Dr Alastair Leckie, Consultant in occupational medicine OHSAS, NHS Fife President, Society of Occupational Medicine

Dr Alastair Leckie, Consultant in occupational medicine OHSAS, NHS Fife President, Society of Occupational Medicine

Who am I? NHS consultant in occupational medicine Director OHSAS

What is OHSAS? Occupational Health And Safety Advisory Service

Customers NHS Fife NHS Tayside Commercial

NHS service(s) OH H&S V&A Manual handling OT Physiotherapy CAPS Asbestos

Agreements? Nothing Service partnership agreement Service level agreements Joint service level agreement

Joint SLA Benefits Efficient Effective Economic Flexible Resilient Enhanced role for OHSAS staff Costs Two masters Authority to make decisions Interdependencies politics personalities

Standards? Boards own? NHS Scotland? Scottish Government? UK Government? HSE? Good practice

Quality Lack of standards SEQOHS ISO Outcome based Difficult eye of the beholder Improved patient care! DoWeMad

DoWeMad? Work status questions: Are you / is your employee? At work, with normal hours At work, with restricted hours Off work due to health reasons Off work due to non-health reasons If at work, are you / is your employee? Doing normal duties without difficulty Doing normal duties, but struggling Not able to do all normal duties

Outcomes 1. At work, with normal hours, normal duties 2. At work, with normal hours, struggling 3. At work, with normal hours, restricted duties 4. At work, with restricted hours, normal duties 5. At work, with restricted hours, struggling 6. At work, with restricted hours, restricted duties 7. Off work

EQ 5D Mobility Self care Pain/discomfort Anxiety/depression Usual activities

Realities Less money Increased demands, expectations, services Service review

000 Efficiency savings = cuts NHS Fife Projected Costs NHS Fife less efficiency savings NHS FIFE Tayside AND Projected NHS TAYSIDE Costs OHSAS FUNDING NHS 2006/07 Tayside to less 2012/13 efficiency savings 1,900 1,425 950 475 0 2006/07 2007/08 2008/09 Financial 2009/10 Year 2010/11 2011/12 2012/13

Increased demands 9000 NHS Tayside activity 2010-13 8000 7000 6000 5000 4000 3000 Pre-employment Screening: Management Referrals & Reviews: Communicable Diseases Screening: Contamination Injury Assessments: OVERALL TOTAL 2000 1000 0 2010/11 2011/12 2012/13

Redesign Worked with redesign team Primarily reactive Failing to meet statutory minimum requirements Limited resource Long, painful, tortuous, never-ending, repetitive to get back to the start!

Statutory provision Professional advice Education, information and instruction Specialist training Statutory occupational health advice Statutory surveillance Fitness to practise advice/sickness absence

Discretionary Outbreaks/infection control Influenza vaccinations First day reporting Occupational therapy Physiotherapy Counselling and psychology

But Accepted Proposal went to NHS Directors meeting Decision obtained Prevention, protection...and rehabilitation Employer set standard with advice

Positive Improved relationships Raised profile Standard set and agreed Agreed long disputed roles and responsibilities Good news story still to come

c.f. Dockyard Advised need to consider sub-contractors health surveillance needs Option appraisal 1. Get subcontractors to provide 2. OHSAS provide 3. Accept risk of not doing

Decision Health surveillance must be provided Quality and cost better with one provider OHSAS Risk assessment done, numbers identified, requirements set Costed proposal Decision pending

Conclusions Life isn't easy Communication, communication, communication Perseverance Senior management buy in Organisation involvement DoWeMad to patient care?

Happy to take any answers.