NHS Grampian Occupational Health Service

Transcription

1 NHS Grampian Occupational Health Service External contract activity Housing & disability Fitness for work & wellbeing services Occupational Health Teaching & research First Aid Training Travel advice & immunisation s Annual Report 2009/2010

2 NHS GRAMPIAN OCCUPATIONAL HEALTH SERVICE ANNUAL REPORT 2009/2010 EXECUTIVE SUMMARY KEY THEMES Overall activity has risen throughout the period 1 April 2009 to 31 March / /2010 Counselling Self Referral Management Referral (PSSA) Pre-Employment Screening Travel Referral Major activity for 2009 H1N1 vaccination programme delivered 8853 H1N1 vaccinations and 4389 seasonal influenza vaccinations to a mixture of NHS Grampian staff and local authority staff. What we are: The Occupational Health Service offers a wide range of clinical and managerial skills to support employees and managers in achieving a healthy, productive and effective workplace. We also deliver services to the public in Grampian and support the wider health initiatives to improve the wellbeing of the population of Grampian. What we do: The NHS Grampian Occupational Health Service provides a wide range of services including: Strategic involvement Attendance management Control of infection Health and safety Occupational health Pre-employment health screening Health surveillance Immunisation and screening programmes Health assessments (e.g. night workers) First Aid training Initial and refresher courses delivered throughout Grampian.

3 Working Health Services - Fitness for work DWP pilot site from January 2010 supporting small and medium sized enterprises throughout Grampian Expert assessment of fitness for work and advice on workplace adjustments Counselling Support for substance and alcohol misuse Physiotherapy Housing and disability assessments In partnership with Aberdeen City and Aberdeenshire Councils. Travel advice and immunisations Our trained travel advisers provide advice on any immunisation or precautions to take when holidaying abroad or travelling on business. Teaching and research We are a teaching and training department with links to the University of Aberdeen. External contract activity We work with external organisations including the University of Aberdeen and Scottish Ambulance Service and other external contractors. Development aims in Deliver integrated attendance management to NHS Grampian and other stakeholders Develop the housing and disability assessment service with local authority partners Expand and market the NHS Grampian Travel advice service Progress the service development to paper-lite systems

4 FOREWORD: Dr E Murphy, Lead Consultant Occupational Physician Welcome to this summary of the purpose and activity of NHS Grampian Occupational Health Service over the period You will see from the activity data that the integrated service continues to provide a wide range of core services as well as responses to new initiatives, both local and national. The purpose of this and subsequent annual reports is to inform NHS Grampian to whom the service is accountable. AIM OF NHS GRAMPIAN OCCUPATIONAL HEALTH SERVICE: NHS Grampian corporate objectives of learning and growth through ensuring effective staff involvement in achieving a healthy and positive work experience are supported by NHS Grampian OHS. This support is based on excellent clinical skills and systems enabling adherence to Staff Governance and Clinical Governance Standards. The services provided to NHS Grampian range from pre-employment screening, immunisations, support for managers in promoting attendance, redeployment programmes and employee support through self-referrals, workplace adjustments and counselling. Support for statutory health and safety requirements in health surveillance programmes and display screen equipment assessments is also undertaken. Specialist reports in support of applications to the Scottish Public Pension Agency Scheme are provided where appropriate. Activity reports are integrated within this report to reflect the range of service provision. Quantitative data regarding activity for the period 1 April 2009 to 31 March 2010 is presented. NEW INITIATIVES New initiatives undertaken during the year include: Integration of the housing and disability assessment services Development of the Grampian travel advice service Establishment of the NHS Grampian attendance management group supporting NHS Grampian in working toward the HEAT standard of 4% absence at 31 March NHS Grampian Occupational Health Service has continued to deliver quality occupational health services over the last twelve months and it is thanks to the dedicated professional team that this has been possible.

