OH Today Spring 2022

Next Edition The 26th Ruth Alston Memorial Lecture Delivered by Dame Carol Black

Partners of OH Today

2

OH TODAY

Spring 2022

CONTENTS

Editor

From the President

5

An Occupational Health Clinician Perspective on GP reports

8

Why writing in Plain English adds value!

14

Looking Beyond Pregnant Workers and New Mothers with Women’s Health

18

Teachers and Workplace mental health, an Occupational Health case study

23

Are 'Teeth & Nails' included in your Risks Assessments?

28

Covid-19 Newsround and Toolkit

31

Are you ready to take back control of your work-life balance?

35

5 Key Considerations For Restarting Lung Function Testing

38

Occupational Therapists and Occupational Health A great fit

40

LYNN PRATT Assistant Editor JANET O’NEILL Production Editor IAN GARNER

Copyright © iOH 2021

Published by iOH, The Association of Occupational Health and Wellbeing Professionals

ioh.org.uk

email: admin@ioh.org.uk

Views expressed in OH Today are those of the contributors and not necessarily those of iOH.

Nor does iOH necessarily endorse any of the products or services mentioned or advertised in the publication.

ioh.org.uk

OH TODAY

3

The Association of OH & Wellbeing Professionals are pleased to annonce the

26th Ruth Alston Memorial Lecture & Gala Dinner 15th March 2022 at 7pm Hilton Birmingham Metropole Hotel, NEC The Ruth Alston Memorial Lecture will be delivered by :

Professor Dame Carol Black The title of her Lecture will be:

Independent Review of Drugs: What part should Occupational Health Professionals play?

Dame Carol was commissioned by the Home Office and the Department of Health and Social Care to undertake a 2-part independent review of drugs, to inform the government’s thinking on what more can be done to tackle the harm that drugs cause.

Event open to Members/Non-Members, join the iOH Event details can be found on the iOH Website Tickets are limited to 60 and available at Eventbrite discount for members Sponsored By :

From the President Neil Loach

T

he nights are beginning to get a

and this will cause the NHS to plunge

bit shorter and spring is starting

into even greater trouble than it is in

to show the heads of it’s many

already. The Royal College of Nursing

blooms. We will soon be able to sit out

have published and updated their policy

in the garden and enjoy some kind of

recently and I have to agree with their

normal social life. But there is still a

stance.

stark warning that Covid is not quite done with us yet. The latest figures (at the time of writing this) show in excess of 640,000 cases in the previous 7 days with a weekly death rate of 1618 where a positive covid test was reported in the previous 28 days. This is still a worrying

I would therefore urge our members and the OH Community to embrace the following in their day to day OH Practice: Ensure staff have easy access to the vaccines they need within the working

time for all of us. However, with the

day.

vaccine rates slowly climbing there is

Providing staff with access to clear

still hope that this will come to an

information about the risks and how to

acceptable plateau in the coming

overcome or manage those risks, as well

months. Popularly known as the “Covid

as information about the value and

End Game”.

benefits of vaccination.

Mandatory Covid Vaccines for all NHS

Providing confidential support to staff

and Social Care Workers remains a focus

who have any vaccine related concerns

of recent news activity with the cut off for first vaccinations having passed.

There remains much controversy over

how just and appropriate this policy is.

Whilst I have my personal opinions that vaccination offers us the best chance in an extremely troubling scenario, there remains the fact that some people do not want a vaccine for whatever reason.

I respect their choice. Various

There is said to be a review of this mandate in the coming days and I sincerely hope that sense prevails and a compromise can be found to alleviate the problems associated with this enforcement. Many 100’s have already been forced out of their social care roles and I could not bear to see this within the NHS also.

organisations have raised at the very

At the time of going to print, a public

highest levels that this will lead to fewer

consultation was launched which closes

frontline care workers in the sector if

on Wednesday 16th February. This

they are removed from their positions

strongly signals a U-Turn. Let’s hope ioh.org.uk

OH TODAY

5

that sense prevails and a reasonable

speaker on this most challenging topic.

solution can be found that encourages,

The event is sponsored by Vitalograph

but not coerces NHS workers to take up

UK.

the vaccine.

The order of events is as follows:

On a much lighter note, iOH HQ is busy beavering away to finalise the Ruth Alston Memorial Lecture and Gala

Order of Events 7:00-7:30pm- Drinks Reception -

Dinner which will be held on Tuesday

Prosecco on arrival.

15th March 2022. This event is the 26th

7:30-8:00- Key Note Speaker

one held and it promises to be a

Professor Dame Carol Black

fantastic evening. Professor Dame Carol Black is our guest speaker. Anybody that

8:00-10:00- 3 Course Dinner Service with Wine.

has ever heard Carol speak before will know that we are in for a treat when she

I hope that you enjoy reading the

joins us. The subject of her talk will be:

fantastic edition of OH Today. There is

Independent Review of Drugs: What part should Occupational Health Professionals play?

certainly no exception. We have articles from Danny Clarke of Simply People who talks about Women’s health. A fabulous article from Phina Amahoro of PAM Group on mental health in

Home Office and the Department of

teaching.

part independent review of drugs, to inform the government’s thinking on what more can be done to tackle the harm that drugs cause.

There is also a fantastic offer from Sarah Hailton-Gill for those considering self employment. Leap Into Consulting can help with that transition and I am sure that this will be a great benefit to all

It is clear that there is still much work to

those thinking of making such a

do in tackling this drug crisis and the

momentous step.

subject will rally the OH Community into action to assist those in recovery to reintegrate into society and OH Practitioners need to be a vital part of

this in returning to the workplace.

The event will take place on the evening of the first day of the Health & Wellbeing at Work Event at the NEC Hilton Metropole Hotel at 7pm. Tickets can be booked here. We’d love to welcome you to our fun packed evening where you will be able to network with many of the stalwarts of the current OH Sector as well as listen to an amazing

OH TODAY

our recent editions and this one is

Dame Carol was commissioned by the Health and Social Care to undertake a 2-

6

much to be celebrated in the quality of

Spring 2022

Finally, I am delighted with the progress we are now making with separating all the articles from OH Today into standalone pieces for reading and use by

the OH Community. The articles can be found here on our Blog Page.

Happy reading! Please pop by and see us at the NEC on the 15th & 16th March and come and have a chat to see how you can be more involved in securing the future of iOH. on board!

Neil Loach

We’d love to have you

An Occupational Health Clinician Perspective An opinion piece by Janet O’Neill Clinical Director PAM Group

M

ost Occupational Health

tribunal. Employers need to ensure

(OH) practitioners feel their

dismissals are fair and avoid a tribunal

heart sink when the

where possible.

employer or manager requests a report from the GP or has written independently to the GP. This does not always lead to an easy or productive outcome in many cases, for a number of reasons.

Employers aren’t required to continue to employ individuals who aren’t meeting their contractual obligations of performance (as set by the employment

GPs may have limited understanding of how health can affect work and work can affect health

Some employers feel they need to ask for a GP and an OH report or ask OH to write to the GP specialist when gathering evidence. This is not always

necessary and can as it can muddy the waters despite this being suggested by CIPD, ACAS, and the Government.

Let me explain why…

1.

agreement and under the Employment

employee’s advocate. They owe

Rights Act 1996), which includes

allegiance to their patient. As a

sickness absence. In circumstances of

GP once said to me “if my patient

frequent short-term, long-term, and

tells me they cannot work, then I

health-related performance issues, they

have to take this on face value”.

are required to speak to the employee and investigate the medical issues

2.

affect work and work can affect

investigations could include obtaining a questions such as an understanding of timeframes for which the person’s

health. After all, this is not their area of expertise.

3.

employee’s role.

their contractual employment individual would benefit from reasonable adjustments if they possibly have a disability (ACAS).

It sounds simple but it isn’t! Employers have to consider timeframes and possible adjustments. Taking into consideration the impact on the organisation, costs, other employees, any precedence, other areas of the business, etc. Unfair disability dismissals are common reasons a employee can take their employer to a OH TODAY

Spring 2022

GP’s may not understand the patient's workplace or the

health will impact their ability to meet obligations (CIPD) and whether the

GP’s may have limited understanding of how health can

(CIPD), before making a decision. These GP or OH report to help answer crucial

8

First and foremost, the GP is the

4.

