Dear Colleagues

I hope you have all been able to take advantage of some long-awaited sunshine over these last few weeks. It has been lovely after a packed day at work to enjoy some walks in the warm evenings. 

Our bulletin remains packed with some helpful information for you to digest. Following our Board meeting in May, both Dr Alina Mohan and myself have been engaging with various stakeholders regarding the ‘Entonox’ concerns that have arisen and you will see a summary of findings in this bulletin. 

June also saw the annual FOM/SOM conference being held in Newcastle where the new SEQOHS standards were launched. If you haven’t seen them yet then they can be found via 2023-SEQOHS-Standards-March-2023.pdf (fom.ac.uk) . The NHS specific standards are still being finalised, and the Network is supporting NHS England in developing these alongside the Faculty of Occupational Medicine. 

If you haven’t already done so, don’t forget to register for our conference in September – a limited number of places are still available and it’s a great agenda as well as valuable networking time. 

As school and university lives draw to a close for another academic year, occupational health remains very busy – autumn planning; new doctor intakes; new healthcare student intakes - but I do hope you all have an enjoyable summer and get some much needed ‘R&R’ at some point.

Best wishes

Hilary Winch

Chair, NHS Health at Work Network

In this edition:

1.    Book Your Place: Annual Conference 13 & 14 September

Registration is now open for the NHS Health at Work Network Annual Conference 2023! We have some brilliant speakers lined up – see our conference programme.

The conference is taking place on Wednesday 13 and Thursday 14 September 2023, at the Chesford Grange Hotel, Old Kenilworth, Warwickshire, CV8 2LD.

For those of you who are members and have subscribed to a conference package, we have already written to you with the relevant registration forms.

We also have a limited number of remaining 24-hour places available to book on a first-come, first-served basis, at a heavily discounted rate for members, as well as an unlimited number of day-places available for Thursday 14 September. Please contact our conference organiser, Anna McNeil at forumconferences@btinternet.com if you would like to book conference places. 

2.    Entonox Exposure

At the May NHS Network board meeting, we discussed the current situation regarding Entonox exposure in maternity units which has been in the press over recent months and the different approaches that are being undertaken in various regions. NHS England’s guidance document that was published in March 2023, NHS England » Guidance on minimising time weighted exposure to nitrous oxide in healthcare settings in England, which did not indicate any staff screening requirements, however some Trusts have opted to undertake vitamin B12 screening. 

Hilary Winch, Network Chair, met with John Crooks, HM Principal Inspector of Health and Safety, Head of Health and Social Care Services Sector and Martin McMahon, HM Inspector of Health and Safety, Health and Social Care Services Unit who is the policy lead within the HSE for Acute Trusts and has been working with Trusts on this issue. They both confirmed that the key focus should be on control and monitoring (as per NHS England’s guidance). Entonox can be very sporadic in use, and as such, even if air levels are high in peaks of usage, if calculated over the eight hours weighted average, then the work exposure level is likely to be low. As a result, currently there is no indication that any staff health surveillance and/or biological effect monitoring of B12 levels are required. Of course, if the environmental monitoring indicates levels above the work exposure limit, then further consideration would be required and specialist hygienist advice sought. 

The HSE have sought guidance from Dr. Steve Boorman who confirmed with them that a percentage of the population have a vitamin B12 deficiency anyway, and as such if you screen and find low levels of B12, this does not provide conclusive evidence that this is a result of work exposure, nor does it provide assurance that the control measures are sufficient (which is the purpose of health surveillance being undertaken). Consequently, the key action required is to implement the control measures, and then monitor the effectiveness of these measures. 

It is noted that some external (non-NHS, non-OH) companies in their air monitoring reports are recommending undertaking this B12 screening of staff. The HSE commented that some companies undertaking monitoring do not have Occupational Hygienist specialist guidance and so some of recommendations may not be appropriate.

In summary, working with our Health and Safety colleagues focusing on control measures and monitoring of air levels, rather than screening staff for B12 levels, is the most appropriate action at present.  

3.    New On-line Resources for Network Members

The work on developing some good occupational health practice to share with our members continues. The new OH Guidance section on our website is available to Network members here. The content of the clinical guidance has been reviewed over the last month. In addition, we are finalising a Blood Exposure Incident Response document and also working on some immunisation policies.

