SOM Summer Magazine 2023

Q&A with Dr Lanre Ogunyemi, SOM President SOM blog: Stepping into the proactive wellbeing field

Janet O’Neill

Deputy Head, National School of Occupational Health

Introduction

At the SOM/FOM conference, the National School of Occupational Health (NSOH) ran a successful interprofessional education (IPE) workshop. Growing the multidisciplinary team (MDT) OH workforce is key to widening access to OH for working-age people. This is reflected in the NSOH strategy. Encouraging clinicians into an OH career is fundamental, such as through promoting taster OH placements for undergraduates in the MDT, supporting a SOM careers day for nurses and doctors and developing a mentoring scheme, again with SOM. Leading a project with the Joint Work and Health Directorate has culminated in the NSOH facilitating an initiative to centrally fund OH courses (register interest here).

The encouraging movement of OH providers in developing and delivering internal nurse and AHP training programs, alongside facilitating hybrid occupational medical training posts between the NHS and private OH sector has led us to partner strategically with COHPA.

A next step will be for providers to deliver a recently approved level 3 Ofqual accredited technician course developed by SOM with NSOH input. An MSc-level NMC qualification for nurses is due to start in 2024, with a linked apprenticeship. Other universities are showing an interest in course development, with an MDT focus - a next level, MDT advanced practice is one to watch. Mapping of skills and competencies will follow the Growing OH&WB MDT research project, supported by our focus on IPE.

Some highlights from the SOM/FOM Conference...

Right: Dr Danny Wong welcomes delegates to the SOM/FOM conference held in Newcastle in June;

Top Left: SOM President Dr Lanre Ogunyemi, ACOEM President Dr Kenji Saito and FOM President Prof Steven Nimmo; Bottom Left: Dr Sheetal Chavda, Dr Victoria Mason, SOM Past President Dr Shriti Pattani, SOM President Dr Lanre Ogunyemi and Dr Rae-Wen Chang

Occupational Health Awareness Week

Monday 18th - Sunday 24th September

The aim of Occupational Health Awareness Week is to provide information to small and medium-sized enterprises (SMEs) about the role and value of occupational health.

We also aim to promote occupational health as a career – for information and to register for our Careers Fair taking place on Wednesday 27th September online and in person in London, go to https://www.som.org.uk/events.

Look out for a short video that SOM is producing on introducing OH for SMEs and a guide for SMEs. There will also be targeted advertising on social media. A new report on Occupational Health and Wellbeing will be launched at a webinar on 18th September.

New strategy needed to tackle healthcare burnout crisis

A new approach is needed to tackle high levels of burnout among healthcare workers, a new report has concluded.

Shocking figures recently showed that NHS England experienced an absence rate of 5.6 percent in 2022, the equivalent of losing nearly 75,000 staff to illness, often caused by burnout.

170,000 staff have also left, or are planning to leave, the NHS due to stress and workload pressures.

SOM has published Burnout in healthcare: risk factors and solutions which details the steps needed to help combat the condition, found to be rife in healthcare.

Drawing on research data from a wide variety of sources, the report found that those working in healthcare, such as doctors, nurses and care workers, are particularly prone to experiencing burnout.

According to the 2022 NHS workforce survey, more than a third of healthcare staff report feel burnedout at work, with staff in clinical roles found to be most vulnerable. Further data shows that 54 percent of doctors displayed signs of emotional exhaustion and nearly 40 percent of nurses ‘often’ or ‘always’ felt burned-out at work.

Burnout is not a medical condition, but a state of physical and emotional exhaustion caused by excessive, prolonged, and untreated interpersonal workplace stress. It occurs when individuals become emotionally exhausted, cynical, and disengaged from the job and feel a sense of ineffectiveness and loss of purpose. It can have wide-ranging damaging effects on workers’ health, job performance and quality of life and is extremely costly for the healthcare sector. The thoroughly evidenced report recommends primary, secondary, and tertiary interventions throughout the healthcare sector to protect employees against burnout and enable those returning from absence because of the condition to do so effectively and safely.

• Primary level interventions are those that tackle the root causes of burnout. It is crucial to ensure workload is manageable, adequate support is available, leadership is compassionate, inclusive, and ethical and staff are recognised and rewarded for their work and achievements. Training managers to support the wellbeing of their staff, identify early signs of burnout and encourage help-seeking are also particularly important.

