The government’s response1 to the Black Review recognises the particular challenges that small employers face in providing access to occupational health (OH). They are usually too small to have dedicated HR or OH teams, and often believe they lack the time or resources to tackle health and wellbeing issues before problems emerge. Sickness absence, in particular, can have a disproportionate impact on small businesses, prompting the government to state: “this sector, more than any other, will need support to achieve better health and wellbeing outcomes for its staff”.
In an attempt to plug this gap, the Department of Health (DoH) invited NHS occupational health providers to bid for a share of £20mcapital funding to build demonstration sites that would eventually deliver high quality OH to both the NHS workforce and other staff in their areas. Five bids were accepted as demonstration sites in the first wave of the project in April 2007, and were followed by a further six organisations in April 2008.
The NHS Plus capital investment project2 is overseen by a national programme board, which is responsible for the overall delivery of the programme and ensuring it meshes with other DoH policy work. The project is hosted by an NHS organisation – Plymouth Hospitals NHS trust, using a service level agreement that sets out how the trust holds the delegated budget and the contracts of employment for the project team.
Advice is drawn from a range of stakeholders, including NHS customers, such as the chief executives of trusts, OH professionals and representatives from the British Medical Association (BMA) and Royal College of Nursing (RCN). An independent evaluation of the demonstration site project has been completed and is due for publication.
One of the first capital builds to see the light of day under the NHS Plus project is a new occupational health and wellbeing centre based on a business park in York. Private sector practitioners, including physiotherapists and psychotherapists, are able to rent treatment rooms in the new building, enabling the centre to offer a “one-stop shop” of OH services to more than 14,000 local employees, including the trust’s own staff.
Andrew Gilbey, assistant director of occupational health at York Hospitals NHS Foundation, believes his team’s strong track record of commercial growth in recent years helped make the York bid successful, but also presented challenges for the future. “We’ve achieved significant growth in our commercial activities in recent years – growing income tenfold in the past 10 years, and increasing our headcount from 10 to 48 – and needed to move to modern, professional accommodation,” he says.
The York service receives new enquiries every week, and Gilbey believes its location in a fairly compact, small city means word-of-mouth recommendation successfully translates into new business.
The York project is keen to explore the development of a one-stop shop, providing a broader range of services than those traditionally offered by NHS-based providers. “We want to work alongside the private sector. Workfit, a Leeds-based physiotherapy company, and the Naburn Partnership, which provides counselling and psychotherapy, both rent space in our new building,”Gilbey explains. The aim is to eventually build these services, and others such as complementary therapies, into contracts with external clients.
It was decided to locate the new OH centre in the biggest business park in York, which is home to 250 small- to medium-sized enterprises (SMEs) employing 7,500 staff, effectively moving the service closer to the business community. “However, NHS staff are still important to us, and we provide regular onsite clinics down at the hospital,” Gilbey adds.
It has always been a central premise of NHS Plus that income from external clients should be used to improve OH in the NHS, for example, by extending the range of services available to NHS staff.
The York centre is able to employ a clinical psychologist to work with NHS staff, funded by its external work, helping to remove NHS employees from waiting lists for these high-demand appointments.
A good track record in providing OH to SMEs also helped a bid from Buckinghamshire Hospitals NHS Trust to win funding back in 2007, according to Jean Sweetman, head of workplace health services (OH) at the trust.
The Buckinghamshire service already had more than 50 SME clients before embarking on its capital project and has seen its total client base expand from 70 to 95 over the past two years.
Centre of excellence
This growth put pressure on the previous facilities and the OH service had tried to relocate three times before winning the DoH funding. A new centre of excellence for OH services opened its doors in January 2009, based on an industrial park one mile from the trust’s Wycombe site. The new centre is in an “ideal location” for providing a wider ranging service to local employers because it is on the junction of a number of motorways and hasplenty of parking, unlike the old hospital site, according to Sweetman.
Word of mouth
Persuading SMEs to invest in workplace health is never easy, and is set to become even harder in the recession. Word-of-mouth recommendation is the best way of marketing OH in York, according to Gilbey, who tends to focus on human resources and personnel managers in making his initial contact. “We also have a good profile locally as a result of our capital development, featuring regularly in the local press,” Gilbey adds.
The York service has restructured as part of the capital move, appointing a business development manager to actively network with local Chambers of Commerce and sector-based health and safety forums. For example, the business development manager recently presented the OH services at a construction forum, and this initiative has already resulted in a couple of approaches to the service.
Public sector clients, other than the NHS, constitute by far the greatest proportion of total external income to the York project. For example, although 90 of its 100 clients are SMEs, 10 big public sector organisations account for the lion’s share of the York service’s income.
The recession does make it harder to argue the case for investing in workers’ health, according to Sweetman of the Buckinghamshire service. Her service plans to ride out the recession by focusing on the pre-employment support it can offer SMEs. “Our interventions mean the employer gets a worker who is assessed as fit for the job, and is less likely to present problems later on,” she adds.
“We also get a number of ‘distressed cases’ – an SME will approach us with an employee who has been off sick for a long time and the organisation has reached the point where it is finding it difficult to function without taking action.”
