OH Today Summer 2021

Mental Health Inequalities The Start Point and the End Point of COVID-19?

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Partners of OH Today

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OH TODAY

Summer 2021

CONTENTS From the President

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Mental Health Inequalities: The Start Point and the Editor

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End Point of COVID-19?

LYNN PRATT Assistant Editor

Reasonable Adjustments in the

JANET O’NEILL

Workplace

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Production Editor IAN GARNER

Copyright © iOH 2021

Voice Care in the Workplace

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Effective Communication in Healthcare

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How Does Investing in Your Team’s

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Mental Health Save You Money?

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.

SCPHN The University of Derby

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Experience

Welcome to Leap into HR Consulting

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Welcome Back to Work with

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Cancer

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

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From the President Neil Loach

I

was fortunate enough to have my second covid vaccination recently and this has started to give me hope that we may soon be entering into a post covid phase with some semblance of normality. I know that many of you working in Occupational Health Departments the length and breadth of the country will really be wanting to see us finally get back to face to face appointments and particularly restarting abandoned or altered health surveillance programmes. There is talk of great change in these areas and I am sure we will find a way to make it work safely and effectively. This this has been really challenging time for you all and the Board of Directors and I, cannot express enough thanks and praise for the wonderful jobs that you are doing.

Whether you work in NHS, private industry or working as a sole provider, you have all been doing such amazing work and I am proud to be able to at least in some small way thank you for all that you have done and continue to do during this difficult time.

It’s been a really busy few weeks here at iOH HQ with a lot going on in the world of Webinars. We’ve been hosting a lot over the last few weeks and the turnout has been phenomenal. The feedback is all positive apart from a few technical hitches with the Zoom platform. We have now sorted that, and it will not happen again! (Fingers crossed!). Please visit https://ioh.org.uk/webinars/ to look at the line-up. Remember, it’s first come first served.

This edition of OH Today has some really great articles. My own piece 4

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relates to the University of Derby Specialist Community Public Health Nursing course and gives an overview of the course and what will be learnt. The course is very popular again this year and we are heavily into recruiting for September 2021. Here is where there is a big ask! If you have a placement opportunity in the East Midlands to host a student for one or possibly 2 days per week on a Monday / Tuesday, please email me at n.loach@derby.ac.uk. The placement area will need a Part 3 registered OH Nurse in to act as a Practice Supervisor and preferably another to act as a Practice Assessor.

Hosting a student can bring new and innovative ideas to an established clinical placement. It’s a 2-way learning street.

The article from Hardev Singh Agimal talks about the benefits of effective communication strategies. This can cause harm to working relationships. It’s a refreshing read and one that I am sure you will enjoy.

We have an article, from Sarah Hamilton -Gill on setting up in business as an independent practitioner. The recent webinar outlined the benefits of setting up in business in a post-pandemic world. This is something that in a different life I would have really liked to do, and I am certain it will hit the spot for many of you. The 5 C’s she talks about are what make OH Practitioners the amazing professionals that we are and taking them forward to set up in business is a natural transition.

Cancer and work are not subjects anyone should have to worry about.

Janet O’Neill talks us through this issue with great passion and empathy using a person-centred approach. This is definitely not to be missed. Likewise, Will King’s article on Mental Health Inequalities in the covid age is a really thought-provoking article. Jodie Hill & Crystal Boyde’s article on the Law pertaining to reasonable adjustments in the workplace is also another fabulous read. The duty to provide reasonable adjustments is likely to be heightened in the coming months with the incidence of Long Covid likely to be an issue for employers and OH Professionals alike.

Stephanie Foster, a regular contributor has done us proud again with her article on voice care and this really hit home with me as I talk for a living and it’s hard to shut me up at the best of times.

But on that note. I will shut up and let you feast on the goodies in this journal.

Enjoy!

Neil Loach President, iOH

ioh.org.uk

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Mental Health Inequalities: The Start Point Written by Will King

I

llness, inclusive of mental health, is moulded by society in so many ways and societal setups, exposing inequalities.3 As a species, those who live in ‘blue zones’; five global locations where life expectancy is at its highest (see figure 1)say that a basic human need is a sense of belonging. As the COVID-19 pandemic worsened, humans were reduced to operating in more isolated means, consequently fracturing community value and purpose. Mental health has long encompassed many health inequalities. Those who experience it are more likely to suffer from job loss and financial difficulties (Reducing health inequalities in mental illness). This can often be interlinked with an increase in health risk behaviours, which not only cost money, damage health but also worsen mental health in the long run, despite the instant gratification and improvement that may be felt. These behaviours include the adverse use of prescription medications, smoking, physical inactivity and alcohol consumption. An increase in prevalence by 50.7%, 46.8% and 40.3% respectively has been noted in those who are mentally ill (https:// doi.org/10.1177/0004867415569798).

