Recognised to a degree: the changing face of occupational health

As the profession changes to accommodate legislation and industry requirements, the relevant training options must change too. Nic Paton reports.

The fit note, the possibility of a Fit for Work Service and/or an independent assessment service for long-term sickness absence are three topical subjects pushing occupational health as a concept and a service higher on the politcal agenda than it has been for decades. And then there are the telephone-based occupational health advice line for small and medium-sized businesses, ongoing noises in Whitehall about tax breaks for firms that invest in workplace health support and intervention to consider too. But what is the status and potential of occupational health as a career these days? Is it finally shaking off its reputation for being something of a “Cinderella” specialty?

While there may, on the one hand, be more interest and debate about occupational and workplace health than ever before, on the other hand the economic climate remains desperately difficult for many organisations. This means that, while logic may suggest it makes sense to invest to keep staff fit, healthy, productive and, most of all, present, in reality occupational health provision can be a resource at risk of being squeezed or marginalised just like any other.

“Obviously, at the moment, the economic climate is not that easy; companies do not have the money they once did and may not, as a result, feel able to invest in OH when they are just worried about whether they are going to be able to keep afloat,” concedes Anne Harriss, OH course tutor at London’s South Bank University.

“But, at the same time, there is a much greater awareness than there once was that good health is good business. Companies can save years from someone’s salary or extra recruitment costs by simply intervening effectively. In that context, OH nurses are in a compelling position to add value,” she adds.

So, what is making people decide to go into OH today, and what part is the new-found focus on health and wellbeing by many employers playing? What is the job climate like and what, in turn, is the attraction of going to the time and effort of getting a proper OH practitioner qualification under your belt? Occupational Health spoke to a selection of recent and current OH graduates, and OH tutors, to gauge their views.

Training and learning

Former general nurse turned occupational health adviser Pippa Stanford has run a consultancy called Health 1st in Bury St Edmunds for the past four years, and provides occupational health services and manual handling training to the horse racing industry, among others. She is completing the London South Bank occupational health degree course this summer.

She explains: “I set up my own company at about the same time that the first Dame Carol Black report came out and so found that very inspiring. I wrote a health and wellbeing programme that I began to deliver to various organisations.

“For me, one of the key things is that, at a national level, the Government has strongly recommended the need for occupational health provision in the workplace alongside robust health and safety systems. Businesses are under pressure but sickness absence can also be costly.

“So I think it is an exciting, challenging time; there is a real need for OH practitioners, there is a real need for the service. Occupational health practitioners have the potential not only to impact on the individual client but also on the wider workforce more generally. There is demand, but not all businesses yet recognise the justification for funding the service.

quotemarksOne of the key things is that, at a national level, the Government has strongly recommended the need for occupational health provision in the workplace alongside robust health and safety systems.”

Pippa Stanford
Health 1st

“It is the most exciting work I have ever done; you just feel in a very privileged position to be part of the organisation and in such a position of trust. You also get to work with a lot of different people: managers, HR, health and safety and the employees of course, and most of the time they do listen and act on your advice. There is a recognition that you can make a real impact on an organisation’s productivity.”

Inevitably, fitting the course around the “day job” has been challenging, involving as it has a three-hour trek from Suffolk to London. “Moreover, being self-employed means if you are in university attending lectures or writing essays you are not earning money, so you have to have a real justification for doing it. But I do very much recognise this is a qualification that is going to take my career forward.

“I do think we still need to raise the profile of occupational health generally, and flag up to organisations that it is something that could benefit them; that it can be something tailored to their organisation. I also think we need to be innovative as regards to work opportunities and what we can offer. Moreover, there is still confusion over the name occupational health – it still gets confused with occupational therapy,” she adds.

OH practice is all about providing a proactive service but there is still some mileage to go in terms of employers recognising the extent of what “in-house” OH practitioners can offer, argues Cathy Anthony, OH adviser at Swansea University, who is studying at Glamorgan University.

“Occupational health is a really fantastic career. I love the variety of work. Although qualifications are important, I would say that experience/expertise in your chosen field is what matters,” she says.

Extending education

Gareth Ashcroft is a senior OH adviser at Ysbyty Ystrad Fawr Hospital in Caerphilly and is due to complete the BA in occupational health practice at Robert Gordon University this year.

“I became interested in occupational health when I worked in the acute sector but I suppose I did have quite a blinkered view of what OH was, as many people do. I knew I was interested in health and safety and workplace risk and was just able to take the opportunity; I was in the right place at the right time,” says Ashcroft.

“OH was perceived as quite an ‘old’ specialty, and not somewhere you would go if you were ambitious to get on, but I do think that has changed. Now it is much younger and dynamic. I do think OH is really beginning to make its mark as a specialty within the NHS.

“Over the past 10 years there has been a real influx of occupational health positions in the South Wales area. It is something definitely more on the radar of executive boards.

“For me, the studying element has been hard, but it is manageable as long as you keep on top of your workload. So I would not say I have struggled at any point, but I have had to be disciplined and set aside time at weekends, for example. The fact we are given two study days a month has also been immensely helpful.

