11_managing_occupational_health_20140117153136

Question 1

Occupational health hazards include:

Answer 1

 Chemical, physical and biological agents.  Ergonomic and psychosocial hazards.

Question 2

Acheson’s model of the main determinants of health (Figure 11.4) shows several layers of influence on health and wellbeing.

Answer 2

 Individuals are at the centre with certain fixed genetic attributes that may impact on health, but surrounding the individuals are layers of influence that interact and are modifiable.  Personal behaviours and lifestyle choices, such as smoking habits and lack of exercise, clearly have the potential to promote or damage health.  Interactions with friends, relatives and the immediate community can also influence the health of individuals and communities.  Living and working conditions, food supplies, and access to essential goods and services, are broader influences on a person’s ability to live a healthy life.  The outermost layer shows the economic, cultural and environmental conditions prevalent in society as a whole.

Question 3

Provision of vocational rehabilitation can require input from professionals from many different disciplines, including medical professionals, disability advisers and career counsellors. According to the Vocational Rehabilitation Association (VRA), the techniques used can include: 12

Answer 3

 assessment and appraisal  goal setting and intervention planning  provision of health advice and promotion, in support of returning to work  support for self-management of health conditions  career (vocational) counselling  individual and group counselling focused on facilitating adjustments to the medical and psychological impact of disability  case management, referral, and service co-ordination  programme evaluation and research  interventions to remove environmental, employment and attitudinal obstacles  consultation services among multiple parties and regulatory systems  job analysis, job development and placement services, including assistance with employment and job accommodations  the provision of consultation about and access to rehabilitation technology.

Question 4

IOSH’s Good practice guide to rehabilitating people at work makes the following recommendations:

Answer 4

policy on rehabilitationline manager’s responsibilityEarly intervention is importantregular contact with employeesRehabilitation should begin at an appropriate stageRehabilitation should be considered as soon as it is clear that absence could be lengthyco-ordinated case management approach is bestarrange for the employee to see an occupational health adviserask about what the employee can and can’t doassess whether medical intervention, such as physiotherapy or counselling, will speed up the rehabilitation processplan a programme of rehabilitationmake reasonable adjustmentsconsider any health and safety issuesagree the arrangements for rehabilitation, and record themprogress should be monitored regularlyagree any significant changes to the employee’s role with the occupational health adviser or employee’s GP or specialist

Question 5

In 1977 George Engel critiqued the prevailing reductionist biomedical model of medicine that suggests every disease process can be explained in terms of an underlying deviation from normal function, such as a pathogen, genetic or developmental abnormality, or injury; and proposed a new holistic alternative - the bio-psychosocial model. In his critique of the biomedical model Engel noted that: 4

Answer 5

 Biochemical alterations do not necessarily translate directly into an illness and psychological alteration may, under certain circumstances, manifest as illnesses.  Psychosocial variables are more important determinants of susceptibility, severity, and illness than had been previously appreciated.  The success of the most biological of treatments is influenced by psychosocial factors, for example: the placebo effect.  Patients are profoundly influenced by the way in which they are studied, and the scientists engaged in the study are influenced by their subjects.

Question 6

The bio-psychosocial model

Answer 6

BiologicalPsychological Social=Health

Question 7

Occupational health focuses on three main objectives:

Answer 7

 The maintenance and promotion of workers’ health and working capacity.  The improvement of working environment and work to become conducive to safety and health.  The development of work organizations and working cultures in a direction which supports health and safety at work and in doing so also promotes a positive social climate and smooth operation and may enhance productivity of the undertakings.

Question 8

In complex organisations with a spectrum of occupational health hazards a multi-faceted team of professionals may be required to help manage the risks. The key professionals are likely to be an occupational physician and occupational health nurse / adviser. Other professionals who may have a key role to play include: 6

Answer 8

 Toxicologists  Physiotherapists  Ergonomists  Microbiologists  Psychologists  Health physicists.

Question 9

There are currently three levels of qualification in occupational medicine for doctors:

Answer 9

 Diploma in Occupational Medicine (DOccMed) (recommended minimum standard of qualification).  Associate membership of the Faculty of Occupational Medicine (AFOM).  Membership of the Faculty of Occupational Medicine (MFOM).