5 OVERVIEW OF THE SERVICE NHS Grampian Occupational Health Service comprises a multidisciplinary team of medical and nursing specialists in occupational health. Staff members include: Head Count WTE Medical: Lead Consultant Occupational Physician Specialist Registrar Specialist Trainee (Elgin) Medical Advisor (Travel) GP with Special Interest (Disability) GP Specialist Trainee GP Career Start Medical Advisor Consultant Occupational Physician (Elgin) Honorary Consultant Occupational Physician Nursing: Nurse Manager Senior Occupational Health Advisors Nurses in Occupational Health Nurse Educator (First Aid) Counselling: OHS Xtra: Occupational Therapist (until Dec 2009) Counsellor (until March 2010) Nurse (until March 2010) Healthy Working Lives: Advisors Administration & Clerical: Lead Administrator Project Support Officers Secretary Administration Assistants IM&T Data Support OHS Improvement & Development Manager During there has been further development of the service network based at Foresterhill Lea, Foresterhill, Aberdeen. From this base, many services are delivered throughout Grampian and Moray. Clinics are held in Elgin, Keith, Aberlour, Dufftown, Buckie, Banff, Fraserburgh, Huntly, Maud, Inverurie, Peterhead, Banchory and Stonehaven. During , the post shared with NHS Highland (Consultant Occupational Physician) has continued at 0.1 WTE with additional clinical support of 0.1 WTE Specialist Trainee.

6 The links with the University of Aberdeen remain with Dr Finlay Dick, Senior Lecturer supporting the clinical and training activity within the Occupational Health Service. Nurse Manager, Morag Hives has continued the development of the nursing team. Members of the team are encouraged to progress towards a recognised qualification in occupational health. The post of nurse educator has been established to support the First Aid delivery programme. The administration and clerical support service has also continued to consolidate developments in IM&T. The OPAS occupational health and safety database has been developed and upgraded to facilitate statistical reports. The integrated diary management systems have allowed effective monitoring of appointments including cancelled and failed to attend statistics.

7 ACTIVITY OF NHS GRAMPIAN OCCUPATIONAL HEALTH SERVICE Service Provision and Performance Indicators The process for pre-employment health screening has been modified to facilitate an effective and efficient service to the recruitment process. The impact of vacancy management has resulted in a significant drop in the number of pre-employment health screenings carried out during this period. The Band 5 nursing activity has been re-focused on case management for attendance management of referrals for short term absence which have increased. Immunisation programmes continue with an effective recall system established. Influenza and pandemic influenza planning NHS Grampian Occupational Health Service participated in the Scottish Executive Influenza Immunisation Programme and is already involved in the early planning for the 2010 immunisation programme. The publication of the updated Immunisation against infectious diseases guidance 2006 has allowed review of current internal procedures and processes in relation to immunisation. Key changes are: History of infection in those over ten years old or history of two doses of MMR will be recognised as evidence of immunity to Rubella, Measles and Mumps. Mantoux has replaced Heaf testing. Hepatitis B boosters will be offered at 5 years however staff will be required to arrange their own appointment in OHS. Figure Pre-employment Health Questionnaires Unfit for placement proposed Figure 2 Immunisations Diphtheria/Tetanus/Polio Rubella Vaccination + MMR (including screening history) Hepatitis A Hepatitis B Course Standard course three immunisations followed by a 4 th and 5 th in poor serological response Hepatitis B booster Hepatitis B (Accelerated) Course Typhoid Varicella Influenza ( seasonal)

8 Figure 3 Screening for serious communicable diseases Hepatitis B surface antibody Hepatitis B surface antigen Hepatitis B e antigen Hepatitis B core antibody Hepatitis B viral DNA Hepatitis C antibody Hepatitis C viral RNA Rubella antibody Varicella antibody MRSA Mantoux (replaced heaf testing) Heaf test Tuberculosis HIV antibody Both self and management referrals continue to form a major part of the activity within the department. Written requests for management referrals are assessed and prioritised on a daily basis in order to facilitate the appropriate time, date and level of assessment. grampianohs@nhs.net

9 Figure 4 Number of individuals referred 3000 Total number referred Self Referrals Management Referrals Year referred Patterns of referrals are shown in figure 4 over the last four years showing an increased management referral rate (pink) whilst self referrals remain steady (blue). Since 2007 the mode of delivery of occupational health advice has changed with the roll out of the telephone triage process and early contact with client and manager/human resources using based reports. Figure 5 below gives an indication of activity associated with this mode of delivery. Figure 5 Management Referrals Activity Initial Telephone Contact Review Telephone Contact Medical Assessment Nurse Assessment Medical Review Nurse Review Medical Admin Nurse Admin Joint Meeting 2007/ / /2010 Event

