The changing role of Occupational Health: Getting technical

Just as the introduction of healthcare assistants in the NHS has led to widespread (and often heated) debate among nurses and doctors, so the growth of occupational health technicians has been raising eyebrows within the OH profession for the past few years.

OH technicians, again much like healthcare assistants, are trained to carry out specific basic OH tasks – often repetitive or straightforward things such as audiometry or lung function testing – and may not even have a health background. They are expected to work within closely defined protocols and procedures, but are not expected to make clinical judgements.

In a profession suffering from a national workforce shortage, the idea is laudable enough – releasing OH advisers, nurses and physicians from the more mundane, but necessary, elements of their work and freeing them to concentrate on more specialised, complex or strategic activities.

With OH at the heart of ambitious government plans for an expansion of workplace health support and advice, you would expect anything or anyone who can take up a bit of the slack from hard-pressed advisers and nurses to be welcome.

But, as Carol Bannister, Royal College of Nursing (RCN) OH adviser, points out, while the concept of the OH technician is, by and large, accepted, many in the profession have valid concerns on a number of levels.

“There is absolutely nothing wrong with employing technicians, we do not have a problem with the concept,” Bannister insists. “There are positives, particularly their role in relieving other professionals from doing things they should not necessarily be spending their time on.”

But, she adds: “There is a suspicion that technician is just a byword for ‘let’s get someone in on the cheap’.”

Professional development

Just as seriously, there are concerns about whether technicians get enough support and continuing professional development and whether, once on board, companies try to push the boundaries of what technicians are deemed to be competent to do.

Finally, there are worries about accountability. “Clearly, the employer has a level of accountability in terms of liability insurance, but in terms of public protection and best practice, how do we make sure that things are standardised across the UK? There is no body that represents technicians, no register and no registered qualification,” points out Bannister.

Even enthusiasts for technicians, such as John Warwick, head of OH nursing at aerospace giant Rolls-Royce, agrees that practitioners are right to be vigilant about the risk of technicians being used by employers as, in effect, “OH-lite”.

But trained, supervised and managed correctly, OH technicians can be a hugely valuable adjunct to the profession, he believes. “Our view is that OH technicians can complement OH practitioners and free them to do the more important work that they should be doing,” he argues. “When there is a national shortage of OH nurses, we have to look at alternatives.”

For the past 18 months, Rolls-Royce has used technicians to carry out routine hearing, respiratory and lung function tests, all important and necessary but highly repetitive and straightforward. “A technician is ideally placed to do tasks like that,” says Warwick.

One advantage of using a technician is the speed at which you can get them up and running – normally a matter of weeks compared with three years for a nurse.

Rolls-Royce currently employs two technicians full-time and one part-time (and expects to appoint another one or two over the next two years), who work alongside the 20 OH practitioners, although not on sites where there is only a sole practitioner.

The company has also taken the innovative step of setting up a technicians’ career development package. This means that technicians can, if they wish, move up through a series of grades up to a more senior level. “Each grade has a different level of competencies that come into it,” explains Warwick.

On the thorny issue of cost, Warwick freely admits that using technicians is, of course, cheaper than using or employing more OH advisers. Any business has to look at options to minimise its costs, he says. But as long as you are not cutting corners or solely looking to do things on the cheap, it should be more an issue of how and where you are spending the money, rather than how much, he argues.

Selling points

In fact, OH technicians can sometimes be an active selling point in attracting new, experienced OH blood into an organisation.

“You are not using OH nurses to their full capacity when they are doing hours and hours of surveillance. And we have had two nurses in the past turn down jobs because there was a heavy surveillance element,” Warwick explains.

Another issue that is worrying OH nurses is that of who should be responsible for policing the activities of technicians. They do not come under the Department of Health, RCN or the Nursing and Midwifery Council. Nor, technically, do they fall within the remit of the Health and Safety Executive (HSE) or local authority inspection regimes.

The danger here, apart from the obvious health and liability risks of relying on someone who does not have the required experience or competencies, is that firms striving to embrace the government’s ambitions for improving workplace health will simply fail to understand what they are buying and end up throwing money away.

“I have had a number of calls in the past six months where you have had technicians or others who have set themselves up offering occupational health services who did not have OH nurses or doctors to back them,” says Bannister. “The employer is only going to know there is a problem when they have a problem.”

A clear debate (and agreement) is needed about the current and future role of technicians, their regulation, training, competencies and where the limits should be, Bannister says.

