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Occupational Health and Safety Services for the staff of the NHS in ScotlandReport of the Occupational Health and Safety Service Short Life Working Group |
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Forewordby the Minister for Health and Community Care NHS staff are our most important resource. The Scottish Executive values the contribution of all those who work in the service and want to ensure that their health and well-being is assured. Each year over 80% of the resources we spend on the NHS goes on staff costs. But these 130,000 individuals provide 100% of the care. That means we get a good deal from them. Better health and safety is one way of ensuring they get a good deal from us. |
In this strategy "Towards a Safer Healthier Workplace" we fulfil our commitment to develop a comprehensive, accessible and inclusive Occupational Health and Safety Service.
Implementing this strategy is the responsibility of all organisations in the NHS in Scotland. It should not be an option. A quality working environment is at the heart of quality care. This Strategy is a product of Partnership and offers staff and their representatives the opportunity to influence occupational health and safety policy and practice locally. It is a Strategy for all those who are part of the NHS in Scotland 'family' - for primary care practitioners and their staff, for staff of independent contractors, caterers and cleaners, and students working within the NHS in Scotland.
I am determined that the service provided is clearly visible to staff and an example to all employers in Scotland. The service must be fully integrated with other services under our overarching human resources strategy. It should also support and promote health throughout the NHS in Scotland. Such a service should offer integrated occupational health, safety, personal safety and health promotion, offered by multi disciplinary teams. It should promote improvement in the health of staff and, in so doing, reduce accidents at work and make the workplace a safer place for staff, patients and for visitors.
"Towards a Safer Healthier Workplace" is a document for everyone in the wider NHS family. It is up to everyone to play their part and work together to improve the health and well being of staff. We will also make NHS in Scotland premises safer and healthier environments in which to work. A safer NHS. A healthier NHS. A better NHS in which to deliver the improved patient care the people of Scotland want and deserve.
Susan Deacon MSP
The Occupational Health and Safety Service (OHSS) Short Life Working group was set up in July of 1998 to fulfil one of the commitments given in "Towards a New Way of Working" - the first Human Resources Strategy for the NHS in Scotland (NHSiS). The Human Resources Strategy emphasises partnership, consistency and fairness for those working in the NHSiS. The recommendations in this Report build on these commitments to staff by ensuring they have full access to a high quality, equitable OHSS which is comprehensive and inclusive. The main thrust of the Strategy is that staff of the NHSiS are our most important resource and that no one should be made ill by their work.
Remit of the Working Group
To identify strategic and practical action to ensure a comprehensive and inclusive occupational health and safety service equally accessible to all of the staff in the NHSiS.
Main Issues for the NHS in Scotland
Employment and Health: There are clear links between employment and health. Having a secure rewarding job can do much to provide the social support and motivation so vital to good physical and mental health. Conversely non-secure, low reward, unsafe jobs can undermine the potential for good health. Employers, trade unions and professional organisations in the health service have a particular interest in developing the health of workforces, both to increase the well-being of employees and to reduce sickness and absences so as to improve the service to patients.
Exemplar Role: The health service has an important exemplar role as an employer. Because of its unique position of trust and respect in Scotland the NHS should set an example to all employers. Competent OHSS should as a priority actively seek to provide services to all parts of the NHSiS not at present receiving such services.
The NHSiS OHSS should aim to become a trusted and widely recognised source of comprehensive specialist occupational health and safety advice for employers in Scotland and should establish support through local networks and Health Boards for OHSS with non-NHSiS employers.
Recommendations
The NHSiS must play an exemplar role in the provision of OHSS for its staff.
The primary aim of the NHSiS is to improve health. As a source of trusted specialist advice on OHSS the NHSiS should promote and facilitate the development of high quality OHSS with employers throughout Scotland.
Management Executive Responsibility: The Management executive has a responsibility to ensure that NHSiS organisations are clear about their specific roles and responsibilities in providing a comprehensive, competent and integral OHSS for NHSiS staff.
Employer Responsibility: In 1995 the NHSiS issued guidance on OHSS for the NHSiS, (GEN(1995)4). This clearly set out the responsibilities for all NHS organisations including Primary Care contractors to make OHSS available to their staff.
