1026 Int Diploma IB11 v2

Element IB11: Managing Occupational Health


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Contents Introduction Nature of Occupational Health Categories of Occupational Health Gathering Information Links Between Occupational and General Health Vocational Rehabilitat Rehabilitation ion Bio-Psychosocial Bio-Psychoso cial Model of Health

Managing Occupational Health

5 8 8 9 10 11 13

Sickness Absence Types of Absence The Management of Absence Occupational Health Services Difference Between Health Surveillanc Surveillance e and Health Assessment

15 15 15 16 22 25

References

30


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Introduction The direct and indirect costs of workplace accident and ill health accidents have been extensively researched and documented in recent years. This has clearly demonstrated the great economic burden that such accidents and ill health place on individuals, enterprises, families and on society generally. Human suffering has no measurable cost, unlike economic losses. In most countries, vast numbers of workplace accidents, fatalities and diseases are not reported or recorded. Occupational Ill health requirements differ widely across the world, with many countries having little or no provisions in place to protect workers from occupational health hazards. Data on work related accidents and diseases are essential for prevention of workplace accidents and ill health. International and national provisions do exist, however there is still gross under reporting in many countries of the world. Global gures can therefore only be estimated. Table 1 below compares current estimates of previous years. Table 1: ILO/WHO 2008 fgures produced 2011 Year

Number of Fatal Accidents

Fatal accident/ incident rates*

Number of Fatal Diseases

Total number of accidents and diseases

1998

345,000

16.4

N/A

N/A

2001

351,000

15.2

2.03 million

2.38 million

2003

358,000

13.8

1.95 million

2.31 million

2008

321,000

10.07

2.02 million

2.34 million

*Accident incidence rates are the numbers of accidents per 100, 00 workers The term ‘health’, in relation to work, indicates not merely the absence of disease or illness; it also includes the physical and mental elements affecting health, which are directly related to safety and hygiene at work (ILO, 1981). In the past, the focus has been mainly on safety issues, possibly because accidents are often dramatic and very visible. The long-term nature of many health issues (deafness, musculoskeletal disorders, asthma, cancer, etc.) possibly makes them less dramatic. It is also easier to pretend that damage to health is not work related or that the resulting disability is not really as severe as the victim claims it to be. Exposure to hazards at work lead to damage to health and should be regarded as accidents even though they may take some years to happen and many more years to become apparent in some cases. ILO gures published in 2011 show that occupational ill health is in fact a greater problem even than the occupational injury.


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Figure 1: ILO/WHO 2008 fgures produced 2011

An estimated 1.2 million working people in 2010 were suffering from a work-related illness, of which 495 000 were new cases which started in the year. 75% of the new work-related conditions were musculoskeletal disorders or stress, depression and anxiety. Other work-related illnesses included skin disease, respiratory disease, hearing loss and vibration-related disorders. The ILO continues to play an active role in promoting the ultimate goal of placing occupational safety and health at a high level in the national and global agendas. The ILO Convention on Occupational Health Services in 1985 really set the ball rolling. It advised that occupational health services should aim to prevent the occurrence of work-related ill health and provide guidance relating to: 1.

“The requirements for establishing and maintaining a safe and healthy working environment which will facilitate optimal physical and mental health in relation to work.

2.

The adaptation of work to the capabilities of the workers in the light of their state of physical and mental health.

Notwithstanding, one of the biggest problems within many countries is that there are no mandatory requirements in place relating to occupational health. This issue was addressed by the Committee on Safety and Health at Work during the International Labour Conference in Geneva, June 2006. The Committee adopted a Convention accompani ed by a Recommendation, namely the Promotional Framework for Occupational Safety and Health Convention 2006 and the Promotional Framework for Occupational Safety and Health Recommendation 2006. The Convention was adopted almost unanimously by the Conference Plenary of the International Labour Conference (with only one country voting against it). Article 4 of the Convention is probably the most signicant and relates to each member having to ‘establish, maintain, progressively develop and periodically review a national system for occupational safety and health.’


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A national system for occupational safety and health should include: (a)

Laws and regulations, collective agreements where appropriate, and any other relevant instruments on occupational safety and health;

(b)

An authority or body, or authorities or bodies, responsible for occupational safety and health, designated in accordance with national laws and practice;

(c)

Mechanisms for ensuring compliance with national laws and regulations, including systems of inspection; and

(d)

Arrangements to promote, at the level of the undertaking, cooperation between management, workers and their representatives as an essential element of workplacerelated prevention measures.

