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Occupational Medicine Advance Access originally published online on January 16, 2007
Occupational Medicine 2007 57(3):210-213; doi:10.1093/occmed/kql161
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© The Author 2007. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Short Reports

What determines the size of occupational health services in UK universities?

Katherine M. Venables and Steven Allender

Department of Public Health, University of Oxford, Oxford OX3 7LF, UK

Correspondence to: Katherine M. Venables, Department of Public Health, University of Oxford, Oxford OX3 7LF, UK. Tel: +44 1865 289227; fax: +44 1865 289260; e-mail: kate.venables{at}dphpc.ox.ac.uk


   Abstract
Top
 Abstract
Introduction
 Methods
 Results
 Discussion
 Conflicts of interest
 References
 
Background There is wide, largely unexplained, variation in occupational health (OH) provision between UK employers.

Aim To explain the variation in OH provision across the UK university sector.

Methods Analyses of data from a survey of university OH services and from the Higher Education Statistics Agency. The outcome variable was clinical (doctor + nurse) staffing of the university's OH service. The explanatory variables examined were university size, income, research activity score and presence or absence of academic disciplines categorized by an expert panel as requiring a high level of OH provision.

Results All 117 UK universities were included and 93 (79%) responded; with exclusions and incomplete data, between 80 and 89 were included in analyses. There was wide variation in clinical OH staffing (range 0–8.4 full-time equivalents). Number of university staff explained 34% of the variation in OH staffing. After adjusting for other factors, neither the research activity nor the presence of high-needs disciplines appeared to be factors currently used by employers to determine their investment in OH.

Conclusions Government or other guidelines for university employers should take organizational size into account. Employers may need guidance on how to provide OH services proportionate to specific occupational hazards or other OH needs.

Keywords      Health services research; occupational health services; universities


   Introduction
Top
 Abstract
 Introduction
Methods
 Results
 Discussion
 Conflicts of interest
 References
 
Occupational health (OH) was not included in the UK National Health Service (NHS) at its inception in 1948 and UK legislation does not prescribe the professional OH advice and services employers should fund. Universities have complex OH needs [1] but low OH staffing and considerable variation: the range of full-time equivalents (FTE) for university OH nurses was 0–7.9 and for doctors 0–3.25 [2]. To explore the investment behaviour of employers, we carried out a secondary analysis within our 2002–04 survey of all 117 publicly funded UK universities [2].


   Methods
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 Abstract
 Introduction
 Methods
Results
 Discussion
 Conflicts of interest
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The outcome variable was the sum of FTE from doctors and nurses, a surrogate for employer investment because financial information was lacking and the time of doctors and nurses is the largest cost. Intuitively, ‘clinical FTE’ appears meaningful for employers and OH professionals.

University size and income, research activity and high OH ‘need’ academic disciplines were the institutional determinants of investment in OH considered for the multivariate analysis. Higher Education Statistics Agency (HESA) data for 2003–04 provided numbers of staff and students, total income and income from research grants and contracts. Two research variables were considered: percentage of total income from research grants and contracts and a score out of 200 derived from the UK's 2001 Research Assessment Exercise [3]. HESA uses 47 staff cost centres and 160 student subject areas. Nine occupational physicians independently assigned each group an OH-needs score from 5 (highest) to 1 (lowest); groups whose median was 5 were called ‘high’: medicine, dentistry, veterinary science and nursing. OH service factors were examined in a univariate analysis using information from telephone and mailed surveys described elsewhere [2]. Analysis used SPSS 13.0 and STATA 8.


   Results
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 Abstract
 Introduction
 Methods
 Results
Discussion
 Conflicts of interest
 References
 
Of 93 respondents, four outliers were excluded, and clinical FTE was missing for five. The doctors and nurses in these 84 OH services contributed 129 clinical FTE. The distribution of clinical FTE was unimodal with a median of 1.1 (range 0–8.4) (see Supplementary data at Occupational Medicine Online, Figure 1).

Numbers of staff, students, postgraduate students and undergraduate students were related with correlation coefficients from 0.47 to 0.97 (all P < 0.001) (see Supplementary data at Occupational Medicine Online, Table 1 and Figure 2). We therefore used only number of staff. Total income was highly correlated with income from research grants and contracts (r = 0.95) (see Supplementary data at Occupational Medicine Online, Figure 2) and with number of staff (r = 0.96), so income was not considered further. There was also a correlation between the two research variables (r = 0.82) (see Supplementary data at Occupational Medicine Online, Figure 2) and we chose the score out of 200. Medical, dental and veterinary schools clustered within universities, which had larger OH services than those without (Table 1). Universities with a nursing school alone had services of intermediate size so we condensed high OH need to the presence of a medical, dental or veterinary school.


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  		Table 1. OH service clinical FTE by university disciplines associated by an expert panel with high OH needs and by OH service factors

 
In univariate regression analyses, number of staff was the strongest predictor and alone explained 34% of the variance in clinical FTE; presence or absence of a medical, dental or veterinary school explained 12% and research score 5%. In the multivariate model, variance in clinical FTE explained was unchanged at 35% and the coefficient for number of staff was stable, but the coefficients changed for high-needs disciplines and research quality score, with wider confidence intervals, suggesting they were partly explained by university size and by each other (see Supplementary data at Occupational Medicine Online, Table 2).

