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Surveys conducted amongst members of the Association of NHS Occupational Physicians indicate few changes in the status and development of Critical Incident Stress Management Services (CISMS) in the United Kingdom National Health Service between 1993 and 1996. Limited CISMS are confirmed by the majority of respondents in the two surveys with developments having typically occurred within long-established staff care services such as counselling. In 1996 NHS provision is typically based on the independent use of own resources. A 1996 comparison of NHS with pooled returns from Ambulance Services, Fire Brigades and Social Services Departments indicates few variations in status, provision and levels of expertise in the delivery of CISMS. Other emergency services co-operate to a greater extent with each other than does the health care sector. Occupational Health Department responders confirm availability of expertise resources to provide CISMS, but low priority status frustrates delivery of CISMS. Survey results indicate the NHS is at risk of not fulfilling its duty to care for staff after major incidents. The establishment of regional centres of CISMS excellence with local and national responsibilities is advocated.

occupational medicine

Status and development of critical incident stress management services in the United Kingdom National Health Service and other emergency services combined: 1993–1996