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Network health clinics

Stewart Thorpe went to the doctors to learn about a bold new approach to occupational health


New life has been breathed into a derelict building at London Victoria station. Behind the station’s customer service desk next to Platform 1, Network Rail has opened a bespoke occupational health (OH) clinic for its 3,500 members of staff on the South East route. 

The Victoria site opened earlier this year as a pilot for a planned network of around 20 centres that will open across the country in the next 18 months – a network that sits at the heart of the organisation’s new “Back to Basics” OH and wellbeing strategy.

‘One-stop shops’

Rather than staff attending multiple appointments on different days and sites, the clinics aim to operate as “one-stop shops” for managing their health needs, according to Dr Richard Peters (pictured above), Network Rail’s chief medical officer.

“Our current service delivery model requires employees to attend for a trackside medical, this is done, but if you need to have a hand-arm vibration syndrome (HAVs) health surveillance, because you use vibrating tools as part of your day-to-day job, you’d have to come back on another day to have that health surveillance. 

“Then, if there was a problem with that, you’d again have to come back to see the doctor. That’s three separate clinical appointments, whereas here you’re having the whole thing done at once.”

Dr Peters explained that it marks a shift from having health checks completed on a perceived needs basis, as requested by line managers, to conducting them collectively in a systematic task-specific approach at newly established centres, minimising disruption. 

In the British Rail era, there were on-site health clinics that Bupa later took over. But, as Dr Peters explained, these new centres offer more comprehensive cover, putting workers through a newly designed health, safety and wellbeing medical every three years as well as delivering annual medical requirements. 

Part of this medical assessment covers mandatory health surveillances relevant to their job role – for example HAVS, noise, skin, and respiratory checks, to meet statutory requirements. Another focus is the range of voluntary health assessments that look at fatigue, mental health, cardiovascular risk scores, carbon monoxide levels and body fat, to encourage the early identification and intervention of problems before they develop further. Network Rail’s band one employees have access to health assessments every two years, but operational frontline staff have never had this offered to them. 

“I guess we’re going back to British Rail days but with a 21st century enhancement,” said Dr Peters. “I think this is a really new initiative, and I don’t think there’s any other organisations that are doing this. TfL has a very large on-site clinic, but no one I know is up at this level providing this level of medical service on one day as a one-stop shop. I don’t believe there is anyone across industries. Network Rail is therefore leading in this area.”

Tony Stalgis, rail director for Optima Health – Network Rail’s healthcare provider – works with such companies as ScotRail, Eurostar and HS2 in the rail industry, while colleagues also work in other sectors. He agreed that there is nothing that comes close to Network Rail’s new approach. 

He added: “We cover all industries as a supplier and this is a unique approach. There are different initiatives in different organisations, but this is a very, very comprehensive approach. It’s innovative and a reflection of Network Rail’s commitment to ensure the management of occupational health evolves to reflect the needs of the business.”


Network Rail plans to open clinics in the following areas: 

  • Ashford
  • Basingstoke
  • Bedford
  • Birmingham
  • Bristol
  • Cardiff
  • Derby
  • Doncaster
  • Glasgow
  • Ipswich
  • Manchester
  • Milton Keynes
  • Newcastle
  • Perth
  • Peterborough
  • Plymouth
  • Stratford
  • Swindon
  • Wrexham
  • York

An appointment at Victoria

Not all of the clinics will open at stations – plans for a centre in York involves the use of a purpose built clinic in the delivery unit – but their strategic placement will mean that 94 per cent of Network Rail staff will be within a 90 minute commute of them from their home address. 

Signage was yet to be installed at the Victoria station clinic during the visit by RailStaff in April, but it appeared to be the only major teething problem at the scheme’s pilot site.

Inside, the facility looks very much like a typical doctor’s surgery with a reception, seating area and white walls everywhere.

Instead of working in isolation, an eight-person team of OH technicians, advisors and doctors work together in the Victoria site, which is equipped with all the kit they need to conduct tests, such as drug and alcohol test toilets (the water is diluted blue to prevent sample dilution), a sound booth and consultation rooms. 

Results

By establishing a web of ‘one-stop shop’ health clinics across England, Scotland and Wales, Network Rail believes there will be a significant uplift in the number of health assessments it will be able to conduct – as evidenced by the Victoria pilot.

Looking at working at height assessments, in 2018 only ten were conducted network-wide. In the South East route, the pilot has conducted 82 in the last six weeks alone. 

Overall, 5,000 different assessments were conducted on the South East route in 2018. That number is anticipated to rise to almost 13,000 a year following the clinic’s launch. 

Dr Peters added: “The numbers that are doing night workers’ assessments, skin assessments and respiratory assessments has literally had about a 300 per cent growth in the South East because it’s not relying on line managers to refer. We’re taking that away from them and doing it on a risk-based approach based on the role of the employee. 

“We’re asking our employees specific questions like – do you work at heights, do you drive cars, do you use vibrating tools? We’ve never been in a position in Network Rail to say we’ve got all of these different ‘fitness for task’ medicals because we’ve never worked in that way, it’s always been are you medically fit to work trackside? But that doesn’t necessarily mean you’re fit to work at night, it doesn’t mean that you’re medically fit to work in confined spaces, it just means you’re medically fit to go on track.”

Not only does Dr Peters expect to see an improvement in the overall health of Network Rail’s workforce, he also expects an improvement in workforce safety, particularly surrounding driving and fatigue. 

A new data bank

The thorough way in which these health assessments are being conducted is also creating a huge data bank too, allowing health and safety managers to make informed decisions on what health risks to prioritise tackling.

For example, of the 162 employees who have been for medicals so far, 55 per cent of them are on medication for high blood pressure or to lower their cholesterol, something Network Rail intends to tackle. 

Dr Peters said: “The data allows us to prove the success of the pilot.

“Overall it has been very positive. We have had trauma cases that have come through the door and we’ve referred them for trauma management. We’ve now got people even being referred to sleep consultants. We’re noticing people are coming here with obstructive sleep apnoea which, potentially, could make them unfit for work, and we’re getting them through into sleep assessments. 

“We also have 24-hour blood pressure monitors on site. So, if people have problems with their blood pressure, we can fit the monitor and have the results the next day, reducing anxiety in our staff and giving timely advice to managers and supporting GPs with the information needed to start treatment as needed. 

“I was with the South East route safety director yesterday and he just said ‘It is fabulous, absolutely fantastic.’ The feedback has been amazing. There’s not much more you can say to that because we’ve had so much grumbles about occupational health. 

“Employees generally don’t want to go to the OH because they think they will be told whether they can or can’t work but now they know that if they can’t work, we will support them with a solution. We want to ensure that the health of our employees is not adversely impacted by the work they undertake to support the optimal performance of our infrastructure thus allowing us to put our passengers first.”

Tony added: “The concept is proven, we’ve got some formal commercial evaluations to do but, in terms of what the medical has achieved already, it’s quite clear that it is a success and it’s about then building on that. 

“The routes are chomping at the bit to have a piece of the action.”

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