COVID-19 will have only compounded the inequalities we see.

The COVID-19 pandemic has undoubtedly caused individuals some form of well-being decline over the past year. How we begin to quantify and contextualise this in the workplace environment is hugely important but difficult. Tangible indicators such as 2020 absence rates paint a very troubling picture but these are just the tip of the iceberg as it is not representative of the physical and

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psychological build-up involved overall.

The fallout of the pandemic on the nations holistic health will be huge. To gain further insights into health and the UK workforce, we must look at health inequalities and inequities within daily life. Sir Michael Marmot bought the idea of social determinants of health to the forefront of public health over a decade ago in his ground-breaking ‘Marmot Review’. Social determinants of health are the conditions in which we are born, grow, live and age which somewhat predetermine our health outcomes in life.

The COVID-19 pandemic has simply widened the crevices of structural and social determinants that were already failing the nation's physical and psychological health. Many of these can be seen filtering into the workplace and leaders should be aware of the structural barriers’ individuals face, and work to remove them to achieve health liberation.

The intangible nature of mental health makes it a labyrinth for economists to try and assign value. As we continue to work longer hours, compete for more resources in society and ignore our basic human drivers, we allow the modernfrom-home world to grab hold of our mental health and plunge us into burnout. The process of burnout is more than a concept and currently costs organisations 300 billion pounds a year (Burnout — More Than an Occupational Phenomenon - Spring Health). COVID-19 is a catalyst for burnout, inducing feelings of disconnect and alienation on individuals and undermining the conditions that humans require to thrive in a mental capacity (Monthly Review | Capitalism and Mental Health). We want to positively draw ourselves away from

t and the End Point of COVID-19? medical models of mental health, towards an understanding of social models, including health inequalities, encompassing effects of the environments we live and work on our mental health.

Figure 1

The pandemic has tangibly caused mortality but intangible casualties such as loss of community, disruptions to social cohesion and collapse of routines receive less attention. The social costs of isolation have been uncovered and it is too early to even begin to imagine the fallout we will see in regards to mental health decline post-pandemic. Research demonstrated that communicable disease leads to increased mental health risk and vice versa, demonstrating why relationships between COVID-19 and mental health must be acknowledged (Reimagining Global Health: https:// socialwork.journals.ac.za/pub/article/ view/105). Early intervention in the workplace and acknowledgement of reduced mental health, health inequalities and poor health behaviours, is crucial.

Blue zones 9 core habits that lead to longevity of life and thriving wellbeing, both mentally and physically (Blue Zones—Live Longer, Better - Blue Zones)

Many UK adults are taking medication for depression and anxiety, however, getting to the source of the problem requires further depth than just looking inwards. Structural and social determinants of health exist everywhere. The work environment, work demands and how we manage stress in the workplace can affect individual health, agency and rationality of health choices. Improving workplace health through addressing the six key management standards of stress outlined by the Health and Safety Executive (HSE); demands, control, ioh.org.uk

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support, role, relationships and change can have positive effects on reducing health-risk behaviours associated with poor mental health. These include reducing smoking, sedentary lifestyles, substance abuse, poor nutrition, just to name a few and therefore help to tackle the causal loop of work-related mental health and modifiable behaviours.

One HSE standard of stress to focus on, in this current climate is change.

Inequalities in health must be brought into the consciousness of decisionmakers as whilst we acknowledge everyone has been put through lockdown restrictions and isolation measures, for some, this will have more profound impacts. Consider those with young children, single parents, informal carers and lower socio-economic class who live in typically tighter spaces.

Thinking beyond general boundaries to understand how the health of employees will have been affected as a collective, but also as diverse sets of individuals, is crucial in identifying the social determinants of health that may be further negatively impacted by a changing work environment and increased stressors. Relationships, the cornerstone of human wellbeing, has been highlighted during the lockdown.

