OCCUPATIONAL HEALTH SERVICES

1. OCCUPATIONAL HEALTHSERVICES Author: Lyn Allinson, CMIOSH, MIIRSM, BSc (HONS), RGNHead of Risk Management,  Brighton and Sussex University Hospitals NHS Trust Quality and Safety Directorate, Risk Management Department, Downsmere, Princess Royal Hospital, Haywards Heath, West Sussex RH16 4EX

2. Why have an Occupational Health Service? • to ensure Staff are fit for the job • Pre Employment Questionnaire & Assessments • Fitness testing – security, police • Specialist requirements – exposure prone procedures (EPP), X-ray, Maternity, Paediatrics etc. • Unsocial hours / Night work • New and Expectant mothers / young workers • DDA • Training • and that the job will not harm your Staff

3. Management of sharps/splash incidents first aid, report it…..in hours/out of hours, Incident report and investigation (Datix), policy setting Health Surveillance Prevention of dermatitis / latex allergy Lead Respiratory sensitizers Radiation protection and monitoring Maintaining of Healthy Workforce Advice regarding health conditions affecting work and work issues affecting health Health promotion Immunisations TB, Hepatitis B, Chicken Pox, Flu, others (ensuring up to date (high risk roles and staff) Travel As part of Role Return from Travel in high risk area Specialist support Physiotherapy, Counselling, Debrief service, Post Traumatic events (MPS) PPE (FFP3 – Fit testing ) Cardiac, audio, ophthalmology, alcohol / drug testing (CAA) Audiometry – Hearing protection DR and consultant support Rehabilitationservices What Occupational Health might cover?

4. The Role of the Occupational Health Nurse Definition from NHS careers:- Occupational health nurses are considered to be leaders in public health in the workplace setting. The occupational health nurse role includes: • the prevention of health problems, promotion of healthy living and working conditions • understanding the effects of work on health and health at work • basic first aid and health screening • workforce and workplace monitoring and health need assessment • health promotion • education and training • counselling and support • risk assessment and risk management Discussion re competencies of OH professionals http://www.personneltoday.com/articles/2008/01/07/43730/occupational-health-competencies-framework-fitting-together.html http://www.personneltoday.com/articles/2010/04/26/55058/oh-technician-standards-and-competencies-need-to-be-established.html HSE research -Competencies of Occupational Physicians - The customer’s perspectivehttp://www.hse.gov.uk/research/rrpdf/rr247.pdf

5. HSE search re Occupational Health • A guide to health and safety regulation in Great Britain - WEB42 • Working together to prevent sickness absence becoming job loss - practical advice for safety and other trade union representatives - Web02 • Off work sick and worried about your job? Steps you can take to help your return to work - INDG397 • Off work sick and worried about your job? talking leaflet [MP3 audio 2.3mb] • Managing sickness absence and return to work in small businesses - INDG399 • Sun protection - advice for employers of outdoor workers - INDG337 • A guide for new and expectant mothers who work - INDG373 • New and expectant mothers at work - a guide for health professionals - INDG373hp • Tax rules and the purchase of occupational health support • Don't mix it - a guide for employers on alcohol - INDG240 • Drug misuse at work: a guide for employers - INDG91 • Back in work : managing back pain in the workplace (formerly indg333) • Understanding health surveillance at work : an introduction for employers - INDG304 • Preventing dermatitis at work - Advice for employers and employees (revised) - INDG233 • Healthy workplace, healthy workforce, better business delivery: Improving service delivery in universities and colleges through better occupational health - MISC743

6. Sickness / Absence Management For advice regarding fitness for work e.g: • sickness absence. • underlying health condition. • recuperative duties / return to work.

7. The Six Elements of Managing Sickness Absence HSE has identified six key elements involved in effectively managing sickness absence and return to work: • Recording sickness absence • Keeping in contact • Planning and undertaking workplace adjustments • Using professional or other advice and treatment advice • Agreeing and reviewing a return to work plan • Coordinating the return to work process The guidance from the HSE first published in 2004 and therefore makes no reference to the Fit Note. Although the majority of the guidance remains relevant, you need to keep in mind the existence of the Fit Note in applying any potential recommendations. http://www.hse.gov.uk/sicknessabsence/downloads.htm

8. HSE Flow Chart on Sickness Absence

9. Fit Note - What are the changes? The main changes are: • a new option on the Statement – ‘may be fit for work’; • removal of the option to say an individual is ‘fit for work’; • more space for the certifying doctor to provide information on functional effects of the condition and/or any treatment planned; • tick boxes on common ways to aid a return to work • and during the first 6 months of sickness, the Statement can be issued for no longer than 3 months at a time. http://www.dwp.gov.uk/fitnote/

10. Fit Note - What stays the same? • the Statement continues to be completed only by registered medical practitioners; • the Statement continues to be required only after the 7th day of sickness; • the Statement can still be used as evidence for why an employee cannot work due to an illness or injury; • the information on the Statement is still advice to the patient. It is not binding on the employer; • the requirements for the payment of Statutory Sick Pay have not changed; • and employer’s obligations under the Disability Discrimination Act have not changed.

