Occupational Healthby Anna Harrington
In a nutshell
1. What are health and wellbeing?
Sometimes, definitions of health and wellbeing can clash: for example, someone can do something intrinsically unhealthy, such as smoking, but which makes them happy and therefore gives them a sense of wellbeing.
- All definitions used are quite subjective and are subject to the feelings, interpretations and experiences of the individual.
- The definition of health is not just ‘an absence of disease and infirmity’, but recognises the physical, social and mental aspects to wellbeing.
- Occupational health is about how your health affects your work as much as it is about how work affects your health.
- Wellbeing includes feelings of happiness, fulfilment and life satisfaction.
2. Some UK statistics
HSE report that the rate of fatal injury for 2009/10 represents a statistically significant decrease compared with the average rate for the previous five years. In 2008/09, some 1.2 million UK workers said they suffered from an illness (long standing as well as new cases) they believed was caused or made worse by their current or past work. Of these, 551,000 were new cases.
- Self-reported figures far exceed those which are formally reported. Self-reported are believed to be more accurate. There may be some exaggeration, but this is largely due to the limitations in the formal reporting systems, such as RIDDOR, and the under-reporting that goes on, particularly among SMEs.
- Estimated numbers of those suffering from ill-health far exceed those of the injury statistics.
- Some health conditions, notably MSD and mental health problems, are reported much more frequently.
- The estimated number of lost days represents a very significant human, business and societal loss.
3. Benefits of promoting health
The aim of building a business case for promoting occupational health at work is to secure senior management team commitment and financial resource for the strategic management of health and wellbeing at work. Any or all of the following issues may help you to build your business case:
- Impact on brand image – through informal communication between friends and family about how an employer treats their staff
- Cost of sickness absence and presenteeism (at work, but not fully engaged or functioning).
- Reduced insurance costs – due to risks being managed appropriately
- Reduced risks of claims being taken against the organisation
- Increased employee engagement – through their health, psychological, social needs and aspirations being met in the workplace
- Increased employee productivity – for reasons as above
- The inclusion of health and wellbeing in external quality systems, such as Investors in People.
4. The effects of some specific health issues
When considering the impact of any of ill health condition on an individual’s ability to work, it is essential to recognise that, although there are similar symptoms and signs, the effect these have on the individual will be variable.
- Anxiety and depression can affect work through impaired concentration, communication, motor skills and judgement.
- Diabetics may suffer from hypoglycaemic attacks, peripheral nerve changes affecting circulation and sensation and possible visual impairments. It is necessary for occupational health professionals to assess each individual, especially in the case of occupations which have a safety critical aspect or require shift work.
- Epileptics should be assessed for concerns about shift work (especially night shifts), stress levels and roles with a safety critical component.
- Sufferers from coronary heart disease should be assessed concerning the physical nature of the work, safety critical aspects, and psychological aspects of the work, such as the amount of pressure and stress factors.
- Before embarking on drugs and alcohol testing, it would be prudent for the employer to reflect on the reasons why abuse of these substances may be occurring and to put in remedial action to reduce, for example, stress or long and irregular hours.
- Individuals with a substance abuse problem have the same right to be treated with respect, honesty and to expect confidentiality not to be broken as anyone suffering with a physical or mental health problem.
5. Pre-employment screening and fitness to work
In general, it is now unlawful to enquire about an applicant’s health and/or disability before a job offer is made. This includes questions relating to sickness absence. Therefore occupational health will not normally screen individuals before an offer of employment has been made.
- The purpose of screening, when permissible, would be to enable the individual to do the job to the best of his or her ability, perhaps through the employer making reasonable adjustments in the workplace.
- Fitness to work medical standards may be advisory or statutory. They may be applied prior to employees entering environments which have risks inherent to them, such as mining and other work in confined spaces.
- Employees in jobs that are safety critical, such as pilots, rail workers, seafarers, food handlers and oil and gas workers have standards of fitness which individuals have to achieve and maintain. The purpose is to prevent a major accident or occurrence due to ill health in an employee.
- It is necessary, when setting fitness to work standards, that they are non-discriminatory and justifiable.