Being able to connect with colleagues, friends and family members at the drop of the hat was taken for granted but now we realise how crucial these interactions were for our mental health. Considering virtual fatigue, making time for nonwork conversation, encouraging people to check in on each other, signposting and giving support can ameliorate the negative effects to some extent. If colleagues feel supported and empowered they get a sense of belonging which creates a work community and a work community leads to self-efficacy, efficiency and a cohesive work culture/atmosphere.

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Health inequalities in the workplace have always been there, we are just becoming more aware of them. No one individual should have their health or status determined in life by the circumstances they were born into but it happens all too often and whilst these often begin outside of the workplace, these effects can be mitigated with good work environments. With the current pandemic, demographics may well be an intangible contributor to the cause of death, which can and has been exacerbated by workplace conditions and workplace demands (ONS). This is not an issue that will resolve itself.

Action is needed or we risk causing further fallout in inequalities, productivity and loss of social cohesion within our work communities.

Addressing workplace factors is essential in reducing health inequalities, however, the workplace is also an ideal arena for raising employees' awareness of self-management to improve general and mental health and wellbeing. This may help to reduce poor lifestyle choices, as noted previously when managing in the current and future world.

Health inequalities in the workplace have always been there, we are just becoming more aware of them.

Figure 2 The PERMA model explained One program is Martin Seligman’s PERMA model, a ‘theory of happiness’.

The PERMA model is a fair and impartial pursuit of happiness. Everyone has, within our grasp, the capability to forge strong relationships, find what makes us tick, celebrate our achievements and identify where our energy is best spent.

A positive mindset is something in which we can craft, much like you would practise a sport or playing an instrument. It is a trait; a semipermanent characteristic that can overhaul the way we approach the future if we commit to the themes of this model. Engagement is all about finding what gets you into an occasion in which everything is harmonious, called the flow state. If we can find our

flow, we are one step closer to achieving a positive state of mind. Relationships are the epitome of a human thriving state. We are social creatures and depend on this connection with other beings which lockdown has highlighted.

Investing time, respect, energy, and authenticity into meaningful conversations with everyone we interact with daily, builds us a resilience and support network. Developing meaning in life is a subjective experience, created by discovering what brings you joy and committing to it. Achievement is celebrating your personal and professional victories and learning to allow the positive moments in the day to outweigh the negative moments.

Will King, Health and Wellness Expert at ToHealth Ltd. BSc in Sport and Exercise Science Studying MSc in Global Public Health currently. ioh.org.uk

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T

his is a topic that often becomes

litigious as many employers get it wrong, either because they

Reasonable Adjustme

Thrive Law gives

simply don’t make adjustments, or they don’t know what to do. Alternatively,

Written by Jodie Hill and C

employers make a decision not to make adjustments because they don’t think the duty is applicable or worse, they simply don’t know of their legal obligation to do so.

Where does the duty to make reasonable adjustments come from?

Employers are required to put reasonable adjustments in place where they know that an applicant, employee, worker, volunteer or intern has a disability and because of this, is placed at a substantial disadvantage at work.

This occurs at the point of knowing of the impact of the disability on the

individual, which could be as early as a job interview.

This duty is set out at section 20 and Schedule 9 of the Equality Act 2010 (“EqA”) and essentially requires the company to adjust something in the workplace to assist in alleviating the substantial disadvantage faced by the disabled person in their role.

When does the duty arise?

A company will not be obliged to make reasonable adjustments unless it knows or ought reasonably to know that the individual in question is disabled and likely to be placed at a substantial disadvantage in the workplace. A company may know about a disability even where an individual has not specifically disclosed one. For example, if a staff member is in a wheelchair, or 10

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has a panic attack at work which their

manager sees and supports them with.

The duty to make reasonable adjustments to reduce or remove an individual’s disadvantage can arise where the individual is placed at a substantial disadvantage (in comparison with those who are not disabled) by: 1. The company’s provision criterion or practice [“PCP”].

The EHRC - Employment Statutory Code of Practice (the EHRC Code) provides an example whereby an employer has a policy that designated car parking spaces are only offered to senior managers. If a junior staff member has a mobility impairment and therefore, needs to park close to the office, it is likely to be a reasonable

TIP – ther legal requ ment for vidual to a disabilit a formal d sis for the arise.

ents in the Workplace

temporary or movable items".

s us some insight

substantial disadvantage if an individual

Crystal Boyde of Thrive Law

re is no uirethe indidisclose ty or for diagnoe duty to

For example, a requirement to go upstairs to get to the office is a is in a wheelchair. In these circumstances, a reasonable adjustment would be putting in a ramp or asking them to work on a ground floor instead of having to work on a floor with stair access.

