NHS occupational health services in England and Wales--a changing picture

AIMS: To establish the extent of doctor input to occupational health (OH) service provision in the UK National Health Service (NHS) in 2001 and to compare this with inputs in 1998. METHOD: A postal questionnaire was used to obtain information from OH medical staff employed by the NHS in England and Wales. RESULTS: The NHS OH service has seen an increase between 1998 and 2001 in the amount of doctor time per employee. Doctors tend to work now for more sessions per week. The proportion of doctors holding specialist qualifications has also increased. An increased number of NHS employees now have access to consultant care for occupational medicine. OH departments increasingly tend to provide services to employees beyond the NHS and are thereby able to generate income to further the development of the service. CONCLUSIONS: Steady progress is being made in improving the provision of OH services within the NHS. However, substantial variation exists in the apparent level of access to such provision. The government policy for all NHS staff to have access to a consultant-led service is not yet met. NHS Plus will impact on this picture and deserves study in the future.     

Medical and dental staffing prospects in the NHS in England and Wales 1993

This article provides a brief update on current national policies affecting medical education and training, and information on the present medical and dental workforce. Although of general interest, senior medical students and doctors in the training grades may find it particularly helpful when considering choices of future career. As there may be marked local variations in career prospects for any one specialty, further information and advice is available from Regional Postgraduate Medical and Dental Deans, specialty advisors (through Royal College and specialty associations) and clinical tutors. The information in this article relates to the present situation only and a review of previous articles in this series may be useful to observe certain trends.     

Medical and dental staffing prospects in the NHS in England and Wales 1991

This article offers some background information to help junior doctors, and those who advise them, to make decisions about their future careers. Further information can be obtained from the Regional tables, which the Department of Health circulate to Regional Postgraduate Deans, Health Authorities and clinical tutors. All the information presented here is retrospective. Comparing this with the previous annual articles in this series may help you to assess the likely future prospects in your particular specialty.     

Medical and dental staffing prospects in the NHS in England and Wales 1992

This annual article is intended to help young doctors and dentists make informed decisions about their career paths, in the light of the current prospects of obtaining a career post in any specialty. Regional details of the national figures presented here may be obtained through individual Regional postgraduate deans, Health Authorities and clinical tutors. This article summarises the most recent figures available, and comparison with previous articles in this series may help to identify employment trends.     

An evaluation of occupational health services within the NHS in London

AIMS: To establish the nature, extent and organization of occupational health service provision for employees within the National Health Service (NHS) in London and to review the systems for monitoring performance. METHODS: Human resources directors and occupational health managers were contacted from a random selection of NHS trusts in the London area and invited to complete an interviewer-led questionnaire. RESULTS: All seventeen trusts interviewed claimed to provide an occupational health service to their employees, with 88% providing this service in-house. The organization of the services varied, although most resided within the human resources function. Only 29% of the trusts could provide a written occupational health policy. Teaching hospital trusts had the most qualified and the highest numbers of medical staff. District/General hospital trusts had the least qualified clinical staff. Although most trusts were able to provide a comprehensive range of services, 87% of occupational health managers felt they could only provide a reactive service. Income was generated from non-NHS sources by 88% of the trusts and all were aware of NHS Plus. There was an indication that some trusts assigned NHS Plus status did not meet the standard of NHS Plus, although the survey took place only 3 months after the launch of NHS Plus. CONCLUSIONS: There was a significant variation in the nature and extent of occupational health services in the NHS trusts. As a consequence, there may be differences in the level of occupational health service available to staff across the NHS in London.     

The management of occupational health by NHS Trusts in the north of England

This paper reports the findings of an audit of the management of occupational health arrangements in 36 NHS Trusts in the Northern and Yorkshire region of England. A questionnaire was designed based on a national NHS occupational health standard to obtain data on eight categories of occupational health activity: health and safety; pre-employment assessments; Infection Control; health surveillance; sickness absence; ill-health retirement; health promotion and record storage. The management arrangements for occupational health were varied. Assessments of workplace hazards, prevention of HIV-positive workers from performing exposure-prone invasive procedures and the assessment of pregnant workers were identified as issues for further consideration. Provision of competent and effective occupational health services will assist in the management of sickness absence and in the protection and promotion of health of staff. It will also contribute to the health and safety of patients.     