GP’s have around seven minutes for patient assessment and can provide repeat fit notes without further evaluation. With the current COVID situation, obtaining appointments can be difficult in some areas (BMA). Fit notes are often provided with little understanding of the impact on employment, and GP reports follow a similar vein.

e on GP reports

So what do employers need to do?

make a decision based on their

Employers need to meet their duty as

such as illness timescales, prognosis,

part of the Employment Rights Act by

likely recurrence, whether the person is

gathering health-related evidence to

likely to be considered disabled and

knowledge of what is reasonable.

Therefore, they ask common questions

ioh.org.uk

OH TODAY

9

what support or adjustments could be

suggested. They may ask whether work is contributing to ill health and a

Well 

been assessed by their GP recently

number of other questions. To answer

and they won’t have an up-to-

these questions, unlike the GP, OH

date view of their patient

professionals have specialist knowledge of: -





the workplace



the risks within a particular role



the benefits of work



understanding of health





from the employee (AMRA 1988).

GDPR stipulates transparency when dealing with special data and therefore this requires us to

health and understand the

explain exactly why the

impact of biological,

information is required. If this is

psychological, and social factors

because of an employer request

on the ability to work

and not our own, this can be more difficult.

the functionality of the individual 

when the questions are not ours

what treatment may be helpful,

but the managers. Questions have

supporting early intervention

to be justified to the individual as



adjustments and support

they need to be aware of what is



Legal requirements e.g., specific

asked of them in informing the GP/specialist (DPA 2010).

Health & Safety legislation, the Equality Act 2010; The Data



If the individual has provided a

Protection act 2018, and Access to

consistent and thorough history,

Medical reports 1988

asking the GP to verify it could possibly lead to a strained

(CPD online; CIPD Occupational health;

relationship between employer

Gov.UK Occupational Health; NHS

and employee.

Occupational Health) As you can already see with the comparison between a GP and an OH

Employers won’t always be comfortable with us taking the word of employees

practitioner, we are better able to match

about their health.

the individual with the workplace and

But

answer the questions based on an assessment of the employee.

But why else are we reluctant to request a GP report?

OH TODAY

We have to ask specific questions of the GP. Again, more difficult

can and cannot do

10

Consent needs to be obtained

the biopsychosocial model of

matched to the role i.e., what they



The information the GP provides is often not very helpful.

interventions and primary care



They can take so long to obtain and can date quickly.

conditions including 

Sometimes an employee hasn’t

Spring 2022

When we assess an individual we utilise our active listening skills. We use verbal and visual observation skills, and marry the history with what would be expected

clinically. We check consistency, use

Discussions with specialist

validated assessment tools, and judge

practitioner nurses, practice

the evidence. We utilise numerous

nurses, and also treating

sources of evidence to ensure the

clinicians such as community

assessment is robust and relates

psychiatric nurses (CPNs),

specifically to that person’s job.

Occupational Therapists, Physiotherapists, etc can assist in

And

understanding the current

When assessing the employee and

situation and future treatment

providing a report, we answer all the

considerations. I had a

questions asked of us to the best of our

particularly successful case of a

ability and justify that answer. A GP or a

young man with diabetes type 1

specialist report may not be needed to

who needed to work night shifts.

answer these questions unless the

The Specialist diabetes nurse

employee is vague, a poor historian or

worked closely with me to support

they have a safety-critical role. In these

this chap to remain in work, with

cases, we are unable to rely on their

the alternative being a capability

account and may need to obtain “further

dismissal.

medical evidence “or FME to ensure the answers we provide are robust and



(driving, working at heights, etc.)

defensible. There are several ways of

then the individual can obtain the

obtaining this of which a GP or report is

evidence themselves from the GP

one: 

or specialist or even provide Most employees now have access

evidence from the DVLA. Most

to their medical records online

GP’s and specialists oblige with

such as with the NHS App or via

the outcome of cardiology tests

their GP surgery. Additionally,

etc. when they understand the

specialist services use apps such

need related to enabling the

as patient view or Patient knows

individual to return back to work.

best, allowing the employee to

Individuals are entitled to copies

obtain information such as

of results and it is far quicker if

medication lists, investigation

they obtain the information than

outcomes. They can be useful to

if we or their employer request it.

build a picture of the person’s health and prognosis. 





The OH service may have access to specialist assessments for

Prescription lists are useful in

example Control and Restraint

understanding the condition and

assessment (PMVA), Functional

management.

Capacity Evaluations, or

Individuals can access the specialists letter, shared with the GP. This can help to understand treatment considerations.



If the role is safety-critical

Many clinicians seek verbal consent to seek information from primary care practitioners.

Workplace assessments usually undertaken by a Musculoskeletal (MSK) specialist or Occupational Therapists (OT). Psychotherapy or psychological assessments, neurodiverse assessments are other independent assessments, ioh.org.uk

OH TODAY

11

all of which build the medical

There are many case law scenarios

evidence of fitness and capability.

supporting OH outcomes as opposed to

The OH practitioner may need further medical evidence because they don’t understand the impact on the individual or the prognosis. To give some case examples: 

A gentleman with a spinal cord implant (a pain management tool) declines to use a work vehicle with electric seats. He feels it will interfere with the electromagnetic

field of the implant. As there were no longer any manually adjusted seats, there was a risk of job loss.

The manufacturer was contacted



GP’s when comparing employee access to evidence. Although the decision often depends on the organisation's sickness or attendance policy, OH is seen as independent and more likely to provide practical and pragmatic advice.

Tribunals themselves hold that an OH report can be relied on by an employer, “even if it contradicts other medical reports unless it is clearly unreliable” such as when it is not evidence-based or there has been no assessment (examination or interview) of the employee. Diana Kloss 2007.

by the OH practitioner and the

In conclusion

gentleman was reassured.

My opinion is that the decision on

A young man with nocturnal

whether further medical evidence is

seizures providing a vague history

required should lie with OH

and therefore unable to undertake

practitioners, where an employer has

his safety-critical role. With

access to an OH Service. There are many

capability dismissal looming he

considerations that need to be carefully

agreed to OH obtaining a GP

thought out. For small to medium

report which advised that

organisations, platforms such as Simply

cannabis use was the trigger for

People can assist businesses to source a

his seizures. The drug and alcohol

provider.

policy was enforced and the young man became both cannabis and seizure-free and therefore retained his role.

Some occasions requires an in-depth understanding of the clinical situation, therefore obtaining a specialist report is essential. The OH practitioner’s skill is knowing when and what further medical evidence is required. This may require escalating to a senior or discussing the case with a peer. After all, two heads are always better than one when a case is less than clear and/or there is a safetycritical element. OH physicians always need a GP specialist report when considering Ill Health Retirement.

12

OH TODAY

Spring 2022

Janet O’Neill Clinical Director PAM Group

Why writing in Plain English adds value!

E

mployers commission Occupational Health to supply an opinion in the form of a written re-

port. They ask us to assess and advise them on how an individual’s health affects their ability to perform their role and to suggest adjustments. But how often have you stopped to ask yourself, how effective am I being at getting this information across? We may give excel-

lent evidence-based advice, but what use is that to the customer, if they cannot easily understand the report?

I recently read a blog that made me stop and reflect on this. Morris (2014) suggests “In work, we write so we can do something. If you want your writing to achieve its goal, then do all you can to make life easy for your reader. Keep it short, avoid unnecessary technical language, and use clear, simple words. It 14

OH TODAY

Spring 2022

By Stephanie Foster, Clinical training lead, PAM Group

will increase your chances of being read and understood rather than skimmed or binned.”

The Plain English Campaign highlights the importance of avoiding “gobbledegook” to make sure information is accessible. Their website offers advice on writing in Plain English, as well as providing an A-Z suggesting simpler alternatives to complex words.

