Occupational health in the new NHS.

Editorial Occupational Health in the new NHS Occupational health services in the National Health Services (NHS) came late and still vary from district to district both in quantity and quality of service. From small beginnings, the provision of occupational health services has expanded and now every health district either has its own service or has hospitals within it with services oftheir own. Most of these services are nurse based, although few are nurse led; despite the cliche that occupational health is a team based endeavour, there seem to be few doctors who are not prepared to be leader of the team. Substantially more occupational health nurses than occupational physicians are found within the NHS, however, and the medical input is relatively small; most often provided by part time physicians, many of whom have no special training or qualification in occupational health. There are few consultants in occupational medicine within the NHS and fewer training posts and although agreement has been reached recently with the Department of Health to establish more posts of senior registrar, it is certain that there will never be enough training posts to ensure that each district has its own consultant. One of the great drawbacks of occupational health in the NHS is the lack of uniformity either of provision of service or of the type of service which is offered. The staffmay comprise a couple ofnurses and a part time clinical assistant giving no more than the most basic care up to a few large units employing several nurses, a consultant and other physicians (perhaps including a trainee), an occupational hygienist, staff counsellors, and other specialists brought in on an ad hoc basis. There is presently no agreement on the basic requirements of an occupational health unit within the NHS and some attention to this is long overdue. Similarly, there is no uniformity of note keeping and not even any mechanism for the transfer of notes when a member ofstaffmoves from one health district to another. It is quite likely, for example, that when a nurse moves to another hospital she will be treated as a new employee and asked to complete a pre-employment questionnaire (which she will already have done at least once before). She may have to attend for (another) health assessment, she may well be required to submit to another Heaf test and a blood test to establish her concentration ofantibodies to hepatitis …