Question 10

Nurses who carry out occupational health surveillance should, as a minimum, be registered with

Answer 10

the Nursing and Midwifery Council (NMC). They may also hold an occupational health qualification at Certificate, Diploma or Degree level. If the nurse does not have an occupational health qualification then they should work under the supervision of an appropriately qualified clinician (doctor or nurse).

Question 11

Generally the distinction between assessment and surveillance is the same as the distinction between

Answer 11

measuring and monitoring

Question 12

There are many activities that can be done to measure or monitor the health of employees that should not be confused with health surveillance. Examples include measures necessary to comply with legal duties such as:

Answer 12

 Pre-placement and annual medical examinations to assess an individual’s fitness for work, under the Ionising Radiations Regulations 1999.  Health screening such as eye and eyesight testing under the Health and Safety (Display Screen Equipment) Regulations 1992.  Assessments of fitness to drive or operate cranes within dock premises under the Docks Regulations 1988.  Fitness for work health assessments offered to night workers under the Working Time Regulations 1998.

Question 13

Health surveillance is about

Answer 13

putting in place systematic, regular and appropriate procedures to detect early signs of work-related ill health among employees exposed to certain health risks. It is also about acting on the results to prevent any progression of work-related ill health.

Question 14

Health surveillance offers a range of potential benefits for the employer and employees, including: 5

Answer 14

 Detecting harmful health effects at an early stage, protecting workers and helping to keep them fit for work.  Checking the on-going effectiveness of control measures.  Providing data by health records to help detect and evaluate health risks.  Providing an opportunity to train and instruct employees further in safe and healthy working practices.  Giving employees a chance to raise concerns about the effect of work on health.

Question 15

Health surveillance may be appropriate where

Answer 15

a risk cannot be reduced or controlled to such a level that it will not be harmful to health.

Question 16

The following conditions should be met for health surveillance to be appropriate: 4

Answer 16

 The work is known to damage health in some particular way.  There are valid ways to detect the disease or condition. To be effective health surveillance has to be able to reliably show that damage to health is starting to happen or becoming likely. The technique must be accurate, safe and practical.  Damage to health must be likely under the particular conditions at work.  Surveillance should benefit the employee in some way.

Question 17

Health surveillance action guide 8

Answer 17

1. Involve employees and theirrepresentatives2. Obtain specialist advice ifappropriate3. Identify the most suitable healthsurveillance procedureConsider the type of hazard, degreeof risk, likely health effects, affectedemployees, relevant procedure(s),whether in-house expertise exists4. Design system, putsomeone in charge5. Set up the programme6. Carry out procedures/feedback information7. Keep records8. Monitoring, action and evaluationProtect individuals at riskReview your risk assessmentImprove risk controlDiscuss grouped results withemployee representatives

Question 18

The range of techniques available

Answer 18

Self-checks A responsible person making basic checks for signs of disease Enquiries about symptoms, inspection and examination by a qualified person Clinical examinations Biological monitoring and biological effect monitoring

Question 19

When health surveillance shows that an employee’s health is being affected by work, the following steps should be taken: 4

Answer 19

 Prevent further harm by temporarily removing them from exposure to the hazard, or reducing their exposure.  Refer the individual for further examination and/or treatment by an occupational health doctor.  Re-examine the relevant risk assessment(s) to determine what further action may need to be taken to protect the rest of the workforce or to extend surveillance.  Improve control measures as necessary, seeking specialist advice (from occupational hygienists, for example), as necessary.

Question 20

Health surveillance results can be used in two ways:

Answer 20

(1) Individual assessments should aim to improve the protection of the employees covered. (2) Analysis of group data provides an insight into how well the health risk control programmes are working.

Question 21

Legal requirements for health surveillance

Answer 21

Control of Substances Hazardous to Health Regulations 2002 (CoSHH) Control of Noise at Work Regulations 2005 (CNWR) Control of Vibration at Work Regulations 2005 (CVWR) Health and Safety (Display Screen Equipment) Regulations 1992

Question 22

Legal requirements for medical surveillance

Answer 22

Control of Substances Hazardous to Health Regulations 2002 (CoSHH) Control of Lead at Work Regulations 2002 (CLAW) Control of Asbestos Regulations 2012 (CAR) Ionising Radiation Regulations 1999 (IRR99)

Question 23

Health surveillance programmes should include keeping a health record for each individual. These are important because they provide: 3

Answer 23

 an historical record of jobs involving exposure to substances or processes requiring health surveillance  a record of the outcome of previous health surveillance procedures (in terms of fitness for work, restrictions required etc)  information for HSE or local authority inspectors to show that health surveillance has been carried out.

