Now that the dust has settled, it is worth reflecting on how the decision of the two occupational health doctors’ bodies not to merge will affect the future of occupational health services, writes Lindsey Hall.
A majority of members in both the Faculty (FOM) and Society of Occupational Medicine (SOM) were in favour of merging into a single organisation in the vote conducted in September 2014. However, the SOM’s constitution required an even bigger majority than the one the vote had produced, so that seems to be it for now. In the same week as this vote took place, the Scots decided, by an even narrower majority than that required by the SOM, that they wanted to remain part of the UK.
The dynamics and reasons for the joining and separation of groups, organisations and countries are complicated. As a nation, we have been a union for about 300 years and part of the EU since 1974. We joined the EEC, which was quite a different concept and, since political and constitutional integration has loomed ever larger on the horizon, it seems that we increasingly want to distance ourselves again.
Many in Scotland wanted to end the union but also wanted to remain part of the EU. Many in the FOM and SOM, who were generally in favour of joining up, stated very clearly “not like this”. Some were very clear on what “not like this” meant; others were less so, but there is an argument that one should not set out on such a path without some idea of where it ends up, and that path was becoming increasingly unclear.
The main reason that the FOM and SOM considered merging was that both organisations are arguably too small to survive on their own, particularly the SOM, which is primarily an interest group. At least the FOM has some history of being hardwired to the General Medical Council before it adopted charitable status, and it also maintains a recognisable mandate for top-level advice and standard setting in the OH profession.
But, as the idea gained publicity, there was the prospect of a few thousand OH nurses, thoroughly disillusioned by both the Nursing and Midwifery Council (NMC) and Royal College of Nursing wanting to join. With the addition of the allied professions of physiotherapists, occupational therapists (OTs), mental health nurses and others, all of whom having a full-time role in OH, there were the makings of a very powerful entity. However, it was undoubtedly one that was far removed from the vision the FOM and SOM had had when the idea of merging the two doctor-led groups was first considered.
Key questions OH professionals must answer
So, let us get back to basics and ask a couple of simple questions: what is it we all do and what is it we want? Are we all nurses, doctors, physiotherapists and the like, with our own distinct roles and identities, or are we all workplace health professionals united under the principles of the moral, legal and financial reasons for ensuring good health at work? Are we different trees in the same forest or are we individual trees occasionally waving at each other on a hillside?
At present, the hillside is the reality and it is creating a vacuum – a big space in which no one is managing the wider context of the workplace health profession. But is that because we have lost sight of what the profession is? Organisations such as the Commercial Occupational Health Providers Association, the Association of Occupational Health Nurse Practitioners (AOHNP) and the Council for Work and Health all have a role, but none has a function that is overarching.
The NMC regulates the nursing profession, but a commonly held view among those in OH is that it has not got a clue about the OH setting. I would be surprised if those groups of OTs or physiotherapists working full time in OH did not have a similar view of their own governing bodies. The further away you are from the core, the less well represented you seem to be, which was the argument many Scots had for their separation.
Case for joining forces
When company doctors ruled the roost in big manufacturing OH departments, the world was a much simpler place. Nowadays, OH services have become more diverse and old hierarchies have been stripped away. If we all remain as separate trees on a hillside, then a noble and individual identity might be attainable, but we must not be surprised if it is cold and lonely most of the time. If we choose the relative warmth of the forest, then perhaps we can all take on a much clearer and more active role in managing it.
Education and training requirements could be better identified and provided. Insurers can fully understand the indemnity issues and provide suitable and cost-effective products. Validation and
appraisal will be simpler and more relevant to our everyday roles, and our advice will be more cohesive and valuable. We will better understand the value of our individual roles and experience in a multidisciplinary environment.
And maybe we can obtain a critical mass that means we are big enough to have a well-respected voice. We will all have our different shade of leaf and bark, which is crucial to the diversity of the group and the advice we all provide, but we increasingly need a more collective vision for the most important groups of all, the Great British working public and the organisations, businesses and institutions that employ them.