The Progression of OH (Occupational Health) education and training today
Exploring current ideas within Occupational Health (OH) and wellbeing training and education has already begun. We need to build on this momentum to meet future needs.
The National School of Occupational Health (NSOH)
The NSOH was founded in 2014 as a collaboration between Health Education Englans (HEE), now NHS England, and the Faculty of Occupational Medicine (FOM) to tackle the shortage of skilled OH Physicians and was soon expanded to OH Nurses and the multidisciplinary team, the only school in HEE to do so.
The school is headed up by Dr Ali Hashtroudi and is supported by Professor Harjinder Kaur, National Trainee Program Director. The NSOH, a major stakeholder and leader in the OH arena, has the vision of optimising the health of the workforce, focusing on the right professionals, with the right skills and values providing OH services.
The Multi and interdisciplinary team (MDT)
We have long recognised the need for other appropriate health specialists in OH (CWH 2014. There are tasks only some clinicians can do and tasks several clinicians can do, leading to interdisciplinary working. It may be that alternative health professionals meet a specific need for that organisation or are part of a wider team looking at various aspects of health and wellbeing. Whatever the case, we need to be mindful of a fractured service with lots of pockets of advice and support. Therefore, there needs to be a catalyst or a hub to spokes of the service. This is usually the nurse or doctor especially if they are qualified in OH, however, as education expands to other specialists and education in leadership increases, this may change.
Collaboration in education and training
As a small school, collaboration, and partnerships with our stakeholders, including those in the MDT are essential. We like to see ourselves as a catalyst in the OH world for training and development, working in partnership on strategic initiatives is our unique approach; –
Over the last year, the NSOH has led a task-and-finish group with the Work and Health Unit (WHU), focused on the Government response: Health is everyone’s business. An exciting project reviewing how we can increase the OH workforce to meet future demands by increasing access to training and education.
SOM supports the school with a careers day for doctors and 2023 will see the first Nurse and AHP (Allied Health Professional) careers day which includes information on training and education (27th September 2023). SOM has supported the development of a shadow scheme for those wishing to have a taster day in OH and the development of a mentoring scheme for those new to OH. A recorded webinar on career progression in OH was supported by SOM and a webinar on student placements in OH was held in May and recorded, not forgetting the SOM OH careers week.
The school has worked closely with the FOM supporting the new curriculum and development of the new FOM-accredited OH Diploma in OH practice for nurses, which should be extended to AHP by the end of 2023.
Work with the FOHN (Faculty of OH Nursing) education committee led to the 2016 Education standards for OH, the basis of OH Education for some Higher Education Institutions (HEIs). Other work included a career progression framework and a trailblazer group for the NMC SCPHN OH Nurse apprenticeship qualification now being mapped to the new NMC standards for SCPHN-OH going live in 2024. Collaboration to develop consistency in titles for OH Nurses is soon to be published.
A research project working on a multidisciplinary (MDT) with training and education, is underway with Growing OH & Wellbeing and the London Centre for Work and Health. Included is an interdisciplinary workshop which will be held at the FOM/SOM workshop in June this year.
Current Training & Education
The NSOH are the central body for OH to advise on training the OH &W workforce.
The school’s role in the development of the workforce includes encouraging the development of new courses, quality-assuring courses, and standards, increasing posts and applicants for training, and assisting apprenticeships. This includes quality assurance consultants training, accrediting training posts and supervisors, supporting trainees and trainers and the FOM in decision-making relating to training. The development of hybrid training posts for OHP trainees is a new initiative, working within both the NHS and the private sector in some circumstances. The school’s work is showing promise with the highest number of applicants in the last year and standardised quality. Webinars for trainees are delivered with the recordings available. A compilation of all known OH courses, including for the MDT is being worked on and will be published in the next few months. A one-stop shop for all OH education and training.
