Trends in NHS doctor and dentist referrals to occupational health

BACKGROUND: Ill-health in doctors can affect performance and fitness to practice, and consequently patient care and safety, placing an important responsibility on National Health Service (NHS) occupational health (OH) services. Anecdotal discussions amongst NHS occupational physicians suggest an increase in the number of doctor attendances over time, with continuing focus on mental illness. AIMS: To analyse OH referrals in doctors and dentists over 3 years. METHODS: A retrospective evaluation of all doctor and dentist referrals to the OH service in one Scottish NHS board from April 2011 to March 2014, comparing this to management-reported sickness absence (SA) data held by the organization. RESULTS: We found no significant change in overall OH referrals for doctors and dentists during the evaluation period. Mental illness was the commonest referral reason in all 3 years at 32, 38 and 30%, respectively, but no significant change in mental health referrals was demonstrated within the study period. SA events significantly increased during the three study years (356, 426 and 469, respectively; P < 0.05). OH referrals for those absent from work increased significantly between Years 1 and 3 (16 and 30, respectively; P <0.05). CONCLUSIONS: SA events and OH referrals for those absent from work significantly increased between April 2011 and March 2014, but there was no commensurate (statistically significant) increase in overall OH referrals. These findings do not support anecdotal suggestions of increasing OH (or mental ill-health) attendances but can be used as a benchmark for other NHS organizations and for future trend comparisons

Differences in opinions of occupational physicians on the required competencies by field of practice: results of an international Delphi study

Background: The activities and work demands of medical professionals, including occupational physicians (OPs), fall into three categories: clinical, academic, and administrative. Work demands of an OP consist of these three categories and additional specialty specific roles and competencies. Research on the core competencies and skills required for OPs have identified high levels of consensus amongst OPs internationally, however these opinions have not been examined between areas of practice specific groups. Furthermore, it has been identified that to a large extent academics are often the group who define the skills required of OPs. The aim of this study is to compare the opinions of OPs grouped by field of practice on the common core competencies required for occupational health (OH) practice using results from an international survey. Methods: An international modified Delphi study conducted among OPs, completed in two rounds (Rating-Round 1; Ranking-Round 2) using developed questionnaires based on the specialist training syllabus of a number of countries and expert discussions. Respondents were categorised as Physician, Manager/Physician, and Academic/Physician, based on self-reported job titles and place of work. Results: There was good agreement between the Physician and Manager/Physician groups, with the Academic/Physician group deviating the most. The top three and bottom three principle domains (PDs) were in good agreement across all groups. The top three were clinically based and would be considered core OH activities. The PDs with considerable intergroup variance were Environmental Issues Related to Work Practice and Communication Skills, categories which may reflect direct relevance and relative importance to the job tasks of respective groups. Conclusion: This study demonstrated general agreement between the three occupational groups. Academic/Physician opinions deviate the most, while good agreement is depicted between the Physician and Manager/Physician groups. The findings of this study can help identify potential gaps in training requirements for OPs and be used as a stepping stone to developing training programmes that are reflective of practice and tailored for those predominantly undertaking these specific roles

Emergency Response Improvement Project

The objective of this CNL internship project is to improve team response to emergencies through staff education and protocol development with 100% participation within six months. This need was determined after an intense analysis following a near code on a pediatric patient. After an investigation, two problems were chosen as a focus for improvement: limited educational opportunities, and poor coordination and delegation during codes. Lewins’s theory of change was used as the theoretical framework, which involves the concept of unfreezing, movement, and refreezing. The method utilized was to offer education and training sessions twice per month in the form of a mock code blue scenario. The timeline was six months and included the following action items: investigate the microsystem, conduct development meetings, develop an educational curriculum, conduct mock codes, and evaluate the outcomes. The action items were carried out by a combination of the CNL, the CNS/educator, and the team. The activities in the timeline were completed through the first PDSA cycle and its evaluation. Six nurses attended the course along with the CNS/educator. A debriefing was held and questionnaires were handed out and later returned for analysis. The final outcome for the specific aim was not completed but current participation stands at 24%. The participants overwhelmingly state an improvement in skills and a reduction in the stress with regard to their involvement in the mock code and their confidence about functioning in an emergency situation in the future. The recommendation is to continue with the PDSA cycles twice per month until all of the pediatric nurses have received the course, and then continue with the cycles once per month to engage the remainder of the staff

Constructing the social in the fiscal: A discourse analysis of Irish budget speeches (1970-2015)

Budget speeches are important discursive institutional practices in which fiscal and monetary policy are presented to parliaments on an annual basis. The issue of ideology and the contingent nature of discourse is rarely considered with budgets delivered in specific policy contexts presented as pragmatic truth statements unhindered by the distorting lens of ideology. Employing contributions from post-structural discourse theory, dialogism, critical realism and corpus linguistics this thesis addresses three research questions: what discourses are employed in Irish budget speeches from 1970 to 2015? How are these discourses structured? How are social imaginaries and subject positions constructed through these discourses? Methods consist of a preliminary close reading informed by post-structural discourse theory of a sub-corpus of Irish budget speeches from 1970 to 2015; this initial stage provides periodisation and insights into the structural composition of discourse within Irish budget speeches during this period. The second method involves the application of keyword and concordance analyses to examine the changing composition of keywords and their semantic meanings over time, using the periodisation derived from the initial close reading. It is found that Irish budget speeches are structured around four discourses, a left-liberal discourse from 1970-1977, a period of extended dislocation from 1978-1982, a soft-neoliberal discourse from 1983-2008 and a neoliberal austerity discourse from 2009-2015. The thesis presents a novel periodisation of the structure of Irish budgetary discourse, models those discourses while illustrating methodological innovations and theoretical developments to the field of post-structural discourse theory and discursive institutionalism respectively