10 Counselling services are available to all NHS Grampian employees and any employee can now self refer to this service. At times there have been significant waiting lists and, in line with service redesign, additional models of service are being explored. Figure 6 Counselling Initial Review Due to service redesign and the increasing evidence of the effectiveness of workbased cognitive behavioural therapy alternative models of service delivery have being explored for Telephone counselling has been successfully introduced resulting in reduced waiting times and a flexible responsive service. Health surveillance programmes have been developed and refined according to risk assessments for the following hazards: Figure 7 Health Surveillance/assessment Audiometry Display Screen User Exam Hyperbaric Medical MRSA Night Workers Hand & Arm Vibration Latex/skin Respiratory Surveillance Varicella Due to the ongoing difficulties with latex and skin hygiene products within the workplace a skin recall system has been established for those health care workers with potential problems. It is hoped that during further removal of latex products continues thus reducing the risks to employees. Managers have been made aware that where latex cannot be removed appropriate health surveillance should be in place. The SPPA (Scottish Public Pensions Agency) requires a specialist Occupational Physician report in support of applications for early release of pension and lump sum on grounds of ill health and NHS Grampian Occupational Health Service now has five trained specialists able to support this activity. During 2008 a new pension criteria for ill health related release of pension was introduced involving lower and upper tiers. Figure Recommended for ill health retiral/termination on grounds of health

11 The Cross Grampian performance review group asked Dr Murphy to lead on a subgroup to review management of attendance and work toward the HEAT target of no more than 4% absence at 31 March Clearly with this activity in managing attendance it is anticipated that management referrals to OHS will continue to increase. At March 2010 overall NHS Grampian sickness absence rate is 4.52% (for the year 4.63%). During it is hoped that all those who have absence of over 21 days will be referred to OHS for support and advice. NHS Grampian Monthly Absence Rates Absence Rate 6.00% 5.50% 5.00% 4.50% 4.00% 3.50% 3.00% Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Months 2007 Absence Rate 2008 Absence Rate 2009 Absence Rate 2010 Absence Rate Management of potential exposure to blood borne viruses continues as a priority to the service. Figure 10 Action following needlestick incidents Total Needlestick Injuries Baseline blood for storage Month blood sample for storage Hepatitis C viral RNA weeks Liver Function Tests Month Hepatitis C antibody Month Hepatitis C antibody Hepatitis B surface antigen Hepatitis B surface antibody Post exposure prophylaxis commenced Reported to RIDDOR Hepatitis B Immunoglobulin given Hepatitis B Booster HIV Antibody Test NHS Grampian Occupational Health Service also provides initial management of potential occupational exposure to blood borne viruses for contractors, medical students and dental students. In order to maintain confidentiality these figures are included above.

12 First Aid Training has been developed in house by NHS Grampian, and recognised and monitored by HSE, with 15 courses delivered between April 2009 and March Health promotion initiatives, such as the Scotland Health at Work scheme, are supported by OHS through local co-ordinators. Support for Healthy Working Lives development continues locally and nationally. Safe and Healthy Working and Health Promotions have been integrated as Healthy Working Lives. The Workplace Team in NHS Grampian continue to provide the Health Promotions component in addition to being the main point of contact and advisory centre for the Healthy Working Lives award scheme. The Healthy Working Lives award scheme includes a requirement for Occupational Health & Safety, rehabilitation and environmental criteria to be met by clients. Support is provided by Alex Black and Anne Taylor who work as Healthy Working Lives advisors with specialist expertise in the Occupational Health and Safety agenda. This service also supports small and medium businesses with occupational health and safety advice. NHS Grampian Occupational Health Service has contributed to the NHS Grampian Staff Governance standard. The clinical governance programme for NHS Grampian will be submitted in line with the updated OHS clinical standards template NHS Grampian Occupational Health Service attempts to acknowledge complaints in a fair and equitable manner. Figure 11 Compliments/ Complaints Compliments Complaints Compliments Complaints Compliments Complaints Compliments Complaints Clients GP/Specialists Managers Human Resources Miscellaneous Total

