Occupational health’s reforming voice needs to be heard

It is early days yet for the Government’s expert review of occupational health. But with the political “noise” of Brexit drowning out all else, OH practitioners need to be proactive – and loud – in making the case for reform, argues Nick Pahl.

As this edition of Occupational Health & Wellbeing went to press in April, details of the Government’s expert group on occupational health had yet to be made public.

At the Society of Occupational Medicine, we are working closely with the Government’s Work and Health Unit to ensure the details are right but, overall, it is vital there is rapid progress. Some action has begun, for example work has started by the unit to allow allied health professionals to be involved in fit notes. A group is also looking at how royal colleges can make a new commitment to work and health.

Clearly, we all want all health professionals to see work as an outcome of good clinical care. However, while encouraging all health professionals to think about/introduce work into a clinical consultation discussion may be positive part of a wider “occupational health (OH) strategy” it does not, and should not, imply the dilution of the role of occupational health professionals.

Occupational health practitioners need to press the case for access to qualified OH professionals for all the working population. The society and Faculty of Occupational Medicine have written to work and pensions secretary Esther McVey stating this and have also met with the junior minister.

Our document Occupational health: the value proposition also makes this case. It is vital the level of OH professional input should reflect clinical/occupational need.

Inevitably, the potential funding model is critical. A mixed market model of the NHS and the private sector is the most realistic in the next 10 years, in which, for example:

  • The private sector has incentives for occupational health investment in their organisations, for example for sub-contracts. It is great to hear that there are contractual requirements to invest in occupational health in HS2, for instance. It would be good to extend this requirement to all Government contracts. We would also like to see the Treasury providing further exclusion from tax exemption of work and health costs, such as specialist equipment, workplace adjustments and travel expenses. We’d also like to see support for specific areas, for example to keep older workers in employment, or sector initiatives such as with the construction sector.
  • The NHS develops a national tariff for occupational health activity that would facilitate workforce investment in OH – such as recruiting an OH nurse or GP with a special interest in occupational health in a GP practice, community locality or an OH hospital department. GP contracts should reflect work and health activity, as should NHS personal health budgets and NHS social prescribing spend. Care Quality Commission inspections should also highlight OH as an “invest to save” quality indicator.

For both sectors there needs to be new local networks to avoid duplication and deliver national health and work activities locally, bringing together the NHS, local authorities and the private sector. I think there are specific areas that need to be taken forward too, for example:

  1. Workforce development. How can we increase the number of new OH health professionals, for example through apprenticeships and how can we develop new courses? The SOM has recently published a document with the FOM on the value of an occupational medicine trainee and we are currently drafting a “career in occupational health” document and organising a careers day for 24 September at the National School of Occupational Health.
  2. Data. What data are we currently collecting on OH and what are the priorities for future data collection, both in the NHS, and the private sector?
  3. Quality. How can we build on current quality improvement and accreditation of services?
  4. Technology. How can we help workers access the advice they need easily and quickly using technology.

Beneath all this is the critical role of the evidence base, and we also want to bring together academics experienced in this area to review the current evidence base and identify gaps.

We need to create clear clinical pathways for work-related health consultations, so that all health consultations with working-age people should include consideration of their work situation and that all health professionals should be able to give basic work-related health advice. They can be helped to do this via education and training, but they must work within their competence and refer to occupational health specialists when necessary.

The final element in the mix is Brexit, which could get in the way of Government time and progress. There is an excellent blog from the TUC on our website which I recommend you take a look at.

I hope we can still see movement of healthcare workers across Europe and the continued mutual recognition of professional qualifications. The SOM would also like to see EU occupational health and safety law enshrined in UK law. The UK has made progress in occupational health during our time in the EU and the public needs assurance that this will continue.

Looking forward, we also need to ensure those workers in the “gig” economy are provided with occupational health support.

This will be covered at the SOM/FOM Occupational Health Annual Scientific conference on 26-27 June in London, where there are important sessions on the future of occupational health with Peter Cheese, (chief executive, Chartered Institute of Personnel and Development), Professor Debbie Cohen, (Cardiff University) and Dr Jonathan Leach (Royal College of General Practitioners).

Nick Pahl is chief executive of the Society of Occupational Medicine

Occupational Health: the value proposition, The Society of Occupational Medicine, May 2017, available online at https://www.som.org.uk/sites/som.org.uk/files/Occupational%20health%20-%20the%20value%20proposition.pdf

“Protecting health after Brexit”, by Hugh Robertson, head of health and safety, TUC, available online at https://www.som.org.uk/protecting-health-after-brexit-hugh-robertson-head-health-and-safety-tuc

2 Responses to Occupational health’s reforming voice needs to be heard

  1. Avatar
    Prof Anne Harriss 7 May 2018 at 10:06 am #

    Excellent points. We need a much greater supply of occupational health professionals. A supply of well qualified occupational health nurses, with the specific skills are required to underpin this strategy. In contrast to the funding for other specialist community public health nurses, such as health visitors and school nurses, OH nursing education has been seriously underfunded. The requirements of the NMC for OHN practice teachers to hold a teaching qualification has made it very complex, particularly for those universities recruiting large cohorts of students, it has been particularly challenging to find placements for nurses trying to make a career move into OH Nursing. Furthermore. there are no specific OH nursing skills incorporated within the NMC Standards for Specialist Community Public Health Nursing. This has resulted in a spectrum of courses: the modules of some are pathway specific. They are totally focused on OH nursing but delivered using public health principles; modules in other centres incorporate a large proportion of modules which are shared with health visitor and school nurse students. The modules of the latter are highly focused on general public health with minimal pathway specific OH nursing. The NMC are also endorsing an approach for HVs/SNs to undertake a 10 week period of practice in OH with just one module incorporating practicing in an alternative field of practice, a strategy I cannot endorse but I will leave it to others to leave their comment. I wonder whether HVs would be happy for OHNs to move into their specialty with this level of pathway specific knowledge/experience. Apprenticeships are a great step forward with regards to funding but I fear they may be coming a little to late.

  2. Avatar
    Su Chantry 7 May 2018 at 12:29 pm #

    The government have a drive for aprenticeships across all sectors of industry . Maybe an opportunity for OH to use work place apprentice schemes to support the profession and business sector health management simultaneously .

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