Working Health Services Scotland: a four-year evaluation

Background: Working Health Service Scotland (WHSS) supports the self-employed and employees of small and medium-sized enterprises (SMEs) in Scotland with a health condition affecting their ability to work, who are either absent or at risk of becoming absent due to it. Aims: To evaluate the impact on health and work outcomes of WHSS clients over a 4-year period. Methods: Data were collected at enrolment, entry, discharge and follow-up at 3 and 6 months after discharge. Clients completed up to three validated health questionnaires at entry and discharge—EuroQol five dimensions (EQ-5D) and visual analogue scale (VAS); Hospital Anxiety and Depression Scale (HADS); and Canadian Occupational Performance Measure (COPM). Results: A total of 13463 referrals occurred in the 4-year period; 11748 (87%) were eligible and completed entry assessment and 60% of the latter completed discharge paperwork. The majority of referrals were due to musculoskeletal conditions (84%) while 12% were referred with mental health conditions. Almost a fifth (18%) of cases were absent at entry and back at work at discharge. Work days lost while in WHSS was associated with age, length of absence prior to entering WHSS, primary health condition and time in programme. All health measures showed significant improvements from entry to discharge. Improvement in general health was sustained at 3- and 6-month follow-up. Conclusions: The WHSS evaluation findings indicate that participation was associated with positive changes to health and return-to-work. The extent of the positive change in health measures and work ability can be highly important economically for employees and employers

Case management training needs to support vocational rehabilitation for case managers and general practitioners: a survey study

<b>Background</b><p></p> The use of the biopsychosocial model of health and case management for effective vocational rehabilitation (VR) has been confirmed for many health conditions. While Case and Condition Managers (CCMPs) use this approach in their everyday work, little is known about their views on training needs. A review of the training curriculum for General Practitioners’ (GPs) revealed little training in VR and the biopsychosocial model of care. This study aims to identify Case and Condition Managers and GPs perceptions of their training needs in relation to employability and VR.<p></p> <b>Methods</b><p></p> 80 Case and Condition Managers and 304 GPs working in NHS Lanarkshire, providing a comparison group, were invited to participate in this study. A self-completion questionnaire was developed and circulated for online completion with a second round of hardcopy questionnaires distributed.<p></p> <b>Results</b><p></p> In total 45 responses were obtained from CCMPs, 5 from occupational health nurses (62% response rate) and 60 from GPs (20% response rate). CCMPs and the nursing group expressed a need for training but to a lesser extent than GP’s. The GP responses demonstrated a need for high levels of training in case/condition management, the biopsychosocial model, legal and ethical issues associated with employment and VR, and management training.<p></p> <b>Conclusions</b><p></p> This survey confirms a need for further training of CCMPs and that respondent GPs in one health board are not fully equipped to deal with patients employability and vocational needs. GPs also reported a lack of understanding about the role of Case and Condition managers. Training for these professional groups and others involved in multidisciplinary VR could improve competencies and mutual understanding among those advising patients on return-to-work

Comparison of competency priorities between UK occupational physicians and occupational health nurses

Objectives: The competencies required of occupational physicians (OPs) and occupational health nurses (OHNs) separately have been studied in various countries but little research has made direct comparisons between these two key occupational health (OH) professional groups. The aim of this study was to compare current competency priorities between UK OPs and OHNs. Methods: A modified Delphi study conducted among professional organisations and networks of UK OPs and OHNs. This formed part of a larger Delphi, including international OPs. It was undertaken in two rounds (round 1—‘rating’, round 2—‘ranking’), using a questionnaire based on available OH competency guidance, the literature, expert panel reviews and conference discussions. Results: In each round (rating/ranking), 57/49 and 48/54 responses were received for OPs and OHNs respectively. The principle domain (PD) competency ranks were very highly correlated (Spearman’s r=0.972) with the same PDs featuring in the top four and bottom three positions. OPs and OHNs ranked identically for the top two PDs (good clinical care and general principles of assessment and management of occupational hazards to health). Research methods was ranked lowest by both groups. Conclusions: This study has observed a high level of agreement among UK OPs and OHNs on current competency priorities. The ‘clinically focused’ competency priorities likely reflect that although OH practice will broaden in response to various factors, traditional ‘core’ OH activities will still be required. These mutually identified priorities can serve to strengthen collaboration between these groups, develop joint education/training programmes and identify common professional development opportunities

Using Cognitive Mapping to Longitudinally Examine Political Brand Associations

This paper uses cognitive mapping techniques to understand how brand associations, an important aspect of political brand equity are formed, differ, and change, from the perspective of citizens, across the four largest Irish political parties between 2013 and 2016. The paper focuses in particular upon the strength, favourability and uniqueness of these brand associations. The results constitute a first attempt to longitudinally explore changing political brand associations through cognitive mapping techniques, using data generated with the participation of hundreds of citizens. Our findings suggest that this approach can contribute to our understanding of how and why political brand associations change over time

Visions of the Future in Budgetary Discourse

Whilst there is ample precedent to argue against the common-sense notion that the ideological leanings of political parties are congruent with their implementation of fiscal policy (Boix, 2000; Garrett & Lange, 1991; Hibbs, 1977; Liargovas & Manolas, 2007), there is a relative dearth of research on the role of discourse in shaping fiscal policy with one notable exception by Maatsch (2014). With this in mind, we approach the issue of examining fiscal policy through a fixed, contested and subverted within particular texts” (Howarth, 2005, p. 341). This paper examines how the future is constructed in Irish budget speeches delivered between 1970-2015 using a combination of close readings and collocate analysis of the word future over four subcorpora. We commence with a brief overview of extant literature on the role of discourse in policy process analysis before outlining our methodological approach. This is followed by an overview of key results and analysis, concluding with discussion and final remark