational health service to an
employee who may be going to move on after, say, two years rather than 10 or
20? In such an environment, employers feel they are less likely to reap the
longer-term benefits of keeping an employee fit and healthy and so are less
inclined to invest in occupational health.

But, if the short-term incentives are less clear, this is all the more
reason for the Government to provide a strong lead, argue OH nurses. Moreover,
for a Government struggling to improve the NHS and meet the ever greater health
expectations of a nation demographically getting older, a greater emphasis on
workplace health would make political sense too.

"If the Government got it right, the number of people needing to access
the NHS would be much reduced," argues Dunlop.

And the RCN’s Bannister adds determinedly: "This Government needs to
start spending some serious money on improving access to competent
professionals and continuing professional development."

As soon as he was appointed, Occupational Health put in a request for an
interview with David Lammy. "He’s just getting his feet under the table,
give him a month or so," came the reply.

We hope he will take up the offer. In the meantime, the advice from OH
nurses, it seems, is "talk to Gordon Brown but, most of all, come and talk
to us". Don’t get too comfortable behind that Whitehall desk, David.

Who’s who at the Department of Health

Since 1997, four ministers have had responsibility for workplace health issues.
Up to last year’s General Election, occupational health fell within the remit
of the public health minister at the Department of Health.

Tessa Jowell, now culture, media and sports secretary, was the
first to hold the position under health secretary Frank Dobson.

When Dobson stood down to run as Mayor of London in October
1999, his successor Alan Milburn brought in Yvette Cooper, who is now
parliamentary secretary in the Lord Chancellor’s Department.

A shake-up at the DoH after the General Election saw
occupational health become a stand-alone ministerial area of responsibility for
the first time, combined with NHS Plus.

Hazel Blears, who had been brought in to the DoH in December
1997 by Milburn, was made a minister and promptly given OH as one of her

This continued until the resignation of transport secretary
Stephen Byers in May. The reshuffle in the wake of this saw Blears promoted to
public health minister and David Lammy brought in in her place.

Among the other parties at Westminster, the Conservatives lump
occupational health in with the rest of the shadow health brief. It is the
responsibility of shadow health secretary and former GP Dr Liam Fox.

The Liberal Democrat with responsibility for OH is former
pharmacist Sandra Gidley.

Within the Scottish Parliament, occupational health is
currently part of health minister Malcolm Chisholm’s brief.

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