Studying the evaluations of occupational health conferences, one often hears the exasperated comment from the many OH practitioners who ply their trade in the business world that: “there was too much of an NHS focus” when discussing the bill of fare served up by the organisers.
Perhaps this criticism is justified as, as one of the largest employers in the world, the NHS does have a presence, and most people reading this will have had some experience of working there at some stage in their career.
Many advances in occupational health have been led by dynamic practitioners in the business world and perhaps unfairly, without due recognition. Sometimes, however, we need to bite the bullet and examine what is happening in the NHS, particularly because of the influence this can have on our practice, regardless of whether we work in this huge institution.
Agenda for Change
One recent example is Agenda for Change, where thousands of people have had their jobs evaluated and pay and conditions adjusted. This has obvious implications for all in OH when they examine the thorny issue of reward for service, or set out to appraise staff.
If there is anyone still reading this who does not work in the NHS, I would like to thank you for your perseverance and draw your attention to another ‘big bang’ that is about to occur in the NHS. Despite having a consultation period, this event has probably been overshadowed by other changes and might, on the surface, appear to be of note only to special interest groups such as human resources professionals and NHS OH providers.
I refer to the newly revamped ‘ill health retirement scheme’, which became effective in England and Wales on 1 April, and slightly later in Scotland and Northern Ireland.
Ill health retirement scheme
It is important not to confuse the ill health retirement scheme with the changes to the main pension scheme, which allow existing employees to opt in to the new scheme, as the ill health aspect will apply to all pension scheme members. So why the fuss? Well, this initiative fundamentally changes how we view people with chronic illnesses.
The government, through various superannuation schemes, picks up the tab for ill health retirement. But this will change to NHS trusts being responsible for the payment, and therefore they will have an incentive to keep staff on rather than feel a sense of accomplishment when problem people have been retired off.
An example would be where, say, a nurse needed substantial adjustments to her workplace costing £20,000. This would fill most NHS managers with horror, but in the new scheme, the early retirement package may cost approximately £100,000. So if you do the maths, there is no doubt that rehabilitation is a good idea.
However, we lose many valuable experienced people every year, not because we do not have the ability to undertake rehabilitation, but because the will to implement it is not always there. And when programmes are in place, they tend to be focused on the long-term sick, who statistically are less likely to return to regular and reliable employment than those who are off perhaps for the first two months and managers take the wait-and-see approach.
So there is likely to be increased demand by trusts on their OH providers to design and implement rehabilitation programmes. This will bring opportunities and challenges to all those who work in OH, specifically recruitment and training challenges. If NHS managers decide to invest in enhancing their services, and remember there are huge financial drivers here, this may have an effect on OH in all industries.
As far as NHS staff are concerned, they also have an incentive. Those familiar with the existing scheme will know that to meet the criteria for retirement an individual must be ‘permanently unfit to do their specific job’. This will change to a two-tier system where, if a person is unfit to do any job, they will still get an enhanced pension. Whereas if they are unfit for their own job but could undertake other employment, they would only get a pension based on their contributions to date without enhancement.
There is a belief that this will encourage staff to take a realistic look at moving to other jobs in the service, even if it is on a lower pay scale. An example could be the afore mentioned nurse who is no longer able to do nursing duties, but could work as a band-two ward clerk. Again, OH will be involved in these decisions.
It is often the case that regardless of what type of organisation we work for, we can accept some policies at face value. But when we are faced with changes to things that have value judgements and justice issues attached, it can be hard to see the full implications at first glance.
If you have not had a chance to study the changes, take a look and ask yourself what will this mean for you and your practice, even if you feel you have left the NHS behind you.