B1 Ollie Flashcards
History of Occupational Health
Paracelsus (1493-1541)-miners
Ramazz ini 1713: 50 occupations - De Morbis Artificial Percival Potts 1775- Soot and scrotal cancer
Thomas Legge - first Medical Inspector of Factories 1898
History of Occupational Health
Phossy jaw - match making (phosphorous ) Workers in felt-hat industry - Mercury Pottery workers and lead
Bladder cancer in rubber workers Pneumoconios is in miners
Byssinosis - lung disease from fibres (textile workers )
Occupational Health Hazards
Chemical - liquids , dusts , fumes , fibres , mists , gases , vapours
Physical -noise,vibration,radiation,heat and cold,pressure
Biological-insects,mites,moulds,yeasts,fungi,bacteria,viruses
Ergonomic -posture,movement,repetitiveactions,illumination, visibility
Psychosocial – worry,work pressure,monotony,unsocial hours, stress , subssance abuse
Information Sources
Self-reported illnes s reports through the Labour Force Survey Reports of ill health by doctors and s pecialis t phys icians (Health and Occupational
Reporting Network-THOR and THOR-GP)
Death certificates
The Reporting of Injuries , Dis eas es and Dangerous Occurrences Regulations
Industrial Injuries Disablement Benefit (IIDB)Scheme
Labour Force Survey
Annual s urvey of approx 50,000 hous eholds
Questions relatedtojob,workplaceinjuries,trainingetc Managed by Office for National Statis tics
Self-reported Work Related Illnes s Survey
Figures from s urvey extrapolated to whole population
Health and Occupational Reporting Network
THOR-GP data from approx 300 GPs
MSD mos t common type of work-related illnes s Mental health illnes s -more days off Specialistdoctors reports -THOR
Internal Information Source
Occupational health s taff e.g.
occupational health nurses
Res ults of health s urveillance and health as s es s ments Riskassessments,especiallyspecificassessments suchas thosefor manual handling and dis play s creen equipment
Written procedures and policies (e.g. on alcohol and drug us e) Internally produced leaflets and guidance
Content of training courses and toolbox talks
External Information Sources
Professional bodies such as IOSH & HSE
Regulations , ACOPs and as s ociated guidance
Other public bodies
Commercial internet bas ed information s ervices Periodicals and journals
Trades union information
Consultancies
Published material e.g. text books /internet
Government Strategy (1)
Health, Work and Well-being, Caring for our Future 2005:
Engaging s takeholders
Improving working lives
Health care for working age people
Government Strategy (2)
Health, Work and Wellbeing :
The Workplace Well-being Tool
The Fit Note
Health, Work and Well-being Co-ordinators
Planning for Epidemics
Covid 19
Influenza
Government action
Employer action
Government Action (1)
Planning in advance
Gathering information in advance about the likelihood and effects of epidemics and pandemics
The preparation and development of vaccines
Government Action (2)
Where vaccines are not available the stockpiling of drugs to treat the symptoms of the disease (such as Tamifluagainst flu)
Slowing the s pread of epidemics by res tricting s ocial or other large gatherings
Res tricting travel to areas where pandemics are pres ent Providing information through a variety of s ources
Employer Action (1)
Carrying out risk assessments relating to potential epidemics Putting in place systems to keep a breas of government information and appointing a senior manager to co-ordinate ares pons e if necessary Ensuring cover is in place where key personnel may become ill
Ensuring systems for rapid communication of information to staff
Employer Action (2)
Consider contingency funding for epidemics
Ensuring any facilities are in place inadvance for prevention measures e.g. sufficient hand basins in appropriate places for hand was hing Consideration of methods to separate employees to reduce spread (social distancing)
Ensure that systems are in place for employees to report
symptoms at an early stage and quarantine
Vocational Rehabilitation - Principles