“I think OH is now on the horizon and it is definitely going to stay that way. There is a lot of investment going in workplace health and risk management and more collaboration between specialist teams; we are very much moving away from simply being seen as ‘the sick police’. People are accepting OH much more, and that can only be good,” he adds.

Upgrading qualifications

Alison Keemar has been in OH nursing since the 1980s, predominantly as an OH adviser with IBM, and on turning 50 in 2011 decided it was time to upgrade her qualification. She is also studying at Robert Gordon University.

quotemarksThere are going to be a lot of new initiatives coming through in which OH is going to play a pivotal part.”

Alison Keemar
OH adviser

She explains: “I think continual learning is so important. The more evidence-based OH can make itself the better and I have already made some changes to our clinical practice as a result of what I have been learning on the course.

“I do think nurses are going to have to continue to deal with the classic risks, but there is likely to be more work around people’s working lives and issues such as managing an older workforce. OH is going to be dealing with many more employees who would previously have already been in retirement, and the health implications from that are likely to be significant.

“There are going to be a lot of new initiatives coming through in which OH is going to play a pivotal part, if it is not already doing so. There is likely to be more work around the public health side of occupational health, even though there will always be a focus on the hospital and clinical side, too. I am very much looking forward to seeing what will change over the next 20 years, it is going to be a really interesting time,” she adds.

Debbie Knott, an occupational health staff nurse at Barnett and Chase Farm Hospitals NHS Trust, has just handed in her final assignment for the two-year part-time BSc specialist practitioner in community and public health – occupational health qualification at Brunel University.

Knott says: “I got into occupational health, ironically, because I had an accident at work and could not really go back into my ward job and an opportunity became available. No two days are the same and the work is very varied: it can be health and wellbeing, health and safety, health promotion and education, and so on.

“As a role, occupational health has definitely changed. It has become more focused on wellbeing. Years ago it was all about illness and treatment, now it is more about looking at everyone as a human being, in work and outside work, as well as things such as stress and diet.”

Her occupational health staff nurse colleague at the hospital, Althea Marles, completed the same course in 2011.

She says: “Obtaining the specialist qualification really allows you to expand your knowledge base. I was encouraged to do the degree by my managers.”

“OH is such a broad area, from managing health and safety, wellness, disease, blood-born exposure and so on. But I do still think it is a Cinderella specialty to a degree, in that a lot of people still do not understand what the role of the OH nurse actually is. For example, there is often confusion around the fact that we cannot diagnose, only advise.”

Reaching out

Another practitioner who is celebrating the completion of her course, at South Bank, is Gale Booth. She works for a consultancy called Building Health in Lincolnshire, which does a lot of contracting with the construction industry.

“OH is high on the agenda these days but it still does not have the funding allocated to it that it needs. Nevertheless, more and more employers do seem to be accepting that this is really the way to go and a way to add value, not only for surveillance work,” she says.

“I feel in a very privileged position to be able to go in and talk to men who have perhaps not been near a health professional for 10 or 20 years. The other day we were running a respiratory surveillance programme and caught a young guy with a nasty tumour on his lungs – it would probably have been found eventually by his GP but we picked it up much earlier and I am sure that will have made a difference. I feel we have a real role to play working between the patient and the GP.

“I really feel I have taken control of my life and career – people listen to you and have a lot of respect for you, much more often than they might for a hospital nurse. There is also the scope to be more entrepreneurial and inventive,” she adds.

What the tutors say

“One of the attractions of occupational health has to be that you can end up working with anyone; it’s not just the NHS. It could be MI6, John Lewis, a big bank or a small manufacturing firm making rollerblades. You can very much carve out your own niche,” explains Anne Harriss, reader in educational development and course director for occupational health nursing and workplace health management at London South Bank University.

Rosemary Shaw, course leader for the occupational health practice at Robert Gordon University, Aberdeen, explains: “You can, too, be anything from a hands-on practitioner to someone who deals more with policy issues. It also has the capacity, if you’re that way inclined, to allow you to start out on your own in business.

“Occupational health is becoming less of a Cinderella specialty, and, yes, companies out there are now looking for practitioners who have a degree under their belt. We have a lot of students who come from England, some from Wales and, of course, many from Scotland, plus some international students.”

“Recruitment generally is down this year, which may be a reflection of the economic climate. But employers do increasingly want nurses with degrees. There is a drive for OHNs to do more sickness absence management while technicians are doing more of the more basic tasks. OHNs are also being required to interpret results and have a managerial role.

“But there is always a way to go when it comes to communicating with the general populace and the health profession, especially the fact that someone can call themselves an OH adviser without having any qualifications whatsoever,” she adds.

In terms of choosing the right OH course, Harriss concedes that whether you go for distance learning or face-to-face learning, it is going to be a personal decision about what works best for you.

She says: “Some people do find distance learning easier because there is less interaction required or because they cannot take the time off. Others can find it isolating and much harder as a result.”

“It may sound obvious but the important thing is to look very closely at the content of the course and whether it meets your needs, because it is going to be a big time and financial investment.”

Shaw agrees: “When it comes to continuing professional development the emphasis is very much on blended learning nowadays, so it is very much a combination of students sometimes needing to come into the university but a lot of the time being able to access materials online. We do a lot of continuing professional development modules.”

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