How OH nurses deliver and manage health surveillance and spirometry as we emerge from the pandemic, latest Covid-19 resources and toolkits, and an update on the government’s workplace health reforms were all on the agenda at the recent SOM/HSE occupational health nursing conference. Nic Paton reports.
Whether it was updates on health surveillance and spirometry, a deep-dive into the government’s thinking on occupational health reform, or simply advice on some of the latest resources practitioners can use to manage Covid-19, September’s Health and Safety Executive (HSE)/Society of Occupational Medicine (SOM) occupational health nursing conference had a lot to offer practitioners.
Starting with the online event’s keynote presentation, Alison Wellens, head of the health and work branch at the HSE, made clear her appreciation of the commitment and sheer hard graft practitioners have put in to support workplace health during the pandemic.
“It is only appropriate to recognise the outstanding contribution that nurses, who make up the largest proportion of the workforce within the NHS, have made during the period of the pandemic, not only providing frontline care for patients but also contributing to the support of frontline workers to enable them to work safely. So, thank you all for your outstanding work,” she said.
Yet, even though the pandemic has accelerated workplace change significantly – and of course remains the key focus right now – some of the longer-term challenges facing occupational health had not gone away, she cautioned.
“Covid has brought many new and unexpected challenges; it has a huge effect on how businesses and individual work. It has also brought into focus the relationship between health at work and public health at large. The concept of hybrid working – a type of flexible working – is also new to many,” Wellens said.
OH delivery post pandemic
“More generally, we face a rise in an ageing workforce in the UK, with a clear trend towards workers staying economically active for longer. The traditional career for life may become a thing of the past. It is anticipated that people will work gigs rather than having full-time continuous work with one employer and temporary positions will be common and people’s workplaces will change, as will the risks they are exposed to.
“The impact of the changing work, workplaces and demographics of the workforce need to be considered carefully. You can see how there is the potential for both negative and positive impacts on health and possibly an increased demand for early intervention by occupational health professionals,” Wellens continued.
“What can occupational health nurses contribute to this? The knowledge and influence of occupational health nurses in the workplace and on work activities is crucial in improving the health of an organisation and of its people. The quality of the assessment that you carry out is vital. You are ideally placed to understand and advise on the health risks that workers are exposed to, as you have first-hand knowledge of the workplace and the associated risk.
The knowledge and influence of occupational health nurses in the workplace and on work activities is crucial in improving the health of an organisation and of its people.” – Alison Wellens, Health and Safety Executive
“This means the employer gets sufficient advice on managing workplace health risks, workers’ fitness to work, and any adjustments they require. You also have a key role in assisting employers to prioritise and understand the management of work-related health risks so they comply with the law and they protect workers’ health,” Wellens added.
Within this, there remained “a very significant job” to be done to protect workers’ health and prevent harm, she emphasised, and OH nurses had a key role to play.
“We do that job better together, all of us. HSE has a prominent role to play but it is also the decisions and actions taken by employers, working with all of you, the occupational health professionals, that also makes the difference and can have the greatest impact. Finally, it is more important than ever for us all to understand the risks, share our experiences and good practice as well as our future thinking,” said Wellens.
Insight into government thinking
Jean King, deputy director for health in the cross-departmental Work and Health Unit, provided a fascinating insight into the government’s ongoing thinking around workplace and occupational health reform. This, of course, was articulated in July’s long-awaited response to the Health is everyone’s business consultation but King’s presentation added some much-needed flesh to the bones of the government’s proposed changes.
King pointed to 2019 research by the Department for Work and Pensions around the disparities in terms of access to OH that illustrated very clearly why occupational and workplace health reform is so badly needed.
The research, Health in the workplace: patterns of sickness absence, employer support and employment retention, had found that 61% of supervisors had access to occupational health versus 43% of employees without supervisory responsibility. White collar employees were 21 percentage points more likely to have access to OH services than their blue-collar counterparts.
Full-time staff were 25 percentage points more likely than those working between one and 15 hours a week. Public sector access (72%) was higher than that in the voluntary/non-profit sector (52%) and light years ahead of the private sector (39%). People in professional occupations (64%) more likely to have access, as were those in larger organisations (92%), versus medium-sized employers (49%) versus small (18%).
The pandemic had, of course, then added a whole layer of further barriers and challenges, not least long Covid. As King put it: “It has brought new challenges for occupational health and really shone a light on the importance of work and health support and that multidisciplinary partnering.”
Praise for pandemic response
Like Wellens, King had only praise for the profession’s response to the pandemic. “OH providers responded to the challenge so swiftly, including a shift in the way they delivered services and supporting employers. I particularly want to acknowledge the contribution occupational health nurses have made over the past 18 months and their continued importance within the health and work sector, showing adaptability in challenging and rapidly changing circumstances. We want to learn from the experiences and adaptability the sector’s shown to deliver services in the context of Covid-19 working environment.
I particularly want to acknowledge the contribution occupational health nurses have made over the past 18 months, showing adaptability in challenging and rapidly changing circumstances. We want to learn from the experiences and adaptability the sector has shown” – Jean King, the Work and Health Unit
“As we do look to recover from the pandemic and to build back better, we have got really important plans to boost economic growth and employment, and supporting work and health is an important part of that. It is also a really important part of the levelling up agenda,” she said.
King, however, reiterated that one of the barriers to OH fulfilling its potential here is its longstanding capacity/workforce constraints, with 44% of providers unable to fill roles, typically clinical roles. Between September 2018 and August 2019 (so even before the pandemic), 89% of the available private occupational health capacity had been taken up, and 19% of providers had said they were working to 100% capacity.
