Choosing occupational health services

New standards for occupational health services should help employers make better choices, reports Howard Fidderman.

On this page:
Developing occupational health service standards
New occupational health service standards
Box 1: Standard principles
Box 2: Occupational health service Standard F - relationships with workers.

One of the largest health and safety conundrums employers can face is how to ensure the expert advice they are seeking is up-to-scratch. The Institution of Occupational Health and the Chartered Institute for Environmental Health are, with HSE support, still looking into a national accreditation system for safety practitioners. But in terms of choosing an occupational health service (OHS), the process became easier on 13 January when the Faculty of Occupational Medicine (FOM) published voluntary standards (PDF format, 259.41K) (on the FOM website) "to support the achievement of safe, appropriate and effective quality services by OHSs in the UK". A voluntary accreditation system for the standards is set to follow in early 2011.

Box 1: Standard principles

The FOM lists five principles that guided the development of the standards:

  • openness - public availability should mean that providers, purchasers and workers understand the standards they should expect;
  • accessibility - all providers, whether in the public or private sector, will be able to apply for accreditation, with the fees "affordable, realistic and proportionate" to the applicant's size;
  • significance - the standards and minimum requirements will reflect ethical and professional guidance and consensus, with the aim of uniform good practice;
  • objectivity - accreditation will be based on documentary evidence and observation; and
  • prudence - the evidence should ideally be gathered as a result of another routine activity, rather than specially prepared.
The early publication of the standards will, explains the FOM, allow OH services "to acquaint themselves with the standards and start to put systems in place to collect the evidence required for the accreditation process". The FOM is also using 2010 to promote the standards with the professional bodies that helped devise them, and is calling on all OH services in the NHS and the private sector to comply with them during 2010.

Accredited standards will, believes the FOM:

  • "enable services to identify the standards of practice to which they should aspire;
  • credit good work being done by high-quality OH services, providing independent validation that they satisfy standards of quality;
  • raise standards where they need raising; and
  • help purchasers differentiate OH services that attain the desired standards from those that do not."

Developing occupational health service standards

The standards and accreditation have their origins in two Government reports on NHS services (on the Department of Health website) and Carol Black's inquiry into the health of the working population (on the Working for Health website), which advocated clear standards of practice and formal accreditation of all providers of support for people of working age. The FOM and the Society of Occupational Medicine, among others, highlighted the problems arising from a lack of standards and accreditation in their responses to Black's call for evidence.

Supported by the Department of Health, the FOM worked with eight representative bodies in 2008 to develop the OHS standards: the Association of NHS Occupational Health Nurses; the Association of National Health Occupational Physicians; the Association of Occupational Health Nurse Practitioners (UK); the Commercial Occupational Health Providers Association; the manufacturers' organisation EEF; NHS Plus; the Royal College of Nursing; and the Society of Occupational Medicine.

The FOM published draft standards in June 2009 for formal consultation, eliciting 28 responses by 31 August 2009. It then piloted the standards with 17 OHS providers of varying sizes, sectors and geographical location before modifying them for publication.

Although the accreditation process is still to be finalised, the FOM anticipates it will comprise a prequalification questionnaire, customer satisfaction survey, a web-based assessment, an on-site external audit, and self-assessments in years when there are no external audits.

New occupational health service standards

 
 

An 'important development' for OH

Professor David Coggon,
president,
FOM

 

The new standards are restricted to core clinical OH services provided by doctors, nurses and OH technicians, and do not cover "non-clinical services that are often part of a comprehensive OH service, for example hygiene and ergonomics". The standards complement those required by the clinicians' own professional bodies.

The standards are split into six topics and require an OHS to:

  • conduct its business with integrity and maintain financial propriety ("business probity");
  • maintain adequate OH clinical records, and implement and comply with systems to protect confidentiality ("information governance");
  • ensure its staff are competent to undertake their duties, and that there is appropriate supervision of the staff ("people");
  • conduct its business in facilities that are safe, accessible and appropriate for the services, and ensure medicines are handled appropriately and that medical equipment is safe and appropriate ("facilities and equipment");
  • deal fairly with purchasers and be customer-focused ("relationships with purchasers"); and
  • ensure that workers are treated fairly, and respect and involve its workers ("relationships with workers").