Another organisation that has made a success of using technicians is the Health and Safety Laboratory, part of the HSE. It has used technicians for the past four years, initially for assessing miners for hand-arm vibration injuries and, more recently, for respiratory function testing.

“Our technicians have very specialised knowledge but in a very narrow area,” says Dr Andrew Curran, scientific director for the laboratory’s Centre for Workplace Health. “They are also monitored by a nurse.”

Curran says this supervision element is important: there needs to be a clinical support hierarchy, just as you get among clinicians and other healthcare specialists within any OH technician model.

“OH technicians need to know what the boundaries are and when and how to refer anything on,” he explains.

The Health and Safety Laboratory has recently joined forces with the University of Sheffield and Sheffield Teaching Hospitals NHS Trust to look at ways of formalising the qualification for technicians. “We are keen to develop some kind of qualification for technicians. There are some core things that people should know and we want to see how we could run a series of modules where those skills can be developed,” Curran says.

Core skills could include risk assessment processes, legal considerations and clinical governance, he suggests. Trainee technicians could then move on to a series of discrete modules developing more specialised, practical skills. Ongoing refresher courses would also need to be considered.

“The OH technician is an important part of the OH package, but on their own they are not going to give a comprehensive service and may even provide false reassurance,” warns Curran. “There does need to be an appropriate command structure.”

OH technician pioneer

One of the pioneers of using OH technicians within the UK was consumer goods manufacturer Unilever. It first appointed a technician, a former paramedic, in 1996, mostly for things such as first aid, audiometry and hearing conservation, says Caroline Mabbs, occupational health nurse manager for the company in the UK.

While the first technician, because of his specific skills, has since moved into a specialist first-aid role, other technicians have also been taken on. One, a former cashier, for instance, handles a lot of the OH administration, including diary management, management of medical records and also some screening of pre-employment forms.

Mabbs says: “A technician releases OH advisers for other tasks. If people’s skills and knowledge are under-utilised then you are going to lose people. You want to keep people stimulated, but there need to be clear parameters. There is a debate about the analysis of results – for instance, should a technician taking an audiogram that is obviously normal be able to say so, or should they always pass it on to someone else?”

A key element of the debate will need to be the role of schools and colleges. At the moment, every time an employer takes on a technician they have to, in effect, ‘reinvent the wheel’, drawing up their own competencies, running their own training programme, supervision protocols and so on. Mabbs echoes Curran in suggesting that, “some of the education establishments could pull together a programme of baseline training”.

Offering standardised training and career progression, plus better development, supervision and support, would also help make the role of technician more attractive and so help make recruitment easier. It is often overlooked that, much as OH nurses and advisers are hard to come by, good technicians don’t grow on trees either.

“Resourcing them is an issue, because where do you get them from? You cannot just get them off the shelf,” says Mabbs.

Formal approach

So, where is this all leading? Certainly, there appears to be a clear need for the technician role to be formalised, perhaps through some form of registration, and there certainly needs to be a debate about parameters, training, competencies, supervision and support. That in itself would help to clear the air of some of the fears and misconceptions about the technician role, and could even help to educate employers about the differences between, say, an OH physician, adviser, nurse and technician.

In the current political climate, it is a debate the profession can ill afford to ignore, and probably ought to have had some time ago, argues Curran. “Occupational health is moving up the agenda. There are a number of initiatives that the profession should be grasping. This is the first time that OH has had this profile, and so we need to be thinking of ways of building on the available momentum,” he says.

And Mabbs, for one, offers what she freely concedes is a provocative (but possibly not unrealistic) view of a future where OH technicians have become as integral, and complementary a fixture as advisers and nurses.

“If you look back 10 years, OH advisers never managed the department, it was always the physician. But now OH advisers do manage departments, and it is not unusual for doctors to report into them,” she points out. “So, if you go forward 10 years and if you had a technician who was a good manager, should there be any reason why they should not be managing a department? We should keep ourselves open to the idea, as long as they have the management skills.

“Once you can get over the perceived barriers – the fears that ‘they are taking our jobs’ – people will start to see how technicians can benefit service delivery, the business and OH advisers too. Once you are over that, then they will be more accepted,” she adds.

Part two of the series the Changing Role of Occupational Health looks at new models for OH delivery.

Tips for an effective technician model

  • Look at why your employer is doing it, is it simply a way to cut corners?
  • Set clear parameters for the role and what you expect from the technician
  • Be clear what competencies are required for the role
  • Ensure you have close supervision and an effective clinical hierarchy
  • Ensure the technician knows how and when to refer cases on
  • Consider establishing a technician career progression structure and look at the possibility of continuing professional development

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