occupational health

Welcome to Occupational Health

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There has never been a better time to become an Occupational Health practitioner.  The Council for Work and Health have published a report outlining the shortage of Occupational Health specialists.  Read more here.  As an independent Specialist Practitioner and a Director of the AOHNP , I look forward to welcoming and supporting nurses and technicians joining our team.

If you are new to OH,

  • look out for the professional development programme that I am developing for the NHS NPAG which will start again in September 2016;
  • please consider joining the AOHNP as a student or associate member to develop your skills and your career.

The importance of Acting Together

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Again, the Health and Wellbeing conference in March this year was an excellent opportunity for me to network and re-enthused me in my mission to remove the health-related barriers to employment. Over the last few weeks, I have been contacted by newly acquainted professional colleagues ranging from sleep specialists and independent Occupational Therapists to Remploy specialists to collaborate and improve the offering for workers with long term conditions and disabilities.

Although I am now very optimistic about the future of Occupational Health, does the HSE’s strategic aim of Tackling ill health address the issues underlying disease and absence? Highlighting and addressing the costs of work-related ill health may go some way to understanding the immediate impact for an employer, but does it help them to prevent absence?

The Law of Unintended Consequences

In 2009, the Boorman review emphasised the importance of creating healthy workplaces and the importance of working with staff.  I would urge those responsible for identifying and implementing new initiatives and measures to consult carefully with employees, especially those with long-term conditions.   Teachers are a particularly good example of how, regardless of good intentions, these initiatives have to be applied by human beings, not machines.  In this case, it is essential that schools can provide consistency of teachers and sustainable improvement in academics and citizenship.  It is likely that students on pupil premium, who form OFSTED’s current priority group, will be a principal beneficiary of these improvements.

Teachers are a particularly good example of how, regardless of good intentions, these initiatives have to be applied by human beings, not machines.  In this case, it is essential that schools can provide consistency of teachers and sustainable improvement in academics and citizenship.  It is likely that students on pupil premium, who form OFSTED’s current priority group, will be a principal beneficiary of these improvements.

Support services provided by the charitable sector:

The Education Support Partnership (ESP) and Retail Trust (RT) continue to impress me with the support available to staff working in their industry sectors.  Despite this, I fear that schools will increasingly struggle to deliver against the government’s changing priorities and objectives when having to cope with growing sickness absence.  Teachers and support staff try to access support, but community mental health services appear to find this difficult to provide unless the individual is in crisis.  IAPT services have long waiting lists for counselling and apart from the charitable sector, employees at risk of being unable to cope with work and going off sick fail to access preventative support. This lack of access is despite staff willingly collaborating to try to find the best solution for their patients.

NHS IAPT services have long waiting lists for counselling and apart from the charitable sector, employees at risk of being unable to cope with work and going off sick fail to access preventative support. This lack of access is despite staff willingly collaborating to try to find the best solution for their patients.

The government’s fit for work programme is helpful where an employee has been off work for 4 weeks or more, but independent Occupational Health practitioners can offer specialist advice support and solutions to both the individual and their managers to prevent absence from occurring in the first place.

EAT redefines ‘normal day-to-day activities’

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“Normal day to day activities” now include work activities, e.g. moving and handling.

Following the Employment Appeal Tribunal (EAT)  judgement in February, this year in Ndebele and Kasterlee UK Limited & Others the Judge found that the “Claimant did not return to work on or after 2 January 2014 because her employer had refused to make reasonable adjustments for her disability.” The finding that this is an unlawful act that demands compensation” is a new decision significantly changing the definition of disability for the Equality Act has been made in Banaszczyk v Booker Limited.

The EAT decided that a distribution centre worker was disabled within the meaning of the Equality Act 2010 due to his impaired ability to carry out certain tasks at work.   This case emphasises the importance of a competent, evidence-based and comprehensive occupational health (OH) report, and significantly increases the scope of day to day activities for the Act.

Case background

The claimant was a picker in a distribution centre whose long-term back condition following a road traffic accident adversely affected his performance at work, and affected his ability to meet the target ‘pick rate’.  He had been dismissed on capability grounds and brought claims for unfair dismissal and disability discrimination.

The claimant’s back injury impaired his ability to work to lift cases of goods of up to 25kg – the employer’s required rate – but the original tribunal judged that moving and handling was not a ‘normal day-to-day activity’.

The EAT allowed the appeal and replaced the Employment Judge’s decision with a declaration that the Claimant did have a disability due to the impact of the claimant’s decision on his work activities. This decision included the moving and handling but did not include the pick rate. The OH evidence reported that the Claimant’s work activities were substantially and adversely affected by his physical impairment, and therefore the Employment Judge should have concluded that the Claimant was disabled as defined by the Equality Act 2010

Discussion

OH professionals are often asked by management to comment on the Equality Act 2010. This case clearly shows that it is not the role of the occupational health professional to comment on the Act, but to provide management with the information and evidence they might need to decide whether adjustments required to enable the individual to carry out his / her role are reasonable and practicable.

EAT decision

Royal_courts_of_justiceThe EAT overturned the ruling of the employment judge and substituted a finding that the claimant was disabled.  The EAT found that it was clear from the evidence that the claimant had a long-term physical impairment that affected his ability to carry out his duties.

The EAT was satisfied that the lifting and moving of goods was an activity carried out by a large number of people at work, across a range of occupations. On this basis, it was a ‘normal day-to- day’ activity. The effect of the claimant’s impairment was that he was significantly slower than others in carrying out these activities.

