NHS occupational health services need to develop competence, credibility, communication and consistency to meet the challenges of an uncertain future. This is what Professor John Harrison told delegates at the NHS Plus annual conference in April.
“We need to be able to talk about what we do a lot better than we have in the past so that people understand,” said Harrison, director of NHS Plus.
He added that the Government was reviewing how it procures occupational health services and is concerned that providers work in silos.
Harrison also said that NHS OH services needed to look more closely at the needs of those commissioning occupational health. “We always have to ask ourselves why people would buy services from us. What is our USP [unique selling point]?” he added.
The annual conference was the last funded by the Department of Health, as NHS Plus becomes self-funding from 2012.
Current NHS Plus projects include a new clinical governance review system and clinical quality indicators for NHS OH services. There will also be a second audit of NHS back-pain interventions from the Health and Work Development Unit (HWDU). Members of NHS Plus are also committed to achieve accreditation by March 2013 under the Safe Effective Quality Occupational Health Service (SEQOHS) system launched in 2010.
“SEQOHS is giving us big opportunities as a network of OH professionals to share information and best practice,” said Amanda Hinkley, interim chair of the NHS Health at Work Network.
The message was repeated by keynote speaker Dean Royles, director of NHS Employers, who said that accreditation will help to address a variation in quality in NHS OH services. “SEQOHS gives a guarantee of excellence to both commissioners and staff,” he said.
Royles also encouraged delegates to develop a “21st-century service” and respond positively to the challenges laid out in the Government’s public health White Paper Healthy lives, healthy people and the recommendations of the Boorman report on health and work in the NHS.
NHS OH services needed to look more closely at the needs of those commissioning occupational health.”
Professor John Harrison
Royles added that new GP consortia gave OH an opportunity to influence commissioning of OH services and encouraged NHS OH providers to work with trust boards and commissioners. He said there was a concern that some trust boards do not want to engage in this process and OH should work to get the message across, promoting the business case and use “invest to save” approaches.
Cynthia Atwell OBE, former chair of the Royal College of Nursing (RCN) Public Health Forum, said that challenges for NHS OH services included developing larger multidisciplinary teams and changing management expectations about OH.
Atwell argued for a more active approach to coordinating and planning services based on users’ needs, which would give OH a more enriched role. “You’ve got the knowledge and the skills. Take the lead and make the changes,” she said.
According to Atwell, the key challenges facing NHS OH are:
- in-house vs outsourced OH services;
- the need for larger OH services with multidisciplinary teams, which will give access to a variety of expertise including OH technicians, physiotherapists, occupational therapists and psychologists;
- changing the norm from the traditional expectations of management and OH staff themselves; and
- a more active approach to planning and coordinating services based on the needs of employees and therefore allowing an enriched role for OH nurses and doctors.
In-house vs outsourced
Atwell said that in-house NHS services needed to promote their advantages over outsourced services. “There are special needs in relation to NHS staff like infection control,” she added. “If you’re providing a service to blogs’ widgets down the road, you don’t need the same skills. I don’t think [outsourcing] is the best [option].”
Atwell also said that the way services were costed did not always take into account the added value provided by in-house services. “One of the problems is the cost. It’s based on how many [people] you can see and on tasks. There’s very little time for proactive work. If you don’t know what your workforce is like, how can you advise?” she said.
Atwell admitted that she was “devastated” when the RCN announced that it had abolished its dedicated OH nurses forum and set up the Public Health Forum.
“But it’s turned to our advantage because OH is now leading the agenda on that forum,” she said.
Dr Richard Preece, NHS Plus director of organisation development, advised delegates to improve their ability to influence the commissioning of OH services, adding that NHS Plus will provide OH with some of the tools needed.
It’s our job to do a much better job in future and we’ll do it by being informed providers working alongside informed commissioners.”