11. Is the advice on the Statement binding on employers? No! • It is up to the employer after discussing the Statement with their employee (and if necessary seeking advice from an occupational health professional), how to act on the doctor’s advice.

12. Is a final sick note required before an employee can return to work? No. • With the new Statement of Fitness for Work the doctor can say if they do or do not need to see the patient again but unlike the sick note, the Statement of Fitness for Work does not include the option for doctors to advise someone that they are fully fit for work. It is a myth that an employee needs to be ‘signed back’ to work by a doctor. • Employees often do not need to be fully fit to return to work.

13. RIDDOR - Reportable disease Occupational health doctor (or GP) if they notify you that your employee suffers from a reportable work-related disease, then you must report it to the enforcing authority. An OH service will do this for you. Reportable diseases include: • certain poisonings; • some skin diseases such as occupational dermatitis, skin cancer, chrome ulcer, oil folliculitis / acne; • lung diseases including: occupational asthma, farmer's lung, pneumoconiosis, asbestosis, mesothelioma; • infections such as: leptospirosis; hepatitis; tuberculosis; anthrax; legionellosis and tetanus; • other conditions such as: occupational cancer; certain musculoskeletal disorders; decompression illness and hand-arm vibration syndrome. • A full list of reportable disease Also assist with over 3 day injuries, major injury or fatalities investigations.

14. Musculoskeletal disorders (MSDs) Musculoskeletal disorders (MSDs) include problems such as low back pain, joint injuries and repetitive strain injuries of various sorts. http://www.hse.gov.uk/msd/ Risk factors causing MSDs can be found in virtually every workplace from commerce to agriculture, health services to construction. An estimated 11.6 million working days a year are lost to work-related MSDs. • MAC tool – • The MAC tool helps users to identify high risk workplace manual handling activities.http://www.hse.gov.uk/msd/mac/introduction.htm • Upper limb disorders • ART Tool - The Assessment of Repetitive Tasks tool helps identify tasks that may result in injuries to staff.http://www.hse.gov.uk/pubns/indg438.pdf • Back pain • Physiotherapy (acupuncture, chiropters or osteopath) • Fast Track • Pain management (clinics) • Display Screen Equipment (DSE) • DDA • Training • Specialist requirements – chairs, equipment, • Pushing and pulling activities – 11% of manual handling - related RIDDOR accidents investigated by HSE involved pushing and pulling. http://www.hse.gov.uk/msd/pushpull/index.htm

15. Other Sources of information – MSDs • NHS CHOICES- http://www.nhs.uk/Conditions/Back-pain/Pages/Introduction.aspx • NICE - http://guidance.nice.org.uk/CG88/PublicInfo/pdf/English • Backcare - (Carers guidance) http://www.backcare.org.uk/1715/Books.html • Arthritis Research UK -http://www.arthritisresearchuk.org/arthritis_information/arthritis_types__symptoms/back_pain.aspx • The Chartered Society of Physiotherapy - http://www.csp.org.uk/ • The British Pain Society -http://www.britishpainsociety.org/ • The Back Book - http://www.tsoshop.co.uk/bookstore.asp?FO=1160007&DI=346223

16. Health Surveillance What is health surveillance? Health surveillance is any activity which involves obtaining information about employees’ health and which helps protect employees from health risks at work. The objectives for health surveillance are: • Protecting the health of employees by early detection of adverse changes or disease; • Collecting data for detecting or evaluating health hazards; • Evaluating control measures. It should not be confused with general health screening or health promotion. Health surveillance is necessary when: • there is a disease associated with the substance in use (e.g. Asthma, Dermatitis, Cancers); • it is possible to detect the disease or adverse change and reduce the risk of further harm; • the conditions in the workplace make it likely that the disease will appear. http://www.hse.gov.uk/pubns/priced/hsg61.pdf

17. The Employer’s Checklist- 4 stage approach • Do I have a health risk problem, or a need for occupational health input, in my workplace? • What/who do I need to control/provide it (a doctor or nurse or a 'responsible person')? • Take that action. • Is it working (check on what's been done)? Health surveillance process overview HSE also publish Understanding health surveillance at work INDG304

18. Management of Stress • Policy • Stress organisational assessment • Focus groups • Specific individual or department • Audit • Organisational staff survey • Training for management and Staff • Occupational Health referral • Counselling services http://www.hse.gov.uk/stress/roles/occupationalhealth.htm

19. HSE OH role in the Stress Management Stds • Acting as champion and / or representing OH on a steering group. • A critical role in helping with early identification and treatment and, onward referral and helping line managers with this. Use OH specialist knowledge to inform and train other key players in the organisation. • Outside the line management chain; individuals find the objectivity and confidentiality this brings reassuring, especially if the problem is in their line management chain of command. • A focus in the organisation for health and related issues and can act as an important interface with, or conduit to, external specialists. • A role in health promotion that is especially relevant in the area of work related stress. • Collect and analyse health and other statistics that will be useful for elaborating trends and patterns of ill health.

