As many OH professionals approach retirement, Nic Paton finds that there are too few younger nurses to replace them.
Is OH facing a retirement crisis? “Crisis”, of course, is an emotive word – but speak to many within the profession and the ageing demographic of OH and where the profession’s leaders and practitioners of the future are going to come from is a real concern. Some speak of a workforce “time bomb” or even of OH being at risk of becoming “healthcare’s Marie Celeste”.
Certainly, it is clear that OH is an ageing profession. Figures collated for Occupational Health by the Nursing and Midwifery Council (see box 2) show a workforce skewed towards the 40s and 50s age bracket, with a much smaller cohort of OH nurses coming along behind.
Yet, as OH nurse Helen Kirk, who runs consultancy HK Consulting, points out, it would be wrong to make the leap from this to arguing that OH is facing a looming crisis.
“Attend any major OH conference or meeting and it is pretty clear OH is an ageing specialty. A look round the room usually confirms the workforce stats,” she says.
Attend any major OH conference or meeting, and it is pretty clear OH is an ageing specialty.”
“I wouldn’t describe it as a crisis for OH – posts are still being filled – but the lack of new blood doesn’t bode well for the future. The real problem long term is the lack of emergent leaders; even if we continue to fill vacancies the development of the specialty will suffer. The OH ‘ship’ could become healthcare’s Marie Celeste – still afloat but without direction.”
This is certainly an issue that is becoming increasingly well recognised. For example, an NHS OH workforce workshop run by the Department of Health last year came to the conclusion that, “there is an urgent need to address recruitment and retention concerns in occupational health”.
The solution, it argued, was “multi-factorial” and needed to include “improving training in occupational health during basic clinical training, positioning occupational health under the public health umbrella, effective marketing of occupational health, defining the career pathways for occupational health practitioners and improving academic opportunities as well as the academic profile of the specialty”.
Concerns about the future pipeline of OH practitioners were also highlighted in the Council for Work and Health’s June report Planning the future: delivering a vision of occupational health and its workforce for the UK for the next 5-20 years.
This recommended that the council develop and implement a marketing campaign for OH that promotes the demand for OH and “ensures there is sufficient capacity of suitably trained and competent practitioners to deliver the demanded evidence-based interventions”. It also made the point that intensifying worries about the workforce are coming just when OH is potentially faced with significant opportunities, not least the establishment next year of the Government’s proposed health and work assessment and advisory service.
Fewer physician trainees are entering the profession and there are similar challenges for nurses and the allied professions”
Council for Work and Health
As the report made clear: “Just at the time when occupational health is becoming so important to so many, the specialists within the occupational health team are under threat – fewer physician trainees are entering the profession and there are similar challenges for nurses and the allied professions. The funding for training is unsustainable, the research base is diminishing and affordable access to comprehensive occupational health services for the majority of the UK’s working-age population is limited or non-existent.”
Audrey Dean, business development manager for recruitment company Key People, says that it is not a question of shortages. “The market is very good at the moment; it is a candidate-short market but it has been like that for a long time now,” she says.
Nevertheless, anecdotal evidence from her team does suggest that the vast majority of new registrants on her books are aged in their 40s or older.
“One issue, to my mind, is that there is less sponsorship around and healthcare providers really do not offer as much training and support. If the bigger healthcare providers took more responsibility for giving people a leg up on the training ladder, then we would have more trainee positions. They can have such a big role to play,” she says.
“Knowledge of OH as a specialism is not great; OH is not well marketed. The public at large are still fairly uncertain about what OH actually is and many still confuse the speciality with occupational therapy. If you took a straw poll of student nurses I suspect you would still find a lot of ignorance about what OH is.”
For Kirk, another issue is that it is increasingly difficult for OH practitioners to obtain employer support for the work that is leading the specialty.
“This is creating the perfect storm of lots of people leaving and newcomers unable to lead. The specialty is still an attractive option for nurses. There are lots of opportunities for professional development, good remuneration and career satisfaction, but it can be difficult to get started. I know students on specialist programmes struggle to get funding, time for courses and study, and practice teacher support,” she says.
OH is often not well understood as a career choice by many nurses, but it has a lot to offer, with many opportunities for career progression”
Graham Johnson, Bupa Health Clinic
“Nurses’ and doctors’ initial experience of OH can also be off-putting. They can feel nagged to attend for jabs or feel under investigation because they’ve been unwell. Their experience in the NHS is rarely of state-of-the-art technology, outstanding facilities, cutting-edge research and practice, and tangible organisational impact.
“The characteristics of their OH experience just aren’t attractive to aspiring talent. The solution is to create that enduring positive impression from day one,” Kirk adds.
Solutions need to include better promotion of role models within OH, better and more advanced career paths and easier access to the profession for new trainees, she suggests.
Barriers to training are a real issue, agrees Anne Harriss, course director for OH at London South Bank University.
“If you think about the leaders within the profession, the big names, they are all of the same sort of age. It could be a real time bomb. Of course we do have some younger students, but one of the problems with OH training placements that is a real nightmare is that you have to have one with a qualified OH nurse. Natural wastage means there is a shortage of OH nurses, so there are not as many who are able to take on students,” she says.
“I would like to see OH incorporated into pre-registration nurse education; at the moment, there is no requirement to do that. Some universities do it, but not many. We need to convince people that OH is a valuable specialty.
