Debate: Fitness for Work statements - whose job is it anywhere? Presented by: Violet Chidombwe - Occupational Health Advisor Prison Service Setting Also Part-time locum Practice Nurse in an inner City Surgery Contact:

Hold your horses! Facts about Occupational Health Nursing Practice:  Contributed to sickness absence control up to now  Distinct discipline applying relevant multi-skills & knowledge  Evidence suggests good models of practice exist  Other ways to prevent sick absence have been suggested

Shifting the balance or the workload? ?

History repeating itself?  Lack of committed effort to support the growth of OH Services nationally  Statistics on sickness absence remain a headache and costly  OH input discounted in mainstream health improvement & regeneration programmes  What is Occupational Health Nursing to many?

Therefore, ‘To do or not to do’? Implications for OHNs:  Increased administrative procedures (forms, Access & Communications)  Prescribing medicines & referral for investigations  Fast tracking to treatments & NHS waiting lists would still be a challenge  Perceived conflict of interest from staff representatives & employees

Focus on Legalities: See AOHNP (UK) Website: Jan Maw on Nurse Prescribing (See AOHNP (UK) Website The 9th Ruth Alston Memorial Lecture given by Diana Kloss ‘The legal liability of the occupational health practitioner: benefit or burden?’ (16/10/03)

Focus on pathway to the sick note: Alternative Solutions  Improve working practices & accountabilities for safety  National Access to affordable OH support services & Training for OH personnel  More innovative preventive health promoting initiatives including e.g. chronic self-health management programmes (e.g. Expert Patient Programme)  Public education

When all is not said & not done:  Should OHN’s be drawn into all this?  Practical implications of such an extensive task:  Funding/Resources?  Crossing boundaries & legal & professional implications?  Is time over-ripe for more support for workplace health promotion?  Should access OH provision be legal requirement for businesses to trade?

References - Slide 2  DOH. (1998). Occupational Health Nursing: Contributing To Healthier Workplaces. ENB. (Launch by T. Jowell, MP, Minister of State and Public Health.  DOH, AOHNP (UK) & RCN (2003). Taking a Public Health Approach in the Workplace. DOH.  Dorman, P. (2000). SafeWork - The Economics of Safety, Health, and Well-Being At Work: An Overview. ILO Publications.  Charley, I (1954). The Birth of Industrial Nursing. London: Balliere Tindall.

References - Slide 3  O.Donnell, M. (Dr). (2004). Occupational Health Professionals Cannot Resolve Sickness Certification Problems. Occupational Health Review. 109:  Health First. (1994). A Very Tense Debate: Medics Demand Their Own Scheme. Health First. 7: (Health First commentary on the 1994 BMA conference report: Environmental and Occupational Risks of Health Care–Available from BMA House, Tavistock Square, London).  Griffin, N. (1992). Occupational Health Advice As Part of Primary Health Care Nursing. London: HSE.

References - slide 4  Pickvance, S. (1998). Inequalities in Occupational Health. Occupational Health Review. 73: 16.)

References - slide 7  Williams, S. et al. (1998). Improving the health of the NHS Workforce. London: Policy Studies Institute.  HSC et al (2000). Securing Health Together: Healthy Work, Healthy at Work, Healthy for Life – A Long Term Occupational Health Strategy for England, Scotland and Wales ‘. HSC.