Look to the future

first_imgLook to the futureOn 1 Jun 2004 in Personnel Today Comments are closed. Related posts:No related photos. We talk to leading practitioners from the HSE and OH on their predictionsfor the profession of the futureAn employee calls in sick and goes off to see his GP, where he complains offeeling under pressure and generally unwell. The doctor, who’s sympathetic,listens carefully and, rather than signing him off there and then, suggests itmight also be a good idea to pop down the corridor to the walk-in occupationalhealth clinic. Sounds fanciful? Get used to it, as it could be the way OH is going. InFebruary, the Health and Safety Commission (HSC) launched its new strategy forhealth and safety in the workplace, designed to set out a blueprint beyond itscurrent Securing Health Together strategy. What is clear from the document is that, just as the nature of the workplaceis changing, so OH and health and safety will have to change in the future.Indeed, OH is likely to move much more centre stage as the workplace healthfocus gradually shifts away from picking up the pieces after a chemical spill,or dealing with a broken limb caused by a falling piece of heavy machinery. The challenges of the future, according to the Health and Safety Executive(HSE) and OH practitioners, will be much more around stress management,musculoskeletal disorders (MSDs) and absence. What the new strategy has done is to set out a number of key goals to helpimprove workplace health and safety. These include requiring the HSE and localauthorities to target resources at the areas of greatest need, and to have theconfidence to be less active where risks are well managed. In thesecircumstances, the emphasis will instead be on advice and support. Similarly, there will be greater involvement of workers to manage riskfactors such as stress, employee well-being and rehabilitation. There will be arequirement to make information more accessible, with clearer advice. Therewill also be a need to build better, closer relationships between the healthand safety bodies, while emphasising that support does not necessarily meanenforcement. There is a huge commitment attached to the new strategy, argues BrianEtheridge, head of the HSE’s strategy and intelligence division. “This is something we are committed to deliver. We are committed tofive high-level programmes of activity, one of which is improving occupationalhealth and safety support,” he says. “The strategy is framed around the idea that the world is changing, andwe need to change to keep relevant. It is about looking forward and thinkingabout ways in which we can remain able to address issues around thecorner,” he adds. The fact the strategy stresses occupational health and safety support isimportant too, argues Elizabeth Gyngell, head of the HSE’s better workingenvironment division. “It is distinguishing it from the old service – itis not just a medical route. It’s about providing whatever support that companyor individual needs, which might be ergonomic.” The new strategy takes Securing Health Together forward, stresses ColleenBowen, head of the HSE’s OH support policy team. At its heart is a focus onproactivity – preventing risks before they happen. “It is not just aboutputting plasters on injuries. We want to prevent the risk happening in thefirst place,” she says. The construction industry is a good case in point. The HSE has been settingup a support model, which should be rolled out across the industry later thisyear. Similarly, when it comes to MSDs, the focus is on developing a more active,case management approach, Bowen says. The HSE is also in the throes of developing a management attendance tool tohelp small businesses. “It is a long-term programme, and we haven’t gotthere yet. But I think there’s going to be a snowball effect in industry,”she says. Another key area that the HSE is working on is developing more ‘gateway’services, perhaps through telephone helplines or NHS Plus, which could beaccessed by employers and employees. The main focus of OH in the future is going to be sickness absencemanagement and rehabilitation back into the workplace, predicts OH consultantand ex-HSC commissioner, Cynthia Atwell. “OH has been trying to do these things for years, but with all thesenew strategies, it is almost as if OH is being reinvented. I can see OH beingprovided through a lot of outlets,” she says. As GP surgeries expand their health-related activities, and bring in morealternative services, such as those already provided by practice nurses andcomplementary therapists, OH could be another service that fits into a primarycare, as appropriately as a workplace, setting. This becomes particularly relevant when you bear in mind the push by GPs, aspart of their new contract, to get shot of sicknote certification. The idea isto have made ‘substantial progress’ to moving certification out of GP practicesby 2006. And, back in April, pilots were due to start for examining thepracticality of OH taking on some of the responsibility. However, it appears that the pilots have still, as yet, to get underway,casting doubts over whether this sort of timetable is too ambitious, or evenfeasible. Atwell believes OH could provide health advice and promotion through GPpractices, and could help deal with workplace health issues. What level ofpractitioner would do this, however, is a moot point, as it is