2. Page
Introduction .....................................................................................................1
Chapter One Responsibilities..............................................................................3
Chapter Two The Range 6 Functions and Services Included in
Occupational health and Safety Services.......................................9
Chapter Three NHS Occupational Health and Safety Service Standards .............12
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The Effective Management of Occupational Health and Safety Services in the NHS
Contents
3. 1. Good occupational health and safety is an essential part of the effective
management of the health of people at work. It can reduce ill health and
accidents and should improve employee morale and performance.
2. This guidance sets out, for the first time in the NHS in England, the
range of Occupational Health and Safety Services (OHSS) which should
be available to all staff working in the NHS. It also describes
responsibility for the provision of OHSS and sets a number of standards
for their delivery. The OHSS standards form part of the Improving
Working Lives (IWL) standard.
3. The guidance is the result of consultation with a range of stakeholders in
the NHS, including NHS managers, the health trade unions, the Faculty
of Occupational Medicine and the Association of NHS Occupational
Physicians. The new guidance supplements The Management of Health,
Safety and Welfare Issues for NHS Staff (HSC 98/064) and The Provision
of Occupational Health and Safety Services for General Medical
Practitioners and their Staff (reference 23922, May 2001).
Occupational health and safety
4. This document refers throughout to Occupational Health and Safety
Services (OHSS). It is recognised that occupational health and safety
services may be provided by different organisations, all managed
separately, or as an integrated health, safety, occupational health and
human resource function. However managed or provided, these three
groups of professionals must work closely together as by doing so they
can make a significant impact for the better on the working lives of their
NHS colleagues.
NHS Plus
5. The standards, services and responsibilities set out in this document
form the basis for the effective management of occupational health and
safety services in the NHS. We shall shortly be launching NHS Plus, an
initiative under which Occupational Health Services may be sold to
outside industries, including small and medium enterprises (as many
occupational health services are already doing). It is, however, vital that
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The Effective Management of Occupational Health and Safety Services in the NHS
Introduction
4. NHS staff themselves are provided with adequate occupational health
services. It should be noted that Trust Chief Executives will be required
to sign off that this is the case before their services are allowed to register
for NHS Plus.
Access to specialist advice
6. In occupational health (OH) units which are not led by a specialist
occupational physician there is already a requirement for a contract to
ensure access to specialist advice when required. OH units are not
required to use specialist occupational physicians for routine medical
assessments but the specialist occupational physician must be involved in
the strategic management and the quality assurance of the service as well
as difficult clinical problems and specific issues such as HIV and
Hepatitis B infected healthcare workers.
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The Effective Management of Occupational Health and Safety Services in the NHS
5. Chapter One
Responsibilities
1. Providing a first class Occupational Health and Safety Service (OHSS)
for NHS staff and GP’s and their staff is the responsibility of all who
work in the NHS. Successful implementation requires input from the
Department of Health, Trust and Health Authority Boards, OHSS
professionals and NHS staff themselves. This chapter summarises the
responsibilities necessary for the effective provision of Occupational
Health and Safety Services. It shows the group, organisation or
individual responsible for each action and the expected time scale for
implementation. Time scales are defined as; short term within 12
months, medium term within 18 months and long term within 36
months.
2. The responsibilities set out below reflect the major issues of
responsibility identified by the Department of Health’s Occupational
Health in the 21st Century Working Group and by the Scottish
Occupational Health Forum.
The Department of Health:
Annually
IMPROVING WORKING LIVES
• will monitor the OHSS performance in the NHS through the
Improving Working Lives Standard and the Human Resources
Performance Management Framework
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The Effective Management of Occupational Health and Safety Services in the NHS
6. Short Term
All Chief Executives and Boards :
Immediate
Annually
OHSS MANAGEMENT
• should publish an OHSS report as part of their Annual Report
• should use the collated returns to monitor and to inform the need
for OHSS.