Whatever helps someone with a health problem to stay at, return to and remain in work
Key principles:
The need to intervene early
The need for good quality case management for those who need professional support
The importance of a bio-psycho-social approach, that
considers all of a person’s needs for getting or keeping work
Vocational Rehabilitation - Benefits to the Employer
Early intervention may prevent minor injuries becoming s erious Fewer employer’s liability claims
Reduced s taff abs ence
Reduction in overtime/temporary s taff cos ts (including training cos ts ) Les s dis ruption and los s of expertis e
Increas ed morale of employees
Vocational Rehabilitation - Benefits to the Employee
Ps ychos ocial benefits
Reduced ris k of los ing income
Les s chance of los ing promotion pros pects Return to work more quickly
Les s pain and s uffering
Bio-ps ychos ocial Model
3 Cirlces joined with Health in the middle
Psychological
Sociological
Biological
Rehabilitation Policy
Aims and scope
Clearly defined roles and res pons ibilities Communication of the policy
When rehabilitation is appropriate
Confidentiality requirements
Employee pay (e.g. if working reduced hours )
Clearly define proces s to be followed
Review arrangements
Cons ultation arrangements
Documentation e.g. employee agreement to the programme
Overcoming Barriers to Return
Working arrangements
Work environment
Work adjustments
Pathways to Work
National programme available to all claiming incapacity benefit Mandatory for new claimants
60% private and voluntary s ector
40%Job CentrePlus
Medical as s es s ment and return to work programme Coalition government - Work Programme
Condition Management Programmes (CMPs )
Established by NHS Primary Care Trusts
Support from specialist Incapacity Benefit Personal
Advisors at Jobcentre Plus
Financial s upport to eas e the trans ition back to work
Acces s to NHS health profes s ionals with s pecialis t s kills in health and work
Self management of long term conditions through s upported health education
Access to one to one cas e management andgroup work
JobCentre Plus
Supports people of working age from welfare to work
Part of DWP
Runs Access to Work:
Available to unemployed and employed where disability s tops them carrying out parts of their job
Each JobCentre Plus has a Disability Employment Advis er who deals with applications
Once a s upport agreed, individual or employer can claimfunds through the s cheme
Occupational Health Service - Aims
International Labour Organisation:
To protect workers against health hazards at work
To adapt the job to s uit the workers health s tatus
To make a contribution to the physical and mental well-being in the workforce
Stages in Occupational Health and Hygiene Practice
Recognition
Measurement
Evaluation
Control
Occupational Hygienist
To identify:
Chemical
Physical
Biological
Ergonomic
Psychosocial hazards
To measure and evaluate exposure
Interpretation of results and determination of risk
The design and application of control measures Provision of education and training
Preparation of labels /information and keeping records Res earch and development
Occupational Health Physician
Qualified Medical Practitioner (i.e.a Doctor) who specialises in Occupational Medicine
5years training (MD)
2 years for GP (MRCGP exam)
4yrs HigherSpecialistTraining(HST)
Associate of Faculty of Occupational Medicine (AFOM) exam: become MFOM after dissertation
Also Diploma in Occupational Medicine (DOccMed), basic level for GPs
Occupational Health Phys ician - Roles (1)
Advis ing on health and s afety policy
As s is ting in the control of s icknes s abs ence and reviewing the fitnes s of employees afterwards , even managing their rehabilitation
Advis ing on employees fitnes s to work
Managing acces s to firs t aid facilities
Occupational Health Physician - Roles (2)
Organising health promotion activities
Designing and managing substance abuse programmes at work Advising on the management and alleviation of
stress
Assessing employees eligibility for long term disability benefits or ill-health retirement.