unlikely to bethe sort of thing a high-powered, specialist practitioner would consider thebest use of their time. One possible model could be the development of nurse assistants in the NHS,who would work alongside the qualified nurses, believes Atwell. Some sort of OHassistant providing general advice and first port-of-call support, and with theability to recognise when a referral to a specialist practitioner or GP isappropriate, could be a workable solution. “You could have healthcare assistants or OH technicians who might dorelatively basic things such as audiometry or lung function checks. Then thequalified OH nurse could interpret those findings and suggest a best course oftreatment,” she suggests. “But they would have to be working underthe supervision of an OHN.” Even in big companies that employ fully-qualified OH nurses, there is oftentesting that could just as easily be done by someone with fewer qualifications,she argues, freeing up the specialists to do what they do best. Of course, such ‘blue-skies thinking’ is all very well, but where are allthese new practitioners going to come from? There is already a shortage of OHnurses, advisers and specialist practitioners. And even if there was anexpansion of NHS Plus, it would be unlikely to have the resources, capacity orexpertise to provide the necessary numbers. Atwell suggests that, if people are being used in different ways, thenperhaps there needs to be a long, hard look taken at entry routes into theprofession and levels of training. Similarly, there will probably need to be agrowth in the number of independent OH consultants. In an ideal world, when you start a business, going to see an OHpractitioner to make sure people are employed in the right way should be on thesame list as going to see the bank manager, believes Graham Johnson, businessdevelopment manager at Interact Health Management. “At the moment, OH is a cog in the wheel, but we are still not seen byemployers to be needed as part of the development of new companies,” hesays. It should be the case that insurers specify an OH consultation for a newbusiness as a matter of course, he adds. Too often, OH and health and safety are thought of as something threatening,and only to be called in when things have gone really wrong. So there needs tobe an education process. “If you did a Mori poll of 1,000 people askingthem what occupational health was, you would see a lot of blank faces,” saysJohnson. “We have a reasonable idea about what a nurse does, but not OH.There are so many different ways of providing OH, and so many models,” heexplains. OH will increasingly be an advocate in the workplace, a bridge betweenmanagement, HR and employees, and as such will need to work evermore closelywith all sides, suggests Sharon Horan, director of OH nursing services at AonHealth Solutions, and chair of the Society of Occupational Health Nursing.”We will be looking at a whole new range of issues, psychological andmusculoskeletal. There will be more involvement of workers, too, in asking howwe can do things better,” she says. “There is still a big educationalresponsibility.” As OH becomes a more high-profile issue within the workplace, so it willneed to become more visible and prevalent, agrees Judy Cook, president of theAssociation of OH Nurse Practitioners. “We need to be clear what OH is. Up to now, we have been quite focusedon safety. I think in the future we will need to become more focused onoccupational health and occupational ill-health, as well as safety. The worldof work is changing, and our role within it needs to be clarified,” she explains.OH will probably become more multi-skilled, she adds. “In 10 years’time, we will probably have better identified what needs to be done and whoneeds to be trained. “There are an awful lot of people out there stillsticking on plasters because it is what their employers want. But just becausetheir employers want it, does not mean it is the right thing to do. So there isan element of educating employers about the role of OH.” Employees, too, will probably become much more involved. Much like Atwell,Cook believes there may be a move towards a new tier of OH nurse, who carriesout more basic functions and has fewer qualifications than their specialistcounterparts. “There may be a move towards simplifying risk assessment.Employees could be doing a lot of risk assessment themselves,” shesuggests. Reducing sickness absence will also be a key challenge for the publicsector, she believes. The effectiveness of the NHS OH service will be criticalto this. There will need to be an increased awareness among employers, bothpublic and private, about for what purpose they want OH. Bizarrely, considering how much employers are talking about absence andsickness management, one of the biggest challenges facing the service may be increating demand, suggests the HSE’s Bowen. This is not because there is notenough to do but, again, because there is not enough understanding about how OHand health and safety can help. “People want it once they have got it, but often they do not know thatit is out there. So there is an element of creating a demand for theservice,” she argues. If the HSE is successful, the profession could find itself severely indemand in years to come. www.hse.gov.ukwww.aohnp.co.ukwww.rcn.org.uk Previous Article Next Articlelast_img

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