Consequences

This case increases the scope of day to day activities and demonstrates the need for OH professionals to include a functional assessment for activities commonly carried out in the workplace when advising management on fitness for work with a long term condition or disability.

This decision is a reminder that the meaning of ‘day-to-day activities’ will be construed widely by a tribunal and includes activities commonly carried out in the workplace. An employee whose ability is substantially impaired at work is likely in most cases to be regarded as disabled within the meaning of the Equality Act 2010.

Additional resources

ACAS provides guidance for employers about the extent to which the Act applies, and whether other adjustments and adaptations will need to be considered as “affirmative action; if that employee or job applicant shares a particular protected characteristic, suffers a disadvantage connected to that feature, or if their participation in an activity is disproportionately low.”

 

 

Coaching in OH to reduce compassion fatigue.

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I don’t usually use the word “should”, due to its negative connotations and the implication that something didn’t happen.  However, my thought for today is whether OH professional training should include a coaching qualification.

A report in today’s Guardian argues that coaching support for professionals would improve retention in the difficult-to-recruit sectors, such as social care.  This sector is particularly vulnerable to mental health symptoms consistent with compassion fatigue. Proactive health assessment may identify employees with potential vulnerability to compassion fatigue, e.g. personality attributes, who would benefit from coaching and mentoring as part of supervision or personal development planning.

Professional coaches known to me include  Sally Anne AireyAthena Professional and Kelly Moller.

Your opportunity to influence training offers

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Hot off the press:

I am so excited to have been invited to work with NPAG, to develop new training and development modules for their OH programme.  I have so many ideas, I don’t know where to begin!

Immediate ideas (on top of the existing programme) are:

  • Health surveillance – philosophy and practice 
  • Fitness for work
  • Performance management
  • Clinical governance and audit

If your organisation has a training requirement not covered by the current programme, NPAG would like to hear from you – we thrive on developing new ideas with our clients.  We can assist in delivering a product that is suited to your needs and requirements. Our involvement can be decided by you. Our team has a wealth of experience designing courses, workshops and seminars for clients.

Contact NPAG today and find out how we can help you.

Current NPAG programme of professional development for OH nurses:

  • Employment Health Screening
  • Spirometry
  • Audiometry
  • Management of Physical Hazards
  • Sickness Absence Management Referrals
  • Health & Safety

Clinical Professional Development for Nurses working in Occupational Health

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This year I joined the NHS National Performance Advisory Group as an Associate; and on Thursday I delivered my first training module to RGNs, Assistant Practitioners and Technicians working in Occupational Health.

Clinical Professional Development for Occupational Health Nurses modules offer AOHNP members a 10% discount.

The first two modules I have delivered were Employment Health Assessment and Assessment and Case management in COSHH health surveillance.

Learning outcomes for this course are as follows:

  • Legal & ethical framework
  • Medical fitness standards
  • Safety critical work
  • Vaccination, immunisation and exposure prone procedures
  • Reasonable adjustments and the reasonably practicable test
  • Assessment and evaluation of functional capacity
  • Case Management Advising employers

Listed below are some interesting questions from delegates on arrival.  One of the key factors to note is the number of staff who are not RGN qualified, but who are carrying out employment health screening within the NHS.

Specific questions (and answers) about OH practice

  1. Occupational Health over-ruling a sick note – when can this be enforced?
    • New guidance on the fit note published by the Government in March 2013 and could allow an employer to give precedence to the views of an occupational health practitioner over those of a GP.
    • In the guidance for employers and line managers, under the headline “Is the fit note binding on me?”, the Government has made it clear that the answer is “no”.
  2. As New OH staff, what are my expectations?
    • Work within your level of competence.  Best practice is to follow the NMC code of conduct, even if you have not yet completed your RN training.  “6.1 make sure that any information or advice given is evidence-based, including information relating to using any healthcare products or services, and 6.2 maintain the knowledge and skills you need for safe and effective practice.”
  3. What are outcomes of fitness for work?
    • Fit for the role as described, no adjustments or adaptations required
    • Fit with adjustments or adaptations (description required)
    • Fit with individual risk assessments to identify safe working practices (stress, manual handling, DSE, etc.)
    • Unfit (usually only confirmed by an Occupational Physician)

Comments about experiences in OH

  1. Views on untrained staff advising Fit for work – on Health Conditions
  2. In’s and out’s of referrals – incorporated in training
  3. We’re always at the end of list for meetings – coming soon blog on raising the profile of Occupational Health
  4. Progress within OH? – coming soon blog on professional development
  5. How to convince staff that OH is not a punishment

Specific skills

  1. What is needed before we give clearance? – incorporated in training
  2. Immunisations and vaccinations – incorporated in training
  3. Better knowledge of legislation / Acts – incorporated in training
  4. Best Universities to do OH degree?
    • 26 SCPHN courses are identified on the NMC website.  Some courses require additional placement and training for Occupational Health, such as workplace health surveillance and therefore you are strongly advised to contact individual institutions before registering on a course; to confirm that their course offers specialist modules meeting the specific requirements of OH in practice.
    • Exciting developments are happening in the field of Occupational Health.  A new Faculty of Occupational Health Nursing has been formed and the School of Occupational Health promises to bring specialist multidisciplinary training to the profession soon.
    • Further information from fellow OH professionals can be found by joining the AOHNP, or following the

For more information about training and development days for OH nurses and technicians, check out the NPAG:

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