6. Equality Act 2010 and fitness for work
The aim of the Equality Act 2010 is to outlaw discrimination against any individual due to age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race and religion, sex and sexual orientation. A corner stone of the act is that employers should make reasonable adjustments to allow disabled people access to and progress in employment. There are three areas on which the employer needs to focus when considering reasonable adjustments:
- Avoiding the substantial disadvantage where a provision, criterion or practice applied by or on behalf of the employer puts a disabled person at a disadvantage compared to those who are not disabled
- Removing or altering a physical feature or providing a reasonable means of avoiding such a feature where it puts a disabled person at a substantial disadvantage compared to those who are not disabled
- Providing an auxiliary aid or service where the disabled person, but for the provision of that aid, would be put at a substantial disadvantage when compared to those who are not disabled.
7. Possible effects of work on health
Positive effects include
- Improved health through improved living conditions
- A sense of belonging or being part of a group, thus reducing feelings of isolation
- Heightened self esteem
- The chance to achieve life goals.
Negative effects may include health issues, such as
- Occupational hearing loss
- Vibration syndrome
- Occupational skin disease
- Occupational lung disease
- Occupational cancer
- Blood borne viruses.
8. Shift work
The effects of both long working hours and shift work are a consequence of disruption to circadian rhythms and sleep deprivation. They include
- Anxiety, depression, neuroticism
- Possible cardiovascular disorders and cardiac effects
- Gastrointestinal disorders/dysfunction
The health implications of the increased adoption of flexible work and employment patterns are wide ranging:
- Precarious forms of employment may generate feelings of job insecurity and stress
- Temporary workers are likely to be at increased risk of injury, as the risk of workplace injury is higher during the first four months within a new job.
9. Health surveillance
The purpose of health surveillance is to gather health-related data that indicates the health of a defined population and to monitor for adverse effects of exposure to a defined hazard. Some of the most common types of work-related health surveillance and the relevant pieces of legislation are
- Lung function testing – Control of Substances Hazardous to Health, Regulations, 2002, (COSHH)
- Biological monitoring (blood, urine, sweat, saliva) – COSHH and Control of Lead at Work 1995
- Audiometry – Control of Noise at Work Regulations, 2005
- Hand-arm vibration screening – Control of vibration at Work Regulations, 2005
- Eye sight screening – Display Screen Equipment Regulations, 1992
- Skin surveillance – COSHH.
10. A healthy working environment
The workplace environment needs to be one which encourages productivity and promotes good health and wellbeing. The Commission for Architecture and the Built Environment (CABE) suggests the following six points when considering the creation of a healthy environment:
- Ease of movement and accessibility
- Character, quality and continuity – workplaces that positively interact with the surrounding areas
- Diversity – having workplaces as part of a mixed use development
- Sustainability – minimising the consumption of energy
- Adaptable – able to accommodate changes to requirements
- Management – ease in the maintenance requirements.
11. Main types and causes of sickness absence
Employee absence from work is significant to the economic viability and smooth running of an organisation. Absence costs money and is disruptive to production and to the workplace community.
- Absence can also be classified into planned and unplanned: planned absence occurs when the employer and employee have agreed a period of absence; unplanned relates to an unpredicted occurrence that has forced the employee to take time off work.
- The top five most common causes for manual and non manual short-term sickness absence are minor illness, stress, musculoskeletal problems, recurring medical conditions and back pain.
- The most common causes of long-term absence are acute medical conditions, musculoskeletal injuries, stress, mental ill-health and back pain.
- The CIPD 2010 Absence Survey put a median cost of £600 per employee per year.
12. Management of sickness absence
Management of sickness absence should be a cooperative effort between managers, the employee concerned and appropriate professionals.
- The line manager must make attendance standards clear, keep in touch with sick employees, keep relevant data confidential and take all appropriate action to ensure a smooth return to work.
- Human resources will have responsibility for writing, implementing and centrally monitoring the absence policy.
- The employee is expected to maintain a good level of attendance. They are expected to follow procedures set out in the organisation’s absence policy about informing the workplace of any absence.
- You may, with the employee’s consent, need to obtain further information from their doctor.
13. Absence/attendance policy
The effective management of attendance and sickness absence will require a multi-interventional strategic approach. It is not just about how to return someone back to work after a long period off sick, but about collecting and analysing quantitative and qualitative data to give a picture of attendance. It is also about creating a workplace that encourages attendance and productivity. The purpose of the policy is to set out the organisation’s expectations with regards to
- Standards of attendance and the procedures that need to be used to deal with non-attendance
- The roles and responsibilities of employees, line mangers, human resources and others, such as occupational health and employee assistance services
- The competencies it expects line managers to acquire and how it will assist them in attaining these competencies.