Dr Richard Preece
In an interactive session, Preece established that most delegates were not proficient in commissioning or bidding and had not read NHS Plus guidelines on commissioning OH. Preece advised NHS Plus members to commission collaboratively rather than individually, as at present. The process should be informed by evidence, legal compliance, good practice, clinical expertise and patient needs.
“It’s real, it’s now and it’s our job to do a much better job in future and we’ll do it by being informed providers working alongside informed commissioners,” said Preece.
Preece also said that OH had to develop a plan to ensure there would be OH practitioners in the future as well as sufficient “sub-specialist” expertise covering areas such as blood-borne viruses, TB, occupational asthma and ergonomics.
“There are far too few consultant-level OH nurses, in my view,” he added.
Dr Hamish Paterson, chairman of the Association of National Health Occupational Physicians (ANHOPS), and Paul Darcy, interim chair of the Association of NHS Occupational Health Nurses (ANHONS), said that the merger of the two groups would lead to a more powerful organisation.
Darcy emphasised the need for multidisciplinary cooperation to see off the threat of outsourcing: “We need to collaborate with health and wellbeing and health and safety. People may have forgotten that ANHONS existed. It is very active.”
The groups are using social media tool Twitter to help get the message across.
“If you find it and become one of our followers online, you can find out what we have to say,” said Darcy.
Graham Johnson, clinical lead nursing at Bupa Health and Wellbeing UK, put the case for using OH technicians.
Johnson said that there was a strong case for the registration of OH technicians and this is supported by the RCN, which plans to release guidance, “Roles and Responsibilities of Occupational Health Support Workers”, in June 2011. He said that experience at Bupa suggested it took 12 weeks to get a technician to be competent to cover health surveillance tasks.
“We need to be in a commercial market,” he added. “Many organisations have discovered we can’t have highly trained OH practitioners doing these routine jobs.”
He said that in future OH technicians could even administer vaccinations.
“The important thing is they [technicians] will work under supervision and have work delegated to them by OH practitioners,” Johnson added.
“Many organisations have discovered we can’t have highly trained OH practitioners doing these routine jobs… It [using technicians] is the future I see in OH. And hopefully some of these people will go on to become OH nurses. Why not train your own in the NHS? Set up an NHS Plus academy.”
You must have broad engagement at the highest level and must have staff involvement, staff engaged in the design of services. If you don’t, you won’t succeed.”
Dr Siân Williams
Three institutions offering OH nursing degrees that also offer training for OH technicians are the University of Glamorgan, the University of Warwick and Leeds Metropolitan University.
Dr Siân Williams, clinical director of the HWDU at the Royal College of Physicians, gave an overview of the first national audit of the National Institute for Health and Clinical Excellence (NICE) guidance for the workplace in NHS trusts in England.
The guidance covered long-term sickness absence, promotion of physical activity in and out of work, mental wellbeing, smoking cessation and obesity.
Obesity was by far the least addressed aspect of health at work, with only 15% of trusts having a plan or policy to help reduce obesity among staff. Only 31% of trusts provided evidence-based weight-management programmes recommended by NICE guidance and only 31% had promoted healthy choices in shops and vending machines, although 60% had done so in restaurants.
Williams said that the results showed the importance of senior leadership to the success of health promotion. “You must have broad engagement at the highest level and must have staff involvement, staff engaged in the design of services. If you don’t, you won’t succeed,” she added.
Poised for success
Professor Lindsey Davies, president of the UK Faculty of Public Health, said that the Government’s public health White Paper “Healthy lives, healthy people” has “some really good stuff” in it.
“They get the idea that in order to improve health at all ages, you have to make interventions at all ages,” said Davies.
However, she added: “There are huge challenges about how this unwieldy thing [the public health reforms] will deliver in the future.”
She also saw “great potential” in OH working with public health, “helping employers to see what they can do to help public health. Every little bit helps”.
She acknowledged it was not certain that local authorities would rise to the challenge of their new responsibilities for public health. “I’d love to think local authorities will take it seriously and say it’s our responsibility, but I’m not sure about this. It needs a lot more thinking through,” she said.