What is Occupational Health? A guide for employers.

Occupational health (OH) is a branch of healthcare specifically trained to understand both the short and long-term impact of work on employee health and of health on work, with an emphasis on functional ability of workers in relation to their role. Each year millions of employees suffer preventable ill health linked to their occupations. Pre-Covid-19, 500,000 workers were evidenced to be adversely affected by stress per year and more than half of overall ill health pertains to musculoskeletal (MSK) conditions such as back pain. The Centre for Mental Health (May 2020) predicts an additional 500,000 cases of mental ill health due to Covid-19.

OH, is evidenced to stem the flow of work-related ill health, taking a proactive stance via education and health promotion to achieve this goal. OH, is evidenced to be cost effective, increase productivity, shield against litigation, enhance reputation and attract high quality employees in a competitive market. Currently only 50% of the UK population are able to access OH, and there is robust economic case (currently under consideration by government) for the implementation of access to OH for all employers, particularly small and medium enterprises, and to address the depleted mental health of the workforce due to Covid-19.

https://www.som.org.uk/sites/som.org.uk/files/Occupational_health_the_value_proposition.pdf

Currently the hierarchy of major work-related risk has shifted to prioritise the risk of Covid-19 transmission. OH, is now tasked with providing Covid-19 specific advice to both employers and employees, and importantly, Covid-19 specific health assessments and assignment of Covid-19 risk vulnerability categories. Covid-19 vulnerability risk assessment is required by law for all employees returning to, or in work, particularly those with moderate or higher risk, to inform risk assessments for employers. OH, provides support and advice in order to ensure that employers remain legally compliant in providing safe workplaces and working practices.

OH, also provides prehabilitation (pre-return to work rehabilitation) for those who wish to return to work post-shielding, to combat anxiety, deconditioning and increased risk of injury.

The Health and Safety Executive (HSE) identifies two significant areas which can be adequately addressed by OH:

1.    In compliance with the Health and Safety at Work Act (1974) OH can proactively address the negative impact of employment on worker’s health and the health of others.

OH, utilise their expertise to identify both potential and actual causes of ill health to workers and determine the appropriate action required via robust risk assessment and recommendation of suitable control measures.

2.    In compliance with the Equality Act (2010), OH can support employers to ensure that employees with disability or impairment are given equitable and reasonable employment opportunities.

Pre- employment (pre-placement) assessment interviews can support both employer and employee with both physical and psychological health risk assessment and recommendation of support and/or adjustments if appropriate. Where impairment or disability occurs during employment, OH can provide case management to assist employers to support employees to successfully remain at work.

OH, can assess an employee’s fitness for their allocated role and tasks, and can make recommendations for adjustments at work such as manual handling and ergonomics or psychological support.

What responsibilities lie with the employer?

To comply with the Health and Safety at Work Act 1974, employers must risk assess and address hazards in the workplace, thus providing a safe place of work. This applies to both physical and psychological health which must be evidenced to have been given parity of esteem. Employers are now tasked with providing and evidencing specific and individualised Covid-19 vulnerability health risk assessments for employees, either to return to work or remain in work, to ensure legal compliance in providing safe workplaces and working practices.

According to the Society of Occupation Health’s return to work Covid-19 toolkit (SOM 2020) the first of the government’s key five principles involves undertaking such risk assessments. “Given the required confidential medical knowledge required to undertake such assessments, OH professionals are best placed to undertake this role. Managers, HR, employee representatives and health and safety representatives should not be undertaking medically based risk assessments” (SOM 2020).                              The toolkit has been produced in collaboration with CIPD, BITC, MIND and ACAS.

To satisfactorily meet legal requirements and meet with the wide range of health, safety and welfare legislation, a collaborative range of skills are required, which can rarely be met by health and safety personnel and policy alone. Employment assistance programmes (EAPs) can be useful, are often unable to meet with legal requirements, vary significantly in quality and are often unable to support the needs of moderate to complex physical or psychological cases. OH, are experts at collaborative working at all levels.

(Intel Corporation (UK) Ltd v Daw [2007] IRLR 355 CA, made it clear that having an EAP did not mean employers could avoid other interventions, such as stress audits. The court said that an EAP is not “a panacea by which employers can discharge their duty of care in all cases”.)

What responsibilities lie with the employee?

Employees must ensure that they always follow their training guidance, especially regarding use of equipment, to ensure that they do not endanger colleagues or business users. Employees must report accidents, injuries, or illnesses through the appropriate channels, and report any personal changes such as medication use that could impact on workplace safety for self or others. Employees must comply with government guidance regarding Covid-19.