Health technology assessment for the NHS in England and Wales

In healthcare decision making, there is an important functional separation between assessment and appraisal. In the U.K. National Health Service (NHS), this distinction is illustrated by the separation of roles between the Health Technology Assessment Programme and the National Institute for Clinical Excellence. However, it can be seen at every level within the healthcare system. Assessment of a technology is a scientific task that synthesizes all relevant evidence on effectiveness and cost-effectiveness; its results are therefore generalizable. Appraisal of the technology is informed by the assessment but adds context-specific judgments on the applicability of the evidence, the feasibility and impact of alternative options, relative priorities, and wider social and ethical aspects. An explicit distinction between assessment and appraisal is helpful in achieving clarity, consistency, and consensus. It also makes clear the need for a wide range of assessment reviews to support decision making by commissioners, providers, and users of health services. Increasingly, the secondary research supported by the NHS R&D Programme is being distributed electronically. It is also being used to identify areas in which further primary research should be commissioned.     

Integrating occupational health services and occupational prevention services

BACKGROUND: Despite the human and monetary costs of occupational injury and illness, occupational health care has focused more on treatment than prevention, and prevention is not part of many clinical occupational health practices. This represents a failure of occupational health care to meet the health care needs of the working patients. METHODS: MEDLINE searches were conducted for literature on occupational medical treatment and the prevention of occupational injury and illness were reviewed to for linkages between prevention and treatment. Policy discussions which identify examples of programs that integrated prevention and treatment were included. RESULTS: Although examples of the integration of clinical and preventive occupational health services exist, there are challenges and barriers to such integration. These include inaction by clinicians who do not recognize their potential role in prevention; the absence of a relationship between the clinician and an employer willing to participate in prevention; economic disincentives against prevention; and the absence of tools that evaluate clinicians on their performance in prevention. CONCLUSIONS: Research is needed to improve and promote clinical occupational health preventive services.     

Medical and dental staffing prospects in the NHS in England and Wales 1990. Medical Manpower and Education Division, Department of Health

Information is presented in this paper to help those involved in medical and dental career planning. Further data are available from Regional tables, published annually by the Department of Health, and circulated to health authorities, postgraduate deans and clinical tutors. All of the information is retrospective, however, and can only be used to assess trends in prospects.     

Medical and dental staffing prospects in the NHS in England and Wales 1989. Medical Manpower and Education Division, Department of Health

The Medical Manpower and Education Division of the Department of Health publishes information in this Journal each year on the current state of medical and dental manpower in England and Wales, to assist medical and dental students and newly-qualified doctors and dentists in their career choices. Additional information can be obtained from the national and regional census tables which are usually published by the Department of Health each Autumn. These are circulated widely to all health authorities, postgraduate deans and clinical tutors. Information based on census data is useful, but is always for the previous year. It should be used to consider trends in medical manpower prospects.     

Prisons and health reforms in England and Wales

Prison health in England and Wales has seen rapid reform and modernization. Previously it was characterized by over-medicalization, difficulties in staff recruitment, and a lack of professional development for staff. The Department of Health assumed responsibility from Her Majesty's Prison Service for health policymaking in 2000, and full budgetary and health care administration control were transferred by April 2006. As a result of this reorganization, funding has improved and services now relate more to assessed health need. There is early but limited evidence that some standards of care and patient outcomes have improved. The reforms address a human rights issue: that prisoners have a right to expect their health needs to be met by services that are broadly equivalent to services available to the community at large. We consider learning points for other countries which may be contemplating prison health reform, particularly those with a universal health care system.