“I would also like to see training for OH nurses being centrally funded, much like school nurses or health visitors. OH nurses who are not employed by companies have to fund their own course fees, not to mention things like not getting paid while on placements and travelling expenses. The Council for Work and Health should push for more funding from the Government, but I cannot see that happening.”
One of the Council for Work and Health’s recommendations was that OH needed to become much more of a mainstream specialty, and this is indeed something that needs to be grasped if more young doctors and nurses are to be attracted, says Christina Butterworth, deputy chair of the council and president of the Association of Occupational Health Nurse Practitioners. There also needs to be more of a push to communicate the variety, rewards and challenges of a career within OH.
“OH is an exciting career. But we need people to be following us. There are a lot of us coming up for retirement in the next 10 to 20 years. We have never been very good at telling people about what we do. We are not very well recognised within general nurse and medical training,” she says.
Dr Steve Iley, medical director, health services at Axa PPP healthcare, agrees: “There is a cohort that will be moving on to retirement over the next five to 10 years and we are just not getting the trainees through.
If all our colleagues sell OH to just one recruit each we would be overwhelmed with new talent. It’s that simple”
Helen Kirk, HK Consulting
“Changes to medical training mean OH is seen as an odd choice to go into straight after medical training. Yet anyone at work will eventually end up at the feet of OH, and the age range of our clients is already expanding; it is just a reflection of the modern workplace.
“So OH is going to deal with a much wider range of the population and there may need to be a significant change in resources, especially if we start to see people outside work too.”
Dr Richard Heron, immediate past president of the Society of Occupational Medicine and chief medical officer (CMO) at BP, says: “We need to inspire health professionals towards OH in career terms.”
“Personally, I feel that I have the best job in the world and if more people were aware of the kinds of jobs that are possible within occupational health it may be that it could attract capable people at an earlier point in their career.
“As CMO of BP I have a massive, varied and challenging role that takes me around the world, doing occupational and public health, emergency planning intervention and working with health authorities. People are just not aware of the kind of jobs that are possible within OH. If they were, we might be able to attract capable younger people to OH and occupational medicine as a career.”
OH is already changing and becoming much more multidisciplinary, says Graham Johnson, clinical lead of nursing at Bupa Health Clinics. But there is a huge need for better communication about, and promotion of, OH and what it does and offers, he adds.
“OH is often not well understood as a career choice by many nurses, but it has a lot to offer, with many opportunities for career progression. We offer a unique service in many ways, but for a number of years there has been a lack of recognition,” he says.
“We need to raise awareness of the link between health and work across the whole of the nursing profession in order for them to understand the impact OH can have on people’s working lives, and thus create a wider understanding of our role.”
Certainly, “selling” OH is something colleges, the Faculty of Occupational Medicine (FOM), the Society of Occupational Medicine (SOM), the Nursing and Midwifery Council, OH leaders and even the Government could all play a part in. But, Kirk says, it is something all OH practitioners who want to see the best for the future of the profession need to get involved in.
“This isn’t about a few OH leaders, it’s about leadership from all OH practitioners. We have some great people around and have seen some noteworthy steps forward: the opening of SOM to all disciplines; collaboration through the Council for Work and Health; OH nurse-led research being published in Occupational Medicine; the discussions led by Olivia Carlton and Heron on a single FOM-SOM, for example,” she says.
“I have no trouble enthusing about occupational health and my students are bright and engaged. If all our colleagues sell OH to just one recruit each we would be overwhelmed with new talent. It’s that simple.”
While the Nursing and Midwifery Council declined to offer comment for this article, it was happy to pull together statistics illustrating the current complexion and age demographic of the OH workforce.
While these figures do not in themselves indicate that there is a looming retirement crisis, they do serve to show that the majority of OH practitioners are indeed in the 40-54 age bracket (see box 3).
To an extent this simply echoes the general age demographic of the nursing profession, (see box 2). But the key difference is the disparity between the 25-39 age group within nursing generally – which suggests a relatively healthy future workforce pipeline – and that of OH nursing, where there is a much smaller proportion of nurses within this age range. That, of course, does not necessarily mean future shortages – as long as there is a relatively consistent flow into the profession, it may not particularly matter, and may even be a bonus if the predominant age demographic is that of nurses entering at a more mature stage in their career.
But the likely upcoming demands on OH, especially against the backdrop of the establishment of the health and work assessment and advisory service, does mean it is perhaps an area that needs closer investigation, as well as a debate around funding, profile and access, to ensure that OH can continue to meet the future demands of workplace health and wellbeing.
Age breakdown of entire register (nurses, midwives and Specialist Community Public Health Nursing (SCPHNs)), in terms of age, as of 15 July:
Aged under 25 years: 21,417
Aged between 25 and 29: 53,099
Aged between 30 and 39: 148,501
Aged between 40 and 49: 212,835
Aged between 50 and 54: 111,971
Aged 55 years or older: 125,091
There are 26,658 SCPHNs on the register, according to the Nursing and Midwifery Council. The breakdown of those in occupational health is as follows:
Aged between 25 and 29: 5
Aged between 30 and 39: 310
Aged between 40 and 49: 1,205
Aged between 50 and 54: 862
AGed 55 years or older: 134
Age not provided: 976