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There were serious concerns about the future of occupational health training even before the pandemic threw our education system up in the air. A high-level panel recently discussed the need for new thinking around OH training, entry routes into the profession, and methods of delivery, including the future role of degree-level OH nurse apprenticeships. Nic Paton listened in.
With the new academic year now under way, there is a lot we still don’t know about how education will be delivered long term in the new post-coronavirus “normal”, with schools, universities and colleges all feeling their way through a very different, and challenging, educational landscape.
For occupational health practitioners, educators and those looking to enter the profession, the challenge is not just how education and training will be delivered this academic year and beyond, although it is already clear this has been a severe challenge for many universities this autumn. There is also the wider question, and worry, of how the financial and economic impact of the pandemic is likely to affect the longer term provision and funding of OH education within our university system, especially given that courses were disappearing at a concerning rate even before the pandemic.
It was against this backdrop – but before the pandemic had turned all our lives upside down – that an expert panel at the Health and Wellbeing at Work show in March debated ‘the future of occupational health training’. The discussion, chaired by Steve Nimmo, director of assessment at the Faculty of Occupational Medicine (FOM), brought together Elisabeth Eades of the Faculty of Occupational Health Nursing, Mandy Murphy of Health Education England, Dr Paul McGovern, representing FOM, and Neil Loach, from both the University of Derby and iOH, the Association of Occupational Health and Wellbeing Professionals.
Each panellist gave a short presentation addressing some of the key issues, as they saw them, currently within OH training and education.
Need for clearer vision as a specialty
Dr McGovern, an OH physician at Medigold Health and trainee representative for FOM, said that, for him, there were three main points to emphasise. “First, I think OH training needs to be multidisciplinary. Second, we need to promote the specialty. And third, we need to have a clearer idea of what we do. And, of those, the very first thing we need do is know what we do as a specialty.
“We often talk about being multidisciplinary; people say it is a good idea, people nod and agree. More so in occupational medicine than many specialties, we have such an opportunity to make training really multidisciplinary. For it to be involving different clinical disciplines in training, and training them together as much as possible.
“Occupational health nurses, occupational health doctors, technicians, occupational therapists, physiotherapists with occupational health interests, ergonomists – there is a lot of overlap between what we do. If we are to deliver services in an holistic way, the closer we can train together, the better we will be able to deliver services. If we train together we will work well together and, ultimately, it is about delivering services effectively to clients, be they the NHS, companies or provider organisations who are providing services,” Dr McGovern said.
“We also have an opportunity now to promote our specialty, one that is too good to miss. There are a lot of doctors in the NHS in specialties other than occupational medicine who hate their jobs; who are miserable every day, notwithstanding coronavirus and the difficulties they are going through now. People are not happy in their work, and of course we can help them as occupational clinicians.
“But we also have an opportunity to show people what a great career occupational health can be. We therefore need to work in a multidisciplinary way to consider how we can present ourselves in a way to encourage people to come and get involved; be that the odd session, full-on training or becoming senior members of the specialty. I think it is something we need to really consider,” he added.
Role of training posts
Neil Loach, senior lecturer in OH nursing at the University of Derby and vice president of iOH, highlighted the development of an apprenticeship for OH nurses as an alternative pathway into the profession (and see the end of this article for an update on this) but also how there needed to be a wholesale rethink about how OH education is delivered. This of course very much aligns with the government’s plans announced over the summer to double nursing apprenticeships generally.
“Health Education England (HEE) has funded health visiting and school nursing training posts very successfully all over the UK. There are hundreds and hundreds of health visitors and school nurses being trained with HEE funding. It has allowed those specialists and specialties to successfully train lots of students in a supernumerary status and, obviously, that ensures suitable practice education is achieved,” he pointed out.
“The creation of training posts that mirrors training posts for medics allows a nurse to train and learn whilst in practice, but in a protected environment. But it is also currently one of the things leading to attrition in lots of the different courses because employers can’t actually provide some of the protected training time the NMC [Nursing and Midwifery Council] standard demands. So, we need to have an enhanced multi-agency review. This really comes back to what Paul was saying about a multidisciplinary approach. I think we’re all in total agreement with that,” Loach emphasised.
New thinking around how OH training is delivered and structured
Mandy Murphy, strategic OH services adviser and deputy head of the National School of Occupational Health at HEE, agreed there needed to be new thinking around how OH training is delivered and structured.
“We work in multi-generational organisations now. For the first time we have got five generations working in organisations together, and it creates lots of challenges but also lots of opportunities. I often think about how occupational health, and occupational health training particularly, has changed. I trained about 25 years ago and, I tell you, the route to training is pretty much still the same today as it was then,” she said.