Occupational Health Nurse(1)
A registered nurse whos e name appears on the
professional register of the UKCC and who holds a post-registration qualification in occupational health nursing recorded with the UKCC
This may be an occupational health nursing certificate, diploma or degree in occupational health nursing studies
UKCC- UK Central Council for Nursing, Midwifery and Health Visiting
Occupational Health Nurse(2)
Nursing qualification (Degree level)
Additional specialism – typically 1 year full time post-graduate Graduate Diploma - Specialist Community Public Health Nursing (Occupational Health Nursing)
Registered with National Nursing and Midwifery Council
Occupational Health Nurse-Functions
Pre-employmentand medical s creening Health s urveillance Treatment Health education Rehabilitation Advice and counselling Record keeping
Employment Medical Advisory Service (EMAS) (1)
To provide specialist support to the HSE
To investigate complaints regarding ill-health made by individual employees and others
To investigate health is s ues raised by GPs and other medical personnel
EMAS (2)
To carry out workplace inspections , to investigate occ. health risks and where necessary enforcement action
Provide occupational health advice to employers and employees
To carry out epidemiological research
Health Surveillance
The process of systematically us ing strategies and methods to as s es s the adverse effects of work on the health of workers
Examples - audIometry, biological monitoring , inspection
of skin by a responsible person, completion of questionnaires regarding
symptoms of the effects of vibration
Health assessment - general assessment of health, rather than the effects of hazards at work
Health Surveillance - Functions
Protection of health of the individual employee
Detection at an early s tage of any advers e health effects
Assisting in the evaluation of control measures Data may
be used for detection of hazards and assessment of risk Other purposes : e.g. immune status assessment
Health Surveillance - Criteria
There is an identifiable disease or other identifiable advers e health outcome
The dis eas e or health effect may be related to exposure
There is a likelihood that the dis eas e or health effect may occur
There are valid techniques for detecting indications of the disease or health effects
Health Surveillance - COSHH (1)
f appropriate for the protection of employees health
Substances lis ted in Schedule 6 (e.g. VCM)
If an identifiable disease or adverse health effect
If there is a reasonable likelihood that the disease or effect may occur under the conditions of work
If valid techniques available
Health Surveillance - COSHH (2)
Suitable health surveillance: Biological monitoring Biological effect monitoring Medical surveillance Enquiries about symptoms Review of records Keep records 40 years
Controlof Lead at Work Regulations - Health Surveillance
Medical s urveillance if expos ure s ignificant Als o biological monitoring
Records kept for 40 years
Other Legal Requirements - Health Surveillance
Control of Asbestos Regulations: Medical s urveillance every 12 months Records kept for 40 years Ionising RadiationRegulations: Medical surveillance for Classified Workers and those subject to over exposure Every 12 months Records kept for 50 years
Noise-Health Surveillance
Provided where risk ass essment indicates that there is a risk to health
Exposure above the upper exposure action value
Audiometry
If hearing damage is identified then the employer must refer the individual to a medical practitioner
Records to be available for ins pection
Vibration - Health Surveillance
Provided if the Exposure Action Value is likely to be exceeded or if health is likely to be put at risk due to vibration at work
Records to be available for inspection
HealthandSafety(DisplayScreenEquipment)Regulations -Health Surveillance
Employers must provide eye tests to us ers of DSE, or people who are to become users
Further eye test must be provided at appropriate intervals or if requested due to visual problems
No reference to records
Assessment and Management of Fitnes s for Work
Short-term sickness absence
Long-term sickness absence( more than 4 weeks)
Unauthorised absence or persistent lateness
Other authorised absences e.g. annual leave, maternity, paternity etc
Measuring Absence - Lost Time Rate
Total absence (hours or days) in the period x 100 divided by Possible total (hours or days) in the period This gives time lost as a percentage of the total time worked
Measuring Absence - Frequency Rate
No of spells of absence in the period x100 divided by No of employees
Average number of abs ences per employee expressed as a percentage.