To help you adapt your writing style you may want to try software such as Editor (available with an office 365 subscription) or Grammarly. Both programmes help ensure correct spelling and grammar. Getting this right helps emphasise your professionalism and inspire your customer’s confidence in your advice. If you get a letter or report that has errors in it, how does this make you feel? Does

it inspire trust? Probably not. Proofread-

before putting it all together. So, the

ing your report aloud can help show you

greater the number of words used in a

any mistakes. If you saw my article on IT

sentence, the more concentration and

Accessibility you will know that I use the

focus the reader needs to understand it.

read-aloud tool either in word or a

Writing in plain English does not mean

browser to do this (Foster, 2021). I find

“talking down” to your audience. In-

it helpful as it reads what is actually

stead, it is a writing style that makes it

written, not what I think is there.

easy for them to understand your work

You can use the Flesch Reading Ease

at the first reading. The use of overly

score to gauge how easily your audience

complicated language, rather than im-

can understand your work. The higher

pressing, can make your report harder to

the score the easier the article is to read.

understand. I admit to a twinge of sad-

ness in retiring some of my favourite words, such as ameliorate and expedite.

To make your writing easier to read try to:

But if my customer needs to reach for the dictionary or read a sentence two or three times to understand my meaning,

Keep sentences short, ideally to 15-20 words or less.

•

•

Use everyday words

•

Avoid specialist words or jargon, but if they are necessary give a definition.

Mostly use an assertive rather than passive tone.

Assertive sentences state facts and show who is doing what.

•

(Plain English Campaign)

I have not achieved my aim.

Writing in plain English does not mean “talking down” to your audience

References Foster, S. (2021) ‘Disability and IT Accessibility, OH Today, pp. 12–17. Available at: https://issuu.com/ioh1/docs/ oh_today_autumn_2021 (Accessed: 28 January 2022).

How to write in plain English (no date).

Available at: (Accessed: 29 January 2022).

Morris, M. (2014) Guest Post: Clarity is king – the evidence that reveals the desperate need to re-think the way we write Government Digital Service, Government Digital Service. Gov.uk. (Accessed: 28 Jan-

An average 13-year-old can understand writing with a score of 60-70. Microsoft Word will calculate this for you if the feature is enabled. It will also give you

uary 2022).

Useful websites Free guides (plainenglish.co.uk)

the average number of words per sen-

Introducing Grammarly for Windows

tence.

and Mac | Grammarly Blog

As you read the words of a sentence you

Get your document’s readability and level

interpret their meaning. You do not

statistics. Available at: sup-

form a final impression of what it says

port.microsoft.com/en-us/office

until the end. The longer the sentence, the more you must hold in your memory ioh.org.uk

OH TODAY

15

Health and Wel

14th - 16th M

Professor Dame Carol Black

One of the things I’m most looking

always great to learn from people’s

forward to in the new year is being able

personal stories and this year will be no

to meet in person the colleagues and

exception. As a survivor of a forced

friends we have made over the past 16

marriage, Bal Kaur Howard shares her

years of running the Health and

own harrowing story and explains how

Wellbeing at Work event at the NEC.

employers can support victims of

Whilst our virtual event in March 2021

domestic and honour-based abuse in the

was a resounding success, nothing really

workplace. Men can also be victims of

beats the buzz of 4000 delegates over

abuse and Mark Brooks OBE offers a

two days coming together to exchange

greater understanding of the barriers

ideas, learn from best practice and catch

they can face and how to better support,

up with fellow occupational health

recognise and signpost them.

professionals.

This year we have developed an exciting programme that reflects the seismic change that has transformed the way we work and the environment we work in.

We live in disruptive times and rebuilding the resilience and wellbeing of employees as they return to work will Professor Neil Greenberg

Dr Chami Rathmalgoda

be paramount. Professor Neil Greenberg

It is heartening to see that both

returns to headline our new Building

Government and employers are starting

Resilience programme, with Dr Noreen

wake up with regard to women’s health

Tehrani discussing the role of

issues and we are delighted to announce

psychological surveillance in building

the launch of a new Women’s Health

resilience. Mental health continues as a

programme this year. Henpicked’s

growing burden on employees and

Deborah Garlick joins forces with enei to

businesses alike, with financial

provide an update on breaking the

instability, job insecurity and domestic

menopause bias, highlighting potential

abuse all on the rise. Jaguar Land Rover

legislation changes and what this might

have tried multiple interventions to

mean for employers. Optima Health’s

support employees, and it’s CMO Dr

Columba Urey discusses the impact of

Steve Iley offers an insight into what did

menopause and peri-menopause on

and didn’t work and how to deploy best

mental health within a work context,

practice in your own organisation. It’s

together with some practical workplace

llbeing at Work

March 2022 strategies to manage this. Atkins

have had to adapt their approach post-

Global’s Jennifer McClellan teams up

COVID, especially workplace

with Hallam’s Natasha Knowles to offer a

spirometry. Guy’s and St Thomas’ Dr Ali

personal and professional perspective

Hashtroudi has been responsible for

on pregnancy loss, whilst See Her

developing and implementing their

Thrive’s Clare-Louise Knox looks at how

Long-COVID clinic dedicated to

to recognise the signs and symptoms of

NHSstaff and shares his team’s

Premenstrual Dysphoric Disorder, how it

experiences as well as a glimpse into

can affect employees and what support

future challenges. Health Psychologist

employers should provide. Transport

Dr Julie Denning profiles some

for London’s Dr Chami Rathmalgoda

innovative interventions to enable

profiles TfL’s management of employees

employees with Fybromyalgia to return

Dr Steve Ilay

to work while sleep expert Dr David Lee examines the correlation between LongCOVID and sleep disorders and how we can help employees to overcome these.

Also look out for iOH President Neil Loach discussing the benefits of Clinical Supervision and the role this plays in enhancing clinical outcomes and clinical with endometriosis and Barbara Wilson

staff retention.

shares her personal story of working

We are really looking forward to welcoming you back to the event in March so be sure to visit www.healthwellbeingwork.co.uk to view the whole programme – registration is now open with early bird rates available.

with breast cancer.

Many employers are facing the inevitable challenge of managing employees with Long-COVID. Professor Paul Cullinan’s Lungs at Work team draw

Neil Loach

upon their experience as the UK’s

busiest occupational lung disease

Lauren Sterling

service, covering the breadth of occupational respiratory issues within the pandemic, from detection and surveillance, assessment and diagnosis through to short and long term management. They explain how they

Deborah Garlick

Looking Beyond Pregnant Workers and New Mothers wi

By Danny Clarke, MIOSH Simply-People

18

OH TODAY

Spring 2022

ith Women’s Health

T

he issue of women’s health in

the workplace often conjures up thoughts around pregnant

workers, new mothers and the usual risk assessment. Thereafter there is the debate about maternity leave, the treatment of women returning to work after giving birth and how they can use keep in touch days to make sure they aren’t replaced or forgotten.

Though this is an extremely important aspect of women’s health, particularly

since 61% of women believe that maternity leave and childcare disrupt women’s opportunities to progress into managerial roles (Women in the workplace statistics 2019), these are not the only element of women’s health that needs to be addressed in the workplace.

What are workplaces missing when it comes to women’s health and how can they begin moving in the right direction?

How does women’s health impact the workplace?

Around 11 million women have taken long-term health breaks during their working lives, and 3 million have left their workplace due to female health issues. From menstruation to postnatal depression, women’s health issues affect them in the workplace, and when left

unaddressed, have a negative impact on both them and the business. As an example, almost a third of women have taken sick leave due to menopausal symptoms such as hot flushes, brain fog, anxiety, fatigue, and migraines – yet only 25% told their manager the real reason why (Supporting women in the workplace 2017).

The reason it is so essential to broaden ioh.org.uk

OH TODAY

19

the discussion around women’s health

as endometriosis causing pain and dis-

beyond pregnant workers and new

tress.

mothers is because nearly all women will experience female health issues at some point in their lives, most of which aren’t covered in workplace policy and general awareness the way pregnancy/ maternity leave is. This requires a level of understanding, compassion, and knowledge from business leaders, senior members of staff and HR. In the same way that we know someone who has a cold should look after themselves, we should also know that a woman experiencing brain fog and fatigue should be

Alongside this, stress, anxiety and depression are cited as the common conditions reported by women in the workplace, with contributors to these conditions including caring responsibilities, ageism and sexist perceptions in the workplace. Research has also indicated that unsympathetic colleagues and managers can prevent women from talking about the difficulties they are facing

or getting support from colleagues (Ageing better).

able to look after themselves as well – it begins with normalising the discussion around women's health.