A recent development in education and training strategy is the Growing OH&WB people strategy, an NHS people promise. Improving the knowledge and skills of existing OH staff will create quality and therefore a movement upwards, providing space at the bottom for more people to move into OH as a career. Recognising and encouraging talent supports the development of an MDT workforce and provides attractive career pathways. Made possible with accessible training, good-quality education, and leadership development. This focus is encouraging new people into OH. A research project, mapping the skill fit of the MDT team into OH will support the development of future education and training needs.
Where are we now
NSOH pyramid of OH education
Baseline OH knowledge and understanding
There is no awareness of OH via pre-registration institutions! Therefore, the current NSOH project to increase the number of OH departments providing pre-registration students with placements is an essential element (Queens Nursing Institute QNI 2023). The SOM shadow scheme is another baseline opportunity as is the mentoring scheme to support those wishing to enter OH, with basic industry knowledge. A few universities, for example, London Metropolitan and Nottingham University, are building undergraduate courses which have an element of OH, both nursing and physiotherapy, which bodes well for the future. Incorporating OH into all undergraduate health qualifications, as well as relevant college and secondary education students will be the ideal.
To support organisations, a one-day introduction to OH course has been built by the RSPH which is an innovation and a positive step towards more formal awareness of OH. More training at this level is needed.
Core foundation knowledge is a specific area of education and training growth
Several OH providers including the NHS, have commenced their in-house “grow their own” clinicians training courses. This supports the growth of the workforce, necessary if they are going to service their commitments and grow. An NSOH and COHPA initiative is looking to develop a working group across providers for consistency and quality.
Newcastle NHS trust has a 2-week introduction to OH course, sold out till the latter half of this year.
A fortunate development in OH education has been the introduction of the FOM diploma in OH practice for nurses to go alongside the FOM Dip Occ Med for Doctors. To be opened to the MDT by the end of the year. This foundation-level but comprehensive qualification will be excellent for those professionals wanting to increase their knowledge and gain a qualification without attending HE. It is also an ideal steppingstone to a more formal qualification for those who want to ease themselves in. Another comprehensive suite of courses, to consider at this stage, is the NPAG clinical professional development in OH for nurses.
BACP has a set of core competencies for workplace psychotherapists and counsellors, however no course has yet been created to deliver these.
Physiotherapists have access to ACPOHE courses which are an excellent foundation in core OH MSK-specific knowledge.
The Vocational Rehabilitation Association (VRA) suggest several courses including a 2-day vocational rehabilitation course for case managers involved in OH.
Educating technicians has been a concern as training programs for this cohort have dried up over the last few years and some may not have the level of education that lends itself to a degree or MSc. However, following a 2-year stint with a working group, Cordell Health has built an online theoretical-based OHT course which matches the SOM online competency standards and Open Awards are due to launch their OFQAL accredited level 3 technician award. The hope is that this can lead to an apprenticeship allowing employers to make the most of the levy
Specific Industry knowledge
OH, is unique in that industry knowledge can vary quite significantly. There has been a singular lack of specific industry training, other than on the job, however that is going to change. The rail sector has developed a 5-day training program which should be rolled out shortly and the college of policing is looking to develop a similar type of course.
Many OH physicians also choose industry-specific specialisms such as offshore medicals; ionising radiation; HAVS; lead etc. and are usually registered with the HSE. Several OH Nurses are specialist in Travel Health and a number are specialist in mental health or other aspects of health pertinent to OH.
Nottingham University Workplace Health and Wellbeing PG course including MSc is an excellent multidisciplinary course for developing skills in a particular arena including wellbeing as the course encourages research in the student’s particular areas of interest.
This is an area of growth in education and training.
Physician training posts are increasing as are the number of applicants. Recently the NSOH supported the FOM with a new curriculum and is committed to supporting those undertaking formal training and going through the CESR or portfolio route to becoming specialists.
Manchester University continues to provide a popular Occupational Medicine (OM) MSc and public health in OH MSc with nurses, hygienists and Doctors attending. They are committed to exploring other avenues for multidisciplinary OH education so is likely to develop their offering.
