After the Indian railways and the Chinese army, the NHS is estimated to be the largest employer in the world.
According to figures published last year by the Department of Health (DoH), almost 1.3 million people are now employed by the health service, including 386,000 nurses, 109,000 doctors, 122,000 scientists and therapists, and 36,000 managers.
Looking after the health needs of such a vast population is obviously a major challenge. There are about 220 OH departments in 650 trusts across the country. Many more buy in services from outside.
On top of this, through NHS Plus, NHS OH practitioners are increasingly being encouraged to sell services to the commercial sector. Working as an OH professional within the NHS, therefore, is never dull and certainly always challenging.
As Mary Brassington, OH service manager at Birmingham Heartlands and Solihull NHS Trust, explains, once qualified, OH practitioners are always in demand. “You promote them to keep them because they are worth it and because you have invested in them for two years,” she says. “Turnover is very, very low in my unit.”
Apart from everyday concerns and responsibilities, demand for the expertise that only OH can bring is being fuelled by an increased focus on workplace health, absence and rehabilitation across both the private and public sector.
OH, already stretched as a profession, is being asked to take on new responsibilities, such as sicknote certification and, increasingly, drug testing. Demand for practitioners, if anything, is set to grow.
Within the NHS itself, issues such as needlestick injuries, MRSA and workplace stress continue to test the resources and expertise of the service.
The government’s ambitious plans to overhaul incapacity benefit and get more people on long-term sick leave back into work are expected to add to the burden, as will the increased use of migrant workers, who often bring their own health issues with them.
For those looking to join, or indeed come back, to the service, one big attraction is that, when it comes to pay, the NHS is no longer playing catch-up with the private sector – or at least not as much.
The government’s Agenda for Change pay framework, first published in December, has played a key part in this process. Not only did it set a new NHS minimum wage and boost the salaries of newly-registered nurses, it set out a new framework for job evaluation and career progression.
Most OH practitioners will normally start off at around E grade (currently between 18,230 to 22,015 outside London) or F grade (20,220-26,180), but will quickly move up to G or H grade (from 23,860 up to 31,960) or higher.
“There are far more opportunities for promotion than there were once, simply because you cannot hang on to qualified OH nurses,” explains Brassington, who is also chairwoman of the Association of NHS Occupational Health Nurses.
Evidence of this was clear back in December, when Occupational Health reported that pay levels across the profession appeared to be rising sharply.
At the time, Birmingham City Council had begun advertising for a new director of occupational health at a salary of a whopping 110,000. Recruiters reported the fact that physicians were able to command high rates for sessional work. This meant organisations had to work harder to attract them into full-time positions.
Similarly, demand for OH nurses and advisers is such that salaries are definitely being driven up, with publisher Lexis-
Nexis IRS estimating the average full-time salary for an OH professional having now reached 32,000.
The creation of NHS Plus four years ago has given many NHS OH professionals a new string to their bow: access to a wide range of commercial organisations.
“While a lot of the big corporations use their own OH services, we are getting a lot of smaller ones coming to us through NHS Plus,” says Brassington.
This means there is more variety than ever, with nurses exposed to a wider range of challenges, sectors and activities. There is also scope to get involved in areas such as marketing and selling of services, which would once have been thought completely off limits to an NHS OH professional.
“We have contracts with local schools, accountants, even a kitchen cupboard manufacturer,” adds Brassington. “It is very, very interesting work.”
One downside of the challenging new environment, however, is the workload facing NHS OH professionals. What might be termed the ‘heat and burden’ of the job has rarely been greater.
A survey last year by recruiter OH Recruitment highlighted rising stress levels within the profession, as nurses, both commercial and public sector, struggled to cope with growing responsibilities and workload.
OH practitioners, committed to watching out for stress, burn-out and workplace ill-health in others, frequently failed to notice the symptoms in themselves.
Then there is the profile of OH within the health service as a whole. When OH nurse Tammie Daly was made the first OH nurse consultant in 2003 – covering Nottingham’s City, Queens Medical Centre and University hospitals – it was hoped that her appointment would blaze a path for others to follow suit. It has taken time but, with a number of other nurses now following her lead, OH is beginning to have much higher visibility within NHS organisations, although there is much that could still be done, Daly believes.
“Workers often do not know why they are attending and still worry that we are a management tool rather than an aid to help. But we are tending to get out more and visit other departments, we are becoming more accessible,” says Daly. “We are getting a lot more calls for advice.”
The main downsides of working within the NHS, Daly suggests, are that, as it is such a large organisation, you can sometimes feel it is hard to make an impact.
“You often do not feel you get to know your clients as individuals, like you would in a smaller organisation,” she says. “And because you often pass cases on to other experts, you may not get the breadth of experience you might in a small business.”
Workload can definitely be a factor – with NHS OH practitioners often dealing with many more clients than their commercial sector counterparts. There may often be a need for quicker response times too, particularly when dealing with issues such needlestick injuries or vaccine requests.
A common complaint from NHS OH professionals – as with so many others working in the service – is a lack of space. Offices are often less plush than in the private sector.
On a positive note
Yet, Daly believes, the positives do outweigh the negatives. Pay levels, even with the improvements, may still be less, but the lucrative NHS pension has become extremely valuable in these days of disappearing final salary pensions. There is also generally more job security than in the commercial sector.
Particularly since Agenda for Change came in, there is now much more scope for progression, Daly argues. “It is easier to move up the scale and get more pay,” she says.
“Things have definitely got a lot better in recent years,” agrees Daphne Plowman, senior recruitment consultant at Cheviot Recruitment. “People are recognising the advantages of working for the NHS, where in the past they might have been lured away by big salaries in the commercial sector,” she adds.
Organisations looking to recruit OH professionals into the NHS are emphasising more and more the benefits of the service beyond salary – things such as pensions, sickness protection and job security, she argues.
A sense of dja vu
There can be a sense of familiarity in working within the NHS – it is, after all, most likely where you will have trained. And, unlike if you are a one-person team in, say, a remote factory unit, you will have access to a vast array of other specialists and OH professionals to call on.
“The NHS is really good for meeting other people, too. You tend to be working with a team of experts around you and so can get a lot of experience,” says Daly.
The potential for career development, team working and networking with other professionals are also becoming increasingly important factors in luring people either into or back to the NHS, suggests Plowman.
Finally, there is now much more movement between the commercial sector, the NHS and back again. The NHS has become much more open to the skills that the commercial sector can bring.
Joining the NHS, therefore, need no longer be a choice for life. But for many OH professionals, once in, the benefits and the lifestyle it brings mean they are in for good.