• Secondary level interventions focus on improving people’s ability to cope with the challenging aspects of their roles. Particularly effective strategies include enhancing opportunities for peer support, promoting self-compassion and self-care, providing training in a range of stress management tools, and helping staff maintain a healthy balance between their work and personal life.

• Tertiary level interventions focus on treatment and encourage a safe and healthy return to work.

These include taking a person-centred approach to identifying the factors that contributed to burnout and taking appropriate steps to address them.

With burnout being such a pressing issue in healthcare, occupational health, the specialist and expert field of health and wellbeing at work, will be a crucial part of the solution.

The UK is in a fortunate position, with specially trained occupational health professionals, but more investment is needed to expand this workforce through the newly announced workforce plan. SOM is calling for universal occupational health access and will continue to press for more provision until everyone, whether they work in healthcare or in other industries, has the coverage they need to be healthy and happy at work.

SOM CEO Nick Pahl said: “This new report outlines in detail why universal occupational health is so important in fighting burnout in healthcare. The NHS workforce plan aims to reduce the overall leaver rate for NHS-employed staff from 9.1% (2022) to between 7.4% and 8.2% over the next 15 years. This can only occur by investing in occupational health - reversing burnout, tackling root causes, so that NHS staff can return to work well. SOM is committed to working with Government and the NHS to meet these challenges head-on.”

Professor Gail Kinman, the author of the report, said: “Burnout is an extremely serious matter that impacts workplaces across Britain, but it is a particular problem in healthcare settings. We know that doctors, nurses, and other healthcare professionals are more likely than most to experience burnout and therefore it is vitally important that we take urgent action. There are compelling reasons for organisations to support the wellbeing of their employees. This report, which brings together a wealth of research and findings, recommends the real and practical steps that they can take in the fight against burnout to ensure healthcare staff remain healthy and motivated and that recruitment and retention are improved.”

Government cuts to pledges to support the health and social care workforce

SOM is concerned about government cuts to pledges to support the health and social care workforce. There are currently 250,000 vacancies across health and social care. Working conditions in both sectors are challenging, with consequences for sickness absence, retention, and high turnover of staff. Work in health and social care can be high risk and lead to occupational health issues for staff and risk to service users if not managed safely. Workrelated stress and burnout are key reasons for poor retention across health and social care. The majority of social care workers are unlikely to have access to occupational health. Within the NHS, access to occupational health is variable, with primary care staff facing more barriers to access and funding than secondary care staff.

• A policy paper published by the government in April announced that the £500 million workforce investment promised to social care has now been halved.

• The government has confirmed that it will no longer be investing in wellbeing, mental health support and improved occupational health provision for the workforce.

• Changes to QOF guidance for GP practices requires already-stretched practices to interrogate and improve their own workforce wellbeing strategies. This is unlikely to be effective given the system factors driving up demand in general practice, and exonerates NHS England from supporting the general practice workforce, most of whom face barriers to occupational health support.

• The NHS England Growing Occupational Health programme which is leading on routes to more support for staff across the health service is facing significant cuts.

These actions jeopardise the health and capacity of the health and care workforce and will lead to escalating sickness absence and deteriorating retention at a time where service user needs are already not being met.

For the DOccMed and DipOHPrac*,

The Occupational Health Academy, with the support of SOM, presents:

Portfolio Morning, Saturday 19th August 9am-12pm

Will take you through an ideal risk assessment, clinical case and give you ideas for finding a suitable case for your portfolio. You will go through and analyse the FOM portfolio and the type of information needed.

SOM members: £196; non-members £245. Register here.

Unable to attend on the day? You can now purchase the recording at a discounted rate, please click here.

MCQ Weekend, Saturday 23rd and Sunday 24th September 9am-5.30pm

Will cover key principles and information for the exam with OH Ethics and Law, Occupational Hygiene, Occupational Medicine and Exam Tips/Past Topics and help you grasp key concepts to improve your knowledge.

SOM members: £340; non-members £425. Register here.

Unable to attend on the day? You can now purchase the recording at a discounted rate, please click here.