14. Managing long-term absence
The questions which the manager has to answer are
- When do procedures as detailed in the organisation’s absence policy need to be implemented?
- Is the absence justifiable on medical grounds and, if so, is there anything that the organisation can do to facilitate a return to work?
- Are there other reasons for the absence apart from health, such as family/relationship commitments, employee motivation issues, and workplace relationship issues? (It is recognised that an individual and his/her capacity to work are affected by social, biological and psychological factors.)
15. Mental health at work
Most people with mental ill health are able to hold down employment and contribute to the workplace. In addition to the points raised in the management of sickness absence (return to work) the main points are:
- Line managers should know about common mental health conditions
- The workplace culture should nurture and support individuals
- Managers should have the ability to engage with and listen to their team members and should know them
- Managers should ensure confidentiality, yet agree with the employee what can be disclosed to the rest of the team
- Employees with mental health problems should be treated with integrity, honesty, empathy and care
- Keep in touch with employees who are off sick
- Draw up an advanced statement of potential care needs
- If a member of your team has a mental health problem, you should make an analysis of their job tasks, redistributing some tasks, if necessary.
16. Stress management
Your organisation should have a stress management policy which you, as a line manager, should be trained to implement. Stress prevention is divided into stages:
- The first proactive stage should focus on the organisation and the way people interact within it (how do they behave towards each other, what are the unwritten norms and expectations?)
- The second stage is to encourage and build positive beliefs around coping and resilience
- Tertiary management is about helping individuals who are stressed to regain their equilibrium.
17. Musculoskeletal disorders
‘Musculoskeletal disorders’ is an umbrella term used to identify injuries to soft or bony tissue. They include
- Back pain
- Shoulder pain
- Neck pain
- Carpal tunnel syndrome
- Lower limb disorders
18. Musculoskeletal disorders – the manager’s role
When the manager comes to recognise that the individual has an MSD problem, they need to act promptly.
- Investigate the workplace cause, through a risk assessment.
- Discuss with the individual ways to enable them to remain active and at work safely.
- After four weeks, do not hesitate to intervene with supportive guidance and active management
- Use the system of flags and a stepped approach to managing the problem.
- Refer them to occupational health.
19. Workplace health promotion
According to the European Network on Workplace Health Promotion (ENWHP) the following criteria are necessary for quality and effective workplace health promotion.
- Workplace health promotion (WHP) should be a management responsibility with:
- Support and integration of management and executive staff
- Integration in company policy
- Provision of sufficient financial and material resources.
- There should be employee participation in planning and implementation of the WHP measures.
- WHP should be based on a comprehensive understanding of health.
- WHP should be based on accurate analysis and continually improved.
- WHP should be professionally coordinated and information should be made available regularly to all the staff.
- The benefits of WHP should be evaluated and quantified on the basis of specific indicators.
20. An occupational health needs assessment
The Health Development Agency suggests five steps in a health needs assessment:
- Identify the population, define what you want to achieve and who needs to be involved, secure resource and understand the risks
- Identify health priorities; understand the population – who are they?
- Assess a health priority for action – use risk analysis to identify areas requiring urgent action
- Plan for change – reflect back to the aims and purpose; develop an action plan which sets out the priorities and
- Move on/project review.
21. Occupational health help
Once you have carried out a workplace health needs assessment, you can use it to determine levels and types of services needed.
- There are several support schemes and organisations, such as Access to Work and Constructing Better Health.
- The public health function of primary care embraces workplace health and the promotion of health within workplaces, so to this end there are likely to be resources available to assist businesses achieve this aim.
- The highest relevant nursing qualification/registration is the SCPHN (Occ Health), which demonstrates that the nurse has undertaken additional academic OH training to the standards set by the Nursing and Midwifery Council.
- The Faculty of Occupational Medicine is part of the Royal College of Physicians and develops and maintains the standards of professional competence of its members.
- An assessment of competence should always be made by, for example, checking professional registration with the appropriate body, checking past experience and relevance to the organisations’ needs, examining references, and requesting the person attends an interview.