13 Staff (including Medical) Appraisal, Revalidation and Development As part of the General Medical Council initiative to develop appraisal and revalidation for medical specialists it is proposed that the medical staff of NHS Grampian OHS participate fully in peer appraisal and revalidation. The Faculty of Occupational Medicine has issued revised CPD guidance which will be followed, Good Medical Practice for Occupational Physicians. Formal appraisals have been conducted for all Occupational Health Service medical staff during NHS Grampian OHS has also supported the medical appraisal process for NHS Highland Occupational Health Service, NHS Lothian and NHS Grampian (6 formal appraisals performed). Continuous performance appraisal is in place for all members of the nursing and administration team through the Knowledge and Skills Framework. Accountability Mechanisms NHS Grampian Occupational Health Service was designed with accountability to Grampian Primary Care NHS Trust, Grampian University Hospitals NHS Trust and Grampian Health Board. This accountability was via a Management Group with delegated authority for the direction and development of services. Following the review of occupational health and safety services in NHS Grampian the management group has been disbanded. NHS Grampian Occupational Health Service is now directly accountable to the NHS Grampian Board via the Director of Human Resources and Strategic Change, NHS Grampian.

14 Representation on Working Groups and Committees NHS Grampian Occupational Health Service has representation on the following local and national groups: Figure 12 NHS Grampian NHS Grampian Control of Infection Committee NHS Grampian Performance Review Group HWL Working Groups Staff Governance Audit Senior Human Resources Managers Meetings Agenda for Change NHS Grampian Risk Management Group NHS Grampian Pandemic Influenza Coordinating Committee Acute Sector Pandemic Influenza Committee Human Resources Partnership Forum Stress Working Group NHS Grampian absence management group (from March 08) NHS Grampian HR Operational Management and Partnership Group Other External Groups Society of Occupational Medicine NHS Scotland Senior Occupational Health Managers Group NHS Scotland Senior Occupational Physician Group BMA Scotland Council Occupational Health Nurses Forum Occupational Health and Safety Review Implementation Group Specialist Registrars Group in Occupational Medicine Scottish Executive Department of Justice Expert Panel Finished Jan 09 North of Scotland Occupational Health and Safety Group Department of Health Hepatitis Advisory Group Occupational Medicine Editorial Board University of Aberdeen Health & Safety Meetings Healthy Working Lives Working Group Housing Medical Advisers Scotland Scottish Executive Blue Badge Reform Committee

15 Development aims in Deliver integrated attendance management to NHS Grampian and other stakeholders Develop the housing and disability assessment service with local authority partners Expand and market the NHS Grampian Travel advice service Progress the service development to paper-lite systems

16 APPENDIX A During NHS Grampian Occupational Health Service had service level agreements with the following organisations: Macaulay Land Research Institute NHS Education for Scotland Practitioner Services Rowett Research Institute transferred to University Aberdeen July 2008 Scottish Ambulance Service Scottish National Blood Transfusion Service University of Aberdeen * contract renewed for three years from Dec 08 University of Aberdeen Medical School Moray College University of Aberdeen Dental School New Contracts: Robert Gordon University Working Health Services Grampian (part of Scottish DWP pilot)

