Getting the most out of occupational health services

A decent occupational health service (OHS) should is a real asset. It can troubleshoot health problems and it can help rehabilitate the sick or injured and accommodate those with disabilities. But OHS are rare and good ones rarer still. Simon Pickvance and Rory O’Neill spell out how to get the service you deserve.

Introduction

Louise Brooks developed arthritis as a result of physically demanding, repetitive work in a shipyard. The 31-year-old was sacked by A&P Falmouth four years after being diagnosed.

The ship repair company was criticised by a 2007 employment tribunal for adopting an “out of sight, out of mind” approach to her plight, and ruled its behaviour amounted to disability discrimination and unfair dismissal. She had been diagnosed with an arthritic type disability and signed off sick in 2002; subsequent medical reports related the condition to her job. After spending the greater part of four years unpaid she was fired in June 2006. The tribunal heard there were at least 15 other suitable jobs Louise could have been offered, but wasn’t. Louise had been referred to the workplace occupational health service, which did nothing to help her and, self-evidently, nothing to help her keep her job.

There’s a big job for OHS to do. The government says there are 175 million working days lost to sickness absence each year, costing businesses and the economy around £13 billion. Each week, one million people take sick leave every week; 3,000 of these will not return within six months. But not all workers have access to OHS – in 2006, the Department of Work and Pensions reported only 15 per cent of firms provided even basic occupational health support, with only 3 per cent providing comprehensive support.

And where firms do act, they frequently get it wrong (Hazards 93). A June 2007 Investors in People (IIP) survey found that 17 per cent of employers believed it would be too expensive for them to improve their workers' well-being. Another 24 per cent of bosses said they did not know what action they should take. From the workforce side, almost a third (30 per cent) of employees said that their employers think healthy working is either a wasted investment, a waste of time, nothing to do with them or that it doesn’t mean anything.

What can go wrong?

Common OHS defects

1.   Wrong health checks
2.   Ineffective workplace monitoring
3.   Health checks/questionnaires not analysed
4.   Recommendations not acted on
5.   Ineffective remedies
6.   Competent staff not appointed
7.   Staff appointed found not to be competent
8.   Advice of competent staff not taken
9.   No follow-up measurements
10. Lack of overall control of OHS system

OHS functions

A properly functioning occupational health service is not a souped up first aid service, to patch up the wounded and get them back on the job. Increasingly – particularly since the creation of Workplace Health Connect and the recent expansion of the NHS Plus – the NHS offshoot providing occupational health services to firms – OHS are provided externally.

Working well, an occupational health service, whether in-house or contracted in, can improve the quality of work, help assess, reduce and remove risks and ensure suitable jobs and adaptations for ill or injured workers, or workers with disabilities. Key roles include:

• identifying what can cause or contribute to ill health in the workplace, including assessing potential problems from new processes or substances, or changes to existing jobs;

• determining the action required to prevent people being made ill by work, based on a well informed assessment of the risks;

• introducing suitable control measures to prevent ill health, such as back pain arising from working conditions and practices;

• Ensuring people with health conditions, or who have a disability or impairment, are not unreasonably prevented from taking up job opportunities;

• Ensuring people at work are fit to perform their required tasks, for example, by adapting work practices for people with conditions such as epilepsy or asthma, or making sure that people working in compressed air are fit to do so;

• Providing or arranging provision of necessary health surveillance;

• Review of occupational accident, ill-health and sickness records to determine root cause of problems;

• Assessing fitness for work and suitability of available or alternative jobs;

• Providing first aid;

• Providing health education and counselling.

• Supporting sick or injured workers.

The law

Theoretically, all workers in the European Union are supposed to have access to occupational health provision. The UK version of the Euro-law doesn’t put explicit duties on firms to provide occupational health services. Instead, the assumption is that the NHS, supplemented by piecemeal initiatives like NHS Plus and Workplace Health Connect, fill the gaps.

An employment tribunal in October 2006, however, ruled in favour of HSE and said Dundee Council was in breach of the Management of Health and Safety at Work Regulations 1999 because it had neither in-house occupational health specialists nor a contract with an external occupational health provider (see Not good, Hazards 98 ).

Under regulation 5 of the management regulations, employers should make arrangements to manage effectively health and safety. It was this regulation that was cited by HSE when it issued the improvement notice that led to the Dundee tribunal ruling, even though the regulation makes no specific reference to occupational health.

Regulation 6 says based on the findings of risk assessments - required by regulation 3 - the employer should provide employees “such health surveillance as is appropriate”. Employers most also appoint the “competent persons” necessary to allow compliance with legal safety duties (regulation 7).

The safety rep role

Unions have to make sure occupational health services work in the interest of the workforce, and are not the sick leave police. They should be consulted on the design and operation of OHS, and in the selection of competent persons, consultants and advisers.

Union safety reps can also demand information from the OHS to help with their own assessments of possible problems. For example, the Information Commissioner’s Office code on workers’ health information acknowledges safety reps’ rights to information and says: “Safety representatives should be provided with anonymised information unless any workers concerned have consented to the provision of information in an identifiable form.” This could include accident reports, findings of health surveillance or surveys or any other health and safety related information “they need to fulfil their functions”, says guidance on the code (Hazards 87).

But union reps should not just be passive recipients of OHS information. They should use safety committees and consultative processes to require OHS to investigate, with union participation, areas of concern – for example, concerns that a particular job, substance, process or work method could be causing certain injuries or health effects. Findings of the union’s own research, for example bodymapping exercises or surveys, can also be fed back the other way. However, in all cases there need to be explicit ground rules on how information is used – the occupational health service, and management, should only act in consultation with the union.

Information

Hazards website Work and health • Sickness • Tools • Rehabilitation

UNISON advice for union branches on workplace health services

TUC rehabilitation webpages

Work and Health Information Gateway (WHIG)

IOSH occupational health toolkit

NHS Plus

Facility of Occupational Medicine

Health Work and Well-being strategy