Furthermore, the system for occupational safety and health should include, where appropriate: (a)

A national tripartite advisory body, or bodies, addressing occupational safety and health issues;

(b)

Information and advisory services on occupational safety and health;

(c)

The provision of occupational safety and health training;

(d)

Occupational health services in accordance with national law and practice;

(e)

Research on occupational safety and health;

(f)

A mechanism for the collection and analysis of data on occupational injuries and diseases, taking into account relevant ILO instruments;

(g)

Provisions for collaboration with relevant insurance or social security schemes covering occupational injuries and diseases; and

(h)

Support mechanisms for a progressive improvement of occupational safety and health conditions in micro-enterprises, in small and medium sized enterprises and in the informal economy.


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Nature of Occupational Health Categories of Occupational Health Hazardous agents which may be encountered within the workplace can be classied in terms of chemical, physical and biological. In addition, although not strictly agents, occupational health is also concerned with ergonomic and psychosocial hazards. These were discussed in greater detail in earlier elements of this Unit. ▪

Chemical hazards e.g. acids, alkalis, solvents, toxic metals, dusts and bres. These can enter the body in various ways, causing damage the site at which they rst contact the body e.g. the skin, eyes or lungs;

▪

Physical hazards e.g. temperature extremes, radiation (infra red, ultra-violet, ionising), noise and vibration;

▪

Biological hazards e.g. bacteria and viruses including legionella, leptospirosis, hepatitis and HIV;

▪

Ergonomic hazards leading to musculoskeletal damage due to poor postures, excessive loads and repetitive movements. Resulting injuries are a signicant cause of occupationally related sickness absence; and

▪

Psychosocial issues relating to workplace stresses which can lead to mental trauma. There have been a number of recent legal cases which have conrmed that psychological damage due to stress is an issue which needs to be risk assessed in the same way as physical hazards. This is proving to be a signicant challenge to the health and safety profession.

Health hazards should be addressed by a process of risk assessment leading to effective control, monitoring, and review. The risk assessment needs to consider which hazards are present, persons who could be affected and the adequacy of exis ting control measures in place.

Assessment of Occupational Health Risks Earlier Elements of this course give much greater detail regarding how risks associated with each of the above types of hazardous agent are addressed within an occupational context. The basic general principles involved can be summarised as followed:

Recognition / Identication In effect the rst stages of any risk assessment, in which hazards are identied. Methods of identifying health hazards include: ▪

Observation of the workplace premises;

▪

Task analysis in which particular activities are broken down and analysed for all of the categories of risk;

▪

Specic expertise from health and hygiene professionals, e.g. an ergonomist observing an assembly line activity can identify potential ergonomic problems;

▪

Consult supplier information regarding hazardous substances or equipment; and

▪

Review of internal accident, sickness absence or health surveillance records.


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Gathering Information The initial step of the process is to gather information about the organisation’s potential health issues. This information can be obtained from a variety of sources. As well as information from risk assessments, there is a range of existing organisational information which may be useful: ▪

Information from accident reports;

▪

Results of workplace monitoring eg. temperature, air quality;

▪

Information from human resources departments such as staff prole, sickness absence data, staff turnover, reasons for early or ill-health retirements;

▪

Uptake and reasons for referral to occupational health and employee assistance programmes; and

▪

Any issues relevant to health from staff appraisals, complaints, grievances etc.

Information from the Workforce Much of the health needs assessment can be carried out usefully by means of a staff questionnaire, usually given out for staff to complete, although it could be used as a basis of an interview. This will provide a more subjective view of the issues facing the organisation, and will typically cover the following aspects: ▪

Workplace environment;

▪

Staff support issues;

▪

Attendance / sickness absence;

▪

Experience of working life;

▪

Communication and change; and

▪

Lifestyle issues.

The exact content of any health needs assessment survey will depend upon whether it is the rst survey and whether there is already sufcient local knowledge to indicate which areas of working life could usefully be targeted.


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Links Between Occupational and General Health It is increasingly difcult to distinguish between illness caused by work and illness due to other causes. Many common diseases are directly linked to lifestyle factors. There are no clear boundaries and many health problems develop over a long timescale and have multipl e causes, for example cardiovascular disease. This broader view of occupational health allows for factors related to lifestyle to be tackled, for example, alcohol and substance misuse. The overall aim is to promote the general health of workers as well as to optimise working conditions so that work is better adapted to the workers in terms of both their physiological and psychological needs. The overall aims should be: ▪

To provide a safe and healthy workplace;

▪

To promote optimal physical and mental health of all employees; and

▪

To strengthen the relationship between health and productivity so that employees can contribute effectively to the organisation’s goals and also enhance their own personal wellbeing.

Policies on health promotion should be developed alongside those on health protection. A proactive organisation will formulate specic policies on alcohol and substance misuse, smoking, mental wellbeing and minimising stress as well as policies aimed at heart disease prevention, including advice about healthy eating and physical activity. The workplace therefore has considerable potential and for example it has a key role to play in achieving the WHO’s European Health for All targets.The common mental health problems such as anxiety or depression and musculoskeletal disorders are major causes of sickness absence. There is huge scope to improve awareness, early identication and appropriate intervention.