Mock Viva Sessions, Saturday 14th or Sunday 22nd October (45 minute individual session)

Will take you through a Mock Viva session in the style and format of the real exam. Written and verbal feedback is given with a chance for you to ask any questions.

SOM members: £156; non-members £195. Register here.

To access the 20% discount, log in to your SOM account before registering. * Could also be utilised for LFOM exam preparation although not specific.

Why employers need to take action on domestic abuse

The current costof-living crisis is particularly challenging for many people experiencing domestic abuse as the costs of leaving an abuser are greater.

Across the UK, a quarter of all women and around a sixth of all men are likely to experience domestic abuse in their lifetime. This means that most employers will have people in their organisation who are affected by domestic abuse. For those individuals, work may be their only safe place and the actions of an employer can change and potentially save that person’s life.

Domestic abuse is an insidious, largely hidden crime, which impacts children, families, and the wider community. It extends beyond physical violence and includes sexual abuse, violent and threatening behaviour, controlling or coercive behaviour, economic abuse and psychological or emotional abuse. Anyone can be a victim of domestic abuse, regardless of gender, age, ethnicity, sexual orientation, economic status etc.

The current cost-of-living crisis is particularly challenging for many people experiencing domestic abuse as the costs of leaving an abuser are greater. Those with children may fear that they will be unable to support their family if they leave an abusive relationship. Some frontline workers at Refuge have said that survivors have returned to perpetrators because they cannot afford to live alone or as a single parent. Employers can make a difference in easing the financial burden, supporting an employee to leave their abuser, potentially saving their life.

Employers’ duty of care - guidance accompanying the Domestic Abuse Act 2021 makes clear that employers

should consider the impact of domestic abuse on their employees as part of their duty of care. Employers are uniquely positioned to provide both a place of safety and support to those facing domestic abuse, including those who want to escape an abusive relationship. There is also a strong business case for employers to act. The cost to the economy is considerable, with an estimated £14 billion arising from time off work and reduced productivity. Those suffering from domestic abuse will find it hard to perform at their best (or at all) in the workplace.

Research commissioned by the Vodafone Foundation in 2019 found that only 5% of employers had introduced a specific policy or guidance on domestic abuse at that time. This needs to change. Employers should:

• Implement a domestic abuse policy or guidance (or review and update your existing policy or guidance). EIDA members can access a useful policy template for free.

• Provide trauma-informed training to key people so they know how to respond if a colleague discloses that they are affected by domestic abuse.

• Ensure they have details of providers of specialist support so they can signpost people to the help they need.

Susan Bright is CEO of the Employers’ Initiative on Domestic Abuse (EIDA), a network of over 1,250 employers taking action on domestic abuse.

Key points from the new NHS Long Term Workforce plan

The document is in full here.

Overview statement – “Support the health and wellbeing of the NHS workforce and, working with local leaders, ensure integrated occupational health and wellbeing services are in place for all staff.”

Point 25: “ICSs need to develop and implement plans to invest in occupational health and wellbeing services. These should align with the national Growing Occupational Health and Wellbeing (OHWB) Together strategy along with the ICS design framework. The Growing OHWB Together strategy sets an approach to improve health and wellbeing support practices to keep people well. It goes beyond reducing sickness absence, taking a preventative approach through system-wide, integrated and multidisciplinary services. Such approaches make good business sense.

For example, the University of East Anglia and RAND Europe demonstrate that investment of £80 per member of staff in mental health support can achieve net gains of £855 a year through savings from absenteeism and presenteeism. While local context will drive priorities, a core offer could include rapid access to mental health and musculoskeletal advice, guidance and treatment services. As set out in the Fuller Stocktake report, ICSs should look to extend occupational health and wellbeing provision across primary care organisations. NHS England will work with systems and stakeholders to consider how best to complement local investment in OHWB services to keep staff well and therefore increase workforce capacity and productivity.”

Point 95: “The forthcoming government consultation on ways to boost occupational health coverage intends to identify the composition of the multidisciplinary workforce required to deliver employmentfocused interventions to support the wider working age population. Responses will be used to inform ongoing occupational health workforce planning. Occupational health professionals can advise on employment and support people to return to and remain in work, which benefits individuals and the wider economy, as well as the delivery of NHS services.”

