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"OHSS should provide standards of performance which go beyond statutory rights" |
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Standards and Development of OHSS
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. OHSS managers must set up a small group to review and put in place common minimum standards for pre-employment screening and occupational health surveillance.
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. The Management Executive should liaise with the Scottish Executive Education Department to ensure that all students who intend to take a health service associated course receive a pre-entry occupational health assessment and advice.
Minimum Standards for an OHSS
The NHSiS Human Resource Strategy set out a minimum service of:
The Trust Chief Executives' Sub-group on OHSS reviewed the Occupational Health Services in Scotland and identified variable standards throughout Scotland. The minimum level of service outlined above should be enhanced and informed by the risk assessment process. The service itself should identify quality standards and commit themselves to continuous quality assurance and improvement.
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. There should be formal agreed education and training standards for employees of OHSS. These should also ensure continuing education for staff which may include work with non-NHS organisations to broaden the experience of staff. The clinical occupational medicine component of the service must be Consultant-led.
Main Issues Impacting on OHSS
Sickness Absence: The NHS Pay and Workforce Research Intelligence Unit report in January 1998 entitled 'Comparing sickness absence rates and costs' found that the potential cost of sickness absence for nurses and midwives could be as high as £1.8 million per Trust in a year. This is based on grade E nurses with an average absence rate of 5.6%.
Accidents at work: The HSE estimated in 1993 that an average NHS Trust loses some 5% of its running costs per annum due to accidents alone. The Institute for Employment Studies found that in the NHS the mean working time lost from work through accidents and ill health was 4.9% a year. In an 8 week audit of 30 acute hospital trusts in England the National Audit Office recorded 8,200 accidents. This represents an annual accident rate of 450,000 accidents. The HSE estimates only 35% of accidents are reported. These statistics suggest there are some 183,000 accidents in Scottish Trusts each year of which 46,000 are to staff.
For staff the main causes of accidents are needlestick injuries, manual handling, slips, trips and falls and physical assaults. NHSiS organisations should put in place mechanisms to encourage reporting of all accidents and incidents. With the monitoring and minimum datasets mentioned in
Appendix 1 used as part of a resultant database, the NHSiS should aim to reduce the cost of injuries by reducing the number of accidents and incidents to a minimum. During 2000/2001 NHSiS Organisations must analyse their injuries, accident and incident data to establish a base line and then set an objective to reduce the number of injuries, accidents and incidents by at least 25% by 2006 through the adoption of best practice, training, increased awareness and improved audit of the incidents.
Manual handling: One third of all workplace accidents reported to the HSE in Britain involve manual handling and more than 1,500 manual handling accidents in Scotlands' health services were reported to HSE between 1994 and 1997. Back injury prevention can be cost effective and preventive programmes have demonstrated up to 84% reduction in hours lost from manual handling incidents. Trusts should adopt best manual handling and training practice to reduce injuries.
Needlestick/Contaminated Sharps Injuries are one of the most common. They are also an injury which often go unreported. Needlestick injuries and other contaminated sharps injuries are avoidable with use of good practice and care. NHSiS employers should adopt best practice and training to reduce needlestick/contaminated sharps injuries.
Stress and depression are health issues for NHSiS employees. Much NHS work is particularly stressful and employees may require substantial support services. In one health board 70% of nursing referrals to the OHSS are related to stress or depression. NHSiS employers should develop policies aimed at reducing stress in the workplace for all employees.
Violence and Aggression have no place in the workplace. They are increasingly being recognised as important issues for NHSiS staff both within NHSiS Trusts and when working in the community. These issues are important causes of stress. The risks can be reduced in many ways including staff training, and 'planning out violence'. A simple example is Trusts avoiding long waiting times for highly stressed patients and relatives. Security services and staff protection may also be required.
Security of Employment: NHSiS employers should develop and adopt good employment and retention practice. The NHSiS should make every effort to retain staff who are permanently or temporarily disabled or who are finding their current post difficult or stressful for whatever reason. Policies should dovetail with OHSS to give security of employment to staff and may involve a change of:- duties, job, hours, shift patterns or a review of job practice.
Action point
The Management Executive must:
All NHSiS Organisations must:
OHSS must:
The figures in brackets relate to the Action Plan in section four
"Employers to collect and
evaluate information which is consistent and
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Information and Research
Monitoring and reporting of all OHSSs' 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. Recording of musculo-skeletal disorders feature highly in certain groups such as nurses and ambulance staff. Illness such as dermatitis, asthma and infections are not commonly recorded as major occupational health problems. Anecdotal evidence also suggests that a main burden of ill-health may be due to psychological and mental factors including stress. This may indicate a lack of reliability of such information similar to the under-recording of accidents at work. 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. The Management Executive should initiate pilots to accurately identify the incidence of workplace staff health problems.
Research Study
Academic bodies involved with the NHSiS should consider how they could increase the quality and quantity of research in this area. The Chief Scientist Office has funded a two year study to design a practical tool to quantify the costs of accidents, ill health and absenteeism. Validation of the study is being funded by the Management Executive as one of the pilots in partnership with Tayside Primary Care NHS Trust and the Health and Safety Executive. This research will identify the benefits of action to reduce risk and improve working conditions in the NHSiS.