“We’ve got to move away from the idea that you just go on one course over two years and that is it. I think competency is the new career currency, and this is what we need to look at – and I would like to see more modular training and more multidisciplinary classrooms.
“If we could have modular training, that then has all of these professional groups in one room having a conversation on that topic. We would become much more competent and learn more about the skills of other professionals, and what we contribute to that space in our different ways,” said Murphy.
“We need to look at blending how we learn, and whether it needs to be a mix of virtual training alongside training with groups, peers or individuals. We have got to make it more accessible because, with courses closing, it is difficult for people, say, in the south to travel to Scotland because they want to do the course there, and vice versa.
“I’d like to see more definitive, clearer pathways into occupational health. A lot of people tell me they fall into OH, or stumble across it. We’re not very good at telling people about all of the opportunities that are there for people.
“I also think businesses need to take more responsibility for training. There can be quite a lot of ‘well the NHS can train doctors or nurses and we’ll just take them at a certain stage’. If we can use the apprenticeship approach we can open up a lot more training opportunities, training places and support, in different environments.
“Finally, I’d like to see more centres of excellence. In occupational health nursing we’ve seen quite a dramatic fall in OH courses, in courses closing – we’ve had 48% close in one year. So, we’re going to have to rethink what it is we want from our academic contribution to occupational health training. Do we have perhaps just one, two or three centres across the country where, actually, the focus is very pathway-specific and it is about the quality of that education, not necessarily about bums on seats?” Murphy questioned.
More engagement with students
The final panellist, Elisabeth Eades, director and trustee at the Faculty of Occupational Health Nursing, associate at the College of Policing, and OH adviser to the National Police Wellbeing Service, explained that, like Mandy Murphy had just highlighted, she had ‘fallen into’ occupational health back in the late 1970s.
“It wasn’t my career intention, but it just happened and here I am all those years later. And we so often hear this. So, why aren’t we out there telling student nurses in universities about occupational health? We really should be telling them about what sort of career they could make for themselves and the various levels they can achieve,” she emphasised.
“We’re very good at our jobs but we’re not very good at selling ourselves to others. We need to be going out to students, talking to them about OH and maybe offering training, a placement as part of their student nurse training – their first degree – allowing them to have some opportunities to experience what OH is like and what sort of career they can have in occupational health,” Eades pointed out.
“My second point is around courses. I’ve spoken to a number of employers where they have difficulty with allowing people to do training because they are not sure about the courses. Courses, we know, are few and far between now; I think there are probably four or five SCPHN courses in the country.
“People who spend their money, and employers who support or sponsor people, need to know the curricula is going to produce somebody who is fit for purpose. It is really important that that happens. We need to have new and innovative ways of allowing people to learn, certainly multidisciplinary and new avenues.
“We are talking a lot about using technology to enable people to learn. Equally important, and following on from that, is learning in practice; being able to have the right sort of supervision so you end up with the right sort of career for yourselves and that you are providing the right sort of service for the employer,” Eades said.
The event now moved into a brief question-and-answer session. Concerns were raised about who was going to be the equivalent of a practice supervisor for apprentices once the OH apprenticeship scheme was fully up and running, and what level of competence they would need.
As Mandy Murphy put it: “We have an amazing opportunity at the moment. We have an opportunity to set the standards of what we need, which will then influence the academic and the training support, and that is where the apprenticeship route comes in. We can set a defined route for people that also meets the needs of the employer. It is not just about the academic support; it is about what you get on your clinical placement as well and where you work.”
Role and future of SCPHN standards
The role, and future, of SCPHN (specialist community public health nursing) standards was also raised. The NMC has indicated it intends to carry out a review of post-registration training for OH nurses, including the possibility of new standalone OH training pathways, as part of its ongoing re-evaluation of its SCPHN standards.
Neil Loach highlighted how, for all its limitations, it was important for OH practitioners not to lose sight of the value of the broader public health elements that are wrapped into SCPHN. “The way we deal with it at Derby is that, if there is a keynote lecture on a public health discipline then I’m there as an academic in occupational health to transfer that into ‘the real world’. So, although it may be public health-focused, you get multidisciplinary learning and, actually, I teach health visitors, school nurses and district nurses – so they get an occupational health flair put into their curricula as well,” he pointed out.
“The future of occupational health nursing is by no means guaranteed. Without the supervision and the experts we have got, it isn’t going to go very far. So tapping into all those resources and coming out with a nurse who is going to be fit for the future is going to be vital; we need to work together as a whole occupational health community to ensure that that happens,” he added.
More multidisciplinary approach in future?
As the discussion drew to a conclusion, the role of allied health professionals was also discussed, in particular how to enhance and maximise their contribution to OH service delivery. “There is a lot of work going on in terms of CPD and bringing the community together,” highlighted Neil Loach. “But it needs to happen on a multidisciplinary training level, to bring everybody in, to work a similar standard. I think this is the first step, really.”
