Musical chairs

first_img Comments are closed. It’s all change at the Department of Health as the latest reshuffle meansthere is yet another new face responsible for overseeing workplace healthissues. Some argue that if this Government wants to make a real difference, itneeds to have a huge shake-up of how OH is managed and enforced, by Nic Paton The surprise resignation of transport secretary Stephen Byers in May broughtabout a much wider reshuffle of the Government than political pundits had beenexpecting. Why this should be important to occupational health nurses is that,yet again, it means a new face is dealing with workplace health issues in thecorridors of Westminster. Ever since Labour came to power in May 1997, Occupational Health has beenpressing the Department of Health to agree to an interview with the minister ofstate responsible for overseeing occupational health issues. We have argued –and officials have agreed in principle – that Occupational Health would be aperfect forum for the minister of the day to set out his or her stall to theprofession. Yet despite having at least twice got to within days of sitting down for aface-to-face chat, each time events or reshuffles – with the Byers reshufflebeing just the latest – have conspired to ensure it does not go ahead. Rightly or wrongly, OH is one of the responsibilities considered appropriateto be handled by a junior member of the Department of Health ministerial team. Four ministers in five years As a result, those picking up the OH baton will often be new ministers orthose destined for greater things. Since 1997, four ministers have hadresponsibility for workplace health issues (see box) – nearly one a year. On the plus side, it could be argued that Labour is putting some of itsbrightest future stars in charge of OH issues. Indeed, the latest incumbent,David Lammy, is Britain’s youngest MP and is widely tipped for higher office. In many respects, too, the Government’s record on workplace health is not atall bad. A central plank was the launch in 2000, with the Health and SafetyCommission, of its Securing Health Together and Revitalising Health and Safetyoccupational health and health and safety strategies. These 10-year strategies have set targets to reduce the incidence ofwork-related ill-health, the number of fatal and major injuries and workingdays lost to injuries and ill health. NHS Plus Another major initiative was the launch last October of NHS Plus. This sawNHS OH units encouraged to outsource their services to the wider community, inparticular to small- and medium-sized enterprises (SMEs), through the use of adedicated website. Politically too, the Government has made changes. Whereas once OH was simplylumped in with public health, it has now become a ministerial area ofresponsibility in its own right, and so rewarded with greater prominence inParliament. Ministers have championed the introduction of better work-life balance,shorter working hours (through the Working Time Directive) and, in the publichealth arena, have tried to tackle levels of smoking and other pervasive publichealth issues such as obesity. But such is the revolving door now at the DoH, OH nurses are becomingincreasingly concerned that ministers do not have time to grasp the key issuesfacing the profession before they move on. This, they fear, results inshort-termism, a lack of focus and an inability to push through change. Carol Bannister, OH nursing adviser with the Royal College of Nursing,believes relations between the Government and the profession are rapidlyapproaching a critical point. Substantial funding needed Speaking personally rather than with her RCN hat on, Bannister argues that,while ministers, superficially at least, are making all the right noises,without extra cash to back their words it may as well just be hot air. “The longer it goes on without any substantial new money spent, themore reason there is for OH nurses to say nothing is being done,” shesays. Strategies such as Revitalising Health and Safety are welcome but withoutextra funding, can only achieve a limited amount, she suggests. “The only money being spent, as far as I can see, is around vocationaltraining and rehabilitation. This speaks volumes about the Government’sattitude towards saving money rather than protecting health. “They have been talking about a strategy for occupational health since1997 and have been trying to implement it since 2000. We are now fastapproaching 2004 – when they expect the 50 per cent targets to be met. It willbe impossible that those will be met if the Government does not put any moneyinto this strategy,” Bannister emphasises. “We are fast approaching the time where the Government is going to haveto evaluate what it has achieved with its strategy and ministers are going to haveto manipulate it because they have achieved nothing,” she adds. Civil servants complain the profession carps on about the fact there are notenough OH nurses to cope, she says. Yet what the Government fails to grasp isthat, if it is left up to employers, whether NHS or in the commercial sector,to fund OH training then it is just not going to happen at the levels required.Government grants are needed towards training of OHNs, Bannister argues. Crack-down on employers The Government could do more, too, to crack down on errant employers,suggests Anne Harriss, director of the BSc course in OH nursing at South BankUniversity. The fact that providing an OH service for employees is not a statutoryrequirement is a failure that has yet to be addressed by any Government, shecontends. “My personal feeling is that more could be done. It isunfortunate that anyone can be a nurse with an interest in occupational healthand that the quality of OH nursing and provision is patchy,” she says. The Securing Health Together document was “a move forward” andmoves to get GPs and practice nurses more involved in OH, while laudable, arenot a solution. “Where are they going to get the OH knowledge from? And it is sometimestempting for GPs to move into OH because it can be lucrative for them,”she worries. The idea behind NHS Plus was “excellent”, she