Each of the standards represents something that OH services "must do as an overriding duty of principle in order to meet the requirements for accreditation". The standards are split into two or three parts, each of which is accompanied by minimum requirements: these too must be met and are supported by examples of suitable but non-exhaustive evidence. Box 2 shows the standard, minimum requirements and suitable evidence for the sixth standard (F) on relationships with workers.

The faculty's president, Professor David Coggon, claims the standards are an "important development" for OH. He believes they are "practical and proportionate" and potentially will "improve OH services significantly in the UK".

Box 2: Occupational health service Standard F - relationships with workers

The standards for relationships with workers are as follows:

  • Standard F1: An OHS must ensure that workers are treated fairly.
  • Standard F2: An OHS must respect and involve workers

Scope

These standards, minimum requirements and examples of suitable evidence are intended to apply to OHSs in the UK, in support of their accreditation as a provider of OHSs.

Not all minimum requirements apply to all OHSs. The relevance of minimum requirements to different types of OHS is identified.

Where the standard and/or any of the minimum requirements are not applicable, the OHS must provide a signed declaration to confirm that they are not applicable.

Standard F1: An OHS must ensure that workers are treated fairly

Minimum requirements

The following minimum requirements apply to all OHSs:

  • F1.1 An OHS must inform workers about how their personal health information is recorded and used, how to access their personal information and their rights in relation to how their personal health information is used and shared.
  • F1.2 An OHS must ensure that clinical staff obtain informed consent for procedures and for the use of workers' personal health information in accordance with professional guidelines.
  • F1.3 An OHS must ensure that workers are informed of the professional role of clinical staff and the purpose of different interventions.
  • F1.4 An OHS must promote a culture of equality and treat workers fairly, uninfluenced by their age, beliefs, colour, culture, disability, gender, lifestyle, race, religion, sexuality and social or work status.

Examples of suitable evidence

F1.1 - Copies of leaflets that define workers' rights and documentation of how these leaflets are distributed.

- Health questionnaires and other health forms that are given to workers contain explicit statements to describe how personal health information is used and how workers may access that information.

- Minutes of meetings with workers and/or their representatives to demonstrate that such information has been communicated.

- A protocol that defines how workers are informed about how their personal health information is used and how workers may access that information and documented evidence of adherence to that protocol.

F1.2 - Procedures or protocols for health consultations and procedures that define: the process for ensuring that the worker understands the reasons for attending the consultation and/or performing the procedure; whether or not consent is required; and the form of that consent (implied, verbal or signed) is clear.

F1.3 - Copies of leaflets that define the professional role of clinical staff and the purpose of different interventions.

- Explicit statements appear on health questionnaires and other health forms that are given to workers to describe the professional role of clinical staff and the purpose of different interventions.

- Minutes of meetings with workers and/or their representatives to demonstrate that such information has been communicated.

F1.4 - A diversity or equality policy and documented evidence of adherence to it.

- Staff training records and signed statements of understanding of the policy.

- Customer feedback from workers, their representatives or worker focus groups.

- A signed attestation by a single-handed practitioner that there have been no complaints, or that any complaints have been properly addressed.

Standard F2: An OHS must respect and involve workers

Minimum requirements

The following minimum requirements apply to all OHSs:

  • F2.1 An OHS must use formal and informal methods to regularly seek information and feedback from workers and/or their representatives.
  • The following additional minimum requirement applies to in-house OHSs:
  • F2.2 An OHS must consult and involve workers or their representatives regarding the provision of OHS and material OH issues.

Examples of suitable evidence

F2.1 - Worker feedback, customer satisfaction surveys from workers or focus groups.

- A folder containing relevant emails and other informal feedback.

- A complaints procedure that defines the circumstances in which workers may make a complaint, whom they should complain to, and how complaints will be managed.

- A comprehensive paper or electronic audit trail of all complaints received, the investigations performed, responses to workers, and any remedial measures.

- Satisfactory Society of Occupational Medicine Quality Assured Appraisal Scheme assessed manager feedback.

F2.2 - Minutes of meetings with workers or their representatives regarding OH issues, for example provision of services, accident and disease statistics, sickness absence information and recommendations for corrective actions.

- Documents to show that all workers have been informed of the OH provision and the services that it offers to workers.