SOM Leadership Conference

Tuesday 19th September, 8.30am - 5pm

Draft agenda:

8.30-9.20am Registration and networking

9.20am Welcome - Dr Vicky Mason, Chair of SOM Council

9.30-10.30am Keynote speaker - Dr Shriti Pattani, SOM Past President

10.30-11.30am Compassionate Leader - Dr Daljit Hothi, Faculty of Medical Leadership and Management

11.30-11.50am Tea/coffee and networking break

11.50am-12.30pm Influencing Boards in the NHS, Corporate, Commercial and Military sectors - Dr Paul Litchfield, ITV

12.30-1.30pm Lunch/networking

1.30-2.25pm Influencing Boards in the NHS, Corporate, Commercial and Military sectors - Part 2 - Air Commodore David McLoughlin OBE, SOM Past President - tbc; Christina Evriviades, Oxford University Hospitals

2.25-3.35pm Breakout workshops:

> Strategy Writing - Dr Samantha Phillips

> Leadership and Followships in an MDT setting - Helen Parsons

> Getting the best use out of Metrics and Data - Dr Richard Caddis

3.35-3.50pm Tea/coffee and networking break

3.50-4.50pm Navigating Change/Re-organisation - Dr David Roomes

4.50-5pm Wrap up and close

The Phoenix Centre, Phoenix Place, London WC1X 0DG

This event is in-person only. It is £50 to attend (includes lunch and refreshments). Trainees can book at the discounted rate of £35contact Ann.Caluori@som.org.uk for the discount code.

SOM special interest groups coming up

• Leadership - Friday 21st July 11.30am-12.30pm

• Commercial providers - Monday 24th July 3.30-4.30pm

• CESR - Tuesday 5th September 4-5pm

• MSK - Wednesday 6th September 2-3pm

• HAVS - Wednesday 6th September 4-5pm

• Drug and Alcohol - Tuesday 12th September 3.30-4.30pm

• Academic Forum - Friday 15th September 12.30-1.30pm

• NIHL - Monday 18th September 12.30-1.30pm

• Sleep - Tuesday 26th September 11.30am-12.30pm

• Pensions - Tuesday 26th September 3-4pm

• Construction/ health surveillance - Tuesday 3rd October 1-2pm

There is also a new SOM SIG planned for operations staffcontact natasha.sethna@som.org.uk to join and do contact nick.pahl@som.org.uk if you wish to join other SIGs.

OH updates

• How can office workers spend less time sitting?

- NIHR recently published a summary of research showing that an intervention to encourage office workers to stand and move reduced their sitting time.

• The power (and competitive advantage) of having a doctor inhouse - Make a Difference article here.

• Suicide Postvention guidance launch

- Launch of the first evidence-based co-produced postvention guidance for NHS staff following a colleague death by suicide, register here.

Stepping into the proactive wellbeing field

I am a physiotherapist with 20 years of musculoskeletal (MSK) experience and have been working in occupational health (Working Well in Gloucestershire) for the past 15 years on and off. I have been the only physio working in an NHS occupational health (OH) department surrounded by great nurses, technicians and doctors, undertaking management referrals and completing DSE assessments and functional workplace visits. This has sometimes been a bit of a lonely journey, but in recent years I have worked alongside some great treating physios, who have been working in our staff service.

In the last five years or so I have had increased awareness that I am working reactively with the staff we support (firefighting) and not looking at the bigger picture of how to support staff in not coming to me in the first place (fire training!). I have a very supportive business manager who came to me with some funding that we could use to tackle health and wellbeing within the trust. Together we decided that working to improve our staffs’ MSK health was a must, as we have high rates of absence in the NHS compared to private sector. There are also areas of high MSK need (specific departments) that we could consider to improve work tasks/staff behaviour.

And so, the proactive physiotherapy service plan was born. Recruitment was slow, but we now have two members of staff on board (well, almost…) who are planning and delivering this service. During the recruitment process we asked candidates to consider what the MSK service would look like and what strategies we could use. My brain went into blue sky thinking and I

have a list as long as my arm of things I would love to achieve with this new service… but, reality bites and we have to consider what will add most value and what is manageable in the 12 month window.