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Vocational Rehabilitation Denition of Vocational Rehabilitation Rehabilitation for work has been dened by the British Society of Rehabilitation Medicine (BSRM) as ‘a process by which those disadvantaged by illness or disability can be enabled to access, maintain or return to employment, or other useful occupation’. Rehabilitation covers a range of measures such as a medical intervention or changes to working arrangements or the workplace that helps an absent employee to return to work. It can also enable an employee who is still working but suffering from a chronic illness to be more effective at work. Aims of vocational rehabilitation: ▪

To avoid unnecessary sickness absence, ill health early retirements and dismissals on the grounds of capability, none of which are in either the employer’s or the employee’s interests;

▪

To help the employee to work or if absent return to work at his or her highest skill or ability level and to do so as early as possible; and

▪

To help employees retain or regain their condence, motivation and relationship with their co-workers and manager.

Business Case for Vocational Rehabilitation Short term self-certicated absences account for most spells of absence but long term absences account for most of the total days lost. It is the long term sickness absences that usually cause the greatest nancial cost to the business. Effective rehabilitation can signicantly reduce that cost. An organisation should have a policy on rehabilitation which forms part of their overall sickness absence management strategy. The policy should dene roles, responsibilities and expectat ions to help create a fair and consistent approach. The need for rehabilitation may be highlighted by either a rst medical certi cate which indicates the need for a lengthy period of absence, or where there is a series of medical certicates provided. Discussions about rehabilitation will form part of the discussions with an employee by their line manager as mentioned previously. Generally, rehabilitation needs to start as early as possible during an individual’s absence. However this will vary depending on the type of condition. For example, and employee who is off sick with a musculoskeletal disorder may benet from rehabilitation at a very early stage, whereas an employee who has suffered a serious physical illness or has had a nervous breakdown will need more time before rehabilitation is appropriate.


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Vocational Rehabilitation Interventions As well as alterations to the workplace and work patterns as discussed previously, the employee may benet from visiting his/her workplace regularly during their absence. By allowing the employee to maintain contact with the workplace, it helps to maintain or build the employee’s condence about returning to work. Specic rehabilitation interventions include physiotherapy, occupational therapy or counselling. Occupational health personnel have an important role to play in advising the employer on possible rehabilitation options, and monitoring the employee’s progress while undertaking their rehabilitation programme.

Barriers to Vocational Rehabilitation Although research indicates the many benets of early rehabilitation for employees with chronic conditions or those on long term absence, there can be a reluctance on the part of bot h employer and employee to commit to it. Employers may view rehabilitation as a costly expense or possibly as an admission of liability if the employee’s condition is work related. Employees may be reluctant to agree to rehabilitation if they feel that the source of their harm has not been solved or they believe that the organisation will not be able to meet their needs. Additionally, if they are thinking about making a claim for compensation, that accepting rehabilitation will adversely affect their claim.


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Bio-Psychosocial Model of Health Many medical practitioners have taken a holistic view that the idea of being well is not just about being in good health but is a combination of good quality of life in both personal as well as work. In 1977, American Psychiatrist George Engel introduced the major theory in medicine, the Bio-Psychosocial (BPS) Model. The model accounted for biological, psychological, and sociological interconnected spectrums, each as systems of the body. The model is shown in the following diagram: Figure 2: the Bio-Psychosocial (BPS) Model

Engel eloquently states: “In order to understand how to treat and prevent disease we need to consider all aspects of the patient, i.e. home life, work life, how society deals with the disruptive effects of illness. Today, individuals are living with diseases that would have taken their lives in the past. We see health and wellness is a broader forum”. The bio-psychosocial model assumes that biological, psychological and social factors can all play a signicant role in pain problems. The major implication of this is that it may be necessary to treat biological, psychological and social issues as interlinked systems. The model draws a distinction between the actual pathological processes that cause disease, and the patient’s perception of their health and the effects on it (illness). Illness and disease are not necessarily directly related. A patient may be well (no disease or injury), but if they feel unwell that is an illness. Similarly, patients who are diseased or injured may say they feel completely all right, and hence do not exhibit illness. The bio-psychosocial model acknowledges the illness, as much as the injury or disease.


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Medical practitioners are more frequently adopting the bio-psychosocial form in their clinical practice. The following outline compares the presentation, diagnosis, and treatment used by physicians who follow the biomedical and bio-psychosocial model:

Biomedical Model Reason for visit:

Patient complains of chest pain.

Presentation:

The focus is on physical causes of disease. The physician will ask few questions on recent diet, pain history, and familial incidence, however, empirical signs and symptoms of myocardial infarction are considered paramount.

Diagnosis:

The clinician will order objective lab tests and monitor vital signs (i.e. temperature, pulse, and blood pressure) that would form the sole basis of any nding.

Therapy:

The doctor will prescribe a medicinal plan for the patient based on biological etiology and pathogenesis.