Open conversations are necessary Though well intentioned, women’s health-specific policies such as menopause leave may give the impression of a tick box rather than openly addressing it. This includes the way in which women’s health is communicated. When women’s health is discussed in the

Verdict Understanding women’s health

+ A commitment to accommodating needs

= A better workplace for everyone

workplace, it can often be directed only at women, even though men may want and also need to understand more about women’s health issues.

Unlike with maternity leave and new mothers returning to work, the knowledge that the workplace has around issues such as endometriosis, menopause, postnatal depression, and perimenopausal anxiety is minimal unless open discussions start to happen.

There is also the link to wider discussions around mental health, which can be an area of overlap with women’s health, including for example post-natal depression, menopause, miscarriage and the chronic long-term conditions such 20

OH TODAY

Spring 2022

Taking action Effective workplace change relies on providing employers/managers with the tools and knowledge to support individuals and providing a psychological safe environment for employees to raise issues with their

employer/managers. The starting point

workspaces. Matching these to the

has to be a commitment and desire to

individual is made possible through

support the health of employees, with a

clear and open discussions and referrals

willingness to be open and supportive.

to OH for bespoke advice if needed.

The first step is reducing the stigma and

Such changes aren’t just beneficial to

raising awareness of women’s health

one demographic of the workforce. They

beyond the scope of pregnancy. There

create an open and supportive culture

are a number of ways organisations such

which then creates a psychologically

as awareness days, training

safe environment leading to reduced

programmes, internal campaigns

absenteeism and presenteeism. An

including women’s health champions

informed workforce can reduce work-

which can be supported by Occupational

related stress caused by a lack of

Health (OH) services. As experts in the

understanding and poorer work

health and wellbeing of the workforce

relationships.

and with clinical knowledge, they understand the link between the wellbeing of the organisation as wellbeing of the people.

Support can also make a huge impact on how women can work and how comfortable they feel about their health, which in turn promotes a more inclusive

Discussion opens the door to

environment. With women making up

understanding and making adjustments

such a large percentage of the workforce

that individual women may need such as

(Women in the Workforce), attracting

flexible working structures, hybrid

and retaining women needs a more

working models, mental health support,

inclusive culture and OH is an area of

as well as physical workspace changes

expertise that can support this.

such as better ventilation and quiet

Danny Clarke, Simply-People

ioh.org.uk

OH TODAY

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Teachers and Workplace mental health, an Occupational Health case study

By Phina Amahoro (RGN, MPH) Trainee OHA at PAM Group Ltd.

M

ental illness is one of the

structure to one’s day; all elements

main causes for sickness

conducive to positive wellbeing

absence and presenteeism

outcomes (Waddell and Burton 2006)?

within the UK and therefore has a

Conversely, the evidence available

significant impact on productivity

indicates that work can also be a source

within the workplace. The number of

of stress and contribute to the onset

teachers reporting a mental health

and /or worsening of common mental

problem lasting longer than one year

health disorders (Waddell and Burton

and using antidepressant medication is

2006) and therefore, alongside research,

growing. There is a growing body of evidence that a substantial number of teaching staff within the UK are reporting work-related stress (Wettstein et al., 2020). Sadly, the department of education says that around 1/3 of new teachers resign within the first five years of completing their training, with contributing factors being reported as anxiety, mood and sleep disorders.

(Jerrim et al., 2021).

substantial number of teaching staff within the UK are reporting work-related stress

exploring case studies, undertaken by Occupational Health, may provide some additional information.

Referrals to Occupational Health (OH) are made by managers when concerns for health and wellbeing or advice relating to health are required. In these

case studies, 25 management referrals carried out by an OH trainee advisor via telephone consultation during 20202021 were studied. The study subjects

Income and work are two important

were limited to referrals of primary and

factors in mental wellbeing (Phillips et

secondary school teachers with mental

al., 2011), so why are teachers leaving a

health problems causing absence or

role which has numerous positive

concerns within the workplace. The

factors such as a good income, a sense of

severity of symptoms, length of an

identity, social status, purpose and

absence, support and medication were

ioh.org.uk

OH TODAY

23

explored as well as any trends,

pandemic as the main cause of stress.

similarities and/or disparities. Each

Fear of contracting the virus due to

teacher was assigned a number between

working in proximity with pupils and

1 & 25 i.e., T-1. Validated screening

difficulty with teaching remotely during

tools used were the GAD7 (Generalized

lockdown appeared to be the cause of

Anxiety Disorder 7) and PHQ9 (Patient

‘Covid anxiety’ in the small proportion

Health Questionnaire 9-question

who reported this. Most of the

instrument). Both are self-reported

participants denied self-harm/suicide

questionnaires that screen for the

ideation now or in the past, with only 2

presence of, and severity of anxiety and

(8%) reporting issues with this in the

depression, respectively (Swinson,

past.

2006).

GAD7 (Generalized Anxiety Disorder 7)

PH9 (Patient Health Questionnaire 9)

1-4 No Anxiety

1-4 Minimal Depression

5-9 Mild Anxiety

5-9 Mild Depression

10-14 Moderate Anxiety

10-14 Moderate Depression

15+ Severe Anxiety

15-19 Moderately severe Depression 20-27 Severe Depression

The most prominent issue (68% 17/25)

Following the OH assessment,

reported by the referred teachers was

participating individuals were

work-related stress supporting

signposted to either the EAP (Employee

Wettstein’s et al’s 2020 research. Upon

Assistant Programme), counselling,

assessment, only 2 teachers scored a

CBT, or other therapies by the OH

range of severe anxiety / low mood (8%),

practitioner. Only 40% had been

the rest of the cohort scored within the

referred for supportive mental health

mild-moderate ranges. Interestingly, the

therapies by their GP with the reasons

incidence of short term and long-term

described as ‘GP appointments being

absences of those studies were similar

difficult to obtain during the pandemic’

with 7/25 (28%) and 9/25 (36%), short-

or that as it was work-related, they did

and long-term absences, respectively.

not ‘want to bother their GP’.

32% of teachers remained at work despite reporting symptoms of workrelated stress, anxiety and or depression. Interestingly, only 4 (16%) of the participants cited the covid 19

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This case study has a number of limitations but does reflect the general literature on this subject. 84% of those reporting work-related stress noted concerns relating to work were not

COVID related. Mental health at work

impact work demands had on their

can be shaped by the interrelationship

mental health and wellbeing. (Scanlan

between the person, the type of work

and Savill-Smith, 2021)

they do and their associated work environment (NICE, 2017). The Health and Safety Executive (HSE) identified six fundamental features of the working environment that can contribute to work-related stress and defined workrelated stress as the “harmful reaction that people have to undue pressure and demands placed on them at work.”

This study included all staff and was not limited to primary and secondary school teachers. What they found was that education staff reporting psychological symptoms caused by work is higher than that observed in all workers across other employment sectors. (HSE 2020; Ofsted, 2019). Evidence indicates that

(HSE), 2009): Features of Work-related stress 1.

2.

3.

4.

5.

6.

7.

Demands – includes workload, work patterns and the work environment.

Control – how much say a person has in the way they do their work.

Support – the encouragement and resources provided by the organisation, line management and colleagues.

Relationships at work – promoting positive working practices to deal with unacceptable behaviour and avoid conflict.

Role – whether or not people understand their role within the organisation and whether the organisation ensures the person does not have conflicting roles.

Change – how organisational change is managed and communicated.

