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.
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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. |