Bio-psychosocial Model Reason for visit:

Patient complains of chest pain.

Presentation:

The aim to ascertain psychosocial and physical processes that may cause the chief complaint, chest pain. The physician may ask for a history of recent life stressors and behaviours.

Diagnosis:

Based on a combination of psychological factors and standard lab tests, the clinician will form a diagnosis.

Therapy:

The physician discusses the available interventions with special attention to behaviours and lifestyles that could inuence pain and adherence to the treatment plan. The patient is involved in formulating and implementing the plan, and maintains a supportive relationship with the clinician.

A study commissioned by the Health and Safety Executive called ‘Management of upper limb disorders and the bio-psychosocial model’ (2007) makes the following statement: ‘The bio-psychosocial model is certainly appropriate to understand the phenomenon of workrelevant upper limb disorders, and has important implications for their management. Biological considerations should not be ignored, particularly for initial treatment of cases with specic diagnoses, but it is psychosocial factors that are important when developing and implementing work retention and return to work interventions’. It can be seen, therefore that the bio-psychosocial model demonstrates a dramatic shift in focus from disease to health, recognising that psychosocial factors (e.g. beliefs, relationships, stress) greatly impact recovery, the progression of, and recuperation from illness and disease.


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Managing Occupational Health Sickness Absence The present day working environment is vastly diverse and involves a variety of activities and processes and equipment. Failure to manage those activities safely can and do result in accidents and injuries to workers, but also in the residual health effects which contribute to short and long term sickness absence. Sickness absence is not just a matter of ill-health. It is affected by a combination of the health condition, personal and work/organisational factors. The last two factors become more important the longer the absence continues. Early intervention is a key principle. The sooner action is taken; the better the chances are of an employee making a full and speedy return to work.

Types of Absence There are different classications of absence, as follows: ▪

Unauthorised absence or persistent lateness;

▪

Authorised absences e.g. annual leave, maternity leave, compassionate leave etc.;

▪

Short term absence; and

▪

Long term absence.

Short-term absence The most common cause of short-term sickness absence for all workers is minor illnesses, which include colds, u, stomach upsets and headaches. However, there are differences in the remaining causes of short-term sic kness absence between manual and non-manual workers. For manual workers, back pain and musculoskeletal injuries are the next largest cause of sickness, followed by home and family responsibilities and stress. For non-manual workers, stress is the next most common cause, followed by musculoskeletal injuries and back pain, and then home and family responsibilities.

Long-term absence The most common causes of long term absence in manual workers are acute medical condit ions, back pain, musculoskeletal conditions and stress. For non-manual workers, the most common causes of long term absence are stress, acute medical conditions, mental ill-health (e.g. clinical depression and anxiety), and musculoskeletal conditions.


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The Management of Absence Many employers are nding it difcult to manage employees on long term ill health absence against a backdrop of disability discrimination legislation. There is also the ever present threat of personal injury litigation, including work related stress claims. With this comes the escalating cost of employer’s liability insurance. Maximising attendance of employees has become a key performance indicator.

Role of the Doctor Patients see their Doctor as their rst point of contact when health problems arise, and trust their advice and guidance. Doctors therefore have a central role in providing advice to their patients where their work is impacting on their health, or vice versa. The Doctor may make a decision on the individuals tness for work taking their illness into account.

Role of Occupational Health Physician It should be remembered that, whilst the GP has knowledge about the individual’s conditions and its impact on their capabilities, it is the employer who has the detailed knowledge of the worker’s job role and their workplace and may decide to seek assistance from an Occupation Health Physician The functions of the Occupational health physician may include the following: ▪

Advise employers and employees on tness to work issues, without disclosure of diagnosis and medication details;

▪

Advising employees and employers on the potential for work to cause ill health;

▪

Request information from the workers GP with the workers consent;

▪

Providing a professional opinion as to whether an employee is medically t to attend relevant hearings in cases of dispute between employee and employer; and

▪

Providing factual reports in cases where the employee is seeking compensation.

Role of Human Resources Personnel Human resources personnel have an important role to play within an organisation in coordinating the sickness management strategy. The key elements of the strategy should include: ▪

A system to record sickness absence;

▪

A method of measuring and analysing the absence; and

▪

A programme of appropriate interventions to manage the absence.

Liaison with other health professionals, managers and the employees themselves will all be an essential part of the process. The sickness management process should be documented in an absence policy which has been consulted on, and is reviewed regularly.


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The Role of the Line Manager The line manager will have an important role in managing an individual’s sickness absence and return to work. The Health and Safety Executive outline six key elements of sickness management at the individual level. These are: ▪

Recording sickness absence;

▪

Keeping in contact;

▪

Planning and making workplace adjustments;

▪

Using professional or other advice or treatment advice;

▪

Agreeing and reviewing a return to work plan; and

▪

Co-ordinating the return to work process.

