However valuable their expertise, most occupational health (OH) professionals recognise that reforming and improving workplace health is not something they, as a relatively small profession, can accomplish alone. Perhaps the over-arching theme of national director of health and work Dame Carol Black’s 2008 Working for a Healthier Tomorrow blueprint for the future of working health was its emphasis on greater collaborative and multi-disciplinary working.
Whether it is through greater use of GPs, case management specialists, vocational rehabilitation experts, or OH technicians, OH nurses (OHNs) and physicians are already, and increasingly, working as part of much wider teams.
It is against this backdrop that the Institution of Occupational Safety and Health (IoSH) has been running a Department for Work and Pensions (DWP)-backed workers’ health pilot project in Leicestershire that offers training to health and safety practitioners in how to identify ill health in the workplace, such as stress and anxiety, and outlines the sort of actions and interventions they might be able to take.
An evaluation of the effectiveness of the two-day programme will be submitted to the DWP at the end of the year, which will make a decision on whether to provide funding to allow it to be run on a wider, national basis.
A workshop was held in September to discuss the progress of the pilot, attended by, among others: Cynthia Atwell, representing the Royal College of Nurses; Theresa Harrison, on behalf of the Association of Occupational Health Nursing Practitioners; and Dr Bill Gunnyeon, DWP chief medical officer. The Society of Occupational Medicine and the Ergonomics Society were also represented, as was Nottingham-based COPE Occupational Health and Ergonomic Services, which has been running the training.
While OHNs generally believe that a development such as this, which has the potential to help get people back to work more quickly, is positive, Black hinted at one of the concerns many in the profession feel about health and safety professionals moving into the health and wellbeing arena. “While it’s important that health and safety practitioners don’t forget the original job they do so well, there is an opportunity for them to acquire new competencies that support the agenda of health and well-being in the workplace,” she said.
“Health and safety practitioners are well placed to take a proactive, preventative role in spotting early signs of worker distress, signposting people to additional help, and helping those who want to return to work to have the appropriate conversations. There’s an opportunity for health and safety practitioners to embrace a new, more supportive role that will help build a healthier workplace,” she added.
It is this issue around competencies and the appropriate demarcation of roles and responsibilities that plays on the minds of some in the profession. With approximately 35,000 IoSH members (not to mention many unaffiliated health and safety professionals) in the workplace, compared with about 4,000 OH practitioners, the worry is that OH’s expertise could become marginalised and its voice lost. Just as worrying is the fear employers – which may be hazy about the difference between health and safety and OH anyway – may take it as an opportunity to use health and safety professionals as, in effect, proxy OH professionals.
Barriers and boundaries
Susan Gee, OH senior manager at Bradford Metropolitan District Council, puts it succinctly. “In principle, it is a good idea,” she stresses. “But the main barrier to this sort of working has to be how far do you go in saying: ‘these are the absolute boundaries’?
“More collaborative working is a good idea, but nothing in isolation works. So you have to have tight guidance on what it looks like and how it will work,” she cautions.
Similarly, Graham Johnson, OH nursing development manager at Bupa Wellness, says: “I hope that people will see this as a way forward. But there is no substitute for specialist occupational health advice. People will need to be assured that there are boundaries in the referral care pathway.”
Nevertheless, he adds: “We have a lot of shared interests with health and safety, so this is something that could become valuable to the occupational health team. We cannot afford to be elitist.”
Training at this level could also be ideal for small and medium-sized organisations (SMEs) that have no OH support but have been advised they need to do, say, health surveillance. “IoSH could do the risk assessment and then bring in OH nurses as the specialists to interpret the results,” Johnson suggests.
And, in many respects, this is exactly how IoSH sees the pilot evolving, argues IoSH president Nattasha Freeman. The fact that the course is just two days long should make it more attractive to SMEs, which are unlikely to be able to spare employees for any longer, she points out.
The idea is not to create health and safety ‘OH nurses’, but to give health and safety practitioners skills that might help them to make an intervention earlier in the recovery cycle.
“We do not want people to become clinicians. We want people to be supporting occupational health practitioners,” Freeman emphasises.
“If we can offer people training that helps them to look at ways of getting people back, perhaps through an earlier referral to occupational health, then that can be part of the solution,” she adds.