• must ensure adequate resources are available for OHSS services
within their organisation
HEALTH AND SAFETY
• must ensure they fully understand and meet their statutory health
and safety obligations
OHSS MANAGEMENT
• will give a clear policy lead on the lines of responsibility within the
NHS and for the management of OHSS
• will undertake to roll out OHSS for general practitioners and their
staff
• will strengthen current guidance to ensure all students intending to
take a health service associated course receive a pre-entry
occupational health assessment and advice
• will issue a set of service delivery standards against which the
performance of NHS OHSS can be benchmarked
• will ensure that the purpose and role of OHSS is known to all staff
and is clearly visible with the NHS and to non-NHS employees
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The Effective Management of Occupational Health and Safety Services in the NHS
7. Short Term
OHSS PROVISION
• must ensure the purpose and role of the OHSS is known to all staff
and is clearly visible within the NHS and to non NHS employees
• must offer a comprehensive, competent, confidential OHSS to all
staff as an integral part of their Human Resource Strategy
• must ensure easy access to OHSS by all grades of staff in hospital
and community services
• must identify and meet the OHSS responsibilities of anyone working
or training on NHS premises
OHSS POLICIES
• must fully involve staff and their representatives in the process to
develop and determine the standards and provision of OHSS,
personal safety policies and health promotion within their
organisation locally
• should have integrated policies on staff health and related issues
including, for example, OHSS, staff security, accident prevention,
counselling, staff health promotion and the working environment
• should have in place policies and procedures which integrate and
promote good working practices which are complimentary to OHSS
• should develop family friendly policies
• ensure that the Trust complies fully with the requirement of the
Disability Discrimination Act and meets the requirements of the two
tick symbol
• should develop policies to give security of employment, where
possible, including rehabilitation and redeployment, as a
consequence of disability or ill health
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The Effective Management of Occupational Health and Safety Services in the NHS
8. STRATEGIES AND TARGETS
• should develop comprehensive strategies on human resource
management, including occupational health, which could result in
substantial savings by NHS organisations through the reduction of
sickness absence and injury benefit claims
• should set organisational targets for reduction of costs associated
with OHSS issues, including sickness absence, injury benefit claims,
early retirement costs due to illness, accidents and injury
MANAGING ATTENDANCE
• must adopt as a minimum the recommendations in the Department
of Health’s Guidance Managing Attendance in the NHS
WORKPLACE HEALTH AND SAFETY
• must implement policies based on risk assessment aimed at reducing
violent incidents in the workplace
• must encourage, facilitate and require staff to record all accidents
and incidents which lead to injury with the aim of 100% recording
of accidents and incidents to NHS staff, patients and visitors to NHS
premises
• must implement policies to protect staff and patients from infection
with blood borne viruses and other nosocomical infections
• must undertake risk assessment of all hazardous tasks and activities
and implement appropriate risk reduction measures
• should implement policies which reduce stress in the workplace
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The Effective Management of Occupational Health and Safety Services in the NHS
9. Medium Term
Long Term
Occupational Health and Safety Services:
On-going
ROLE AND RESPONSIBILITIES
• should offer, as a priority, to provide OHSS to all parts of the NHS
not receiving such services
• must advise employers on employees’ fitness to work and on
adjustments or modifications that can be made to fit the
job/workplace to the individual
SERVICE AIMS
• should play an exemplar role in the provision of OHSS
should aim to achieve OHSS which go beyond basic statutory
requirements
TRAINING
• should provide induction training and lifelong education and training
to minimise and prevent risks to staff and patients
• should provide managers with appropriate training
• should develop education and training plans which clearly address
issues for employees which could put their health at risk while
working for the NHS
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The Effective Management of Occupational Health and Safety Services in the NHS
10. Short Term
Medium Term
AUDIT
• should develop clinical and audit networks to allow benchmarking
and to ensure uniformly high standard OHSS
• must initiate a systematic audit of OHSS programmes
GENERAL DUTIES
• should make their services available and known to all NHS staff and
to anyone working or training on NHS premises
• must ensure with the Infection Control team an appropriate
immunisation and surveillance programme for staff paying particular
attention to blood-borne viruses
• should link closely with existing counselling services to offer
comprehensive counselling and advice services for all NHS staff
• must identify minimum occupational health, immunisation and
health surveillance employment records for transfer between services
• must comply with minimum standards for pre-employment
screening and occupational health surveillance programmes
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The Effective Management of Occupational Health and Safety Services in the NHS
11. 1. An Occupational Health and Safety Service (OHSS) does not work in
isolation, but responds to assessment of need, including hazard
identification and risk assessment. Though services may vary in structure
from area to area, there should be a common commitment to
competence and excellence.
