1.Fit For Work Service
One big concern is the relatively new Fit for Work service, introduced as a way of getting the long-term sick back to work and preventing people from going off sick in the first place. Many think that returning to work is what I do as an occupational health professional – but it isn’t. It’s a bit of it, but not the primary focus.
Occupational health is about preventing work-related illnesses such as asthma from working with flour or spray paints, deafness from working in noises areas and bad backs, to name three.
Unfortunately, many employers think that attendance management is the primary function of OH, so there has been lots of discussion about whether a business with an OH service needs to keep it. After all, there is now the free Fit for Work service. What’s the point?
Does this signal the end of occupational health services as we know them?
As time has rolled out, the Fit for Work service seems to have stalled. The two significant flaws in the service, being:
1. It is not compulsory for workers/patients/employees to attend and,
2. Most consultations are over the telephone.
I can see why it is set up like this. The consent process is critical to the NHS model, thus keeping GP’s on board. And, it is expensive to get people to a central spot or ask potentially ill people to travel for a chat with a health professional.
I believe this type of set up has it doomed Mr Mannering.
I would be interested in looking at how the Fit for Work service is panning out by looking at independently audited statistics, but from what I hear, us OH professionals have little to fear.
2. Acting Unethically
This is one of those things that tends to be more prevalent in the younger members of the profession. I can remember as a newly qualified nurse working in private practice, wondering if I could insist on patients getting out of bed when they didn’t want to. They were paying my wages and perhaps I had to do what I was told?In the NHS it’s clear that getting out of bed is better for you than laying in bed. Trying to get people to do what they don’t want to do when they are paying was a bit like biting the hand that feeds you.
In industry, this becomes more of a dilemma. The business pays your wages, and you have to tell the company to do things they don’t want to do. Mostly it’s OK if the OH service has been around a long time, everyone gets it. But if it’s a new service or, even worse, inexperienced; you could be in for a rocky ride, especially if management doesn’t understand your role or what occupational health is.
Do you want to keep to your principles of good OH or do you want to fit in within the company?
OH is a lonely place; with you a lone voice, with everyone wanting their way.
Been there, done that. To be honest, it’s horrible sometimes.
3. A Witness at an Employment Tribunal
I have been a witness at a tribunal, and I worried myself sick over it. I don’t know if I am a typical case, but terrified did not cover it.I’m not sure of what exactly, but as I am a stickler for ethics and rules, I figured I done something wrong. I always think everything is my fault. The problem is, because we work in an atmosphere of confidentiality, we can never fully discuss the details of a case with management or HR. And I guess they never fully open up to us. It’s human nature.
Returning to the looming tribunal – I needn’t have bothered. Those hearing the case were not the least bit interested in anything I said. I worried for weeks about a 10-minute spell on the stand. I cannot tell you the relief I felt when it was over, and rather embarrassed by my fear.
At the end, I never heard the verdict, and to be honest, it turned out to be a storm in a teacup; but if anyone had told me that earlier, I would not have believed them. I’m not saying that all tribunals are the same but OH professionals are usually there for fact-finding and not to be blamed; in my experience and by looking at case-law, I see it is always management who are responsible in law for employment decisions.
4. Being Outsourced
Internal OH services are expensive and are usually considered an employee benefit or perk unless there is a specific legal need for health checks, e.g. hearing, breathing, skin tests. But when things get tight and managers are looking for cost cutting; the biggest cost savings are always from reducing headcount and salaried staff, or, as they said in my business course days, cutting fixed overhead costs.
It is relatively easy to outsource OH.
There are plenty of companies around(see the SEQOHS website for nationally accredited companies), and it’s an opportunity to check just what you need to offer and not what is on offer.
I’ve worked as both an internal OH employee, and as an OH service provider and the two jobs are as different as chalk and cheese.
Here are some pointers about the differences:
I think of an internal service as the heart of occupational health practice with:
- Time not specified for health activities
- Relationship building with both workers and management, and building up trust
- A more relaxed and less hectic atmosphere
- A comprehensive, yet often, vague service to managers/HR/employees
- The service having limited experience in some areas of health risk/effect
- A broad focus service
The bespoke provider service is more the ‘head’ or business approach to health where:
- Service is specific and monitored, e.g., health surveillance and screening
- The relationships are between the sales teams and HR
- Clear cut limited responsibilities and objectives for OH staff
- Trained practitioners for each specific task
- Financial accountability to company if targets not met
- Narrow focussed service
- No extras unless paid for
Think carefully which type of service best suits your business or, if you are an OH professional, where you would prefer to work.
5.Being Personally Sued or Struck off
Medical professionals who work in large organisations like the NHS or bigger occupational health service providers have the protection of their company and their employer’s vicarious liability. Others working in their own business or outside of the profession find it is a lonely place. Often we are the only medical professional around. Many of us function without the support of doctors and administrative help. We learn to be strong and resourceful or find another job.
We uphold medical ethics. One of the biggest issues in OH is confidentiality. I work in a world where people learn to read upside down and watch who comes in and out of your office. Much of unofficial business life is the community and personalities. News travels fast in a factory. They used to call it the ‘grapevine’.
I am sorry to say, that everyone knew who was having an affair with who and who was in the managerial doghouse. Confidentiality? What is that? But medical professionals must keep up that shield. Otherwise, no one tells you anything, and you need to know the facts if you are dealing with personal health issues. Not only that, your registration as a Doctor or Nurse depends on acting in accordance with our ethical codes. And anyone can make a complaint against us. Have we acted irresponsibly or unethically?
Sometimes it depends on your point of view but unless you’re on your guard all the time you can easily do the wrong thing without even knowing it.
You only have to look at the Facebook groups and chat rooms to see that.
Or if you really want to see outcomes of NMC investigations click here – there are a lot!
And outcomes of GMC investigations and findings – many here too.
Mine and Your Occupational Health Fears
These are my five big worries in my occupational health practice. Sometimes, when I was working flat-out one of them would flash into my mind and with a shiver down my spine, I’d dismiss it. Now I work less frantically and can easily extract myself from situations where there are problems. Luckily my livelihood is not tied to my job, and I have options now. But it wasn’t always like that.
We work in an ethical role, many of us lone practitioners with little support. We chose this job and must learn to live the possibilities.
Me? Although I worry, I’m glad I do what I do.
What are your five worries in occupational health?