Teachers identify 1 & 4 as being of most significance in literature and this case study

As observed in this case study, teachers’

workplaces that assign high demands on

workload (demands), pupils challenging

individuals, without sufficient control

behaviour plus management issues

and support to achieve these demands,

(relationships at work) appear to be the

increase the likelihood of potential work

main drivers for the work-related stress

-related stress and poorer mental

they experience (HSE, 2009).

wellbeing in employees. (Bagnall et al.,

An Education Support survey titled the ‘Teacher Wellbeing Index’ (Education Support, 2021) studied the mental wellbeing of staff working in the education sector. Of 3,000 staff members completing the survey in the UK, 77% reported stress or a common

2016). Therefore, addressing perceived

work concerns may very well reduce the likelihood of recurrence and as such, it is the managers’ responsibility to risk assess and action findings for employees who exhibit or report signs of perceived work stress. (HSE 2018).

mental health disorder, citing work as a

Occupational health (OH) contributes to

trigger. 46% remained in work even

business and organisation success, by

when unwell and 54% contemplated

assisting in the creation and

leaving the education sector, due to the

implementation of strategies and action ioh.org.uk

OH TODAY

25

plans to enhance employee wellbeing,

complement the stress risk assessment,

promote and prevent ill health. Health

the HSE has formulated a targeted

promotion delivered by OH nurses is

guidance document in “talking toolkit

paramount in the; primary (prior to

- preventing work-related stress in

illness), secondary (after illness has

schools” to further allow for open

begun) and tertiary (when illness is

dialogue between management and

established) stages of mental illness

teaching staff to combat work-related

prevention and treatment. (WHO 2015).

stress.

With regards to support for teachers at

An additional supportive measure that

an organisational level, evidence

OH practitioners are able to signpost

suggests that appropriate health and

and guide management to, is a Wellness

wellbeing policies, mental health first

Recovery Action Plan (WRAP). By

aiders, support from unions and mental

developing this WRAP, employees can

health toolkits for employers are key

actively support their own mental health

components in the primary prevention

by reflecting on the causes, and by

for mental ill-health, within the

taking ownership of practical steps to

workplace (Health Scotland, 2020).

help address these triggers. This process

Occupational Health (OH) can support

can also help open up dialogue between

with consultancy, advice and leadership

managers and employees, understand

to employers and therefore school and

their needs and experiences and

education management. Policies and

ultimately better support their mental

procedures are, however, not effective in

health. (Ellen Copeland, 2006; Canacott,

addressing the stress response of teachers reporting perceived work stress or anxiety and low mood that may have occurred. OH practitioners with clinical training are an essential tool in the management of employees’ mental health and wellbeing, and in this case teachers’ mental wellbeing. They are in a privileged position of having insight into the biological, psychological, and social factors of each employee we encounter. As such, OH is able to advise, refer and signpost employees to

appropriate health services and other supportive agencies, (McDowell & Fossey, 2015; Steed et al., 2021) as well as supporting organisations in managing work-related stress. A recognised tool widely used in the UK for this is the HSE ‘Stress Risk assessment’ tool or The Management Standards, which helps to identify and manage stress within the workplace. To

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OH TODAY

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early intervention from OH, is likely to aid improved mental health outcomes

Moghaddam and Tickle, 2019). Overall, there is evidence to suggest early intervention from OH, is likely to aid improved mental health outcomes for employees (Institution of Occupational Safety and Health IOSH, 2016).

As OH practitioners, the main contact with teachers is through management referrals where individuals are then assessed using a bio-psycho-social model, which includes workplace contributors. OH not only provide fitness for work advice, education and support for those managing the employees but also allows OH practitioners to signpost employees to their GP, emergency services, the community mental health team and other supportive mental health charities and organisations (WHO 2015).

In conclusion, this case study supports

Scotland, 2020). OH are a valuable tool

literature indicating relationships (with

because they possess medical and

management, colleagues and or

workplace health, knowledge and skills

children) and workload are major drivers

and are versed in interdisciplinary

for reported work-related stress in the

working. Therefore OH not only assess

teaching profession. Teachers’ mental

and advise the individual but advise and

wellbeing is important, not only on an

lead organisations in preventing ill

individual level but also on a societal

health. All of this contributes to

level as poor mental health outcomes in

employee wellbeing and helps to build a

teachers can directly affect, the school

psychologically resilient workforce.

experience and learning outcomes, of

(Weinberg et al., 2017).

children and young people ((Health

Phina is an experienced nurse who is currently studying for a specialist community public health nursing qualification, focusing on Occupational health. She is particularly passionate about community health and is a trustee of a charity centred on tackling mental ill-health within the African / Caribbean communities - Baba Yangu foundation.

She works for PAM group which she says has been instrumental in her growth as an OH practitioner.

ioh.org.uk

OH TODAY

27

Are 'Teeth & Nails' included in your Risks Assessments?

By Juliette Osborne Behavioural Safety Trainer

E

mployers' responsibilities to

The accompanying guidance states that

workers regarding the provision

employers should, therefore, provide

of Personal Protective

appropriate personal protective

Equipment (PPE) are changing from 6th

equipment (PPE) and training in its

April 2022.

usage to their employees wherever there

The Personal Protective Equipment at Work Regulations 2022 amends the 1992 Regulations to extend employers’ and

is a risk to health and safety that cannot be adequately controlled by other

means.

changes.

What does this mean to those working within Occupational Health?

The Personal Protective Equipment at

No longer is being scratched or bitten

Work Regulations 1992, Regulation 4

considered “Part of the Job ''; no longer is

states:

arm protection optional; no longer can

employees’ duties in respect of PPE to a wider group of workers. You can find interim guidance explaining the

arm protection be considered an afterthought.

“Every employer shall ensure that suitable personal protective equipment is provided to his employees who may be exposed to a risk to their health or safety while at work except where and to the extent that such risk has been adequately controlled by other means which are equally or more effective.”

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OH TODAY

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Those working with patients with complex needs can be particularly vulnerable including Nurses, Carers, Healthcare Assistants, Ambulance Operatives, Learning Development Nurses, Teachers, and Physiotherapists.

One of the reasons arms have been left vulnerable (in the past) was due to the guidance of 'Bare Below the Elbow' taking precedence over Health & Safety

Law requiring Employers to protect staff

Charise said, “The reason I was

from foreseeable risks. But this reason

motivated in creating GIPskins PPE was

stems from 'Teeth & Nails' being

due to staff were being scratched, bitten

omitted from Risk Assessments. It is so

and getting bodily fluids on there arms

important that OH Professionals are

on a daily basis while delivering

aware of the front-line risks that are

personal care .”

commonly overlooked.

Charise met with hospital OH

The change in Health and Safety law

Department Heads to ascertain if

means arm protectors for those at risk

scratches were an issue – to be told it is

must be readily available and not just

under-reported (due to the 'part of the

acquired after an incident has occurred:

job' mindset). She joined the IPS

hence the inclusion of ‘teeth & nails’ in

(Infection Prevention Society) to ensure

Risk Assessment is imperative.

the needs of infection control were

So what is the solution?

Enter Charise Mullings.

taken into consideration when searching for a solution.

She eventually found a material that met the requirements of both infection control and also appropriate for the wearer. This was not the only consideration, the arm protection needed to be discreet & nonthreatening – sensitive to the needs of the vulnerable clients.

The introduction of 'arm protection' for healthcare workers was considered radical at the time as many 'old school'

One care assistant was asked by someone if she self harms, due to the scratches on her arm.

still believed being scratched and bitten was 'part of the job': One care assistant was asked by someone if she self harms, due to the scratches on her arm. She had to cover her arms to avoid disparaging stares. In Charise Mullings inventor of GIPSkins

PPE - appropriate Arm Protectors for healthcare workers; GIPSkins PPE – Grip Infection Protection Sleeves are Bite, Scratch & Tear Resistant, Reusable, Cleanable, Waterproof, AntiFungal, Fire Retardant, NonThreatening & Discreet, Breathable, Latex Free, Bonded seams, trusted Dartex material.

another case, a care assistant was bitten by a child and her bite had turned into sepsis. With appropriate arm protection, these risks can be considerably reduced.

After carrying out product reviews with the Infection Prevention Society (IPS) and extensive trials, GIPSkins PPE arm protectors were launched at the Care & Dementia Show. The feedback was fantastic with a favourite comment being, “It needed to be invented by someone who has done the job, to ioh.org.uk

OH TODAY

29

understand how much arm protection is

For more information on GIPSkins you

needed.” Next, GIPSkins PPE was

can visit their

introduced to the infection control

website www.gipskins.co.uk. You can

sector. Again there was a fantastic

also find informative videos and

response. The message? Bare Below

testimonies on their YouTube channel

Elbow EXCEPT when at RISK!