2. Trusts and other NHS employers will be expected to ensure that the
following criteria, considered the minimum essential requirements for
the provision of occupational health, are met:
• all employees, including locums, students and causal employees,
have access to a competent confidential OHSS;
• the OHSS is geared appropriately to the needs of the organisation
and the health and safety risks identified, and is staffed by
competent and appropriately trained medical, nursing and other
staff;
• staff representatives are consulted over setting up and reviewing the
running of the OHSS. Arrangements should also be made for
continuing discussions, e.g. a user’s committee.
3. The range of services and functions of an OHSS should include as a
minimum:
General guidance and advice
• The development of OH policies and standards in collaboration
with all stakeholders and staff representatives, personnel, health
and safety services and infection control.
• Monitoring the health of employees including work related stress.
• Hazard identification, risk assessment, elimination or control of
risk followed by an audit of effectiveness.
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The Effective Management of Occupational Health and Safety Services in the NHS
Chapter Two
The Range of Functions and
Services Included in Occupational
Health and Safety Services
12. • Advising employers to take into consideration the requirements of
the Disability Discrimination Act 1995 (DDA) so that
adjustments are made, where reasonable, to ensure that people can
work in the NHS regardless of physical or mental impairment.
Health issues
• Immediate access to advice and treatment for blood exposures,
including HIV post exposure prophylaxis when appropriate, and
available outside normal working hours.
• Health assessment in employment e.g. following sickness absence,
in connection with fitness to work or practice, for work related ill
health issues or for ill health retirement purposes. There should be
a facility for both self referral (see Chapter 3) to enable employees
to obtain confidential advice and also for management referral.
• Pre employment health assessment of all new staff carried out
fairly, objectively and in accordance with equal opportunities
legislation and good OH practice.
• Advice on the provision of rehabilitation after a period of sickness
or the appropriateness of return to work on a staged basis to
facilitate early or easier return to work.
• There should be provision of a comprehensive occupational
immunisation programme including tuberculosis, rubella,
poliomyelitis and Hepatitis B and other conditions where
occupationally relevant. The immunisation programme should
have robust arrangements for record keeping and recall for
boosters.
• Appropriate screening, advice and support for healthcare workers
who may be infected with HIV, Hepatitis B or Hepatitis C in
accordance with Department of Health Guidance and provision of
access to advice from a Consultant Occupational Physician, as
appropriate.
• Access for all employees to a confidential Counselling Service.
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The Effective Management of Occupational Health and Safety Services in the NHS
13. Safety issues
• Assessment and reduction of risk.
• Assistance with job design to allow for application of ergonomic
principles and appropriate strategies for risk elimination, reduction
or control.
• Production of comprehensive workplace assessments.
• Monitoring of ill-health and accident statistics - contributing to
the understanding of the working environment, management of
sickness absence and the reduction of risk.
• Training and good practice on the usage and disposal of needles
and sharps and the procedures for the management of blood
exposure incidents.
• Advice on the correct aids and training for use in manual handling
Health promotion
• Education of staff in, and promotion of adherence to, health and
safety legislation and objectives in association with health and
safety, personnel, line managers and other relevant professionals.
• Health promotion and education in the workplace in collaboration
with health and safety, health promotion, personnel and other
relevant professionals.
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The Effective Management of Occupational Health and Safety Services in the NHS
14. 1. The NHS Plan announced that new standards for occupational health
services for NHS staff would be included as part of the Improving
Working Lives standard. Trust and other NHS employer compliance will
be performance managed through the Human Resources Performance
Framework and these criteria should be used by Trusts to ensure that staff
are receiving an adequate service from their occupational health and/or
safety service.
2. The standards set out below are intended to be monitored to ensure
compliance and suggestions are given for monitoring requirements to
facilitate this. It is assumed that both the occupational health service and
those providing health and safety services, if separate, will keep accurate
records of work carried out to allow managers to meet legal requirements
and assess the volume and type of work being carried out. OH
Practitioners will need to ensure that data relating to the following standards
is recorded separately from clinical record to allow for monitoring.