Every workplace will have specific OH needs, which can be met through effective collaboration with relevant stakeholders.

What does Disruptive Management’s OH provide? (Please refer to specific OH provision explanatory guidance also).

Disruptive Management’s OH department is fully GDPR compliant and promotes evidence-based solution focused collaborative working with human resources, managers, and relevant parties. Disruptive Management’s staff (doctors and nurses) are specifically qualified in occupational health and have contemporary complex mental health and Covid-19 assessment, evaluation and health promotion skills.

1.    Retained OH services agreement (RSA)

Specifically designed to remove the requirement for expensive (SLAs) Service Level Agreements in delivery of a service that operates between Adhoc and SLA to deliver the employers “duty of care” obligation to the employees via access to Occupational Health.  

2.    Retained OH support agreement (RSA)

Specifically designed to support Mental Health First Aiders in their role and ongoing auditable requirement of the employer.

 Provision of OH work-related advice.

Advice to employers on risk assessment, and on risk control measures, to protect the workforce whilst enabling operations, and on the principles of the vulnerability of individuals. This can be requested by email. Advice will be provided via return email or telephone call.

Covid-19 vulnerability risk assessment.

A short telecon with a senior OHA and the employee following referral to advise the employer on the clinical vulnerability of the individual employee in relation to Covid-19, and to assign a risk category. A timely report will be provided to the employer with employee consent.

Pre-placement (employment) assessment -:

Pre- placement (pre-employment) assessment interviews can support both employer and employee with both physical and psychological health risk assessment and recommendation of support and/or adjustments if appropriate. In compliance with the Equality Act (2010), OH can support employers to ensure that employees with disability or impairment are given equitable and reasonable employment opportunities.

Post-shielding pre-habilitation assessment

Covid-19 shielding status will indicate that the employee has previously been assessed as highly or extremely vulnerable. Assessment, rehabilitation advice, and recommendations regarding both physical and psychological stamina building pre-return to work post shielding. (This assessment pre-return to work will link to a complex case management assessment).

Complex case management

Examples: Covid-19 high risk and extremely vulnerable employees.

Multiple or complex health conditions.

Complex mental ill health.

Includes-:

Biopsychosocial assessment

Covid-19 risk assessment may include advice regarding specialist referral, the need to seek further medical or specialist information, OH follow up and/or pre-habilitation post shielding advice if appropriate.

Absence and presenteeism (working whilst unwell) case management–

Biopsychosocial assessment.

Covid-19 risk assessment

Recommendations may include advice regarding specialist referral, the need to seek further medical or specialist information, OH follow up and/or pre-habilitation post shielding advice if appropriate.

Specialist mental health case management

Biopsychosocial assessment

Specialist mental health assessment

Covid-19 risk assessment

Recommendations may include advice regarding specialist referral, the need to seek further medical or specialist information, OH follow up and/or pre-habilitation post shielding advice if appropriate.

Specialist Mental Health First Aider (MHFA) support and assessment.

Disruptive Management via OH provides support for your mental health first aiders (MHFAs), and in particular during the additional stressors of the Covid-19 pandemic, which is evidenced to have caused a marked increase in the demand for mental health services, and an increase in the symptoms of mental ill health within the workforce, ranging from mild to severe which may include suicidal intent. Many MHFAs may have been exposed to Covid-19 related stressors themselves, resulting in depleted mental health.

(It is worth noting that individuals suffering mental ill health, which could include MHFAs, do not always have insight into their condition/mental health decline).

Your MHFAs have no control over the disclosures that are made to them by employees seeking help, or on the negative impact to their own mental health over time. As part of an employer’s duty of care under the Health and Safety at Work Act 1974, an employer must ensure the safety of their employees from both physical and psychological ill health at work. The additional psychological labour and stress of the MHFA role indicates that should your MHFA experience mental ill health in the future, that this is the “foreseeability factor” due to the increased exposure to stressful events.

Legally an employer must adequately risk assess, monitor, and implement safe and sufficient control measures for such employees.

OH provides advice and recommendations regarding risk assessment, adjustments, health promotion, support and monitoring for MHFAs, and provides an opportunity to discuss their concerns (as is mandatory for all other professionals working in the field of mental health), thereby protecting the employer from future litigation as a result of a mental health decline in an MHFA due to lack of the above appropriate support.