Change is inevitable if we are to progress. If occupational health ser- vices do not change their approach to providing services then they will disappear. Change is a continuous process, not something that happens once, or even once every few years. Occupational health services must be in a continuous mode of change, adapting to meet the needs of the business to which they are supplying their service.
The introduction of new technology has been a major factor in this, bringing about changes in work from labour-intensive to fully
mechanised, which requires none of the skills developed through the traditional apprenticeship. Many people have been retrained in com- puter and similar skills, which have brought their own occupational health problems.
Occupational health services have been greatly affected by the changes in organisations, employment trends and the changing empha- sis on health care. The recent major developments in the NHS, alluded to in the Introduction to this book, have had an impact on the provi- sion of health care in the community, and occupational health has been identified as being part of the community.
The government’s 10-year strategy Securing Health Together (HSC 2000) outlines a long-term strategy for managing occupational health provision. In particular, it provides a challenge to all occupational health and safety professionals, and others, to develop ways of ensuring that occupational health care is available to all, including small and medium- sized enterprises (SMEs). With this in mind, it will be necessary for all occupational health services to look at their specific operation to see where they could help in the development of this strategy, for example could they provide services to SMEs in their neighbourhood? If so, how would this be managed? What would be the benefits to the community and the employer in doing this? This type of initiative would need to be included in their business plan.
There is competition for the provision of occupational health services through the development of occupational health providers and through local GPs, who are seeking to offer occupational health care through lo- cal health centres. This is very innovative as, with changing patterns of employment, more people are employed by small businesses, which do not have in-house occupational health services. Therefore a massive market exists for these services, which provides income for the GP prac- tice health centre and helps to subsidise its resources, which in turn can be of benefit to the rest of the community.
Some occupational health services are being sold off or put out to tender, while others are growing. Companies are buying occupational health provision on an ‘as and when’ basis, which they see as more cost- effective than retaining an in-house service. By buying in occupational health, companies know that if they do not get the service they want, they can choose not to renew the contract, which gives them control over the service provided. It also means that occupational health providers must supply services tailored to meet a company’s specific needs, and, above all, services that contribute towards the overall success of the business. There are potential pitfalls in this approach.
Clearly, the client’s needs must be met, but the occupational health professional has a duty to advise their clients, based on a risk assessment approach, on meeting health-related legislation relevant to the particu- lar company. It would make little sense, for example, for an employer in an organisation using recognised respiratory sensitisers to offer staff
general health-promotion sessions while ignoring their legal obligations to provide health surveillance of exposed workers. As is discussed in Chapter 16, employers may look to occupational health services to pro- vide ‘competent’ advice under health-related legislation and will wel- come guidance in this area to help define their needs.
There is nothing new about change. What is different in the modern world is the speed at which change occurs, and we must be quick to adapt. Successful organisations recognise the need to keep changing to survive, as standing still means going backwards. Organisations that succeed will invest in equipping people to prepare for and respond to change, and will have developed the skills to deal with this. One ma- jor problem for the occupational health service is moving fast enough within the organisation even to maintain the status quo. As mentioned previously, employers are looking at reducing overheads, and many are putting occupational health services out on a contractual basis, perceiv- ing it as an overhead rather than a benefit. In doing this, the company can control the costs, buying only what it wants, when it wants it.
In order to manage that change, occupational health professionals must develop skills which to many are alien and go against the very essence of their values. This entails approaching occupational health as a business, developing business plans with targets that will contribute to the overall strategy of the organisation. In so doing, occupational health will become an integrated part of the organisation and be seen by managers as supporting their objectives in making the company suc- cessful. Whether the occupational health professionals like it or not, the service is there to support the bottom line. Gone are the days of occupa- tional health being there because ‘it is a nice thing to have’; it must now demonstrate that it adds value to the organisation. This creates some difficulties in the ethical field and, as mentioned elsewhere in the book, good diplomatic skills are now a prerequisite for effective occupational health practice.
Whitaker (2001) provides some good examples of ethical dilemmas in which occupational health nurses may find themselves. Management requiring the support and involvement of a nurse in managing sickness absence is one such situation. However, with the proper policies and procedures in place and with agreed professional standards for practice this should not be an issue. The secret is to pre-empt the problem and manage it in a positive way.
Occupational health services must provide services that are appro- priate, by identifying needs through the risk assessment process and developing services to address those needs. More detail on this aspect was given in Chapter 1. Core services need to be clearly defined, fol- lowing which the occupational health team must ensure that the right skills are available to carry out those services.
The approach to pre-employment screening is one example of iden- tifying need and tailoring a service to suit an individual organisation.
This core function of occupational health services often involves a lot of time and resources if a blanket approach is to be undertaken. Research shows that this time can add little value. For instance, Whitaker and Aw (1995) found that there was no difference in rejection rates of em- ployees screened by a multi-staged process compared with those who were medically examined. This raises the question of whether this is a good use of resources and if it is cost-effective to spend a lot of time on pre-employment screening. If an assessment of the needs of the or- ganisation has been made then the requirements for pre-employment screening will have been identified. From this, fitness standards criteria can be produced, which will set out the fitness requirements for the var- ious jobs, and an appropriate system for screening can be developed to ensure that the standards have been met.
The result is an efficient way of tailoring the service to meet the needs of the organisation while also taking into account relevant legislation.
It ensures that screening relates to the risks involved in individual jobs and aims to help both employer and employee.