Standards & Accreditation for Occupational Health Services Paul J Nicholson

Scope Background Developing the standards Definitions The scope and aims The standards The accreditation process

Background 2006 – Department of Health Standards for Better Health Require a rigorous approach to assessment and accreditation of providers of NHS services – Lord Darzi’s Report High Quality Care for All: NHS Next Stage Review Confirmed Government support for provider accreditation schemes in the NHS – Dame Carol Black’s Report Working for a Healthier Tomorrow

Working for a healthier tomorrow An integrated approach to working age health should be underpinned by: the inclusion of occupational health and vocational rehabilitation within mainstream healthcare; clear professional leadership; clear standards of practice and formal accreditation for all providers; a revitalised workforce; a sound academic base; systematic gathering and analysis of data; and a universal awareness and understanding of the latest evidence and most effective interventions.

Improving Health and Work: Changing Lives The production of agreed common standards will facilitate the development of an accreditation scheme for health, work and well- being services We believe there is a strong desire for some form of national accreditation system across OH & VR services We are committed to funding a project to support the delivery of an accreditation system for OHS and support its first year of operation.

Developing the standards Faculty of Occupational Medicine led 47 people represented 35 organisations Occupational medical & nursing professional bodies [AOHNP(UK), RCN, SOM] Commercial OH providers [including COHPA] Employer representative bodies [BITC, CBI, CIPD, EEF] Worker representative bodies [Unite, USDAW] NHS Plus / HSE / DETINI

Key milestones Agreed domains Agreed 1 st draft Consultation & piloting STANDARDS LAUNCH Accreditation body chosen Pilot web tool ACCREDITATION LAUNCH

Definitions Standard Minimum requirement Accreditation Registration

Definitions A standard is something considered by an authority or by general consensus as a basis of comparison in measuring or judging adequacy, quality, etc

Definitions Minimum requirements relate typically to existing professional guidance –They must be met to satisfy the standard –They are intended to be well-defined and easy to understand

Definitions Accreditation is a self-assessment and external peer assessment process used to accurately assess level of performance in relation to established standards and to implement ways to continuously improve the healthcare system International Society for Quality in Health Care (ISQua)

What does accreditation mean?

Accreditation vs Registration Accreditation is a voluntary process Registration is a statutory process with which providers must comply “to assure people who use health and adult social care of standards of safety and quality, regardless of provider, and to enable independent and strong enforcement where there are unacceptable services”. Care Quality Commission (CQC)

The scope of the OHS standards The standards apply to broad-based clinical occupational health services, be they: –in-house services in the public and private sectors –commercial occupational health providers from single handed providers to large organisations They do not apply to non-clinical services, e.g. occupational hygiene, ergonomics, etc. They reflect existing professional guidance

Aims Enable OHS to identify the standards of practice to which they should aspire Credit good work being done by high quality OHS, providing independent validation that they satisfy standards of quality Raise standards where they need to be raised Help purchasers differentiate OHS that attain the desired standards from those that do not

Voluntary or mandatory? Accreditation will be a pre-requisite for NHS Plus membership

NHS Plus Accreditation NHS Plus Accreditation Standard Requirement FOM StandardsMeet the FOM standards for Occupational Health providers in full NHS Plus core servicesDeliver a range of core services comprising; organisational, prevention, early intervention, employment matters, rehabilitation, promotion of health & training support NHS Plus delivery standardsMeet specified waiting and delivery targets NHS Plus business standards Demonstrate the use of an appropriate costing model and memorandum trading accounts and utilise an annual business plan NHS Plus evidence based clinical standards Demonstrate active participation in clinical audit and application of specified NHS Plus evidence based guidelines

The standards 13 standards are grouped into 6 domains: A.Business probity B.Information governance C.People D.Facilities and equipment E.Relationships with purchasers F.Relationships with workers

The standards Business probity A1Conduct business with integrity A2Maintain financial propriety Information governance B1Maintain adequate OHCRs B2Implement systems to protect confidentiality People C1Ensure staff are competent C2Ensure appropriate supervision

The standards Facilities and equipment D1 Conduct business in safe, accessible and appropriate facilities D2Ensure that medical equipment is safe and appropriate D3Ensure that medicines are handled appropriately Relationships with purchasers E1Deal fairly with purchasers E2Be customer focused Relationships with workers F1Ensure that workers are treated fairly F2Respect and involve workers

Standard A1 An OHS must conduct its business with integrity Minimum requirements: The following minimum requirements apply to all OHS: A1.1An OHS must only publish information about services which is factual and verifiable The following additional minimum requirement applies to all OHS except single-handed practitioners: A1.2An OHS must take reasonable steps to ensure that all of its staff are honest and trustworthy The following additional minimum requirement applies to an OHS that outsources work to another organisation: A1.3 An OHS must maintain systems to check the qualifications of and monitor the standard of work that is outsourced to third party providers

Examples of evidence A1.1A file containing all information about the service published in leaflets or on a website or in CV’s and used for the purpose of promoting its services with objective data to verify that the information is factual and verifiable A1.2A documented procedure for recruitment and selection processes that includes obtaining references As a minimum, a system of self declaration for criminal convictions and any investigations or disciplinary action by an organisation responsible for regulating a health care professional, e.g. GMC, NMC, HPC A1.3Documentation of regular contract performance reviews

Customer survey E1.1 An OHS must provide purchasers & potential purchasers with clear & user-friendly information on fees E1.2 An OHS must agree with purchasers the extent and scope of any business continuity planning that is required to protect service delivery E1.3An OHS must agree with customers, at the outset, the processes for referrals to the OHS, case management and reporting of cases of occupational disease and any onward referral of workers for further investigation E2.1 An OHS must be in touch with individual purchasers to understand their culture, values & needs based on reliable and recent information E2.4 An OHS must use formal & informal methods to regularly seek information about customer satisfaction from purchasers & referring managers

Assessment & accreditation Register for information Register as a user / input OHS details Upload evidence against minimum requirements Perform self-assessment / develop action plans Apply for accreditation

Application Will include an attestation to: –meeting eligibility criteria –providing true and contemporaneous information –complying with all applicable laws and regulations and –having appropriate insurances Must be signed or co-signed by at least one registered health professional

Assessment & accreditation SEQOHS manager assesses readiness for audit Online assessment by 2 auditors On-site audit by 2 auditors Accreditation Annual self- assessment Verified by SEQOHS manager Apply for accreditation At least once every 5 years

What happens if an OHS fails? It depends on what the challenges are Clear recommendations Timescales for improvement Direct support from the SEQOHS office to attain full accreditation We want services to pass, it’s a supportive process We want services to pass, it’s a supportive process

Web-based tool Online self assessment tool Evidence record for external audit Knowledge management system

Knowledge Management System Introduction Top 5 KMS Downloads Latest Uploads Search KMS  Presentations Domain to search Standard to search Minimum requirement to search Text to search for Knowledge Management System

How do I find out more? Online: STANDARDS Hard copy: Faculty of Occupational Medicine 6 St Andrews Place Regent’s Park London NW1 4LB

How do I find out more? ACCREDITATION FOM Winter Conference: 1 st December 2010 Royal College of Physicians Regent’s Park London Online: SEQOHS will have its own web address