“Shortages in the OH workforce, particularly shortages of clinical staff, risk limiting the future capacity of the OH market to deliver services,” she warned.
All of which brings us to the 2019 Health is everyone’s business consultation and the government’s response published in July. King, interestingly, outlined some of the feedback the government had received to the consultation, and which had informed its response.
The majority of respondents, she pointed out, had expressed willingness to submit workforce data to a co-ordinating body, although data protection had been highlighted as an issue. There was strong support to further develop capacity and sustainability within the OH workforce, including the need to increase the numbers of specialists and training opportunities. There was supportive for the profession moving to a much more multi-professional, collaborative, biopsychosocial model and approach.
The responses to the consultation had also, by and large, backed the idea of single body to lead on a range of areas, including the sustainable development of the OH workforce, strategic workforce planning, training and development, governance, workforce models, and standards setting, King articulated.
There was a lack of understanding about OH among employers and complaints that the search costs of purchasing can be high. SMEs in particular were often reactive purchasers and did not understand the costs involved. Employers, the consultation had concluded, liked the idea of a toolkit, a provider database and a needs’ questionnaire, with SMEs again most keen on having more information and support on how to navigate the market.
To that end, the unit was looking at and testing prototypes around improving OH digital data collection. Medic and nurse groups had been set up to explore barriers to taking up training places. A partnership had been agreed with Exeter University on “an evidence-mapping synthesis on multidisciplinary delivery models for OH services”, she said. The unit was also exploring the parameters of what an effective OH leadership body for workforce might look like.
One of the most eye-catching proposals in the government response was the idea of providing targeted financial incentives via a subsidy model to encourage investment in OH.
The consultation response document talked about testing “a subsidy which would aim to gather evidence on whether targeted financial incentives improve access to OH and employment outcomes”.
King highlighted that there would have to be minimum qualification criteria for providers to be included within this, probably based around SEQOHS. The subsidy model is likely to be primarily targeted at improving take-up among small and medium-sized enterprises and the self-employed. The aim is for a co-funded model, split between employers and government, but with employers also able to retain the ability to choose between providers that best meet their needs.
Things are, however, still very much at the testing stage, she emphasised. “This evidence will then inform the business case for whether or not a national fixed-term rollout of an OH subsidy would be appropriate,” King added.
Health surveillance post pandemic
Dr Steve Forman, principal medical adviser at the HSE, examined the role of health surveillance in preventing work-related ill health. He highlighted how Covid-19 had affected the ability of OH professionals to carry out effective health surveillance, especially face-to-face assessments.
“Because of the coronavirus pandemic, we did provide some interim advice around health surveillance performance over the past 18 months, and that did allow some deferral of medicals subject to a satisfactory remote assessment,” he said.
However, he also signposted that, with the easing of restrictions, new guidance has now been published and that, for all medicals after 1 September, there should have been a return to the usual ways of performing health surveillance, with ‘appropriate’ risk assessment and control measures still needed when conducting spirometry, as it can normally cause a patient to cough.
“Face-to-face assessments for health surveillance/safety-critical medicals should be subject to a suitable risk assessment and follow their relevant UK guides on working safely in respect of coronavirus,” he added.
Raising the profile of OH
Sandra Winters, president of the Faculty of Occupational Health Nursing (FOHN), outlined how it remains very much focused on how to market and promote occupational health, and occupational health nursing, as a career choice.
We are exploring all current accreditation/post-nominal-type models that are on offer. We are looking as how as a faculty we can build that into our membership strata” – Sandra Winters, Faculty of Occupational Health Nursing
“To look at how it fits with business imperatives; to look at it at a pre-registration level as well as for business and future leaders. It is very important that our focus is very much around the next steps, the next stages. What does an occupational health nurse of the future need to be equipped with?” she pointed out.
The faculty was also working on guidance on OH consent and confidentiality, on employing OHNs, on an OHN career framework, on the role of SMEs and the setting of educational standards and on greater support for pre-registration nurse work placements.
Potentially one of the most interesting changes, assuming it comes to fruition, would be the development of a accreditation and post-nominals’ model for OH nurses, she outlined. “We are exploring all current accreditation/post-nominal-type models that are on offer. We are looking as how as a faculty we can build that into our membership strata. So how we can offer that career progression, how we can enable that confidence building, how we can enable competence, and how we can assist with credibility through the post-nominal model and achievement,” said Winters.
Valuable tools and resources
The final speaker was SOM honorary strategic clinical adviser Christine Poulter who outlined some of the tools and guidance now available to OH nurses, especially around Covid19 and the pandemic.
She highlighted the range of SOM tools, resources and toolkits, covering everything from presenteeism through to long Covid and more. There were useful resources from the Association for Respiratory Technology & Physiology on ventilation, spirometry and lung function testing. The British Thoracic Society also had valuable guidance on minimising risk around restarting spirometry, as the British Occupational Hygiene Society on reducing ventilation risk around Covid-19.
“Within the hierarchy of controls approach, it may be possible to eliminate the requirement to undertake spirometry altogether. However, as yet, no one has recommended substituting spirometry for a different test other than thorough clinical examination,” she pointed out.
When it came to long Covid, as well as the SOM guidance, she recommended the NHS Employers toolkit Supporting recovery after long Covid and the National Institute for Health and Care Excellence’s Covid-19 rapid guideline: managing the long-term effects of Covid-19. However, resources from Acas and the Institution of Occupational Safety and Health were also worth checking out, Poulter argued.