GIPSkins PPE can be purchased online

There was also feedback from pre-

and are distributed by: Countrywide

dementia support workers who found

Health Care MC Products Ltd.GIPSkins

that despite patients feeling gloves were

PPE can also be found on the NHS

overused - when it came to personal

procurement system (GHX & NEXUS).

care over 90% said they would prefer not to have skin-to-skin contact with staff

as this reduces the risk of sexual arousal which is a subject that is becoming more of an issue.

Further reading https://www.hse.gov.uk/violence/ https://www.bma.org.uk/advice-andsupport/nhs-delivery-and-workforce/

GIPSkins also got great feedback as a

creating-a-healthy-workplace/

solution for those that need to cover

preventing-and-reducing-violence-

their arms for cultural reasons.

towards-staff

Now seven years later NHS Hospitals,

https://www.ncbi.nlm.nih.gov/pmc/

Ambulance Services, Care Homes &

articles/PMC5418898/

Learning Disability Schools have included GIPSkins PPE arm protectors as a part of their uniform. The main goal

now is awareness and reduction in preventable arm injuries within the healthcare sector.

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OH TODAY

Spring 2022

https://www.gipskins.com/1253-2/ https://www.youtube.com/channel/

UCXYIY5ekAx3J5MI914Z-Llw

Covid-19 Newsround and Toolkit

By Lucy Kenyon, iOH

How has Covid-19 has changed OH practice?

I

profile, nor a greater challenge. We’ve had to adapt very quickly. This has led to the early adoption of a

n March 2020, like most health

multidisciplinary team approach and the

professionals, I had to adapt my

expansion of OH.

practice overnight. Training moved

from face to face to online delivery as Trusts were unable to release delegates

to attend in person and were inundated with health declarations. I found myself poring over the emerging COVID-19 pandemic data and information to update the remaining courses to address and incorporate the immediate changes to operating procedures and clinical

As a fellow member of iOH, I’ve been privileged to be able to share observations and learnings from emerging evidence and to participate in the joined-up thinking and innovation that has been taking place across our professional networks.

We continue to see unprecedented demand for occupational health risk

decision-making.

assessment to identify and recommend:

I joined the NHS COVID response to

• Health Protection arrangements to:

assess and interpret the emerging evidence and develop Occupational

Health (OH) policies, protocols and procedures to protect and support the NHS and the SME employers I advise.

What have I learnt?

I don’t think anything could have

 reduce vulnerabilities and impairments affecting or affected by work  improve COVID vaccine confidence through informed discussion of the WHO vaccine tracker • Health Education as part of supportive

prepared or trained me better for

and therapeutic consultations plus

evidence-based practice than the last 22

case management and rehabilitation

months. OH has never had a higher

for those unable to manage their symptoms or treatment effectively

ioh.org.uk

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• Health Promotion through wellbeing

This government tool, Health impact

advice to access lifestyle and health

assessment, is a practical approach

interventions in an accessible and

used to judge the potential health

timely manner

effects of a policy, programme or project

• Health Information to enable individuals to understand and manage their health risks effectively • OH Advice to help individuals and their managers to consider reasonable adjustments and arrangements COVID has led to several changes in the way public health is governed. The new agencies are listed below:

on a population. This is useful if your organisation is bringing in or has brought in any new or revised policies on COVID 19.

Rehabilitation assessment and monitoring tools WHO advises that “These patient assessment measures were developed to

COVID-19 in the UK: The official UK

be administered at the initial patient

government website for data and

interview and to monitor treatment

insights on coronavirus (COVID-19).

progress. They should be used in

Health improvement and disparities:

research and evaluation as potentially

Break the link between community and ill-health Health protection: infectious diseases Health Security Agency

COVID-19 Tools The ALAMA COVID age tool is one of the most ground-breaking applications of emerging data and innovations with

useful tools to enhance clinical decision -making and not as the sole basis for making a clinical diagnosis.2 Dysfunctional breathing MSK symptom and quality of life questionnaire3 Functional impairment 1 Ergonomic risk assessment1

life-saving potential since Ramazzini quantified the relationship between workers and lung disease. The Medical risk assessment is undertaken alongside the UK regional prevalence tool.

The guidance for people previously

considered as clinically extremely vulnerable is also useful.

Their work has inspired me to develop a vulnerable worker risk reduction assessment and checklist that can be

Lucy Kenyon is one of our Non-

saved as a portable PDF on any worker’s

executive Directors and Immediate Past

phone or imported into a reasonable

-president. She also delivers

adjustment passport, applying these

Occupational Health (OH) Clinical

learnings and capitalising on increased

Professional Development as an

employer awareness of risk assessment.

Associate of the NHS National Performance Advisory Group.

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OH TODAY

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References [1] Ahran, T., Karwowski, W. Evaluation and prevention of work-related musculoskeletal disorders in Hungary.

(2012). Advances In Physical Ergonomics And Safety, 209-216. doi: 10.1201/b12323-27 [2] WHODAS 2.0 (World Health Organization Disability Assessment Schedule 2.0): 36-item version, selfadministered © World Health Organization, 2012. Measuring health and disability: manual for WHO Disability Assessment Schedule (WHODAS 2.0), World Health Organization, 2010, Geneva.

[3] Hill, J., Kang, S., Benedetto, E., Myers, H., Blackburn, S., & Smith, S. et al. (2016). Development and initial cohort validation of the Arthritis Research UK Musculoskeletal Health Questionnaire (MSK-HQ) for use across musculoskeletal care pathways. BMJ Open, 6(8), e012331. doi: 10.1136/bmjopen-2016-012331

CPD Resources Newsround Timeline Timeline

OH topic

Summary implications / outcome

19 January 2022

Menopause and the workplace

Support for workers with symptoms

30 December 2021

Health and social care staff

Infection control, testing and isolation

December 2021

Return to work after long COVID: Evidence review HSE

The primary goal should be support at work (job retention), or progressive, adaptive, and appropriate RTW, as good work is generally good for health.

14 December 2021

Pregnant workers

COVID-19 vaccination

8 December 2021

Home / on-site working

COVID fear is not a protected belief GAD7 advised to assess medical severity

1 August 2021

Menopausal symptoms and work: Narrative review NCBI

Forthcoming Parliamentary Committees Date

Meeting Topic

25 February 2022

Asylum Seekers (Permission to Work) Bill: Second Reading Carol Monaghan Migrant workers

18 March 2022

Flexible Working Bill: Second Reading Tulip Siddiq HSE Flexible working report

18 March 2022

Workers (Employment Security and Definition) Bill: Second Reading Martin Docherty-Hughes Organisational change ioh.org.uk

OH TODAY

33

Coming soon!

Mental Health in the workplace; A Practical Guide for Occupational Health Practitioners on Consultation and Report Writing

Mindshift is proud to announce the launch of a brand-new book, aimed at Occupational Health Practitioners, but highly insightful for those working within HR, H & S and Management.

It will be selling for £34, and available via https://mindshiftconsultancy.co.uk/ 5% of any profits will be shared between MIND and Nurse Lifeline

Available to buy from mid-March, 2022 My aim within this book is to fill any knowledge-gaps you may have around the subject of mental distress and to increase your confidence and competence…

This book is packed with helpful information including : • risk factors for and signs of mental distress • supporting someone experiencing anxiety, depression, self-harming or suicidal behaviour,

an eating disorder or psychosis

• tips on getting the most of your assessment • useful phrases to use in your report • templates for your notes and your report • adjustments to support a recovery • case studies • detailed stress risk assessment and action plan • recommendations on wider reading • signposting to key resources

Are you ready to take back control of your work-life balance?

L

ooking back at my work-life balance when I started my corporate HR journey over 30

years ago, it just didn’t exist. I worked

long hours and there really wasn’t much time for anything but work. But I knew I wanted a family as well and corporate life just wouldn’t fit with my future aspirations. Therefore, I decided to set up my own HR consulting business.

Life takes you in directions that you don’t expect, and I found myself as a single mum of two boys. I know hand on heart that had I still been working in the corporate world I would have missed so

much of their precious childhood memories.