We have developed an extensive range of examples of job descriptions, and have shared some competency documents – we would like to share some more clinical and non-clinical competency documents, so if you have any please do send them through to admin@nhshealthatwork.co.uk

This month we are starting to collate example of Service Level Agreements - we would really encourage members to share copies of their template  Service Level Agreements, this could be with your own Trust or external contracts, for us to publish on our website. Of course you can take off organisation names and any other confidential or commercially sensitive information, but we know that many OH departments are looking to compare this area of practice and as such having them in a central place on our website would be helpful for all. If you are willing to share, then please send them to admin@nhshealthatwork.co.uk

4.    HSE Inspections

HSE’s 4-year inspection programme on the risk management of workplace violence and aggression (V&A) and musculoskeletal disorders (MSDs) in the NHS has identified a number of key findings and recommendations.

HSE has shared these findings with all NHS Trust and Board Chief Executives, and also with relevant NHS stakeholder groups and unions. If any Trusts and Boards have not received these findings, contact public.services-sector@hse.gov.uk to request a copy.

HSE will be carrying out further inspections with the NHS over the next 12 months, focusing on the key areas identified in the report. View further details.

5.    Occupational Health Referrals to NHS Practitioner Health

Practitioner Health is a free, confidential NHS primary care mental health and addiction service with expertise in treating health & care professionals. The service has particular understanding and expertise in the special needs of healthcare professionals with mental illness or addiction, how their role might impact on their ability to receive confidential care; and how their condition might impact on their work and potentially their own patients and works in the unique interface between health and care practitioners as regulated professionals and as patients with a mental illness.

The service is open to:

• Doctors & Dentists in England and Isle of Man
• Doctors in Guernsey
• Other staff in England where there is a genuine reason why they cannot access care confidentially e.g. due to the seniority of their role, or the team they work in.
• Regulated health & care staff in Scotland

PH is predominantly a self-referral service, although in some circumstances are able to accept supporting assessments and referrals from occupational health clinicians as long as the reason for accessing the service meets the criteria around confidentiality. Referrals should be made using the online form. The service would not usually accept referrals when the patients concerned are already receiving treatment from a secondary care provider however will assess such registrations and consider if they may have an additional role. PH may provide signposting or liaison to ensure patients access appropriate care depending on their circumstances.

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6.    Diploma in Occupational Health Practice: £150 Member Discount

The At Work Partnership is offering a Network Member Discount of £150 off their Diploma in Occupational Health Practice course. The course will provide a solid introduction to occupational health practice and will offer effective preparation for the FOM Diploma in Occupational Health Practice examinations. The course is being run as follows:

Week 1: 4-8 Dec 2023; Week 2: 15-19 Jan 2024 Revision day: w/c 22 Apr 2024.

Save even more: Book and pay by 1 September 2023 to qualify for the early bird rates! For more information and the full brochure visit: https://bit.ly/FOMDIP23-24

7.    Meet the Board Member: Linda Lewis

Find out what our North West Board Rep Linda Lewis is focusing on this month: 

“Ensuring that we’re delivering on the Growing OH and Wellbeing Strategy continues to be a priority and this month I delivered a workshop with Dr Adam Turner at the NHSE Retaining our NW People: Enhancing Experience and Engagement Conference. I’m also in the process of meeting with colleagues across Central and Greater Manchester and Lancashire regarding starting a community of practice network.”

8.    Member Case Study: University Hospitals of Leicester NHS Trust

University Hospitals of Leicester NHS Trust (UHL) has been providing an OH service for GPs in Leicestershire for 20 years. This was a pioneering approach at the time and is still in the vanguard of innovative OH&WB service provision. From the outset, one of the key drivers has been to provide GPs and practice staff with the same access to OH services as staff working in larger NHS organisations. Read the case study here.

9.    North East Region NHS Network Board Rep Vacancy

We have a vacancy on our Network Board for the North East region, replacing Steven Forster who steps down after more than three years in the role – thank you Steven! Applications are invited from Network Member colleagues working in this regions, to join our Network Board. For an informal discussion and/or an application form, contact Andrew Gilbey, General Manager at admin@nhshealthatwork.co.uk and submit your application by no later than Friday 3 August. 

