Stand up and be counted

When asked to give the Ruth Alston Memorial Lecture this year, I really wanted to say ‘No’ to the request. ‘Please,’ I thought, ‘not me. I’m too busy; I have too much to do.’

Well I did weigh up everything, and came up with the answer that I really was too busy, and that there were lots more people who could, and should, be standing up there speaking.

But then I stopped to think how selfish that was when, for the last 10 years, busier people than me have delivered thought-provoking, encouraging, challenging, stimulating lectures, that have left the audience feeling challenged, threatened, motivated and raring to go.

What right have I to say ‘No’, when I am so vocal about succession planning, and encouraging others to fill our shoes and take OH to 2010 and beyond?

Where are all the younger OH movers and shakers of tomorrow? They certainly won’t be clamouring at our doors if we can’t be bothered to stand up and give them some time and motivation. Can we blame them for not bothering if we can’t be bothered? Too many of my colleagues talk of apathy in the profession – we must stand up and continue to deliver or we, too, are guilty of apathy.

The time had come to look back over the past 10 years and see where we are now, what really is new, and what have we done about moving forward. In other words, where have we gone and where are we going?

As a small speciality, evidenced from low recordable numbers at the Nursing and Midwifery Council (NMC), the numbers of people working in OH are increasing, albeit slowly. The number of practitioners undertaking some form of OH education fluctuates. We still really need champions to ensure we thrive and survive as ‘a small but potent force’.

To quote Carol Cholerton, the association president, when announcing the death of Ruth in November 1994, she challenged OH nurses to “take up the banner that Ruth had proudly and consistently carried, and become actively involved in ensuring the on-going development and growth of the specialism.”

Previous Ruth Alston Memorial Lecture speakers have included academics, barristers, OH physicians, managing directors, private health managers, and heads of major occupational health providers.

While all the lectures had their own individual focus, an undeniable theme has emerged regarding the business of OH – the challenge or challenges that are the very heart of each lecture and I think are core to the future of OH. I don’t intend to rehash these past lectures, but to encapsulate the recurring challenging points and, if you have not already, encourage you to make them into actions.
What are the challenges that will ensure the future success of OH?

Role review

One speaker challenged the audience to “Review the way you see yourselves and the service you provide to meet the new demands of tomorrow’s employers and employees”.

What should our role be? Does it really matter if there is no one definition, as long as the OH professional can impact and influence the business or organisation, while offering informed, evidence-based support that can have measurable outcomes – namely, reduction of loss.
Another challenge was for the OH professional to come out of isolation. Many services and practitioners work within a silo, having little contact with other healthcare initiatives and professionals. There are gaps and overlaps that can have detrimental effects on health and well-being. We need to include professionals from other disciplines that have the appropriate skills and competences to enhance our practice.

Currently, are you using your skills effectively, and only performing work where you alone can add value – work that no-one else could perform with the same competence?

In 1995/96, I introduced to the service I was working in at the time, the post of clinical assistant. The job involved in-house training half time as a receptionist in the OH department, and the remaining time as a clinical assistant to the OH team.

The work involved respiratory function, vision screening, some phlebotomy and simple technical procedures. This fixed-term post was a great success, it satisfied departmental needs; the individual had job satisfaction and the competence acquired from frequency of practice.

Sadly, externally and to my peers, I was “letting the side down, taking jobs away from OH nurses and really rocking the boat”. I was not trying to take nurses’ jobs away, but trying to work smarter with the resources available.

That was 10 years ago – have we really advanced? Where are the training courses for the OH healthcare assistants? We have already had the challenge to take action and must continue to challenge the culture – or the way it has always been done – and a territorial mentality.

Rivals or colleagues?

How many of you have responded to the call to involve other relevant professionals or experts in the OH team? One speaker voiced the opinion that purist OH practitioners, who considered they were the only professionals that could effectively deliver OH interventions, should lift their heads out of the sand and consider who is the appropriate professional to deliver, and whether the other professional may actually be better value than the OH nurse, when considering availability, expertise and cost.

There has not been one lecture when change has not featured. The message that threads its way through the years is: ‘Embrace change and enjoy it. Don’t waste opportunities by rationalising why you can’t do something.”

“The opportunity is now,” according to one speaker, who predicted that the OH market was worth 250m and growing at a rate of 5%, with the challenge “that practitioners needed to review the way they see themselves and the services they provided, so they could meet the new demands of tomorrow’s employers and employees”.

If there wasn’t a major shift in the emphasis on business acumen, we were heading for extinction, we were warned.

Another challenge was: ‘If you can’t or don’t add value, you are a cost!’ In fact, most of the previous speakers have directed their main challenge to a business and managerial focus in OH. Have we got it or not?

Do you recognise the drivers for change in your business environment? Do you understand the business in which you operate? Do you see yourself as operating in a business environment? Are you sure what the customer values from your service are, and can you improve or increase the value of what you offer?

