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The Effective Management ofOccupational Health andSafety Services in the NHS

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

iThe Effective Management of Occupational Health and Safety Services in the NHS

Contents

1. Good occupational health and safety is an essential part of the effectivemanagement of the health of people at work. It can reduce ill health andaccidents and should improve employee morale and performance.

2. This guidance sets out, for the first time in the NHS in England, therange of Occupational Health and Safety Services (OHSS) which shouldbe available to all staff working in the NHS. It also describesresponsibility for the provision of OHSS and sets a number of standardsfor their delivery. The OHSS standards form part of the ImprovingWorking Lives (IWL) standard.

3. The guidance is the result of consultation with a range of stakeholders inthe NHS, including NHS managers, the health trade unions, the Facultyof Occupational Medicine and the Association of NHS OccupationalPhysicians. The new guidance supplements The Management of Health,Safety and Welfare Issues for NHS Staff (HSC 98/064) and The Provisionof Occupational Health and Safety Services for General MedicalPractitioners and their Staff (reference 23922, May 2001).

Occupational health and safety

4. This document refers throughout to Occupational Health and SafetyServices (OHSS). It is recognised that occupational health and safetyservices may be provided by different organisations, all managedseparately, or as an integrated health, safety, occupational health andhuman resource function. However managed or provided, these threegroups of professionals must work closely together as by doing so theycan make a significant impact for the better on the working lives of theirNHS colleagues.

NHS Plus

5. The standards, services and responsibilities set out in this documentform the basis for the effective management of occupational health andsafety services in the NHS. We shall shortly be launching NHS Plus, aninitiative under which Occupational Health Services may be sold tooutside industries, including small and medium enterprises (as manyoccupational health services are already doing). It is, however, vital that

1The Effective Management of Occupational Health and Safety Services in the NHS

Introduction

NHS staff themselves are provided with adequate occupational healthservices. It should be noted that Trust Chief Executives will be requiredto sign off that this is the case before their services are allowed to registerfor NHS Plus.

Access to specialist advice

6. In occupational health (OH) units which are not led by a specialistoccupational physician there is already a requirement for a contract toensure access to specialist advice when required. OH units are notrequired to use specialist occupational physicians for routine medicalassessments but the specialist occupational physician must be involved inthe strategic management and the quality assurance of the service as wellas difficult clinical problems and specific issues such as HIV andHepatitis B infected healthcare workers.


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 whowork in the NHS. Successful implementation requires input from theDepartment of Health, Trust and Health Authority Boards, OHSSprofessionals and NHS staff themselves. This chapter summarises theresponsibilities necessary for the effective provision of OccupationalHealth and Safety Services. It shows the group, organisation orindividual responsible for each action and the expected time scale forimplementation. Time scales are defined as; short term within 12months, medium term within 18 months and long term within 36months.

2. The responsibilities set out below reflect the major issues ofresponsibility identified by the Department of Health’s OccupationalHealth in the 21st Century Working Group and by the ScottishOccupational 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


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


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


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


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


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


1. An Occupational Health and Safety Service (OHSS) does not work inisolation, but responds to assessment of need, including hazardidentification and risk assessment. Though services may vary in structurefrom area to area, there should be a common commitment tocompetence and excellence.

2. Trusts and other NHS employers will be expected to ensure that thefollowing criteria, considered the minimum essential requirements forthe 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 organisationand the health and safety risks identified, and is staffed bycompetent and appropriately trained medical, nursing and otherstaff;

• staff representatives are consulted over setting up and reviewing therunning of the OHSS. Arrangements should also be made forcontinuing discussions, e.g. a user’s committee.

3. The range of services and functions of an OHSS should include as aminimum:

General guidance and advice

• The development of OH policies and standards in collaborationwith all stakeholders and staff representatives, personnel, healthand safety services and infection control.

• Monitoring the health of employees including work related stress.

• Hazard identification, risk assessment, elimination or control ofrisk followed by an audit of effectiveness.


Chapter Two

The Range of Functions andServices Included in OccupationalHealth and Safety Services

• Advising employers to take into consideration the requirements ofthe Disability Discrimination Act 1995 (DDA) so thatadjustments are made, where reasonable, to ensure that people canwork 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, andavailable outside normal working hours.

• Health assessment in employment e.g. following sickness absence,in connection with fitness to work or practice, for work related illhealth issues or for ill health retirement purposes. There should bea facility for both self referral (see Chapter 3) to enable employeesto obtain confidential advice and also for management referral.