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. Minimum datasets should also be collected and collated 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 and to encourage staff to report accidents and incidents. Minimum dataset has been identified for consultation in Appendix 1. The Working Group recommends this data should be collected as a normal part of data collection in the NHSiS through the Information Services Division of the Common Services Agency. Information should be published as part of Practice, Trust, Health Board and Management Executive reports annually.
Minimum Dataset
The minimum dataset identified in Appendix 1 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.
Action point
The Management Executive should:
All NHSiS Organisations should:
The figures in brackets relate to the Action Plan in section four
"There are key benefits
to patient care from healthy staff,
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Resourcing OHSS
The Trust Chief Executives' (TCE) Occupational Health and Safety Sub-group Report identified that standards, management, access, and financing of OH&S services are extremely variable throughout Scotland. The 1995 Guidance in close up the NHS Circular (GEN (1995) 4 clearly set out the requirement for all NHSiS bodies including Primary Care contractors, to make OHSS available to their staff. Resourcing has therefore long been an employer responsibility. There are however minimum new requirements identified within this Strategy which will require to be resourced. Some Trusts and Health Boards are already offering and financing such services. All NHSiS organisations must fund appropriate OHSS through the Health Improvement Program (HIP) and Trust Implementation Plan (TIP) process to a level already achieved by many exemplar NHSiS employers. All NHSiS employers must publish the annual gross expenditure on OHSS for NHSiS staff.
Costs of the existing NHSiS OHSS
The TCE report attempted to quantify the cost of existing in-house occupational health and safety services. In practice this proved impossible to do and the detailed figures obtained were too contradictory to be used. The TCE report estimated that the total expenditure on NHS OHSS was currently less than £5 million per annum. It is clear that the way services are set up, organised and funded varies widely between different trusts and health boards, some services have for example been income-generating while others have not. The main thrust of OHSS policy must be to focus on the health and health care needs of employees and the quality and effectiveness of the services they provide. NHSiS Organisations must ensure that services offered to non-NHS organisations are offered at commercial rates and do not impact on the services provided to NHSiS employees.
Benefits of Accident Avoidance
There will be key benefits to patient care from healthy staff and avoidance of litigation, injury, sickness and compensation costs. This would more than balance the cost of resourcing good OHSS.
Litigation
The legal costs of prosecutions for failure to comply with the law are small by comparison with the costs of paying compensation awarded by the courts. Royal College of Nursing figures for 1996/97 indicate that the total damages recovered by RCN members in England claiming work related injury or ill health was about £4.8 million and increasing. Failure to manage health and safety effectively can result in prosecution by the HSE with the possibility of unlimited corporate or personal fines and/or a term of imprisonment. Crown Immunity for health and safety in the NHS was removed in 1986 and NHSiS employers carry the same duty of care towards employees as private companies.
Impact of health and safety performance on insurance premiums
The insurance industry clearly is able to recognise trusts with good and bad health and safety practices and sets premiums accordingly. According to CE Health (UK), as an illustrative example one new trust established in 1994 (wage bill £60 million) with a poor claims history was quoted £500,000 to cover their employees' liability risks. By actively seeking to improve their health and safety procedures and practices they became regarded as a low risk and their premium in 1996/97 was reduced to £53,000.
Cost of Accidents
Cost of accidents can be divided into immediate costs such as staff time in dealing with the accident, immediate treatment costs and longer term costs such as compensation costs to injured individuals and loss of trained and experienced staff through early retirement or ill health. The immediate and long term cost of accidents in Scotland is estimated at around £26 million per year for accidents alone. Every year in Scotland 400 nursing staff have to retire because of their injuries and HSE estimate that more than £12 million is spent on replacing them. Direct compensation payments for injuries are estimated to cost the NHSiS £2.0 million in 1998/99. These costs are increasing year on year in real terms and are likely to continue to do so as staff awareness and expectations rise. These payments are made under statute and can only be controlled at source, by preventing the injuries. NHSiS Organisations must set organisational targets for reduction of costs associated with OHSS issues, including sickness absence, injury benefits claims, early retirement costs due to illness and accidents and injury.
Nuffield Trust Report.
Earlier this year the Nuffield Trust, responding to an increased emphasis on protecting the health of the workforce in the Public Health Green Paper 'Our Healthier Nation - A Contract for Health, convened a partnership of key organisations to assess all available evidence on the health of the staff of the NHS and make recommendations for Improving the Health of the NHS Workforce. The partnership report includes a short appendix that quantifies the cost of ill-health in the NHS workforce in England and the cost effectiveness of interventions.
Corresponding figures for Scotland show 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 to more than cover the investment cost to fund the type of integrated and inclusive OHSS needed. NHSiS Organisations must develop comprehensive strategies on human resource management, including occupational Health that could result in substantial savings through reduction in sickness absence and injury benefit claims.
Action point
All NHSiS Organisations must:
The figures in brackets relate to the Action Plan in section four
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