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April 13, 2010

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Why occupational health services should be the lynchpin of worker health

Standards aimed at raising the overall quality of occupational-health services1 were launched in the UK in January this year. Dr Paul Nicholson summarises why they should be the lynchpin of the drive to improve workers’ health.

The Occupational-Health Service Standards for Accreditation were developed in response to Dame Carol Black’s review of the health of Britain’s working-age population, ‘Working for a Healthier Tomorrow’,2 published in March 2008. The review advocated clear standards of practice and formal accreditation of all providers who support people of working age.

This drive for standards follows similar initiatives aimed at improving the National Health Service. In 2006, the Department of Health published ‘Standards for Better Health’,3 which require a rigorous approach to assessment and accreditation of providers of NHS services. Lord Darzi’s subsequent report, ‘High-quality care for all: NHS next-stage review’,4 confirmed government support for provider accreditation schemes in the NHS. ‘Working for a Healthier Tomorrow’ makes it clear that standards are also expected for services that operate, for the most part, outside of the NHS.

Developing the standards

Following the recommendation in Dame Carol’s review, the Faculty of Occupational Medicine invited stakeholders to join a working group to develop standards. This group met for the first time in October 2008, and included 47 people from 35 different bodies, representing occupational, medical and nursing organisations, commercial occupational-health providers, government departments, and employer and worker representative bodies.

Funding for the meetings and the publication of the standards was provided by the Department of Health – a key customer, as the standards will be applied to all NHS Plus occupational-health departments, i.e. more than 100 departments that also provide their services outside of the NHS.

Draft standards were published in June 2009 for formal consultation, and were pilot-tested with 17 occupational-health providers from different sectors and of different sizes in England, Northern Ireland, Scotland and Wales.

The pilots revealed that a small number of minimum requirements ran contrary to the intended principle that standards should be proportionate and not cause an excessive administrative burden. In light of this, modifications were made to the draft standards, which will undergo further development with time, as a commitment to continual improvement and to accommodate changes in professional guidance and best practice.

Aims and scope

The aims of the standards and future accreditation process are to:

  • enable services to identify the standards of practice to which they should aspire;
  • credit good work being done by high-quality occupational-health services, providing independent validation that they satisfy standards of quality;
  • raise standards where necessary; and
  • help purchasers differentiate occupational-health services that attain the desired standards from those that do not.

The standards apply to occupational-health services provided by doctors, nurses and occupational-health technicians, but not to non-clinical services that may sometimes be provided as part of more comprehensive occupational-health services, e.g. occupational hygiene, ergonomics, or counselling services. Any provider of occupational-health services will be able to apply for accreditation.

The standards relate to professional activities and do not extend to an employer’s legal responsibilities, which are already addressed by existing laws and regulations. However, occupational-health services that apply for accreditation will be required to attest to meeting all applicable statutory requirements. The affirmation will have to be signed, or co-signed by at least one registered health professional.


It is worth explaining briefly some of the different terminology featured in the FoM document, in particular, the differences between ‘standards’, ‘minimum requirements’, and ‘examples of suitable evidence’.

A standard is something considered by an authority, or by general consensus, as a basis of comparison in measuring or judging adequacy or quality. In the document, standards are expressed as something that occupational-health services “must” do as an overriding duty of principle in order to meet the requirements for accreditation. They provide the basis for evaluating quality of service and will evolve over time. Each standard can normally be met in more than one way and, in each case, various minimum requirements and examples of suitable evidence are described.

Minimum requirements must be met to satisfy the standards, and many of them relate to statutory or professional responsibilities. They are intended to be well-defined and easy to understand.

Examples of suitable evidence are the records that applicants can use to show that they meet the standards and the minimum requirements. Examples are indicative and only illustrate the kind of information that can be used – they are neither prescriptive, nor exhaustive. Service-providers are at liberty to provide whatever they consider to be the most convincing evidence they have available for their achievement of each standard and minimum requirement.

The standards should present no surprises to the good and credible occupational-health provider, since they reflect existing ethical and professional guidance.

Furthermore, not all minimum requirements apply to all occupational-health services. For example, a practitioner who doesn’t provide facilities or equipment will have to satisfy fewer than half of the requirements. Where the standard and/or any of the minimum requirements are not applicable, the provider must sign a declaration to confirm that this is the case.

In an effort to be proportionate and to avoid duplication of work on the part of occupational-health services, other certification will be accepted as evidence, where appropriate. For example, those providers who are accredited to ISO 9001 or ISO 27001 will be able to submit that certification as evidence of meeting the standards for information governance, without having to collate any further evidence.


Such is the level of interest in, and support for, the standards, three occupational-health services volunteered to be pilot sites for accreditation immediately after the standards were launched. Developing and managing an accreditation scheme requires the rights skills and experience, so the process will be contracted out to an accreditation/certification body. The Faculty of Occupational Medicine shall continue to own the standards, but the chosen accreditation body will be responsible for operating the scheme.

Accreditation will be a voluntary and cyclical process. It will provide independent validation that an occupational-health service has demonstrated competence measured against the standards, and is considered to be fit for purpose. Assessment is likely to include a combination of:

  • pre-qualification questionnaire – to include an affirmation that the provider is eligible, will provide truthful information, and complies with all applicable laws;
  • Web-based assessment – to facilitate online submission of evidence to determine the readiness for an on-site assessment visit;
  • customer satisfaction surveys – from a sample of customers and seeking answers to pre-determined questions;
  • on-site external audit, at least every five years; and
  • self assessment – in years when an external audit is not performed.

External auditors will include occupational-health business managers, occupational-health nurses and occupational physicians, and they will be recruited through their professional bodies.

As part of the launch of the accreditation scheme there will be accompanying guidance aimed at employers to help them understand what they should expect from a quality occupational-health service.

Purchasers’ responsibilities

Even before accreditation goes live, purchasers should ask occupational-health services if they comply with the standards and what steps they are taking to implement them. Once accreditation is launched the process should be simplified, since purchasers will be able to check online to see if potential providers are accredited to the standards.

The standards and accreditation scheme do not obviate the need for a purchaser to use due diligence when selecting an occupational-health service. It is the responsibility of a purchaser to take reasonable steps to arrange for a competent assessment of their occupational-health needs. That assessment may be performed by the contracted service, or by some independent competent advisor ahead of tendering for services. It is the joint responsibility of a purchaser and the occupational-health service to agree, within their contract or service-level agreement, the scope of services provided.


The standards provide occupational-health services with a framework for quality-assurance measures that should help raise the overall standard of care provided by such services in the UK. They also endeavour to ensure that those paying for occupational-health services receive services of a sufficiently high quality. Most importantly, however, it is hoped that the standards and accompanying accreditation scheme will help make a meaningful difference to the health of people of working age.


1  Faculty of Occupational Medicine (2010): ‘Occupational Health Service Standards for Accreditation’,
2  ‘Working for a Healthier Tomorrow’ (2008):
3  Department of Health (2006): ‘Standards for Better Health’, available at
4  Department of Health (2008): ‘High-quality care for all: NHS next stage review’, available at

Dr Paul Nicholson is the Faculty of Occupational Medicine’s clinical lead for occupational-health services standards.


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