NHS Plus announces shake-up to reduce ‘inefficient care’

NHS Plus is to undergo a major reconfiguration that is likely to lead to a reduction in the number of posts and the wholesale merging of some services and units.

A report, “The future configuration of NHS occupational health services”, commissioned by NHS Plus and carried out by OH nurse and regional health, work and wellbeing champion Helen Kirk, said the fragmented structure of NHS Plus in England is unsustainable in this economic climate.

The set-up is also a recipe for “ineffective, inefficient, poor-quality care that does not build confidence in colleagues, patients and stakeholders”, it added.

The report recommended the creation of larger, geographically based departments servicing a number of NHS employers.

The shake-up follows warnings by NHS Plus chief executive Dr Kit Harling last month that OH services would not be immune to the more austere financial climate expected in the NHS over the next few years.

Harling told Occupational Health he could not rule out job losses as a result of the reconfiguration. It was more likely that roles and responsibilities would change.

He said: “There will be posts that will be lost. I think it is inevitable. I can see three or four departments, maybe, deciding to come together and creating two in their place.

“We need things to be reconfigured and we need to be taking some costs out of the system. But I stress that is not the same as saying that we need to be, or should be, cutting services.

“It will be more about people saying we have to change what we do on a day-to-day basis and the way we work rather than being out of a job,” he added.

The key conclusions were:

  • OH provision for NHS staff is highly fragmented and inefficient, especially in England. In the North- West, for example, there are 31 separate providers, compared with just a few providers in Scotland and Wales, which is preparing to introduce a single service for the whole country.
  • This fragmentation is so extensive there are many examples of multiple services in close proximity (especially in major urban areas) and many examples of trusts on the same site but supported by different providers. In some cases, NHS staff on one site where there is an OH unit receive OH support from a different location.
  • For junior doctors and healthcare students, services are usually hosted by a single provider that may be a considerable distance from their workplace and who may have limited expertise in dealing with their complexities of healthcare exposures.
  • This fragmentation is compounded by persistent difficulties with diverse IT systems and the sharing of patient information between providers as staff move from one trust to another.
  • A large volume of OH service activity is invested in preparing staff for work at the start of employment (such as screening and immunisation) and also in supporting sickness absence management.
  • Many tasks are straightforward, requiring either no or limited specialist expertise, while some are complex and require specialist OH skills. Yet the skills mix of OH teams does not always reflect this and there could be greater use made of OH technicians.
  • Larger, geographically based departments are needed that provide services to a number of NHS employers. These services should be large enough to ensure the full range of expertise is available and that tasks are undertaken by those who are competent to perform them.

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