Keeping in Contact During Sickness As well as keeping the records of the sickness, it will usually be the line manager who keeps in contact with the individual while they are off sick (although contact may not be necessary for short-term absences). There are a number of reasons why employees may be reluctant to make or keep contact with their employer while they are off sick. These include the following: They may feel anxious, embarrassed or ashamed about needing to be off sick. They may not trust their manager to deal with them in a sensitive and condential manner. They may feel under undue pressure to return to work when they talk to their manager. On the rst contact, the line manager should clarify to the employee why they will be keeping in touch, how often and the method of contact. This will help to develop a trusting relationship. All agreed contacts should be kept, and they should concentrate on the employee’s health and well-being, taking into account that people vary in the way they deal with and recover from illness or accidents. The line manager should keep the employee informed of work issues to keep them ‘in the loop’ and reassures them that their job is secure for them. They may also encourage the employee’s work colleagues to make contact with them.

Planning the Return to Work At an appropriate time, which is likely to depend on the nature of the illness and its prognosis, the individual’s return to work should be discussed. They should be assured that help is available as necessary, to enable them to return to work in a satisfactory way. This may include seeking advice or rehabilitation treatment from other health professionals e.g. occupational therapist the return to work plan should be documented and agreed by both parties.


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On Return to Work On return to work, an interview between the line manager and the employee (and their representative if they wish) can be useful to welcome them back, verify that the sickness absence records are accurate, and discuss any residual issues or concerns. It may be prudent to ask the employee what they would like their colleagues to be told about their absence/illness, and encourage their colleagues to support them in their recovery. Because of the potentially sensitive nature of ill health and sickness absence, it may be benecial to provide line managers with training in interpersonal and interviewing skills.

Recording Sickness Absence In order to ensure effective analysis of the sickness absence the following information should be collected as a minimum: ▪

Name and contact details of employee;

▪

Date of rst absence, number of days absent, expected/actual return to work date;

▪

Cause of absence and whether it is considered to be work-related;

▪

Dates and outcomes of contact with the employee; and

▪

The cause of sickness should be categorised in a way that allows meaningful analysis.

Accurate sickness/attendance records will also signicantly enhance an organisation’s ability to defend itself against allegation of unfair dismissal or disability discrimination.


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Condentiality The generally accepted principles of medical ethics is that medical records should remain condential between the patient and the doctor; not primarily for the protection of any one individual patient’s right to privacy, but for the good of society as a whole. If clinicians were not required to keep condence people would be reluctant to provide them with personal informati on about their physical and mental health. For example the ILO Chemicals Recommendation, No. 177 requires that: ▪

Workers should have access to their own medical records, either personally or through their own physicians; and

▪

The condentiality of individual medical records should be respected in accordance with generally accepted principles of medical ethics.

National Laws will often detail the requirements for the condentiality of medical records.

Analysing Sickness Absence Once recorded and measured, sickness absence can be analysed. It can, and should be analysed at different levels within an organisation: ▪

Individual level – to see patterns of absence by individuals;

▪

Group/department/location level – to identify patterns specic to that section; and

▪

Organisational level – to provide the overall picture.

Additionally, it should be analysed in respect of long term, short term and recurrent absences.

Benets of Recording and Monitoring Sickness Absence It is clear that there are a range of good reasons why an employer should record and monitor sickness absence. The benets of having an effective system in place include: ▪

It ensures that everyone takes responsibility for sickness absence – it engages the line manager in the process, and reminds employees of their responsibilities regarding attendance;

▪

It enables problems (individuals, departments etc) to be identied early so that issues can be addressed and managed;

▪

It allows the employer to quantify and cost sickness absence;

▪

It allows the employer to identify patterns and trends in absence data, and so to target resources most effectively;

▪

It allows the employer to monitor the effects of management interventions; and

▪

It facilitates compliance with relevant legislation.


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Managing Attendance The Absence policy should clearly set out the organisation’s expectations in relation to attendance, and the procedures for dealing with absences. Specically, it should provide: ▪

A clear statement of the standards of attendance expected by the organisation;

▪

Explicit management commitment to the organisation’s absence policies, standards and procedures;

▪

Systematic procedures for managing absence; and

▪

Systematic procedures for investigating and managing ‘problem’ absence.