17 APPENDIX B Housing and Disability Assessment Service 2009 was the second year that NHS Grampian Occupational Health has had responsibility for medical advice to both Aberdeen City Council & Aberdeenshire Councils. The disciplines include :- Award of housing medical points and advice to Aberdeen City (ACC) and Aberdeenshire (Shire) Council Housing Departments Garden maintenance medical advice and decisions to both ACC & Shire Independent medical Blue Badge car parking assessment and decisions to ACC and Shire Appeal Housing grant applications for ACC and Shire Change of heating applications for ACC and Shire Priorities for 2010 include: Computerisation: We envisage a paperless process with forms being ed to and from the two local authorities. Contacts: We continue to have regular dialogue with both ACC and Shire councils on strategy and policy important for both parties. Biannual attendance at Housing Medical Advisers Scotland meeting. NHS Grampian is represented on the Scottish Executive blue badge reform committee revising the 2007 legislation. Change of service delivery to multidisciplinary: Housing medical points awards the majority of the time are made by trained nursing staff. Future model will continue to be nurse delivered with doctor having overall responsibility. Single assessment form: Both ACC and Shire have successfully been using the same single form. Housing points rationalisation: This is recognised as good practice and has not appeared to cause any major issues. Continued service delivery during pandemic flu vaccine months: As with all areas in the OHS department the service came under significant pressure in the Autumn 2009 to continue to process and return forms. The service was able to continue to turn around forms, usually within a two week timescale, having adjusted procedures. Strategic development aims Scanning: progressing towards paper lite system. Training: Continuation of further nurse training to further integrate assessments into main stream OHS service delivery. Contacts: building on relationships already established with ACC and Shire Garden maintenance: Review of content and delivery of this service for both ACC and Shire.

18 Housing Activity Data:- Activity data: 2008/ /2010 Housing - City Housing - Shire Blue badge Heating Garden Maintenance Improvement Grant 3 5

19 APPENDIX C NHS Grampian Occupational Health Travel Service NHS Grampian Occupational Health service began providing travel clinic services from July The travel clinic provides a private service accessible to the public at a competitive cost. It offers travel advice, anti malarial prophylaxis and travel immunisations. Telephone enquiries are received and directed to appropriate staff at any time within office hours. All new travel clients require a personalised risk assessment of their travel health needs. Appointment times vary depending on the complexity of the proposed travel as risk assessed by the travel clinic nurse. Clients returning to complete courses of immunisations can be accommodated in other clinic times if more convenient. Service delivery for new clients is integrated into the OHS nursing team. The travel clinic is a registered Yellow Fever Centre and this has been a major demand on the clinic. Other travel immunisations that have been in high demand are Japanese B encephalitis and rabies vaccines. Activity detailed below: Immunisations 2008/ /2010 BCG 2 3 Cholera Diphtheria/Tetanus/Polio Hepatitis A Hepatitis A&B 6 0 Hepatitis B Japanese Encephalitis Meningitis Rabies Typhoid Yellow Fever Mantoux 7 9 MMR 4 5 Tick Borne Encephalitis 0 5 Prescriptions for antimalarials 2008/ /2010 Chloroquine 7 13 Doxycycline Malarone Mefloquine 8 3 Paludrine 7 12

20 APPENDIX D OHSXtra was a Scottish Executive Health Department fixed term funded pilot project which is open to all employees of NHS Grampian (up until end March 2010). OHSXtra was a pro-active service that provides help to overcome health or welfare problems, perhaps even before sick leave becomes necessary. The project aims to support staff by providing rapid access to a dedicated network of services, including physiotherapy, occupational therapy and mental health support. Although monies awarded to NHS Grampian did not include physiotherapy provision it was agreed that the NHS Grampian Staff Physiotherapy Service activity should be included within the OHSXtra statistics recorded on the Occupational Health Service dedicated data base (OPAS). From April 2010 the Staff Physiotherapy Service has introduced some changes. The service offers two main functions: a phone line/ advisory service and a limited clinical service. The clinical service is targeted towards NHS Grampian employees who meet the following criteria: 1. Have suffered a musculoskeletal problem at work, OR 2. Have problems at work due to a musculoskeletal problem e.g. unable to work, unable to fulfil all their work tasks/ duties The main route of access to the service is via the Phone Line or Internally Mon-Friday11am-12noon The service can also be contacted via on nhsg.ohsphysio@nhs.net Paper referrals can still be made by completing a self-referral form which can be downloaded from the Intranet web-page: Intranet/ Departments and Services/ Physiotherapy Occupational Health Any queries should be directed to Lynn Morrison, Lead Physiotherapist lynn.morrison@nhs.net An overview of total OHSxtra activity for the period to date is shown below. New Patients seen during Grand Total Counselling 844 Occupational Therapy 169 PSSA Management Referral 7006 Self Referral 1226 Physiotherapy 2009