Question 24

Health records are different from clinical records in that

Answer 24

they do not contain confidential clinical details and can therefore be kept securely with other confidential personnel records

Question 25

Length of retention of health records

Answer 25

As a general rule, employee’s individual health records should be kept for as long as they are under health surveillance. CoSHH1998, CAR 2012, and the Work in Compressed Air Regulations 1996 all require that records are ‘kept in a suitable form for at least 40 years from the date of the last entry made in it.’ The guidance to CLAW 2002 also recommends keeping records for 40 years. IRR99 requires that records are kept: … until the person to whom the record relates has or would have attained the age of 75 years but in any event for at least 50 years from the date of the last entry made in it. CNWR 2005 and CVWR 2005 merely require that a suitable record is made and maintained.

Question 26

The Data Protection Act 1998 requires those who hold information on health and medical records to

Answer 26

tell those on whom records are held that a record is being kept, its purpose and that they have a right to see the information and correct it.

Question 27

Signs of drug misuse include:

Answer 27

 sudden mood changes  unusual irritability or aggression  a tendency to become confused  abnormal fluctuations in concentration and energy  impaired job performance  poor time-keeping  increased short-term sickness absence  a deterioration in relationships with colleagues, customers or management  dishonesty and theft (arising from the need to maintain an expensive habit).

Question 28

Alcohol related problems fall into two main categories:

Answer 28

Absenteeism and sickness absence Alcohol is estimated to cause:  35% of all absences from work.  8 to 14 million lost working days in the UK each year.

Question 29

Effects of alcohol on the individual Acute effects

Answer 29

Alcohol reduces physical coordination and reaction speeds. It also affects thinking, judgement and mood. A few drinks may be relaxing and un-inhibiting; getting drunk can lead to arguments, mood swings, and even violence. Large amounts of alcohol in one session can strain the liver and adversely affect muscle function and stamina. The after effects include nausea, vomiting and headaches (hangovers).

Question 30

Effects of alcohol on the individual Chronic effects

Answer 30

Increased risk of:  Coronary heart disease and some kinds of stroke, as a result of high blood pressure.  Liver damage.  Cirrhosis of the liver.  Cancers of the mouth and throat.  Psychological and emotional problems, including depression.

Question 31

Drink driving It is an offence to drive with more than

Answer 31

80mg of alcohol in every 100ml of blood.

Question 32

The approach to tackling workplace problems with drugs and/or alcohol involves four major stages:

Answer 32

 Consultation  Policy  Screening  Support and/or discipline.

Question 33

A drugs and alcohol policy applying to all staff should form part of the overall health and safety policy. As a minimum the policy should: 6

Answer 33

 Clearly state the standards of acceptable behaviour expected of all employees.  Apply equally to all management levels.  Address issues in the workplace that may contribute to increased levels of drug / alcohol use.  Be primarily non punitive.  Clearly state the behaviours likely to lead to disciplinary action.  Provide for rehabilitation and treatment of affected employees.

Question 34

Screening can be a very sensitive issue. No one can be tested against their will, however once testing has been introduced, a refusal can lead to disciplinary action. Careful consideration needs to be given to arrange of issues including: 4

Answer 34

 The availability of suitable, reliable screening techniques.  The expense of the system.  The need for medical support and resources.  What happens in the case of a positive result?

Question 35

Drug and alcohol testing may be undertaken on the following basis:

Answer 35

Pre-employment Conducted prior to an applicant commencing employment. Probation Carried out during the probationary period following commencement of employment. Note: Not practicable with a peripatetic workforce. Periodic Routine testing after specific work tasks (crane and plant operating / vehicle driving) or to agreed time scales. Post-incident Carried out after an accident, where there are grounds to believe that the effects of drugs or alcohol could be a contributory factor. For-cause When an employee’s behaviour (unsteady gait, slurring of words or unusual actions) leads a manager to suspect that drugs or alcohol are involved. Random Purely random testing of the entire workforce or a sub-set of workers. Rehabilitation Precautionary testing after an employee has submitted to a period of rehabilitation.