John O’Donnell, Director, Express Medicals Ltd, reports on better provision of occupational health by considering a number of delivery models.
An interesting model can be seen during the period of the Second World War. Winston Churchill, who was then in his 70s, had an extremely demanding role. Travel demands included trips to Washington, Moscow, Cairo and Yalta.
Whether travelling on a Royal Navy ship or flying on an RAF converted bomber Churchill was always accompanied by his personal physician, Lord Moran.
This can be viewed as the ultimate delivery model in which there is one-to-one attention with immediate referral to appropriate supporting professionals and all the advantages that come from such close attention. Such a delivery model is ideal for specific individuals such as heads of state.
Another model has evolved in the context of modern sports such as football and rugby. A team of medical professionals working under professional leadership support individual sportsmen and women and their teams.
For example, a premiership football club will have an in-house sports doctor who will deal with the club’s medical requirements. The doctor will have access to an array of appropriate investigative equipment (eg : scans of injured joints) and treatments (eg : rehabilitative physiotherapy).
A third model was seen in large manufacturing companies, employing thousands of workers on large company sites, during the twentieth century. This model was characterised by the provision of a dedicated on-site medical centre which was staffed by company doctors and nurses.
The core services included pre-employment questionnaires and medical examinations, the treatment of workplace injuries and the holding of occupational medical records.
The Static Model
A fourth model is a direct descendant of the previous one. This variant on model three relates to very large construction sites.
Readers can learn about such an example by consulting the following publication issued by the ODA (Olympic Delivery Authority), “Be safe Be healthy” (2010). Once again, the key component of this delivery model is the provision of a dedicated medical centre (on-site as opposed to in-house) with dedicated medical and complementary staff.
The ODA says that more than 10,000 pre-employment health checks and nearly 3,000 full medicals were carried out. A progressive approach is taken to the deliverance of wellbeing services to the workforce.
Working in partnership with the Department of Sexual Health from Homerton Hospital, the Hackney Diabetes Centre and the Men’s Health Forum, the medical team was able to deliver an array of health initiatives to the workforce.
Projects addressed diet, smoking, exercise, blood pressure and sexual health. On a big site with thousands of workers this is clearly a model that has much to commend it.
However, it is limited as the on-site medical centre is closed at the conclusion of the project, leaving no occupational health legacy.
The ABC Model – adaptable, bespoke and commercial
A fifth model is that developed by Express Medicals Ltd, over the past 15 years in response to clients’ requests. This has enabled Express Medicals to deliver some 90,000 medical examinations over the previous 5 years.
The core components of the model have been designed to meet the needs of construction and transport companies with locations across Great Britain.
Whilst some client companies have large sites, we have been very mindful that large numbers of companies have workers scattered on sites of varying size, some being quite small, throughout the country.
This model optimises service to client companies by offering the flexibility to attend multiple sites of varying size from huge to tiny, in multiple locations and at very short notice.
Express Medicals said:
‘We deliver our services from three sources. We have two fixed medical centres in London and Stoke. We have mobile staff who can visit any site at home or abroad and we have session clinics across the country.
‘This gives us the flexibility to solve client needs in different ways at a value–for–money cost. The model enables the delivery of a wide range of services, including the provision of traditional occupational health services (eg : surveillance, fit-for-task medicals and referral to a diverse array of medical consultants and other specialists) and innovative wellbeing services.
‘Model five includes an occupational health legacy where an on-site medical centre has been used as part of the delivery vehicle.
‘Administratively, any on-site medical centre functions as part of our total facility with all the long-term advantages that this brings.
‘For example, records will be stored within the database of all our records and medical facilities will still be available for workers requiring services after an-site project ceases.’