Having my own business meant that I had the flexibility to attend schoolrelated events happening during the day, and I could then catch up with work once the boys were in bed.

Roll on twenty-five years and my boys are all grown up and I’m so proud of the men that they have both become.

By Sarah Hamilton-Gill

Setting up my own consultancy wasn’t plain sailing, and it was a lot of hard work, but it also brought with it the flexibility to work my own hours and choose where and when I worked. It’s also brought with it so may incredible opportunities to work with the most amazing clients, from individuals to bigger businesses. If I can do it, so can you!

I would never have imagined that at the start of my journey I would write a No.1 Amazon Best Selling Business Book, and some 14 months later, it still pops up to the No. 1 slot! I didn’t imagine that my journey would take me into not just ‘doing’ but also teaching and coaching.

Since the start of lockdown over 80 new consulting businesses have been launched after consultants went through our virtual leap into consulting bootcamp, and we get to meet 100s more through the free webinars and events that we also put on, to give something back and pay it forward.

ioh.org.uk

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My new Bootcamp Flex will launch in

March and will cater for those who want to do my virtual bootcamp, but at their own pace, under their own steam, with the flexibility to buy-in extra products such as 1:1 coaching.

My special offer just for iOH Members I’m proud that my business is an official partner to the iOH. I’ve made it my mission, wherever possible, to give something

If you are interested in finding out more, please do get in touch! I also have a very special founding members offer just for IoH members.

back and pay it forward. I’m passionate about the people-

I so wish that there had been something

related industry and when I was asked to write this feature, my

like our Bootcamps around when I was

first thought was ‘what I could offer you’ which would be of

starting out. Having your own people

benefit to where you currently are professionally. I hope you

focused or consulting business can be a

like what me and my team have come up with:

lonely place, but one of the great things about my bootcamps is that

A gift for you all Have you been thinking about setting up your own occupational health, wellness, healthcare or people related business? There’s some quite clever science behind finding out if your personality fits to doing this. Would you like to find out more and gain clarity?

It really is as easy as 1-2-3 and as an official partner of the iOH.

I have a one-off special offer just for you, as I’d love to help you take the next step: 

communities are formed, including a private Facebook group, friendships are made, and you have a virtual network around you to help with questions, collaborations or just a listening ear.

We’re not saying that setting up your own business is easy; it’s not. It takes

confidence and courage, but you will never look back, as it also brings with it

Sign up for our profiling questionnaires – we use these to

flexibility, a sense of pride and a better

give career guidance for anyone looking to move into self

work-life balance.

-employment 

Receive your comprehensive profiling reports with lots of insights



Clarity call for you – in just a 15-minute call I can explain what your profiling means for you

It usually costs £180 for our 3-stage ‘is self-employment right

for you?’ but I’m offering this to you for just £45. I guarantee that at the end of step 3, you will have the clarity that you need to decide what happens next.

Get in touch:

Like anything though it’s important not to stagnate and look

Website: www.leapintoconsulting.com

ahead at your goals and aspirations and that’s why I launched

Email: sarahhg@globushrconsulting.co.uk

my virtual Bootcamp at the start of lockdown. I’m proud that to

Connect on LinkedIn: (6) Sarah

date over 80 of my bootcamp graduates have launched their

Gill FCIPD | LinkedIn

own new consulting businesses during this time.

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OH TODAY

Spring 2022

Hamilton-

become more common for lung function

monitoring of confirmed cases of respiratory disease, the backlogs for pulmonary function testing have been building steadily throughout the pandemic.

International guidance on the considerations for resuming pulmonary function services and testing postCOVID has been reasonably consistent.

The top 5 key points to consider when re

5 Key Considerations For Restarting Lung Function Testing

By Vitalograph

T

When considering the re-start of testing, thought should be given to whether the clinical need and the potential benefits of testing outweigh

pandemic has affected all areas

the risks posed by performing the test.

of healthcare, including

Consideration should also be given to

pulmonary function testing services

prioritising groups of patients, with a

which have either been greatly reduced

focus on those for whom pulmonary

or stopped entirely. The re-starting of

function testing will potentially impact

these services requires urgent action so

their treatment pathway or determine

that we can resume the management of

their onward care.

interventions.

2. Is there a need for pretest COVID screening?

Patients with respiratory conditions and

International respiratory organisations

those who display symptoms have

recommend that some institutions may

received the best possible care and

prefer a strategy of testing for SARS-

management that has been allowed

CoV-2 in all patients who are scheduled

during this time. However, with

to undergo PFTs. This could also include

diagnosis often dependent on

the use of pre-attendance

spirometry testing, some provisional

questionnaires.

diagnosis and therapeutic / referral

diagnoses have seen prescribed strategies that may not be required

3. Appropriate PPE and room ventilation.

during the wait for spirometry testing3.

Patients should be instructed in cough

medication and disease management

Similar principles apply to post-COVID recovery patients and the monitoring of their lung function with both spirometry and DLco testing.

Whilst tele-monitoring from home has OH TODAY

1. Do the benefits outweigh the risk?

he impact of the COVID-19

respiratory disease through correct

38

-starting are:

Spring 2022

etiquette and wear a surgical mask as much as possible to avoid aerosol dispersion, while staff should wear appropriate PPE. Adequate room ventilation is strongly advised. If

available use a room under negative

pressure or with mechanical air circulation or ventilate as able (i.e. open windows). Ideally, recommendations suggest that there should be in the region of 6 room air changes per hour3.

Along with both patients and staff maintaining a safe distance from one another, a Perspex screen between

References: 1. ANZSRS (2021); Update on Lung Function Testing (online https://www.thoracic.org.au/documents/item/2012 ) <accessed on:24/06/2021> 2. ATS Workshop Report - Restoring Pulmonary and Sleep Services as the COVID-19 Pandemic Lessens (2020); Ann Am Thorac Soc Vol 17, No 11, pp 1343–1351 DOI: 10.1513/ AnnalsATS.202005-514ST

patient and operator offers an additional

3. BTS/ARTP/PCRS; Risk minimisation in spirometry re-start

physical barrier. Both patients and

(online - https://www.brit-thoracic.org.uk/covid-19/covid-19-

operators should wash their hands

resumption-and-continuation-of-respiratory-services/ )

before and after testing.

<accessed on: 24/06/2021>

4. Use an in-line BVF during testing.

4. ERS Group 9.1 (2020); Recommendation from ERS Group 9.1

Guidance insists on all testing being

online: https://panafricanthoracic.org/images/pdf/

performed using a single use bacterial/

African_Paeds_LF/COVID-19

viral in-line filter. This is to prevent

ERS_91_Statement_on_lung_function_during_COVID-

bacterial or viral transfer to equipment

19_Final_with_Contributors.pdf <accessed on: 24/06/2021>

or into the testing environment. The recommendations also state that the bacterial/filter provide minimum proven

efficiency for high expiratory flow of 600

(Respiratory function technologists /Scientists) Lung function testing-during COVID-19 pandemic and beyond. Available

5. Dunne, C (2019). “Calibrated Flow Bioburden testing of Vitalograph Alpha Flow Heads” Dated 16 July 2019. Report for Vitalograph Ireland Ltd.

to 700 L/min4. Vitalograph Bacterial

6. Bentz, J. R. (2019) “Viral Filtration Efficiency (VFE) at an

Viral Filters (BVFs) have a validated

Increased Challenge Level Final” Report for Vitalograph Ireland

cross-contamination efficiency of

Ltd dated

99.999% across flow ranges of <50L/min

17 January 2019. Study Number 1138680-S01. Salt Lake City.

and >750L/min5,6.

5. Disinfect the testing room between patients.

Between patients, the testing room should cleaned/disinfected as per local

infection control policies. This is to

Nelson Laboratories.

7. Rutala, W. A., D. J. Weber and HICPAC (2008). “Guideline for Disinfection and Sterilization in Healthcare Facilities.” CDC Infection Control Accessed 28 May 2019, from https://www.cdc.gov/ infectioncontrol/guidelines

further reduce the chances of crossinfection.