The policy should clearly state that employees are paid to attend work, and that attendance is therefore the expected norm. It should explain that absence is costly to the organization in terms of covering the absence, effects on quality or production, potential impacts on customers etc. However, the policy should recognize that some absence is inevitable and that those taking genuine absence will be supported and assisted to return to work as early as possible. As well as these general statements, the absence policy should set out clear procedures on the following: ▪

Reporting of absence;

▪

Initial notication of absence;

▪

On-going notication of continued absence;

▪

Requirements for self-certication; and

▪

Requirements for medical evidence of sickness

The procedures should specify the various timescales for reporting absence, how it should be notied/reported and to whom. These procedures should include: ▪

Management action trigger points (discussed later) and procedures for management to take action e.g. in cases of recurrent short-term sickness, or where advice is to be sought from Occupational Health or the employee’s GP;

▪

Contact procedures for making and maintaining contact with an employee who is off sick;

▪

Return to Work procedures, including return to work interviews; and

▪

Disciplinary action – situations that may result in disciplinary action such as cases of nongenuine absence, or a failure to follow the required procedures


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Key elements of a good strategy for maximising attendance include: ▪

Engaging line managers in managing employee attendance;

▪

Reminding employees they are responsible and accountable for their attendance;

▪

Providing opportunities for employees to discuss any problems and raise any issues that may reduce absence; and

▪

Allow for other action to be taken, e.g. rehabilitation or exible working in the event that employees are using paid sick leave for domestic emergencies.

Possible Adjustments In order that the employee can return to work, there are a range of modications or changes which can be made, which will depend on the individual’s specic circumstances. They include: ▪

Providing new or modifying existing tools and equipment;

▪

Providing additional training or supervision;

▪

Modifying work patterns (eg. reduced hours, exible working);

▪

Reviewing communication and management lines;

▪

Modifying procedures for testing and assessment;

▪

Providing a buddy or mentor until the employee’s condence returns;

▪

Reallocating work within the team, or providing alternative work; and

▪

Provide support e.g. time off for rehabilitation, or medical appointments.

It is important that any changes to the workplace or work processes do not put the employee or others at a risk of injury or ill health. Health and safety policies and procedures will need to be taken into account when options are being explored.

Return to Work Plan The decisions that have been made about the individual’s return to work throughout t he absence period should be documented in a Return to Work plan. The plan should include the date of return to work, and any timescale for a graduated return to work. It should specify the specic changes that are to be implemented and any impact these have on the employee’s employment terms and conditions. Finally it should be signed by both parties.


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Occupational Health Services Occupational health is a specialist branch of medicine focusing on health in the workplace. It is concerned with the physical and mental well-being of employees. Occupational health specialists can support organisations through advising on work-related illnesses and accidents, carrying out medicals, and monitoring the health of employees. Occupational health services are also used to assist organisations in managing absence situations – both short and long term. The opinion of an occupational health specialist might be crucial in determining how to manage a capability issue, and the opinion of an occupational health specialist can be key evidence in a claim to an employment tribunal. The ILO Convention on Occupational Health Services (C161) and the Recommendations on Occupational Health Services (R171) were adopted in 1985. In the convention the following denition was given:- The term ‘Occupational Health Services’ means services entrusted with essentially preventative functions and responsible for advising the employer, the workers and their representatives in the undertaking on: ▪

The requirements for establishing and maintaining a safe and healthy work environment which will facilitate optimal physical and mental health in relation to work

▪

The adaption of work to the capabilities of workers in light of their state of physical and mental health.

The above denition is not enough to describe the range of activities carried out by Occupational Health Services. There are a number of functions listed in the Convention as follows: a.

Identication and assessment of the risks from health hazards in the workplace.

b.

Surveillance of the factors in the working environment and work practices which may affect workers health, including sanitary installations, canteens and housing where these facilities are provided by the employer.

c.

Advising on planning and organisation of work, including the design of workplaces, on the choice, maintenance and condition of machinery and other equipment and substances used in the workplace.

d.

Participation in the development of programmes for the improvement of working practices as well as testing and evaluation of health aspects of new equipment.

e.

Advice on occupational health, safety and hygiene and on ergonomics and individual and collective protective equipment.

f.

Surveillance of workers health in relation to work.

g.

Promoting the adaption of work to the worker.

h.

Contribution to measures of vocational rehabilitation.

i.

Collaboration in providing information, training and education in the elds of occupational health and hygiene and ergonomics.

j.

Organising rst aid and emergency treatment.

k.

Participation in the analysis of occupational accidents and occupational diseases.


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There is now a clear recognition of the need to maintain the health and efciency of a skilled workforce. This is best achieved with a versatile team of skilled professionals who are familiar with the needs of the organisation and the individuals within it. Most organisations will contact an external provider of occupational health services or specialist consultants as and when they require assistance. Other organisations, particularly those working in hazardous areas, are more likely to employ their own doctor or nurse. The level of provision is likely to be determined by the size of the organisation and the nature of the operation. An organisation that operates in a particularly hazardous area is clearly likely to need more occupational health support than other organisations.

Role and Functions of Occupational Health Specialists The occupational health service will be provided by a diverse range of occupational health practitioners including Physicians, Hygienists, Toxicologists, Physiotherapists, Ergonomists, Microbiologists, Psychologists, Physicists, and other suitably qualied consultants.