Teaching and training needed to become less siloed, less uni-professional, agreed Dr McGovern. “There is a cultural change that I think will be beneficial. We often at CPD events or internal teaching are taught separately. Breaking that down, I think, is important.
“I think supporting grassroots teaching and training, not necessarily within a specific curriculum or programme as such, would be a good place to develop. Because if people on the ground are used to working together more and then are used to talking, teaching and learning together more, then people expect it more; it becomes the norm,” he added.
This echoed the earlier point about the need for more modular training to bring different professional groups together in one room, highlighted Mandy Murphy. “It is about being very clear about your specific role around the table and your contribution. For example, we all say we can do case management; we all do that. But, actually, we approach it in very different ways.
“So we can learn and understand that contribution that everybody makes. Ultimately, I think we have to change our focus around what looks like a complete qualification,” she added.
The panellists
- Elisabeth Eades, director and trustee, Faculty of Occupational Health Nursing, associate, College of Policing, OHA to the National Police Wellbeing Service
- Neil Loach, senior lecturer in OH nursing, University of Derby and vice president iOH
- Dr Paul McGovern, OH physician at Medigold Health, trainee representative, Faculty of Occupational Medicine
- Mandy Murphy, strategic OH services adviser and professional coach, deputy head, the National School of Occupational Health, Health Education England
- Steve Nimmo, director of assessment, Faculty of Occupational Medicine (chair)
Pandemic delays launch of OH apprenticeships
Like so much else, the anticipated launch of occupational health nursing apprenticeships this year has been delayed by the coronavirus pandemic. At the Birmingham event, Derby University’s Neil Loach had been optimistic the first Level 7 apprenticeship for occupational health nurses would launch this autumn.
But catching up over the summer, Neil conceded the timeframe had now been pushed back. “It is still going ahead, but it is on hold nationally. No universities are going to be looking at it until at least September 2021,” he told Occupational Health & Wellbeing.
The main reason for this delay had been the fact an end-point assessor had not been able to be appointed, in part, again, because of the pandemic throwing everything up into the air.
“Since Covid-19 a lot of the end-point assessments have been dropped from apprenticeships for this season,” Loach pointed out. “We’re still on it however; we are still working on it. In the meantime we have been offering places for September on the normal course. So it is very much business as usual, for both full-time and part-time students.”
The pandemic had meant all universities had had to rethink how courses and placements are delivered, with more online working taking place yet also ensuring standards are still met and there is no detriment to the learning experience for students, he emphasised. “It is a fine balancing act, but it is one where we’re confident we will still be able to have well-rounded and experienced nurses going into practice,” said Loach.
In Birmingham, iOH, the Association of Occupational Health and Wellbeing Professionals, had launched an innovative cut-price £10 membership offer that had sparked a lot of interest among delegates to the event.
The membership offer, a new-look website and a range of other activity meant iOH was going well, despite the challenges of the pandemic for the whole profession, with the association now having more than 200 members, emphasised Loach, who is also iOH vice president.
“We have been working extremely hard behind the scenes to where we are. We are, of course, doing more virtually now than we were; and we will be doing more online things during the year, and we do recognise everyone is very busy within occupational health.
“But it is a testament to Lucy [president Lucy Kenyon] and the board’s actions that we have actually managed to increase membership and go from strength to strength in what has been a really challenging year – £10, after all, is the cost of four cups of coffee!” added Loach.
References
“First occupational health nurse apprenticeship set to be launched this summer”, Occupational Health & Wellbeing, March 2020, https://www.personneltoday.com/hr/occupational-health-nurse-apprenticeship-set-to-be-launched-this-summer/
“Government to double nursing apprentices with £172m funding”, Personnel Today, August 2020, https://www.personneltoday.com/hr/government-to-double-nursing-apprentices-with-172m-funding/
“Disappearing spires – why have OH university courses dropped by half this year?”, Occupational Health & Wellbeing, October 2018, https://www.personneltoday.com/hr/disappearing-spires-why-have-oh-university-courses-dropped-by-half-this-year/
“OH nurses around the table to review Part 3 of the NMC register”, Occupational Health & Wellbeing, December 2019, https://www.personneltoday.com/hr/oh-nurses-around-the-table-at-first-nmc-meeting-to-review-part-3-of-the-register/
“New-look training could be on the cards for OH, as NMC outlines review of SCPHN standards”, Occupational Health & Wellbeing, January 2020, https://www.personneltoday.com/hr/new-look-training-could-be-on-the-cards-for-oh-as-nmc-outlines-review-of-scphn-standards/
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