Page 16 - QARANC Vol 17 No 2 2019
P. 16
14 The Gazette QARANC Association
Army Occupational Health Nursing – Grass Roots Reform
Can you imagine introducing a new capability into the Army, such as the Ajax armoured fighting vehicle, without an equipment care and logistic programme to ensure the platform is ready to fight and can be sustained in battle? Whilst this sounds illogical, in comparison Defence people are our greatest and most expensive capability, yet how we measure their well-being at work, support and sustain them during periods of ill-health is at odds with this reality. As we enter a new paradigm, we witness an evolution in the employment environment having to meet the needs of four different generation types, high rates of civil-sector employment, an aging Army population and a contested recruitment and retention environment. To counter this, a blended model of employment types, commitment lengths and flexible working opportunities have emerged from our policy makers; however, such positive moves are undermined by an Occupational Health (OH) system designed for a different era whose design, architecture and effects are now somewhat misaligned. Critics examining healthcare system reform (Tuohy 1999)1 suggests that healthcare reform occurs as a result of a significant crisis or shifting paradigms, a notion that resonates with the challenges faced by the current OH system.
It was this stark reality that catalysed the energies of the Defence OH Nursing and Therapy community, who following a challenge set by the Chief of Defence People, seized an opportunity in April 2017 to undertake a comprehensive review of OH support to Service Personnel and their employers. The community drew upon P3M© tools such as Stakeholder Analysis and Benefit Realisation Mapping to help shape analysis. It was important to the group to be aware of unconscious biases and professional interests, as these were likely to skew emerging themes. After a great deal of hard work to understand the requirement, examining the evidence base and agreeing areas of best practice, the Defence Fit for Work Network (FfW) was born. Its first task was to make a clear proposition to senior Nursing and Healthcare leaders,
Major Nancy Marriot in action galvanising concepts from the team
to outline what supporting OH effects are now needed, and the role that could be played by Nurses and Occupational Therapists in their delivery. The proposition exploited gaps in service provision and galvanised areas of care where the network already makes a real difference.
FfW focused on three of the five through-life Epochs of Live Well, Work Well and Leave Well as defined by the Defence Health and Wellbeing strategy2, delivering expertise across each theme to address the determinants of ill-health, their impact on employment to enable a deployable and sustainable workforce. Central to the proposition was empowerment to deliver a Nurse-led Fit for Work assessment, conducted at the point of need [in the workplace] improving the validity, reliability and timeliness of advice on employability and deployability. A discrete number of supporting effects would follow, including novel routes of referral, vocational rehabilitation techniques, work-place assessments, making every contact count with public health interventions, and finally transitional support to those leaving Defence. The group agreed that the key to future success was the re-alignment of the uniformed OH Nurse capability from the Joint delivery arena back to the Army, bringing OH closer to the employer in order to influence and inform decision making, not only in the firm base but whilst on operations. A defining requirement was the need for a broader rank-range of OH Nurses from OR 6 – OF4, introducing the notion of a career pathway that harnesses the tactical understanding and expertise of the SNCO Nurse, exploiting that talent and progressively developing their OH KSE and academic acumen up to Nurse Consultant status.
Since the proposition was made the network has continued to work hard to promote the FfW brand and to explore the lines of development in relation to the key OH effects and deliverables. In March 2018, the Defence Fit for Work Network conducted its second workshop at DMS Whittington to update and review progress made. The work achieved in year one is remarkable with a number of sub-groups authorising themselves to lead, explore and identify change
2 Informed through the Defence Annual Health and Wellbeing Report 2015. The five ‘Epochs’ being Join Well, Train Well, Live Well, Work Well & Leave Well.
1
Tuohy CH (1999) Accidental logics: The dynamics of Change in the Healthcare arena in the United States, Britain and Canada. Oxford: Oxford University Press.
OH Nurses and OTs working collaboratively to plan new models for delivery