Management Responsibility: Management has a responsibility for fully integrating OHSS into an overall human resource strategy. Management must fully involve staff and their representatives in the development and determination of standards and provision of OHSS, personal safety policies and health promotion.
Staff Responsibility: Staff and their representatives should take the opportunity to involve themselves and to work with Management in the process to develop OHSS personal safety and health promotion policies locally.
Confidentiality: The OHSS must provide a confidential service to staff.
Structure of OHSS: There is no defined optimum organisational structure for an OHSS although it should be managed by an Occupational Health or Safety professional.
Fully Integrated Services: Each NHSiS organisation should ensure that their OHSS is fully integrated with other related issues affecting the health of staff. Specifically this should include accident and injury prevention, health and safety, health promotion, counselling, personal safety and the working environment within an overall strategy for human resource management.
Education and Training: Education and training plans must be fully integrated with OHSS strategies.
Recommendations
There must be a clear policy lead from the Management Executive on the lines of responsibility within the NHSiS and for the management of OHSS.
Boards of Trusts and of Health Boards, General Managers, Chief Executives and primary care practitioners must be clear about their statutory and exemplar responsibilities and ensure that OHSS provision is an integral part of risk assessment and risk management at all levels in the NHSiS.
Staff in the NHSiS must be offered a fully integrated service which includes occupational health and safety, personal safety and health promotion under an overarching human resource strategy.
OHSS must be appropriate to the needs of staff and the organisation. Services should use a multi-disciplinary team approach in providing services such as occupational medicine, occupational health nursing, health and safety, occupational hygiene and counselling. Liaison with other disciplines such as infection control, physiotherapy, moving and handling and fire safety must be encouraged.
Staff and their representatives must be fully involved in developing and determining the standards and provision of occupational health and safety services, personal safety policies and health promotion within their organisation locally.
OHSS impacts on all areas of employment and business activity and must be fully integrated into all NHSiS organisations' Human Resource strategy and policies. This should include; Education and Training; Health Promotion; Working Environment and Employment Practice.
Access to an OHSS: All staff in the NHSiS must have access to a comprehensive, competent and confidential OHSS. This will apply to anyone working in the NHSiS, including students, regardless of where they work in a hospital, in the community, in primary care general practice or for an NHSiS contractor. Those who work wholly in the NHSiS should be prime recipients of a quality service.
Primary Care and Independent NHS Contractors: Primary Care and independent NHSiS contractors need to be aware of their responsibilities to provide access for their staff to comprehensive OHSS.
General Medical and Dental Practitioners: The Management Executive should initiate a review of how OHSS costs for general medical and dental practitioners and their staff could be met.
Students and Contractors' staff: Students and Contractors' staff working or training in the health service are at the same risk as NHSiS staff with regard to occupational health and safety issues. Occupational health and safety services locally should ensure that they make available their services to anyone working or training on NHSiS premises.
Recommendation
All NHSiS staff must have access to a comprehensive, competent and confidential OHSS. This will apply to anyone working in the NHSiS, regardless of whether they work in a hospital, in the community, in primary care general practice or for a NHSiS contractor.
Service Aims: The aims and standards of OHSS in the NHSiS should be based on evidence of health gain. To develop consistency of approach across Scotland and to ensure the highest quality of service, OHSS should develop a network of services to allow benchmarking and audit to be developed.
Pre-employment Assessment: A pre-employment assessment should be mandatory for all staff. Clinical Occupational health records should be transferable between OHSS in the NHSiS to reduce wasted resources on pre-employment checks and to offer a seamless service to employees and employers. Employees must be assured of the confidentiality of these records.
Pre-entry Health Assessment for Students: Prior to beginning training at university or college prospective Health Service students should be required to undergo the same level of pre-entry health assessment as identified for a substantive post.
Minimum Standards for an OHSS: The NHSiS Human Resource Strategy set out a minimum service of:
Key objectives for an OHSS: Key objectives need to be set to drive forward action. The following should be identified by each NHSiS Organisation:
Staff Standards and Training: The OHSS should be staffed by appropriately trained staff. Educational pathways and training requirements should be clear to those wishing to enter this speciality. The clinical occupational medicine component of the service must be Consultant-led.