So here are our headlines that we want to achieve in the coming 12 months:

• Visiting staff in their workplaces and supporting them with how to set up their computers well to improve comfort and also to encourage movement breaks, stretches and general activity out of work.

• Targeting areas/departments where we receive high levels of management referrals to assess the staff concerns (we can’t provide more staff, but can look at how they undertake tasks). Then provide intervention in the form of activity guidance, treatment where required and adjustment of workplace tasks where possible.

• Supporting our mental health workforce to ensure they are ‘fit for the job’ in terms of being able to undertake restraints with mental health patients safely within the hospitals.

• Lastly if we have a chance one of the new team is a whizz with digital stuff (my ability is woeful!) and she is keen to review the health literacy that we provide our staff with, providing better signposting and positive health messages around MSK health.

If we manage to achieve all of this in 12 months, we should give ourselves a pat on the back and then tackle the task of making these posts substantive and starting to expand the service to include all the other things we want to implement. If you are reading this and screaming at the screen because you think we should be doing something completely different then please do feel free to contact me. We will let you know how we are getting on in a few months...

Together we decided that working to improve our staffs’ MSK health was a must, as we have high rates of absence in the NHS compared to private sector.

Lucy Booth is Lead Occupational Health Physiotherapist at Working Well, Gloucestershire Health and Care NHS Foundation Trust

Upcoming SOM events

Webinars are free to SOM members and £30 to non-members. NB. For a member discount to be applied, please login to your SOM account before registering.

List of upcoming SOM webinars here.

• Occupational hygienists and OH practitioners can deliver for the workforce, Monday 4th September 12-1pm - register here

• South Africa vs UK OH nurse education, Tuesday 12th September 12-1pm - register here

• Conducting and interpreting air conduction audiogram under an OH statutory health surveillance program, Thursday 21st September 10am-2pm - register here

• Earl Dotter Presents: A Life’s Work in Occupational and Environmental Health Photography, Monday 25th September 4-5pm - register here

• Organisational interventions to support healthcare worker wellbeing, Wednesday 11th October 12-1pm - register here

• Submitting articles for publication in Occupational Medicine: Statistical Considerations for Authors and Reviewers, Monday 16th October 4-5pm - register here

• Recognising and managing eating disorders in our day-to-day clinical work, Tuesday 31st October 12-1pm - register here

• Do we really need the concept of burnout in occupational medicine?, Monday 6th November 4-5pm - register here

• Rapid Access to mental health assessment and treatment for healthcare workers: Insights from the Cambridgeshire NHS Staff Mental Health Service, Tuesday 14th November 12-1pm - register here

James Hallam Pro Med insurance product

What is appropriate, adequate and necessary insurance for nurses who work in occupational health?

With the complexities of understanding what you are getting, coupled with prohibitive costs, our research suggests that many occupational health nurses struggle to obtain the correct insurance.

In partnership with SOM, ProMed (James Hallam Insurance Brokers) has created a quality product offering straightforward, flexible and comprehensive cover for occupational health nurses.

Please click here to read the SOM Nurses Indemnity Brochure and find out more.

SOM is partnering with the Global Healthy Workplace Summit, taking place 30th August-1st September at the University of Northampton. Visit the Summit page here. SOM members receive a 10% discountemail Ann.Caluori@som.org.uk for details.

Acas consultation on the draft Code of Practice on handling requests for flexible working

The Department for Business and Trade (DBT) is currently legislating to reform the flexible working provisions set out in the Employment Rights Act 1996. In response to these changes, Acas is updating its statutory Code of Practice on handling in a reasonable manner requests to work flexibly.

The updated draft Acas Code is intended to provide employers, employees and representatives with good practice advice on how the new flexible working rules should work in practice. Statutory Codes of Practice are not legally binding, but they are taken into account by courts and employment tribunals when considering relevant cases.

Closes 6th September, details here.

New Labour Markets Evaluation and Pilots Fund

Cabinet Office/HMT have just opened a Labour Market Trials Fund which was announced in the spring budget - details here.

The focus is increasing labour market participation and progression. The Fund totals £37.5 million over 23/24 and 24/25.

Q&A with Dr Lanre Ogunyemi, SOM President

How did you get into occupational health?