Physicians and Nurses Occupational Physicians and Nurses should be experienced professionals who have obtained occupational health qualications in addition to their general medical qualications. Both, however, need to be aware of their clinical limitations and refer to other experts as necessary.

Occupational Hygienists Occupational Hygienists have an important role in providing technical support with respect to the assessment of occupational health issues arising from the working environment. Close liaison between the two groups of professionals can target adverse conditions early, e.g. routine health surveillance picked up by the Occupational Health Nurse may highlight problems with hand-arm vibration within a particular category of staff. The Occupational Hygienist can then undertake some workplace monitoring of vibration exposure. Alternatively, the Occupational Hygienist may carry out a noise survey and, as a result of the survey, advise the Occupational Health Nurse which groups of staff require ongoing audiometric testing.

Ergonomists The role of the ergonomist is to help create a situation where workers work in an environment which is safe, hygienic, and comfortable, based on the ‘Fit the task to the person, not the person to the task’ idiom. Ergonomists are often involved with the physical aspects of posture and comfort e.g. Computer workstation layout.

Physiotherapists Physiotherapists provide a range of rehabilitation services to the employee to aid recovery after injury and ill-health. Physiotherapists work in diverse settings, including manufacturing and service industries, health care, ergonomic consultancies and private practice. Many organisations have found that use of a fast-track in-house physiotherapy service can save money in terms of shortening sickness absence.


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Occupational Therapists Occupational therapists (OTs) have a comprehensive training covering both physical and psychological conditions, and are also skilled in analysing the practical consequences of illness or disability. The profession has a central role in resolving any residual issues following a period of illness and medical treatment, and also in advising employers about the needs of sick or disabled workers when they return to the work environment. OTs can also assist employees who are still at work but having difculties due to illness or disability. An OT will carry out a detailed assessment of the needs of the workplace and the abilities of the individual, and identify problems and potential solutions. Where appropriate the OT will provide an action plan and oversee its implementation.

Health Physicists Where there is a risk from Ionising Radiation, Health Physicists are an integral part of the occupational health team, assessing radiation doses. Laboratory staff have a support role with biological monitoring. Depending on the size and nature of the organisation, other ancillary services can be provided such as dentistry, dieticians, and other therapies. The work of an occupational health service should also be proactive, aiming to reduce potential problems in the workplace; hence the activities of occupational health professionals are likely to include: ▪

Pre employment heath screening;

▪

Health surveillance;

▪

Managing sickness absence;

▪

Providing a treatment Service;

▪

Assistance with risk assessment;

▪

Counselling;

▪

Drugs and alcohol at work;

▪

Health education and promotion;

▪

Rehabilitation;

▪

Ill-health retirement;

▪

Assistance with overseas workers; and

▪

Advice to the employer.


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Pre-Employment Screening Such assessments are sometimes referred to as tness for work. Pre-employment screening is helpful in identifying any pre-existing health conditions which may affect the individual and to provide a baseline for future health surveillance. For example, a prospective employee may already suffer a degree of hearing loss. An initial hearing test will establish this and help to defend any future claims for hearing damage due to the period of employment.

Difference Between Health Surveillance and Health Assessment Health assessments are tests done on workers where there may not be known adverse effects, where there may not be the possibility of detecting a specic health effect at an early stage (i.e health effects may be detected once the disease appears for example skin dermatitis) and where there may not be proven valid tests that can be done. For example, a health assessment is carried out on lift truck workers to determine their continued tness (for example their eye sight, joint exibility etc) for operating the lift truck. There is no ‘known adverse health effect’ that can arise out of operating a lift truck. Similarly, health assessments are offered to dened ‘night workers’ to determine if they have any current health problems that are being or could be made worse by working at night. There is no ‘known adverse health effect’ specically related to night work that can be identied at an early stage in this type of assessment. Many different types of health effects may be identied, but it is more determined by the individual rather than the night work itself. Health surveillance is looking for some specic health effect in relation to some specic work exposure and there is a valid means to detect the specic problem at an early stage. Health assessments are much less specic and assess the general health of the individual or the continued tness of the person for their work.


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Health Surveillance Health surveillance is setting up systematic, regular and appropriate procedures to detect early signs of work-related ill health among employees exposed to certain health risks; and acting on the results. Examples of Health Surveillance include: ▪

Health questionnaires;

▪

Lung function tests;

▪

Hearing tests, known as audiometry;

▪

Skin inspections; and

▪

Blood / urine analysis.

The benets of health surveillance include: ▪

Ensuring the early identication and treatment of an occupational disease;

▪

Provision of statistics relating to the health of the workforce;

▪

A feedback mechanism for risk assessments, to establish whether control measures are effective; and

▪

Provision of relevant information for defending legal action.