concedes, as long asit does not result in an already stretched NHS OH service becoming even moreover-extended. Angela Dunlop, OH nurse with Scottish Equitable, is more positive, arguingthat things are improving, even if there is still more that could be done. But she adds: “Occupational health should be compulsory for allemployers. The Government is not putting its money where its mouth is. It isexpecting companies to fork out. For a lot of bigger companies that is OK, buthow do you make sure services are available to SMEs such as hairdressers, whooften have dermatitis or other skin problems?” Tax incentives for SMEs could be one option the Government might consider,she predicts. Professional qualifications Much like Harriss, Dunlop wants to ensure that, when someone goes to see an‘OH nurse’ they know he or she will be a qualified specialist practitioner. “It goes from the sublime to the ridiculous. You get individuals whoare essentially glorified first aiders right up to a pure occupational healthservice,” she explains. Health ministers could also do a lot more to raise their profile within theprofession. When asked who the minister with responsibility for OH was, onesenior OH nurse, who wished to remain anonymous, had to think long and hardbefore answering, “Yvette Cooper?”. When prompted, she admitted to recognising the name of Hazel Blears (whotook over from Cooper last year) because she had seen it on the bottom ofcirculars, but she had certainly not yet heard of new-boy David Lammy. Ministers poorly informed Dunlop agrees. Few ministers in her experience bothered to come along toregular nursing forums or make sure they understood the key concerns of theprofession. “What do they know about OH and what the job entails? When youtalk about occupational health they seem just to think about healthpromotion,” she says. OH nurses within the NHS are also sceptical aboutthe Government’s commitment to their profession. A senior NHS OH nurse, who didnot want to be named, believes ministers failed to take OH or workplace healthsufficiently seriously. The arrival of NHS Plus was ‘over spun’, for instance. “That issomething that has been going on quite nicely at our trust for years and years.We have had external customers for a very long time,” she says. Penalties for employers are not harsh enough, meaning organisations are tooready to risk cutting a corner or two. “There is very little penalty for employers who expose their staff torisk. But I do think OH is enforced better within the NHS,” she says,adding that resources for NHS OH services are improving and trusts are doingmore to try to enforce standards. Shake-up needed “Over the years I have noticed there is more attention being paid toOH, but if this Government really wanted to make a difference, it would dosomething radical like a huge shake-up of the way OH is managed andenforced,” she argues. Historically, the difficulty with OH has been that it is often seen as adrain on resources, not a core requirement. With an increasingly transient,mobile workforce this is ever more the case. Where is the incentive for anorganisation to offer a comprehensive occupational health service to anemployee who may be going to move on after, say, two years rather than 10 or20? In such an environment, employers feel they are less likely to reap thelonger-term benefits of keeping an employee fit and healthy and so are lessinclined to invest in occupational health. But, if the short-term incentives are less clear, this is all the morereason for the Government to provide a strong lead, argue OH nurses. Moreover,for a Government struggling to improve the NHS and meet the ever greater healthexpectations of a nation demographically getting older, a greater emphasis onworkplace health would make political sense too. “If the Government got it right, the number of people needing to accessthe NHS would be much reduced,” argues Dunlop. And the RCN’s Bannister adds determinedly: “This Government needs tostart spending some serious money on improving access to competentprofessionals and continuing professional development.” As soon as he was appointed, Occupational Health put in a request for aninterview with David Lammy. “He’s just getting his feet under the table,give him a month or so,” came the reply. We hope he will take up the offer. In the meantime, the advice from OHnurses, it seems, is “talk to Gordon Brown but, most of all, come and talkto us”. Don’t get too comfortable behind that Whitehall desk, David. www.doh.gov.ukWho’s who at the Department of HealthSince 1997, four ministers have had responsibility for workplace health issues.Up to last year’s General Election, occupational health fell within the remitof the public health minister at the Department of Health. Tessa Jowell, now culture, media and sports secretary, was thefirst to hold the position under health secretary Frank Dobson.When Dobson stood down to run as Mayor of London in October1999, his successor Alan Milburn brought in Yvette Cooper, who is nowparliamentary secretary in the Lord Chancellor’s Department.A shake-up at the DoH after the General Election sawoccupational health become a stand-alone ministerial area of responsibility forthe first time, combined with NHS Plus.Hazel Blears, who had been brought in to the DoH in December1997 by Milburn, was made a minister and promptly given OH as one of herresponsibilities. This continued until the resignation of transport secretaryStephen Byers in May. The reshuffle in the wake of this saw Blears promoted topublic health minister and David Lammy brought in in her place.Among the other parties at Westminster, the Conservatives lumpoccupational health in with the rest of the shadow health brief. It is theresponsibility of shadow health secretary and former GP Dr Liam Fox.The Liberal Democrat with responsibility for OH is formerpharmacist Sandra Gidley.Within the Scottish Parliament, occupational health iscurrently part of health minister Malcolm Chisholm’s brief. Musical chairsOn 1 Aug 2002 in Personnel Today Related posts:No related photos. Previous Article Next Articlelast_img read more