The Buckinghamshire service will work with these clients on an ad hoc basis, without the need for an “unwieldy” contract, providing an assessment of an individual’s return-to-work prognosis and advice and support on rehabilitation, including whether the employee is likely to be covered by disability legislation. Sweetman adds that many SMEs use her service on this basis, while larger clients, including other public sector employers locally, are more likely to have a contract.
Current clients are tightening their belts, even those that were considering expanding the range of OH services they buy only nine months ago, according to Sweetman, who adds that the service is “having to work twice as hard to bring in work as we did back in May 2008”.
However, existing clients are still buying pre-employment assessments, health surveillance (for example, lung function testing) and sickness absence management, and the new centre of excellence will “think twice” before it expands into softer OH areas such as complementary therapies.
Private practitioners working under the York centre’s banner are “closely vetted before they’re allowed in the building”, according to Gilbey.
Their professional registration and financial standing is checked, and client references used. For example, the physiotherapy company Workfit provides data on client feedback, and is able to demonstrate the effectiveness of its interventions in improving client health.
“We rent out consulting rooms on a three-year lease, which I believe is important in ensuring a big effort to make the partnership work for both parties,” Gilbey adds.
Recruiting OH specialists to deliver services remains challenging. “I can’t deny there is a difficult recruitment market for OH nurses,”Gilbey accepts, adding: “The NHS is not able to compete with the salaries offered in the private sector, although we can compete in non-pay areas like the range of work we offer, and the chance to become part of a multi-disciplinary team.”
The project recruited its first OH technician last year, a vital role that may expand if demand for health surveillance work continues to grow.
Counselling is predicted to be a growth area of work for the York centre, and it has been successful in offering placements to new diploma graduates from the local university seeking professional accreditation. “We find these placements are a good source of future qualified counsellors – we employ 11 in total at present, some on a bank basis,allowing the staff some flexibility about where they work and when,” Gilbey adds.
Managing a capital project is very different to managing an OH service, and both Gilbey and Sweetman have found themselves on a steep learning curve over the past 18 months.
“The biggest challenge has been the physical relocation of the service to its new building, and we did encounter a bit of slippage on the moving date,” Gilbey adds. “Acquiring new skills connected with managing a capital project – for example, planning and traffic management issues – at the same time as keeping the OH business running, was challenging.”
The OH team at York Hospitals NHS Foundation Trust expects to increase its income by 50% in the year to March 2009, and is on course to reach its five-year growth target in only two.
However, it is also conscious of the need to ensure it grows in a structured way, so that the quality of service is maintained and new work is not taken on at the expense of existing, particularly NHS, clients.
Sweetman describes the development of the new centre of excellence in Wycombe as an “exciting project”, although she agrees with Gilbey that project management presented new challenges, such as designing a transport strategy and examining the impact of the new centre on other local businesses on the new site.
The Buckinghamshire team has recently employed a marketing consultancy to develop a robust database of local businesses, contacts and proposals, as part of building marketing collateral. Sweetman believes her team has done the groundwork and now has a good base from which to move forward.
First wave NHS Plus capital demonstration projects
The following projects share £10m central government funding to build new occupational health sites, serving both the local NHS workforce, staff working in other parts of the public sector, and those employed by small- and medium-sized enterprises:
Buckinghamshire Hospitals NHS Trust obtained £2.5m to relocate its OH service from the district hospital to an industrial unit on a nearby business park. It is designed as a demonstration site for other, smaller NHS trusts operating in semi-rural areas (see main story).
Cambridgeshire University Hospitals NHS Foundation Trust was awarded £1.1m to build a Centre of Excellence in Occupational Health and Wellbeing. The trust added a further £1m funding in early 2008. The idea behind this project is to serve the expanding bio-medical and technological workforce in the area by providing OH services to small and medium-sized enterprises through a new centre based on the Cambridge biomedical campus.
Hammersmith Hospitals NHS Trust is the largest of the five first-wave capital projects, and received £3.2m to develop offsite workplace health management services, “health on the High Street” services to SMEs in West London, and a travel clinic and advice centre. The latter opened in January 2008 and was developed in conjunction with local companies to ensure it meets the needs of business travellers.
Portsmouth Hospitals NHS Trust received £1.4m, to which it added £1m, with the aim of building a wellness centre in the hospital grounds to be a ‘one-stop shop’ for the health needs of working-age people in south-east Hampshire. Local businesses are supporting the 2012 Olympic games, and the project team believes it is well-placed to provide infrastructure support. The project is working with the local JobCentre Plus, Chamber of Commerce and charity Relate on return-to-work initiatives, and will focus on business issues affecting SMEs in particular, including reducing absence costs, improving employee psychological wellbeing and staff morale and motivation.
York Hospitals NHS Foundation Trust used £1.38m from the capital projects fund and £190,000 from the trust to develop an occupational health and wellbeing centre on a local business park.
1❯The Government’s response to Dame Carol Black’s review, www.workingforhealth.gov.uk/Government-Response/Default.aspx
2❯NHS Plus capital investment project, www.nhsplus.nhs.uk/web/public/default.aspx?PageID=294