HEALTH AND SAFETY STANDARDS
Risk Management
Standard:
Comprehensive risk assessment should be carried out by employers to identify
workplace hazards, assess the risks to staff and suggest appropriate action to
remove, minimise or control them.
Monitoring Requirements:
A written risk management policy should be available together with details of
risk assessments carried out, recommendations made and actions undertaken to
deal with the identified risks.
Risk Assessment following accidents
Standard:
All accidents to staff, patients, and visitors reported through the Incident
Reporting System will be followed up and, where necessary, a new risk
assessment undertaken.
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The Effective Management of Occupational Health and Safety Services in the NHS
Chapter Three
NHS Occupational Health and
Safety Service Standards
15. 13
The Effective Management of Occupational Health and Safety Services in the NHS
Monitoring Requirements:
Details of the incident and follow up action, including new risk assessment, to
be available as part of the Incident Reporting System.
OCCUPATIONAL HEALTH STANDARDS
Pre-Employment
(i) Standard:
Pre-employment health questionnaire to be dealt with within 2 working days
of receipt or an initial decision made on further action to be taken
Monitoring Requirements:
Date of receipt of questionnaire and issue of fitness to work advice to be
logged and available on staff clinical records.
(ii) Standard:
(a) Manager notified within 2 working days of the need for potential
new employee to attend for health assessment.
(b) First appointment offered for health assessment to be within 7
working days.
Monitoring Requirements:
Data questionnaire received is logged as is date of notification to manager, date
of appointment and confirmation that appointment was attended.
(iii) Standard:
All new starters to be sent a letter via their manager, prior to commencement,
requiring their attendance in the occupational health service within two weeks
of starting for immunisations.
Monitoring Requirements:
Date letter sent and appointment attended recorded on staff OH record or PC.
In Service Referral
Standard:
Following receipt of a referral from the manager, or self referral, the first
appointment will be offered within five working days for an occupational
health nurse or ten working days for an Occupational Physician.
16. Monitoring Requirements:
Date of referral and appointment to be recorded in staff OH notes.
Monitoring Requirements:
(a) Date of referral and appointment to be recorded in staff OH notes.
Monitoring Requirements:
(b) Written immunisation policy available for inspection
Immunisation
Standard:
(a) All staff will be offered immunisation as appropriate for their
occupation or work activities. An appointment will be given at
their line managers request. It is the responsibility of the employer
to finance immunisations.
(b) There will be an agreed immunisation policy setting out the
requirements for staff groups.
Monitoring Requirements:
(a) Date of referral and appointment to be recorded in staff clinical
records.
Monitoring Requirements:
(b) Written immunisation policy available for inspection
Monitoring Requirements:
(c) There should be a minimum of one recall after failure to attend for
all immunisations which should be auditable.
Health Surveillance
Standard:
All employees who require health surveillance to meet health and safety
legislation with receive surveillance appropriate to their work or exposure.
Monitoring Requirements:
Surveillance to be audited via system showing the date completed, results,
previous test and follow up and when information was passed to line manager.
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The Effective Management of Occupational Health and Safety Services in the NHS
17. Ill Health Retirement
Standard:
The full protocol set out in Managing Ill Health Retirement in the NHS has
been followed in making the decision to recommend ill health retirement.
Monitoring Requirements:
All actions taken and discussions held regarding the recommendation can be
verified by referral to records
OTHER STANDARDS
Access to Counselling Services
Standard:
Following referral by the client or their manager, an appointment will be
offered within 48 hours. Immediate access to a counsellor can be provided by
telephone.
Monitoring Requirements:
Date of referral and appointment to be recorded by the Counselling Service
and available anonomised for audit.
NB: This standard is not to be seen as suggesting that the provision of
counselling services for staff should be through the OHSS, nor should the
OHSS keep a record of referral to the counselling service in their patient
records. Further guidance on the setting up of a counselling service can
be found in The Provision of Counselling Services for Staff in the NHS
(reference 22156, August 2000).
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The Effective Management of Occupational Health and Safety Services in the NHS