Talk to an Expert Contact Vitalograph for more information on how their BVFs can help you safely return to spirometry testing.

T | +44(0) 1280 8270110 E | sales@vitalograph.co.uk www.vitalograph.com/uk ioh.org.uk

OH TODAY

39

O

ccupational Therapists have

historically worked in hospitals, community and

social care settings but our expertise is a great fit with Occupational Health (OH)!

Occupational therapists are a degree-level educated profession and are regulated by the Health Care Professions Council (HCPC). They are an Allied Health Profession and work to our Royal College of Occupational Therapists professional Standards of Practice and Code of Conduct.

Occupational Therapists understand some of the challenges within OH and recognise that industry-wide there is a skill shortage. We are ideally placed to enhance and support existing services, working alongside other health

professionals and developing new pathways to provide vocational support.

However, due to the scarcity of OT’s in OH, the speciality is not really visible in the profession or easily considered as an asset. Let’s hope perceptions change in the near future.

Occupational Therapists an

Why OT’s?

A great fit

Occupational therapy was founded as an

By Lisa Harrison of Rehab Jigsaw

Arts and Crafts movement with an ethos

of learning through doing. Post WW2, it became better understood how a combination of social, economic and biological reasons could impact a person’s health and therefore activities, or “occupations”. Occupations are a basic human need, providing a sense of purpose, structure and routine. When we engage in meaningful occupations, there is a positive effect on health and well-being.

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OH TODAY

Spring 2022

Lisa has worked in independent practice since 2006, spe Therapy in Occupational Health, case management and c range of experience with those clients with orthopaedic, She is a member of the Royal College of Occupational Th the Society of Occupational Medicine and of Case Manag Capacity Evaluation (UKFCE) and has a high level of skill returning to employment with health conditions includin injuries.

nd Occupational Health

ecialising in vocational rehabilitation, Occupational complex neurological rehabilitation. She also has a wide , spinal, pain, cognitive and mental health conditions. herapists Specialist Section for Work and is a member of gement Society in the UK. Lisa is trained in Functional in assessing those with difficulties sustaining or ng those with neurological conditions, including brain

Occupations refer to everyday activities that people need, want or are expected to do as individuals, in families and within communities, to occupy time and bring meaning and purpose to life culturally and personally, according to our individual values.

Training is broad-based and covers both

physical, mental health, cognitive and sensory conditions. Many of the core principles overlap with physiotherapy, all types of nursing, psychology and social work but what makes the profession unique is the focus on occupation.

Practice is shaped and structured according to recognised and respected theories, frameworks, concepts, national guidelines and research.

Occupational Therapists are trained to focus on occupation as the outcome goal when working with individuals. To do this, a person’s strengths, abilities and health care needs are taken into account. A detailed activity (or task) analysis is undertaken to assess and identify barriers to independent function with the aim to develop, recover or maintain meaningful activities including work. The persons’

current situation and conditions affecting occupational performance are assessed and the development of skills to enable people to effectively manage their own occupational needs are promoted. This reduces a delay in recovery or prevents future health needs from negatively impacting work. The expert analysis of activity compliments occupational health provision.

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OH TODAY

41

Good work supports good health.

managing physical, psychological,

Occupational Therapists aim to support

cognitive and sensory workplace

those with health conditions to gain or

demands.

return to paid employment if that is their goal – not all people wish to or can be employed, but almost all people wish to be engaged in activities that they value.

The cost to the economy from illhealth upon those of working age is huge

using the AHP “Health and Work Report”. This report is similar to the current Fit note but provides highly specific recommendations

biopsychosocial approach is used with

about workability. The RCOT

intervention, complementing a medical

report states approximately 93% of

model. Occupational Therapists focus

the 9-10 million GP Fit Notes

on function, how health impacts

issued between 2016 and 2017

performance and ways that can improve

stated unfit for work and no

function to enable greater participation

adjustments were suggested.

in chosen occupations, which may

Whereas the OT is more likely to

include paid employment. The cost to

provide a report with

the economy from ill-health upon those

recommendations to help those

of working age is huge and in the UK,

with health conditions to better self

many working-age adults are living with

-manage in all aspects of life.

a long-term condition – those who struggle with their health are more likely to leave employment, or not work in the first place. We also need to consider the needs of an ageing A recent report published by the Royal College of Occupational Therapists – “Good Work for good health – the difference occupational therapy makes” suggests that there are 3 ways in which occupational therapists can deliver services around work: 1. Universal level: Advice on work for

people with health conditions • Encourage employers to value the

2. Targeted level: Develop vocational services that support people to access and /or maintain employment

• Provide vocational focused interventions, or rehabilitation to those already experiencing difficulties at work, or getting into paid employment.

• Support people with health concerns, their employers and employment services to understand the range of factors that impacts their ability to work. Which could include the person’s skills, health, beliefs, roles and responsibilities, their occupation such as job

health and well-being of their staff

demands and working patterns;

at work and for employers to ensure

regular activities such as family or

that advice on self-management at

care responsibilities and their

work is readily available.

environment including their

• Promotion of early intervention and advice, such as identifying strategies to manage difficulties that employees may have in OH TODAY

judgements on fitness for work

In common with other professions, a

workforce.

42

• OT’s can support GP’s with making

Spring 2022

physical, social and supportive network).

3. Specialist level: Work with employers and occupational health providers to

support the delivery of health and

There is a specialist section for Work

well-being to staff by;

within the RCOT supporting clinical

• Analysis of activity equates well with assessing a person’s job demands in their work environment with the tools and equipment required and therefore subsequently assessing fitness to work, plus the barriers to sustaining or returning to work.

• Recommending reasonable adjustments and return-to-work

plans • Providing “vocational rehabilitation” or vocational case

practice within this field. This group has developed a core and extended scope of practice for OT’s in OH: • Analysis of occupational performance and participation • Job demands analysis – physical, psychological, sensory, cognitive, environmental, social, behavioural • Standardised physical, cognitive, sensory and psychological assessment • Occupational therapy treatment

management to work towards

• Vocational rehabilitation

improving functional performance.

• Group treatment and educational

• Working as part of a multidisciplinary team and recognising the importance of effective communication (verbal and reportwriting) with all stakeholders.

• Sensitive to individual needs and have complex problem-solving skills.

programmes • Transferable skills analysis and career re-direction • Return to work plans • Recommendation of reasonable adjustments • Assess fitness for work and job match • AHP “Health and Work Reports”

Vocational rehabilitation is a multidisciplinary intervention offered to those with physical, psychological and/or social difficulties enabling a return to work or preventing loss of work” for use in external parties (VRA)

• Risk assessment and prevention of further injury/harm • Ergonomic assessment • Worksite assessment • Mental health assessment and identification of adjustments • Equipment and tool recommendations

Occupational Therapists work in diverse settings and roles, collaborate with and

• Seating and posture analysis, including wheelchairs.

act in the best interests of individuals to ensure their optimum health, wellbeing and safety.

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The extended scope was deemed to be:

• Health and well-being promotion in the workplace

and needs for those who may have never

worked, or have been out of work for some time.

• Pre-employment screening • Complex case management • Functional Capacity Assessment All of which align well with the tasks required of Occupational Health.

So how do occupational therapists work with occupational health?

Either in partnership with OH providers or directly with businesses/human resource teams.

Work alongside other professions to deliver broader organisational interventions to facilitate positive change within the workplace Within an OH team these will usually be structured around an existing model of service delivery which is likely to be familiar to many OT’s due to their core training in physical and mental health and experience working in acute, primary and social care. The focus they bring on optimising function and promoting rehabilitative strategies broaden the services.

Occupational therapists working in primary care, including GP surgeries, will already be “in-reaching” to provide vocational support to individuals, which will certainly help many Small Medium Enterprises (SME’s) and their employees, particularly in cases where there is not an existing occupational health provider.

Occupational Therapists are also able to support individuals to navigate pathways into work, by identifying skills

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Spring 2022

For further information, Lisa can be contacted at lisa.harrison@rehabjigsaw.co.uk.

Further resources, including case studies, a job description and cost-

benefit analyses are available from RCOT Specialist Sections: Helping People Work

Ioh.org.uk OH TODAY 46