10. Courses and Resources

New modules in e-learning for health include Occupational Dermatitis and A hairdresser with Hand dermatitis

The Faculty of Occupational Medicine has launched new evidence-based guidelines that aim to assist healthcare professionals in the workplace. They have been produced in an easy-to-read, concise format and the first two guidance documents concern the management of upper limb disorders in working-age people and supporting individuals back to work after Carpal Tunnel Release surgery. These guidance documents have been accompanied by the production of a document summarising the occupational health principles for healthcare professionals.

The latest National School of Occupational Health newsletter is available here.

Menopause and periods guidance is a significant step forward – BBC news item

https://www.bbc.co.uk/news/uk-65766889

HSE inspections of woodworking businesses focus on lung disease. HSE are currently inspecting woodworking businesses to ensure dutyholders know the established health risks associated with woodworking, including wood dust, and have effective controls in place to keep workers safe and protect their respiratory health.

In 2022/23, HSE carried out more than 1,000 woodworking inspections and found 78% of businesses were not compliant in protecting workers from respiratory sensitisers (primarily dust from hardwoods, softwoods and composite materials such as MDF). 

This resulted in 402 enforcement actions taken by HSE. Key areas of concern included: 

• Housekeeping (including dry sweeping of wood dust) 
• Local Exhaust Ventilation (LEV) maintenance and thorough examination 
• Selection of and face fit testing for Respiratory Protective Equipment (RPE) 
• Health Surveillance for exposure to wood dust 

To ensure your woodworking business is managing the risks and is prepared for an inspection, the HSE has free resources and guidance to prevent exposure to dust and protect your workers’ respiratory health:  

• Visit the Dust Kills woodworking campaign website
• Download the free guidance for woodworking (.pdf)

Guidance at NHS England » Wellbeing guardians: guidance for introducing the role in healthcare organisations helps healthcare organisations to introduce the wellbeing guardian function. This function supports the development of a compassionate and inclusive wellbeing culture by independently challenging senior leaders, seeking assurance and recommending models, methods, and resources to support employee wellbeing. It also describes how wellbeing guardians should ideally work with existing roles such as health and wellbeing leads, occupational health, human resources and organisational development teams, and wider stakeholders who support the wellbeing of our NHS people.

The Association of Chartered Physiotherapists in Occupational Health and Ergonomics (ACPOHE) are holding a webinar as follows:

Title: Mentoring those considering a move into OH

Date: Monday 3 July 2023

Time:  10.00 – 11.00

Via: MS Teams

This webinar introduces the idea of mentoring and is linked to the recently launched multidisciplinary mentoring initiative supporting healthcare professionals considering a move into Occupational Health. Janet O’Neill, Deputy Head of the National School of Occupational Health (NSOH) will be talking about mentoring, the initiative, and how you can get involved. Full details, and to book your place, please go to:

https://acpohe.csp.org.uk/event/acpohe-webinar-mentoring-those-considering-move-oh

This Population Health newsletter contains some great learning resources on long term conditions, cultural competence, and public health

Population Health and Health Inequalities: Education and Training Newsletter (office.com)

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The NHS Health at Work Network brings together all OH teams providing health and wellbeing services to NHS OH staff.  It is dedicated to providing consistent, high quality health at work services to all NHS staff through collaborative working.

Members of OH teams in NHS Health at Work Network member organisations can receive the bulletin and access the restricted areas of the website as a membership benefit – if you are not sure of your login details email admin@nhshealthatwork.co.uk   

Please share this bulletin with colleagues and encourage them to register to receive it regularly.  Non-Network members can also register to receive the monthly bulletin here.

You can contact the Network through your regional representative or as shown below.  Please get in touch if you have any queries or comments, if there is anything you would like to see in future issues of the bulletin, or if you have news to share.

Hilary Winch, Chair                                                 hilary.winch@nnuh.nhs.uk

Andrew Gilbey, General Manager                       admin@nhshealthatwork.co.uk  

Postal address: NHS Health at Work, PO Box  857, York, YO31 6FR