• Pre employment health assessment of all new staff carried outfairly, objectively and in accordance with equal opportunitieslegislation and good OH practice.

• Advice on the provision of rehabilitation after a period of sicknessor the appropriateness of return to work on a staged basis tofacilitate early or easier return to work.

• There should be provision of a comprehensive occupationalimmunisation programme including tuberculosis, rubella,poliomyelitis and Hepatitis B and other conditions whereoccupationally relevant. The immunisation programme shouldhave robust arrangements for record keeping and recall forboosters.

• Appropriate screening, advice and support for healthcare workerswho may be infected with HIV, Hepatitis B or Hepatitis C inaccordance with Department of Health Guidance and provision ofaccess to advice from a Consultant Occupational Physician, asappropriate.

• Access for all employees to a confidential Counselling Service.


Safety issues

• Assessment and reduction of risk.

• Assistance with job design to allow for application of ergonomicprinciples and appropriate strategies for risk elimination, reductionor control.

• Production of comprehensive workplace assessments.

• Monitoring of ill-health and accident statistics - contributing tothe understanding of the working environment, management ofsickness absence and the reduction of risk.

• Training and good practice on the usage and disposal of needlesand sharps and the procedures for the management of bloodexposure 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 andsafety legislation and objectives in association with health andsafety, personnel, line managers and other relevant professionals.

• Health promotion and education in the workplace in collaborationwith health and safety, health promotion, personnel and otherrelevant professionals.


1. The NHS Plan announced that new standards for occupational healthservices for NHS staff would be included as part of the ImprovingWorking Lives standard. Trust and other NHS employer compliance willbe performance managed through the Human Resources PerformanceFramework and these criteria should be used by Trusts to ensure that staffare receiving an adequate service from their occupational health and/orsafety service.

2. The standards set out below are intended to be monitored to ensurecompliance and suggestions are given for monitoring requirements tofacilitate this. It is assumed that both the occupational health service andthose providing health and safety services, if separate, will keep accuraterecords of work carried out to allow managers to meet legal requirementsand assess the volume and type of work being carried out. OHPractitioners will need to ensure that data relating to the following standardsis 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 identifyworkplace hazards, assess the risks to staff and suggest appropriate action toremove, minimise or control them.

Monitoring Requirements:A written risk management policy should be available together with details ofrisk assessments carried out, recommendations made and actions undertaken todeal with the identified risks.

Risk Assessment following accidents

Standard:All accidents to staff, patients, and visitors reported through the IncidentReporting System will be followed up and, where necessary, a new riskassessment undertaken.


Chapter Three

NHS Occupational Health andSafety Service Standards


Monitoring Requirements:Details of the incident and follow up action, including new risk assessment, tobe 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 daysof 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 belogged 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 7working days.

Monitoring Requirements:Data questionnaire received is logged as is date of notification to manager, dateof 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 weeksof 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 firstappointment will be offered within five working days for an occupationalhealth nurse or ten working days for an Occupational Physician.

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 attheir line managers request. It is the responsibility of the employerto finance immunisations.

(b) There will be an agreed immunisation policy setting out therequirements 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 safetylegislation 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.


Ill Health Retirement

Standard:The full protocol set out in Managing Ill Health Retirement in the NHS hasbeen followed in making the decision to recommend ill health retirement.

Monitoring Requirements:All actions taken and discussions held regarding the recommendation can beverified by referral to records

OTHER STANDARDS

Access to Counselling Services

Standard:Following referral by the client or their manager, an appointment will beoffered within 48 hours. Immediate access to a counsellor can be provided bytelephone.

Monitoring Requirements:Date of referral and appointment to be recorded by the Counselling Serviceand available anonomised for audit.

NB: This standard is not to be seen as suggesting that the provision ofcounselling services for staff should be through the OHSS, nor should theOHSS keep a record of referral to the counselling service in their patientrecords. Further guidance on the setting up of a counselling service canbe found in The Provision of Counselling Services for Staff in the NHS(reference 22156, August 2000).


If you require further FREE copies of this publicationplease contact:

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Please quote reference 25770 when ordering.

It is also available on our website at: www.doh.gov.uk/healthandsafety

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First Published: November 2001

© Crown CopyrightProduced by the Department of Health25770 1P 2k Nov 01 (CPL)CHLORINE FREE PAPER

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