I had wanted to be a surgeon since medical school and following my basic surgical training rotation in Peterborough I settled on Ear, Nose and Throat (ENT) surgery. Whilst I was a specialist registrar in ENT, I had a health problem that meant I could not operate for at least two years. I did not want to sit in ENT clinics for two years and felt my best option was to consider another career and come back to ENT thereafter, if practicable. I reflected on my then objectives, values and options and settled on occupational medicine as what I would be happiest doing. I became a specialist registrar in occupational medicine at the Royal Berkshire Hospitals Foundation Trust in January 2002 and stayed in occupational medicine after completing my training in 2006.

Occupational health hero?

I have many. Aside from historical figures, one of my earliest is Ewan MacDonald. I first met Ewan as a trainee attending his teaching day on Business & Management in OH. Since then, at every interaction, I’ve been struck by his inspiring combination of selflessness, leadership, humility, courteousness and friendliness. His contribution to occupational medicine speaks for itself and I greatly admire his character. A recent hero is Amy Edmondson. She is a professor of Leadership at Harvard. Though she is not an occupational physician, her work on psychological safety in the workplace has led the way for great transformational growth in organisational culture and continues to benefit an increasing portion of the working population.

Dream dinner party guests (4 allowed)?

Ngozi Okonjo-Iweala, Alexander Armstrong, Barack Obama and Queen Elizabeth II. Ngonzi Okonjo-Iweala is the director of the World Trade Organisation and a former finance minister in Nigeria. Before that she worked with the World Bank. As finance minister, she managed to maintain her credibility in a very challenging corruption infested environment. Alexander Armstrong is the fantastic host of the TV show Pointless. One of those really engaging people who makes conversation seem effortless. He comes across as genuinely curious, very kind and great fun. The latter two, in my opinion, may be the finest (elected & non-elected respectively) leaders the world has seen in the past few decades – What one could learn from them!

Best occupational health book?

An uncommon favourite of mine is the AMA Guides to Evaluation of Work Ability and Return to Work. I found it an excellent complement to Fitness For Work in the final years of my training and early days as a consultant. It particularly helped embed thinking about the concepts of risk, capacity, and tolerance into my practice at a time when that framework was not commonly used in UK practice.

Tell us a joke...

This is not a joke but the satirical part of a deep piece of dialogue on values and belief between Susan and DEATH; characters from Terry Pratchett’s Hogfather novel. It has stayed with me years after first reading it. DEATH’s dialogue is always in capitals for those who are unfamiliar with the Discworld books:

‘All right,’ said Susan. ‘I’m not stupid. You’re saying humans need... fantasies to make life bearable.’

‘REALLY? AS IF IT WAS SOME KIND OF PINK PILL? NO. HUMANS NEED FANTASY TO BE HUMAN. TO BE THE PLACE WHERE THE FALLING ANGEL MEETS THE RISING APE.’

‘Tooth fairies? Hogfathers? Little -’

‘YES. AS PRACTICE. YOU HAVE TO START OUT LEARNING TO BELIEVE THE LITTLE LIES.’

‘So we can believe the big ones?’

‘YES. JUSTICE. MERCY. DUTY. THAT SORT OF THING.’

Dr Lanre Ogunyemi is a consultant in occupational medicine and Medical Director for TOPHS.

About the SOM

The Society of Occupational Medicine (SOM) is the largest and oldest national professional organisation and with an interest in OH. It demonstrates a commitment to improving health at work, supports professional development and improves future employability enhancing our members’ reputation and employability. Members are part of a multidisciplinary community – including doctors, technicians, nurses, health specialists and other professionals – with access to the information, expertise and learning needed to keep at the forefront of their role. Members benefit from career development opportunities alongside practical, day-to-day support and guidance, through local and national networks that are open to all. Through its collective voice, SOM advances knowledge, increases awareness and seeks to positively influence the future of OH. Join us - at www.som.org.uk

SOM Membership offer survey

We are currently investigating ways to improve our membership offer. We have created an online survey in the link below which will help us find out more about what potential members want: https://www.surveymonkey.co.uk/ r/89J6CSW. If you could help us by completing the survey, that would be great. As a thank you, upon completion of the survey you have the option to receive a discount code for joining the SOM as a new member.