The number of universities delivering formal OH nurse qualifications has dropped with Derby, Brunel, Chester and the University of Western England being the last outposts for the SCPHN (Specialist Community Public Health Nurse) course. The NMC recognised the lack of confidence in the course and has published a new framework which is due to be delivered in 2024, at master’s level. Nurses do not need to have worked in OH to be included in the course, however, approximately 50% is practical and therefore assessment and supervision standards must be followed. These have been augmented by the QNI pathway-specific standards for SCPHN practice teachers. Most that qualify without having a job in OH are likely to require a year of preceptorship to cement their learning and 2 years to be considered a specialist (FOHN).
An apprenticeship, supported by NSOH, aligned to these standards, has been built and is being mapped with at least three universities committing to deliver. Considering the employment apprenticeship levy, this may encourage employers who are not currently funding OH education for nurses, to do so. The NHS currently not only fund OH qualifications in some instances but also backfills salary may benefit particularly.
There are 2 other popular University courses, Robert Gordon and Cumbria that deliver occupational health policy and practice courses, based on the PHE 2016 framework. These are mostly attended by nurses but are open to the MDT. At present they are not at MSc level, making them a little more accessible. They do not carry a specialist title; however, the FOHN is publishing an accreditation scheme (OHW+ 2023) where non-SCPHN postgraduate diploma or degree clinicians will be able to obtain a specialist title if they meet the competency requirements.
Leadership is built into these courses; however, leadership is a specialist skill and may be seen as Niche.
There are so many opportunities within OH&WB with many OH clinicians going on to undertake qualifications in psychology, business, compliance, public health, education and even undertake research.
Many OH clinicians go on to own their businesses or become consultants, advising businesses, and providing services. Having leadership skills and a clear understanding of business is essential.
Leadership is a key element to the role of OH. Some may not see it as Niche, however specific leadership training is usually a further qualification that is obtained via a variety of avenues. This may be via an MBA, or leadership courses that are run by NHS Leadership Academy, Cordell Health, and the At Work Partnership amongst others.
Research is another niche but necessary aspect of OH (SOM 2019). The University of Glasgow within Healthy Working Lives and the London Centre for Work and Health, often supported by the Colt Foundation are two such OH centres for research.
Recent Work within the joint NSOH and WHU task and finish group identified 2 themes required for the OH Workforce; one focused on the lack of sufficient and diverse training opportunities and the need to Identify barriers and enablers to new training opportunities whilst maximising existing ones. A need to promote multidisciplinary routes into the OH profession. i.e., increasing the choice of training routes and opportunities into OH, including flexible training and portfolio pathways, was also recognised. Innovation in OH education has been called for, especially as the skill profile in OH come 2028 will be different, with the potential for training to become skill and competency based.
Expanding the portfolio route to more than just doctors is an option to explore. Having a set of competencies will be helpful for this which FOHN are building for nurses. The current MDT and interdisciplinary research will go a long way to support this for other OH specialists.
Hot off the press is the publication of a multi-professional Advanced Practitioner capability and curriculum framework (2023) syllabus in public health. The potential is to develop multi and interdisciplinary working in Occupational Health, building on the strategic public health leadership built during the COVID period.
Developing the multidisciplinary team will bring new skills into all OH and broaden horizons, with further MDT educational opportunities arising. The school is committed to competency frameworks that reflect new ways of working with a wider range of professionals.
Excellent uptake of the SOM and Growing OHWB scholarship program demonstrates the need for training to be funded. There is little consistency in funding at present. The NHS does provide, as do a few OH providers but many still self-funds. The WHU/NSOH funding program is an exciting development for those looking to enter OH, and as a proof-of-concept research project, there is the possibility this will spark further support.
Consequently, we need:
Additional training providers with greater visibility at all levels and all disciplines
Training providers for the Ofqual technician course
Apprenticeships for technicians,
An advanced practitioner public health HEI course
An accredited technician training course
Portfolio and skill-based learning with competency frameworks
Interdisciplinary working and learning
We have come a long way; we have still got a way to go but the future for OH training and education is bright.
Janet O’Neill is an OH Nurse Advisor and Deputy Head of NSOH