Figure 1 illustrates the interrelationships between clinical FTE, number of university staff and high-needs disciplines. The universities with medical, dental or veterinary schools are distributed around the fitted regression line of clinical FTE on number of university staff, which would not have been seen if these disciplines consistently stimulated investment in OH. Figure 1 also illustrates the guidance on OH staffing for hospitals developed by Association of National Health Service Occupational Physicians (ANHOPS) [4].


Figure 1
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  		Figure 1. Scatter plot and regression line of OH service clinical FTE on number of university staff indicating presence or absence of a medical, dental or veterinary school. *1 excluded outlier with a medical, dental or veterinary school. *2 excluded outlier without a medical, dental or veterinary school.

 
Contracted and in-house OH services were similar in size. The longer the university had had an OH service, the larger the service. Doctor-led services were larger than nurse-led services. Services with engagement in university management via the health and safety management committee were larger than others (Table 1).


   Discussion
Top
 Abstract
 Introduction
 Methods
 Results
 Discussion
Conflicts of interest
 References
 
The most important association of clinical FTE was with university size. Large UK enterprises are more likely to provide an OH service than small enterprises [5] but we are not aware of other quantitative research, although the finding is hardly surprising. The ANHOPS guidelines [4], for example, make the implicit assumption that OH staffing should be proportionate to staff numbers. Interestingly, the OH staffing in the average NHS hospital is about three times greater than in the average university [2] a disparity not explained by organizational size because the median number of NHS employees is ~3200 [6] but 2436 in universities, rising to 20 281 if students are included.

Neither high OH-needs disciplines nor increasing research score were associated with OH staffing after adjustments. A priori, a medical, dental or veterinary school implies health surveillance, immunizations, assessments of fitness to practise and related policy development and it is surprising that these universities did not have larger OH services. The change in regression coefficient for research score from positive to negative implies that the more research-intensive universities may be investing less, proportional to their size and profile of academic disciplines, than others.

Several OH service factors were associated with clinical FTE, although this may be reverse causation with larger services more likely, for example, to be represented in the university's committee structure. There were some surprises in the analytical detail. Universities with nursing schools but no medical, dental or veterinary school had smaller services than expected. External contractors' services were somewhat larger than in-house services, a finding which may contradict a common assumption by employers that out-sourcing reduces costs.

We recommend that university size should be included explicitly in guidelines for OH staffing. The needs of students should be considered as well as those of staff—if only 10% of the 2 250 000 students [1] require OH services, this would almost double the size of the population served. Benchmarking against other large employers, such as the NHS, may be useful. There was no evidence that high research activity or high OH-needs disciplines are stimulating investment in OH, which suggests that universities may need guidance on the detail of OH provision.


   Conflicts of interest
Top
 Abstract
 Introduction
 Methods
 Results
 Discussion
 Conflicts of interest
References
 
None declared.


   Acknowledgements
 
This forms part of a larger project [the Occupational Health Services in Higher Education project (GMP229)] funded by the Higher Education Funding Council for England as part of its initiative on developing good management practice. Full acknowledgements to the Funding Council and other agencies and individuals are included elsewhere [1,2]. For this research, Alastair McCall of the Sunday Times provided information about the derivation of the global assessment of research quality and Philip Carrivick, Gordon Hamilton, Christine Rajah, Susan Robson, Alan Swann, Denis Todd, Nigel Wilson and Gerard Woodroof formed the expert panel who assigned OH need scores to university disciplines.


   References
Top
 Abstract
 Introduction
 Methods
 Results
 Discussion
 Conflicts of interest
 References
 

  1. Venables KM, Allender S. Occupational health needs of universities: a review with an emphasis on the United Kingdom. Occup Environ Med (2006) 63:159–167.[Abstract/Free Full Text]

  2. Venables KM, Allender S. Occupational health provision in UK universities. In: Occup Med (Lond). doi: 10.1093/occmed/kql160.

  3. The Sunday Times. The Sunday Times University Guide 2005: The Sunday Times University League Table. http://www.timesonline.co.uk/section/0,8403,00.html (25 November 2005, date last accessed).

  4. Association of National Health Service Occupational Physicians. Assessing the Occupational Health Manpower Levels for NHS Trusts (2). http://www.anhops.com/docs/35_9_ANHOPS_manpower.doc (24 November 2005, date last accessed).

  5. Pilkington A, Graham MK, Cowie HA, Mulholland RE, Dempsey S, Melrose AS, Hutchinson PA. Institute of Occupational Medicine for the Health and Safety Executive. Survey of use of occupational health support: contract research report 445/2002. (2002) Norwich: HMSO.

  6. Hughes A, Philipp R, Harling K. Provision and staffing of NHS occupational health services in England and Wales. Occup Environ Med (1999) 56:714–717.[Abstract/Free Full Text]


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This Article
Right arrow Abstract Freely available
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