Dr Steve Boorman discusses the opportunities created by the establishment of the new single organisation for occupational health (OH) professionals, the introduction of the new disability benefit, Personal Independence Payments (PIP) and other clinical assessment processes. He sees these developments as a significant career opportunity for OH professionals and the road to a promising future.
When I first considered a career in OH, I remember travelling to meet one of the senior well-known leading exponents of the time and him selling me the opportunities that OH practice offered. Over coffee he talked with passion about the diversity of work and powerfully described OH as a broad church. My career in OH has shown me many of the different facets he described. From working across different industries and meeting a wide range of people with widely varying occupations and conditions, there has been little chance to get bored and I think it is a shame that more healthcare practitioners are not recognising the benefits that working in OH can offer.
Dame Carol Black highlighted in her seminal review Working for a healthier tomorrow that the consequences of falling out of work do not just adversely impact the individual, but may also have a measurable impact on the future generation. This viewpoint puts considerable emphasis on the role of OH in our society and one which I think we should unite behind. It is important for us to look at what OH means to others and, indeed, how benefit reform and the new single organisation impacts this.
Over time, an already diverse specialty in OH has widened further, bringing opportunity to other health professionals and technicians to work either in multidisciplinary teams or to provide services that support the OH needs of the working population. Throughout this evolution, there have been many debates about what is, or is not, OH and sometimes it can be difficult to define its boundaries. Some believe that inclusion of environmental medicine, diving medicine or remote care, for instance, is not within the OH remit. In my view, good OH is about ensuring opportunity to promote work and health across all areas that may affect an individual’s work capability.
There is also a common understanding that good OH needs to go beyond simple physical or mental health considerations. The “biopsychosocial” model, which brings together biological, psychological and social factors when trying to understand health, highlights the need to consider the wider social needs of the people we care for. As such, OH professionals increasingly need to identify biopsychosocial factors when objectively assessing people’s capability to carry out a task – something that traditionally was not considered a mainstream OH pursuit.
Disability assessments are a good example of the “biopsychosocial” model in action, and the introduction of new approaches to benefit reform, such as the launch of PIP, has created demand for more face-to-face assessments. Previously, under the Disability Living Allowance (DLA), fewer than one in 10 claimants were seen face to face, but now the majority of PIP claimants are seen by assessors, many of whom will be OH professionals. The introduction of PIP and the need for face-to-face assessments has brought into question whether enough health professionals exist to deliver the number of assessments required and if health professionals should, in fact, consider a career as a disability assessor.
What we are seeing in practice with PIP is the emergence of a new workforce and one being drawn from many different health professional backgrounds. Hundreds of practitioners, from occupational therapy, physiotherapy, nursing, medical and para-medical backgrounds, are choosing to train and work in this area because they have the chance to play a more direct role in the distribution of benefits to those people who need them most. For OH professionals turning to disability assessors, the ability and skills required to look at ways to help people lead independent lives is an ideal fit.
Role of the disability assessor
The role of a disability assessor offers an extremely varied and challenging path, which is appealing to many professionals already working in OH. Claimants range from 16-65 years old and have a substantial range of medical conditions and impairments. The work also requires practitioners to have good clinical and consultation skills and to be confident in identifying and documenting aspects of a claimant’s condition that may not be documented elsewhere. This is a real change in emphasis for many healthcare professionals, but one that Capita is determined to support assessors through.
As chief medical officer, it has been my priority to develop a comprehensive training programme to support assessors in delivering this entirely new assessment and to use the qualifications they already have in place to become a Department for Work and Pensions (DWP) approved assessor. We offer training on clinical conditions, examination techniques, report writing and formal competency assessments – all before a period of supervised practice. Once trained, practitioners’ reports are audited to ensure a consistent high quality that meets the DWP’s exacting criteria.
There are some who argue that carrying out disability assessments and writing up high-quality reports is not an OH practice, but I disagree. In reality, the skills required and applied to create fair, reliable and robust reports – which are capable of standing legal scrutiny if necessary – are very much those we use daily in OH. While by its nature the work is specialised and the training specific, the disciplines of good OH practice apply and these qualities are exactly what Capita is looking for in its own health professionals.
Although Capita has long been carrying out a broad range of health assessments, working across life insurance, pensions, medico-legal and social care, we have built our own unique workforce for delivering PIP assessments. We work closely with disability groups and charities to ensure that claimants are at the heart of everything we do and this is why we took face-to-face assessments one step further by introducing new home assessments for claimants in the regions we serve.
Investing in our new workforce through professional development has been vital in delivering quality assessments. We have also created “champions” to support colleagues in specialist areas such as mental health, physical health, malignancy, dealing with the young or vulnerable, neurological disease, or respiratory disease, for example.
Problems with PIP
It would not be fair for me to talk about the opportunities available for OH professionals in disability assessments without recognising the delays that are being faced across PIP. As an entirely new benefit, with an entirely new assessment process, the end-to-end process is taking longer for claimants than anticipated. However, we are working closely with the DWP to overcome the initial challenges and get us back on track. During this time we are looking for even more health professionals to join us and help improve the service we are delivering for claimants in central England and Wales. What will remain our priority throughout is delivering high-quality assessments for claimants and employing the right people with the right skillset.
A single organisation?
In addition to the opportunities presented to healthcare professionals through a higher demand for face-to-face assessments, the Faculty of Medicine (FOM) and Society of Occupational Medicine’s ambition to create a single organisation gives further prospects to help professionalise and support a new multi-disciplinary disability assessor workforce of this nature. Previously, the FOM created the Diploma in Disability Assessment Medicine for doctors who had a specialist interest in undertaking disability assessments. No equivalent professional standard existed for the wider healthcare practitioner workforce, which is now undertaking a wide tranche of assessments.
The advent of the single organisation will enable OH practitioners to benefit from the community that a common membership organisation creates and this, in my view, should include shared learning and equivalent professional standards. I hope that this will result in a new diploma or certificate supported by the professional body, but accessible to all health care practitioners working in the areas of clinical assessments. Enabling this at professional-body level will help to ensure that providers, such as Capita, can demonstrate independent academic competency of their workforce. More importantly, it will give practitioners the opportunity to gain professional accreditation for the skills they have trained for.
Far from diluting our specialty, I think this heralds an exciting opportunity that will play to the strength of a new single organisation. Modern OH requires a multidisciplinary approach to deliver effectively and the single organisation gives opportunity to embrace this workforce and establish shared standards.
I have very much enjoyed the challenge of extending my work into the field of disability assessments and working with a diverse group of health professionals to identify the training needs and standards required. I hope that other healthcare practitioners will recognise the positive value they can add to the disability assessment arena too. Together we should unite behind this occasion if we are serious about the key challenges of “securing a healthier tomorrow” that Black’s work has so cleverly articulated.