Business benefits

Speakers implored us to become involved in the strategic direction and objectives of our businesses to shape and develop all aspects of delivery, to produce business plans linked to strategy and recognise that future success is linked to financial performance.

We perceive ourselves as contributing to the ‘bottom line’. Do we really appreciate and understand enough about finance to discuss net profit, increased revenue, growth, margins, capital bids or even fighting effectively for our portion of the annual budget?

If we are recognising the cost benefits of our delivery, then we have taken up the challenges to analyse where we can add value. We do this by benchmarking with other providers, reducing losses related to ill health and absence, reducing health-related costs, promoting cultural change, enhancing corporate health image, understanding and leading new innovations and interventions.

If you’re not doing this, perhaps it is because you have been let down by the OH educational system. Has it met your needs? Have you been able to access the appropriate course for your practice and future development? Numerous speakers before me have raised education, and fitness for purpose and practice as obstacles to be overcome.

Integrating theory into practice was cited by a speaker as a requisite back in 1998, stating that there was a requirement for future education to be fit for purpose, responsive to the needs of service providers, industry, the European Union, and national legislation. Education for OH nurses has to be accessible, flexible and adaptable. OH educators were challenged to solve the gap between theory and practice.

As a budget-holding, practitioner manager, the current OH education does not produce the goods that I require, and I know I am not alone.
Where are the virtual universities, the distance learning courses, the flexibilities in education that we require as managers, to develop the future specialists and ensure the survival of OH?

“The academics must teach what OH nurses and employers need, and not what educators want to teach,” according to Carol Cholerton back in 1997.

We need to influence the standard-setters to understand the needs of the OH nurse. How much has changed, and how far have we gone in responding to the challenge of directing the OH syllabus? Do we know what we want? Do we inform the curriculum and standard-setters of what we want? Do the standard-setters in education really appreciate the changing role and function of the OH practitioner? Where are the business modules that will equip the practitioner for their strategic thinking?

We must continue to lobby, inform and influence the standard-setters to achieve what is required, and not necessarily accept what we are given.

Act on proposals

How many of you commented on the recent NMC consultation on post-registration framework? How often do you take note of the publications you receive from the NMC?

You will, I hope, all be aware of the changes of the Nursing and Midwifery Order 2001 that provides for a new allegation of unfitness to practice – lack of competence – which came into effect in August 2004. It is a completely distinct category of allegation from misconduct, and has been structured to deal only with intractable cases of lack of competence, after all other avenues have been exhausted by managers and employers at a local level.

In a recent lecture, a barrister explored the legal liability of the OH practitioner. The challenge from that lecture was to inspire practitioners to debate and research legal duties of an OH nurse. I would encourage all practitioners to constantly monitor and review their practice against clinical, professional and legal standards.

Misconduct cases requiring referral to our regulatory body are rare. However, competence or lack of competence, defined as “a lack of knowledge, skill or judgement of such a nature that a registrant is unfit to practise safely and effectively in any field in which they claim to be qualified to practise or seek to practise”, should now be considered seriously. The RCN is publishing a competencies framework that can be used to review competence for OH nurses.

This is not the time to be complacent. Expectations are high, and customers paying for services deserve quality goods from high-quality providers. Quality is remembered long after the price is forgotten.

We are required to be ethical, credible and professional, and able to promote an image that will assure confidence in OH.
Enough of the past – what of the future?

The government’s Department for Work and Pensions (DWP) is leading projects committed to ensuring that individuals with health conditions are enabled to fulfil their employment potential, as demonstrated in the UK Framework for Vocational Rehabilitation.

The government and industry have joined forces for a project called Constructing Better Health, locally known as ‘Fit Builder’, which will focus on improving the health of construction workers. Lessons learned in this study will form the basis of a national plan to be rolled out across the UK.

For the first time, the recent government White Paper, Choosing Health, draws up comprehensive guidelines for employers. It lacks compulsion. However, it does recognise the effects of work on health. It refers to partnership working, and recognises that absence management and rehabilitation are likely to have long-term benefits to the employer and employee.

The DWP and Department of Health have commissioned studies to explore alternative methods of sickness certification, in response to the new General Medical Services contract 1993, furthering attempts to reduce certification in general practice. The main thrust of these studies is sickness absence management, which uses various methodologies that are OH nurse-led.

These are just a few of what I see as doors opening and opportunities for the future of OH.


I spoke about movers and shakers earlier, and they are all about change. Not doing things the way they’ve always been done, or keeping their head below the parapet.

If you recognise these characteristics in yourself, my challenge to you is shout about it and share your thoughts; lobby those that need lobbying; influence those you can influence; and innovate and develop when and where you can. Question why and then lead the challenge into the future, to borrow a phrase from the early days of the association: “Seize the moment”.

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