The main issues impacting on OHSS are; sickness absence; accidents at work; manual handling; needlestick/contaminated sharps injuries; stress; violence and aggression and security of employment.
Recommendations
Best practice of OHSS must be based on benchmarked standards and common across the NHSiS.
Trusts and Health Boards must set targets for improving staff health and reduction in accidents and injuries to both staff and patients.
NHSiS organisations must develop policies which give security of employment, where possible, including redeployment, as a consequence of disability or ill health.
Information and Research: Monitoring and reporting of OHSS services is essential, as is the recording of outcomes and the affect on staff health. There is a scarcity of good information available concerning the health of staff in the NHSiS. There is need for a comprehensive research base to identify staff needs. Of particular importance will be longitudinal studies to investigate the relation between work factors and health outcomes with intervention programmes based on the evidence of randomised control trials of interventions.
Research Study: Academic bodies involved with the NHSiS should consider how they could increase the quality and quantity of research in this area.
Data Collection and Recording: Employers should collect common minimum information to inform, evaluate and prioritise activity. Minimum datasets should be established at Trust/practice level that can directly inform management and organisation of the service. Smaller minimum datasets should be collected at Health Board and at national level in order to clearly identify needs and outcomes of Human Resource Strategies in the NHSiS particularly related to staff health and safety.
Indications are at present that a large section of NHSiS staff in primary care practices have poor access to OHSS and there is little recording of data related to these staff to inform or evaluate services e.g. accidents at work.
Health Boards, Trusts and Primary Care contractors must institute a standard method for recording and collection of data for all their staff and for those working in or visiting NHSiS premises.
Minimum Dataset: A minimum dataset should be circulated to the NHSiS including Directors of OHSS with a view to agreeing a dataset and the method of collection. The Management Executive should set up a small group to take this forward and fund this as a demonstration pilot to take forward OHSS in the NHSiS.
Recommendations
Trusts, Health Boards and primary care contractors must establish within common NHSiS reporting structures indicators of service supply and quality, standard audit procedures and indicators of outcomes for OHSS. Key indicators of supply and outcome should be published and available for comparative review purposes.
A research base should be developed in OHSS to establish evidence-based programmes to address the most common work related illness issues such as musculo-skeletal disorders and stress.
Resourcing OHSS: There are minimum new requirements identified within this Strategy, which will require to be resourced. Many Trusts and Health Boards are already offering and financing such services. NHSiS organisations must fund appropriate OHSS through the HIP and TIP process to a level already achieved by many exemplar NHSiS employers. NHSiS employers must publish the annual gross expenditure on OHSS for NHSiS staff annually.
Benefits of Accident Avoidance: There will be key benefits to patient care from healthy staff and avoidance of litigation and injury, sickness and compensation costs. This would more than balance the cost of resourcing good OHSS.
Litigation: Failure to manage health and safety effectively can result in prosecution by the Health and Safety Executive with the possibility of unlimited corporate or personal fines and/or imprisonment.
Impact of health and safety performance on insurance premiums:
NHSiS organisations can by actively seeking to improve their health and safety procedures and practices become regarded as a low risk organisations and obtain lower insurance premiums.
Cost of Accidents: NHSiS Organisations must set organisational targets for reduction of costs associated with poor outcome of Human Resource strategies, such as sickness absence, injury benefits claims, early retirement costs due to illness and accidents and injury.
Nuffield Trust Report. (Improving the Health of the NHS Workforce):
The estimated information for Scotland suggests that accidents and injuries cost an estimated £95 million a year. This figure includes £71m for absence, £12.5m for back injuries and replacement staff, £3m for accident-related compensation and £7m for accident-related early retirement. These figures are clearly not acceptable and must be reduced in the interests of staff and patients. Avoidable accidents make up a large proportion of all accidents and it should be possible to significantly reduce their overall cost to the NHSiS and fund the type of integrated and inclusive OHSS needed.
Recommendations
Health Boards and Trusts should through the Health Improvement Programme and Trust Implementation Programme process set out their timetable for achieving appropriate resources for OHSS in the NHSiS.
The main priority for the OHSS must always be to NHSiS staff and any external services provided should always enhance the current service to NHSiS. Trusts and Health Boards which offer external services to non NHSiS organisations should ensure the service is offered at commercial rates.
What this means for the...
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