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The Effects of (Ill)Health on Work

The Effects of (Ill)Health on Work. Jeremy Owen Army Professor of Occupational Medicine. Royal Centre for Defence Medicine and Institute of Occupational & Environmental Medicine, University of Birmingham March 2006. Royal Army Medical Corps Cadetships. Final 3 yrs at Medical School

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The Effects of (Ill)Health on Work

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  1. The Effects of (Ill)Health on Work Jeremy Owen Army Professor of Occupational Medicine Royal Centre for Defence Medicine and Institute of Occupational & Environmental Medicine, University of Birmingham March 2006

  2. Royal Army Medical Corps Cadetships Final 3 yrs at Medical School Annual Salary £12,500 - £15,000 Tuition fees paid & Book Allowance Clinical and Academic support Elective Placements abroad Package worth about £42,000 Excellent training prospects after graduation Enquiries: 01276 - 412744/45

  3. Learning Points Recap – Role of OH Team Defining the scale of the problem Identifying & Assessing Ill-health in the Workplace DDA Fitness to Drive

  4. What is Occupational Medicine ? Occupational Medicine is the clinical component of occupational health…. …It is a discipline concerned with the effects of work on health and the influence of pre-existent health problems on the capacity to work.

  5. Health >>>> Work >>>> Health To ignore the two way interactions between work and health is to risk misdiagnosis, mismanagement and overall failure to do your best for your patients and society at large.

  6. Musculo-skeletal conditions £5.5 billion Averaged cost per employee£400 - 500 Averaged absence per employee7.8 days believe they are suffering from illness, caused by work 2 Million Annual bill for GB work related illness and injuryis £10 Billion Extent of Sickness Absence and Occupational IIl Health in UK

  7. And don’t forget ... YOU and I! OH Stakeholders Work • Colleagues • Employer • Customers • Investors • Public Society • Family & Community • Health Service • Country/Govt • Legislators • Media? Individual • Employee • Patient

  8. Occupational Health Tasks • Identify hazards • Assess risks to health in the circumstances • Manage/control the risks • Match people with appropriate jobs

  9. Health & Work Drivers for widening the workforce: • Moral • Work is good for you • Inclusive society • Financial • Individual Benefits • Organisation Benefits • Societal Benefits • Legal • HSW Legislation • Disability Discrimination Act

  10. Hazards/Exposures • Chemical • Physical • Mechanical • Biological • Psycho-social/Organisational

  11. Matching Jobs and People • People: Health/Fitness, Susceptibilities • Jobs: Ergonomics + Minimising Risks • Psychosocial: Work-Life balance, Stress • Evidence Based Standards • Common Sense

  12. Ill-Health in the Workplace • Few medical conditions are an absolute bar to work • Many conditions impose a relative reduction in capability in certain jobs • However individual can still be productive • ‘Suitable Workplace Adjustments’

  13. Infection Injury Accidents Anxiety Workload Litigation Risks Impact of Illness at Work • Increased risks to the Individual • Increased risks to Colleagues • Decreased Productivity

  14. Illness at Work • Coincidental / Inter-current • Index cases • Exacerbated by Work • Resultant from Work

  15. Matching the Person to the Job • Functional Assessment • Capability Based • ‘Reasonable Adjustments’ • Physical/Ergonomic • Psychosocial/Organisational • Alternative Employment • (Medical Retirement)

  16. Medical Screening • Pre-Employment/Pre-Placement • Initial Training • Periodic • Change of Employment • Clinical Indications • Return to Work/ Prolonged Sickness Absence • Retirement

  17. How do you Screen? • Questionnaire • Self Administered • OH Nurse Administered • Doctor Administered • History & Examination • Doctor or OH Nurse led • Investigations

  18. Who gets What? • Interview, Examination +/- Investigation: • Safety Critical Occupations • Flying, Diving, Driving • ‘At Risk’ Occupations • Specific Work Activity • Specific Workplace exposures (Bio, Phys, Chem) • Questionnaire • Routine/Non-Hazardous Jobs

  19. Maintaining Fitness for Work • Medical Assessment/Medical Screening • Advice to Management • Company Health Policies • Worker (& Management) Education • Health Promotion

  20. Fitness to Drive

  21. Health & Driving • DVLA Concerns - Sudden incapacity • Legal Basis/Statute - Road Traffic Act 1988 - EC Directives - Human Rights Act • Medical Obligations - Individual - Doctor

  22. Medical Standard • Is there a risk of a sudden disabling event? • Is the condition likely to render that person a source of danger when driving? • Civil Law  Balance of Probabilities

  23. Road Traffic Act 1988 • Individual responsibility to report medical conditions • DVLA Medical Staff have authority to investigate medical concerns • Can only restrict the duration of a licence and type of licence (Gp 1/Gp2). • Appeal mechanism for individuals

  24. Driving Licences • Full • Gp1 • Age: 17 – 70yrs • Restricted • Age: 3yrly over 70yrs with health self-declaration • Medical Condition: 1 – 3yrs with medical review • Licence Classes • Gp 1 • Gp 2

  25. Driving Licences • Class 1 • Private Vehicles • Higher acceptable risk • Vision • Medical Conditions • Medication • ‘Grandfather’ rights • Class 2 • LGV/PSV • Lower acceptable risk • Vision • Medical Conditions • Medication • ‘Grandfather’ rights

  26. DVLA v OH Criteria • DVLA criteria • Does a medical condition currently affect a licence holders entitlement • No requirement to consider employment or occupational policies/standards • Only considering duration of licence being issued (Restricted [1 – 3yrs], or Full)

  27. Driving Licences • Medical Obligations • Road Traffic Act • Risk Management (Sudden Incapacity) • Reporting to DVLA • Confidentiality

  28. Medical Concerns • The Medical Condition: • Sudden Incapacity (MI, Angina, DM) • Lack of Motor Control (Amputation) • Neurological Events (Epilepsy) • Vision • Acuity • Fields of Vision • Medication • Effects of treatment (Insulin) • Fatigue • Sleep disorders (Narcolepsy) • Excessive Fatigue (Chronic Pain, Shiftwork) • Alcohol/Drugs

  29. DVLA Medical Guidance DVLA 'At a Glance Guide to the Current Medical Standards of Fitness to Drive' - A Guide for Medical Practitioners http://www.dvla.gov.uk/drivers/dmed1.htm

  30. To ignore the two way interactions between work and health is to risk misdiagnosis, mismanagement and overall failure to do your best for your patients and society at large.

  31. The Effects of (Ill)Health on Work Jeremy Owen Army Professor of Occupational Medicine Royal Centre for Defence Medicine and Institute of Occupational & Environmental Medicine, University of Birmingham February 2006

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