20. HSE OH role with individuals • Mental health 'first-aid'. • Advising line management about 'workability'. • Expertise in case management. • Support to individuals presenting with problems. • Understanding of biology and manifestations that can be taught to others e.g. trends, types of problems seen in the organisation or CPD on stress issues. • Monitoring and surveillance of workplace health indicators that may be indicative of work related stress problems.

21. Occupational health providers have a particular role in working with individuals who are experiencing problems associated with work related stress and helping them either to remain at work or return to work successfully. Key messages • Although individuals may, in the short term, be highly distressed long-term sickness absence is not inevitable. • A common acute manifestation of work related stress is a change in the individual’s performance, showing or reporting some functional impairment, or displaying mood changes. Often these manifestations are noticed by co-workers and line managers rather than the individual concerned.

22. Prevention of sharps /splash incidents Prevention of sharps injuries framework agreement  • European employment ministers have agreed and adopted a directive which will come into force in June 2010 after which the UK has three years to implement the new legislation which is aimed at preventing sharps injuries in the healthcare sector. http://www.nhsemployers.org/HealthyWorkplaces/HealthAndSafety_new/sharpsinjuriesframework/Pages/ECFrameworkagreementonsharpsinjuries.aspx • Policy • Don’t re-sheath • Safer sharps – product selection • Prompt disposal • Use protective equipment • Don’t overfill sharps bin • Training • Reporting / Investigation – risk assessment http://rxhas03/datix/live/index.php?form_id=45&module=INC

23. Occupational Dermatitis • Policy • Product selection • Training for management • Surveillance • hand care week • pre employment assessment • Annual appraisal, manager to check skin • Infection Control • Report symptoms to manager for referral to Occupational Health • Use of Products – Specialist Advice

24. Natural Rubber Latex (NRL) Occupational Health staff will be required to: • Undertake pre-employment screening of all prospective employees working in the clinical environment - this could be as simple as adding a question on the Pre-Employment Health Questionnaire. • Provide advice to all prospective employees and their managers regarding NRL-safe environments. • Provide advice to all employees with regard to NRL protein and chemical sensitisations. • Undertake a risk assessment to determine whether an NRL-safe environment within OH clinical rooms should be the 'norm' to prevent / reduce the incidence of exposure to NRL, to both OH personnel and clients. • Undertake a risk-assessment to determine whether a NRL-free gloves should be used in a client testing / diagnostic situation, where the member of staff is, as yet, undiagnosed. • Use a screening questionnaire for identifying NRL Sensitivity, to assist in determining whether further diagnostics/testing are required. • Once a positive diagnosis of NRL allergy has been made, to undertake a risk assessment within clients workplace, in conjunction with the manager, to ensure a safe working environment for sensitised individuals http://www.hse.gov.uk/latex/occhealth.htm

25. Additional Training and Support Occupational Health Technician training • Aimed at Practitioners working in occupational health and safety and / or human resource teams within both the public and private sectors of employment. • Students from small/medium enterprises (SME´s) with no formal occupational health provider. http://www.hsl.gov.uk/training.aspx/health-and-safety-training-courses/occupational-health-technician-in-practice.aspx

26. IOSH - Occupational Health Toolkit The Toolkit is a free resource. It brings together information, guidance, factsheets, case studies, training materials, presentations and more to help you tackle occupational health problems. • Stress • Musculoskeletal disorders • Skin disorders • Inhalation disorders http://www.iosh.co.uk/information_and_resources/our_oh_toolkit.aspx

27. NHS Employers http://www.nhsemployers.org/Pages/home.aspx Occupational Health and Safety Standards • http://www.nhsemployers.org/Aboutus/Publications/Pages/Occupationalhealthandsafetystandards.aspx Working with radiation in the NHS  • The Partnership for Occupational Safety and Health in Healthcare (POSHH), which is a sub group of the NHS Staff Council have produced advice for managers and staff on working safely with radiation in the NHS. http://www.nhsemployers.org/Aboutus/Publications/Documents/Working%20with%20radiation%20in%20the%20NHS.pdf • Need to notify and HSE accreditation use and dosimetry servicehttp://www.hse.gov.uk/radiation/ionising/index.htm Policy and Guidance on unsocial hours especially night work • http://www.nhsemployers.org/HealthyWorkplaces/HealthAndSafety_new/Pages/NightShiftWork.aspx Additional guidance on role and activities covered by OH in the NHS including infection control for employees and Handling infected cadavers etc. • http://www.nhsemployers.org/HealthyWorkplaces/HealthAndSafety_new/HealthAndSafetyEssentialGuide/Pages/OccupationalHealth.aspx