Absence Policy
Contractual sick pay terms and its relationship with
statutory sick pay
When and to whom employees should notify
When employees need a self-certificate form
When employees require a fit note from their doctor
Right to require employees to attend examination by company doctor Provisions for return-to-work interviews
Guidance on absence during major or adverse events
HSE Guidance - 6 Elements to Return to Work
Recording sickness absence
Keeping in contact with sick employees , including return to work interviews
Planning and undertaking workplace controls or
adjustments to help workers on sickness absence to return and s tay in work
Making us e of professional advice and treatment
Agreeing and reviewing a return to work plan
Co-ordinating the return to work process
Fit Note - If GP Selects ‘May be Fit For Work’
GP mustalso selectone of: Phas ed return to work Amended duties Altered hours Workplace adaptations GP can make additional comments Advice is not binding on employers Employers s hould dis cus s with employee
Fitnes s to Work Standards
Mayneed to specifystandards: Breathing apparatus us ers Confined spaceworkers Fork truck operators Lone workers Company vehicle drivers Workers us ing dangerous machinery
Equality Act - Disability
A physical or mental impairment that has a substantial and long-term adverse effect on a persons ability to carry out normal day-to-day
activities
Normal day-to-day e.g. reading, writing, us ing the telephone, having a conversation and travelling by public transport
Long-term at leas t a year
Substantial not minor or trivial Reasonable adjustments
Equality Act 2010
Issues such as age, disability and pay
Act prohibits a prospective employer from asking about health before offering employment
Employer can ask health questions once a job offer has been made Must then make reasonable adjustment
If then not fit for the role the employer may withdraw the offer
Drugs and Alcohol -Effects
Reduction in reflex/responses election dependent tasks Increased aggress ion due to inhibition removal Perception interference and memory problems
Drowsiness
Discarding of illegally us ed needles
Synergistic effects with substances handled in the course of work
Drugs and Alcohol -Signs
Sudden mood changes
Unusual irritability or aggression
Tendency to become confused
Abnormal fluctuations in concentration and energy
Impaired job performance
Poor time-keeping
Increase short-term sickness absence
Deterioration in relations hips with colleagues , customers or management
Dishonesty and theft (arising from need to maintain
expensive habit)
Independent Inquiry on Drugs Tes ting at Work
Link between drug taking/alcohol and accidents
inconclusive
Lack of evidence between drug/alcohol taking in safety critical industries
Alcohol probably greater concern than drugs No evidence that drug testing is a deterrent
Drug test not indication of intoxication
Employers may be open to challenge under Human Rights /Data Protection Acts
No controls over testing providers and no information about extent of drug testing in UK
Methods of Testing (1)
Breath:
Alcohol breathalyser (colour change in stain tube)
Alco meter catalytic electronic meter (e.g. Traeger) Cannabis detecting meter
Urine:
Most controlled drugs are detectable (e.g. multi-drug test
strips /cups ) also alcohol
Methods of Testing (2)
Saliva:
Multi-drug tes ts available bas ed on immunoas s ay
Alcohol strips
Blood:
Difficult to enforce in the workplace as invas ive
Alcohol and controlled drugs have available analytical methods
Drugs and Alcohol -Testing
Incorporate agreement to tes ting in employment contract
Obtain written cons ent before each tes t
Keep medical records confidential
Introducea’chainofcustody’ tomakesuresamples arenottampered with
Analys is by an accredited laboratory Take appropriate action if tes t is pos itive
Drugs and Alcohol Policy (1)
Statement of unacceptable levels
Statutory requirement in rail and air transport industries in addition to driving on public highway
Information on type and frequency of tes ting including pre-employment testing
Disciplinary code
Actions taken in respect of positive results
Drugs and Alcohol Policy (2)
Support Mechanism
Counselling/psychiatric assistance for persons who seek help Training of managers in symptom recognition/rehabilitation assistance
Effects of prescribed medicines
Keeping Health Records
Personal health surveillance regarded as medical information Confidential under Data Protection Act 1998
Employees have right of access
Should be kept s eparate from ‘normal’ HR records
Employers should be given ‘anonymised’ data to make decisions on controls