Roles of Occupational Health Managing Sickness Absence Many employers now recognise the cost of their business of sickness absence, much of which may be occupational related. Occupational Health departments can assist with managing sickness absence by: ▪

Interviewing staff on return to work or during absence;

▪

Training managers on how to recognise signs and symptoms of stress;

▪

Assisting on action to be taken, specialists referrals if necessary;

▪

Assisting with the development of sickness absence monitoring regimes;

▪

Collating ill-health and sickness absence statistics; and

▪

Targeting certain treatment programmes.


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Providing a Treatment Service Providing specic services such as physiotherapy and dentistry where rapid promotion of recovery can produce clear business benets.

Assistance with Risk Assessment Although this is often regarded as the domain of the Safety Advisor, the Occupational Health Department have a valuable input in a number of areas and may take overall responsibilities for certain areas of assessments such as Manual Handling or Display Screen Equipment.

Counselling The condential nature of many aspects of Occupational Health is often a cause of frustration to line management who may seek information regarding a particular individual. However, one of the positive benets of this is that an effective Occupational Health Department can provide a condential listening service and may be able to address certain work related concerns. The department may also be able to refer staff on to a specialist counselling service. Managing stress is one of the most challenging areas facing the health and safety profession currently and Occupational Health professionals often have more experience of dealing with individuals suffering with stress. There may be specic issues with post-traumatic stress, which occupational health departments can assist with either directly or by passing on to other specialists. Many organisations have ‘Employee Assistance Programmes’ in which an external organisation provides a condential helpline for employees. Occupational Health Departments have a role in setting up and monitoring such regimes.

Health Education and Health Promotion This is an important preventative role which can lead to greater awareness of occupational health hazards for workers. Publicity campaigns can be used to promote healthy lifestyles. Incentives such as cholesterol tests and free pedometers can be used to engage staff interest.

Rehabilitation Occupational health staff can work closely with managers to facilitate return to work following illness or injury. Recent studies have demonstrated overwhelmingly that it is preferable to bring staff back to work part time or on light duties, than to wait until they are fully recovered.

Ill-Health Retirement This can be a difcult issue for companies to manage and Occupational health Departments can assist with providing independent advice regarding tness for work.

General Advice The occupational Health providers can offer advice to employers on policy and management system formulation, the impact of new legislation and the steps necessary for compliance and on defending legal cases and liaise with enforcement ofcers.


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Health Promotion at Work Health promotion is the process of enabling people to increase control over, and to improve their health (WHO, 1986). The scope of health promotion is determined as much by expected outcomes as well as the ways in which they can be achieved. The purpose of health promotion is to encourage and enable people to gain greater control over those factors than can affect their health either positively or adversely. In order to fully promote workplace health, the employer needs to take account of not only working conditions, access to health services, education, income etc. but also of providing information about factors such as lifestyle and behaviour. Promotion of health is aimed at improving health and the quality of life through a variety of interventions which include: ▪

Prevention of disease;

▪

Educating individuals on healthy living;

▪

Lifestyle choices; and

▪

Living conditions.

Each organisation should have in place a Health Promotion Strategy detailing how to promote health in the organization. This should ensure a co-ordinated approach which maximises the use of resources, and ensures that health is at the forefront of activities. When formulating a strategy for workplace health, three key inter-related aspects need to be considered: ▪

Individual Employees are an organisation’s key resource - staff health & wellbeing should be promoted at all times;

▪

The Working Environment must be safe & healthy and that employees’ health and welfare must be protected, through risk assessments and workplace policies; and

▪

The Organisational Structure can have a signicant effect on morale and on how employees feel about their work.

A key advantage of providing health promotion initiatives in the workplace is that staff who participate will tend to have a positive effect on their colleagues. Many individuals are better able to make changes to their lifestyle when they have support and encouragement from their peers.


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Occupational Health Needs Assessment A health needs assessment can be dened as: “a way of helping employees to identify what affects their health in the workplace, what actions are necessary to improve their health and how to implement them”. A health needs assessment is an invaluable foundation upon which to base a sustainable workplace health programme. Although it requires considerable organisational commitment and investment of staff time, it is essential for identifying the key issues affecting staff health. The starting point is to determine what potential hazards there are in the workplace that c ould affect employees’ health. This can be done through an Occupational Health Needs Assessment process. This is an initial assessment to determine health hazards and risks from the working situation and to see where occupational health intervention would be most benecial, to both improve health and reduce inequalities.

Workplace Health and Well-being Policies Once initiatives have been decided on it is important that they are documented in workplace policies and procedures. These will outline the overall intent of the organisation with regard to health and well-being, and provide details of the specic initiatives that have been implemented. They will also provide details of key personnel involved in the delivery of the overall programme and the specic issues, and a date for reviewing the policy.

Workplace Health Services The occupational health needs assessment process will ultimately identify what health services are required in the organisation. The prioritisation inherent in the process will allow resources to be effectively identied and managed.


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1026 Int Diploma IB11 v2

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