3. The company’s failure to provide an auxiliary aid.

The EHRC code provides the example of a blind secretary who is employed by a temping agency which supplies her to other organisations for secretarial work.

Her ability to access standard computer equipment places her at a substantial disadvantage at the offices of all or most of the principals to whom she might be supplied. The agency provides her with

adjustment to the car parking policy to

an adapted portable computer and

give that individual a designated parking

Braille keyboard, by way

space.

of reasonable adjustments.

The PCP will usually apply equally to everyone but place the disabled person at a substantial disadvantage and

What is a disability?

therefore, the adjustment to that policy

An individual is disabled under the EqA

should alleviate that disadvantage.

if they have a physical or mental impairment that has a ‘substantial’ and ‘long-term’ negative effect on their

2. A physical feature of the

ability to do normal daily activities. An

workplace.

impairment will be ‘substantial’ where

the impact is more than minor or trivial.

The EHRC Code provides that physical features could include any of the following: "steps, stairways, kerbs, exterior surfaces and paving, parking areas, building entrances and exits (including emergency escape routes), internal and external doors, gates, toilet and washing facilities, lighting and ventilation, lifts and escalators, floor coverings, signs, furniture and

This does not need to only affect an individual at work, we are looking at the effect on their daily activities, such as walking or driving, sleeping, getting dressed, cooking or eating, being able to concentrate or socialise. ‘Long term’ means the impairment has lasted, or is likely to last, for 12 months or more.

Some impairments automatically meet the definition from the point of ioh.org.uk

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diagnosis. These are cancer, HIV and

reasonable adjustments. If someone has

Multiple Sclerosis. An individual is also

problems accessing an office which is up

regarded as automatically disabled if

a flight of stairs because they are in a

registered as blind or partially sighted.

wheelchair, it is obvious that a

Where a dispute arises, it is for an Employment Tribunal to decide whether an individual’s impairment meets the definition. It is however worth noting this is a different threshold than a medical or ‘blue badge’ definition of a

wheelchair accessible ramp will remove the disadvantage to that individual.

Likewise, it may be appropriate to widen doorways or create more space around desks if you have an employee in a wheelchair.

disability, and in an employment sense a

Where an employee is visually impaired,

disability does not need to be a formally

providing information in more accessible

diagnosed condition. The legal

formats, such as braille, large print, or

definition is subjective; two individuals

audio, could be considered. Adjustments

could have the same condition but only

might also include removing something

one might meet the definition if it

from the workplace, such as a bright

affects them more substantially or lasts

light above an employee’s workstation,

for longer.

or providing something, such as a

Where the effect of an impairment is reduced, or controlled, by medication or treatment (such as a prosthesis or

screen, to reduce the noise and distractions in a busy office environment.

hearing aid), the Tribunal will consider

It is often much harder to identify

the impact of the disability as it would

adjustments where someone is suffering

be without such medication or

from a mental impairment as this cannot

treatment.

be physically seen and therefore, what would minimise the disadvantage is not

If the employer is unsure whether an

clear. Employers must have open and

employee meets the definition,

honest conversations with their

supporting them anyway is safe practice.

employee to establish what would assist

The employer should not need to wait

them. Allowing an employee to work

for them to request reasonable

flexibly, for example, or implementing a

adjustments, or for medical advice, such

phased return to work following a period

as Occupational Health – it is in

of absence may be a reasonable

everyone’s interests for the individual to

adjustment depending on the

be supported in the workplace and

circumstances. Other examples might

adjustments made that would be

include providing a quiet space to work,

considered reasonable and will assist

providing headphones, or allowing

them in their role.

someone to work from home (if they are

Types of adjustments

suffering from anxiety that is linked to travel or punctuality). Where employees

Where an employee is suffering from a

have neurological impairments (such as

physical impairment it is usually more

Autism and ADHD), training or

straightforward when identifying

mentoring, providing a work coach or modifying equipment and processes could assist that individual. The environment should also be considered,

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TIP – A pa of all disc around ad ments sh kept, espe where the rejected s is ever ch lenged, th ployer can why the r was rejec

aper trail cussions djusthould be ecially ey are so if this halhe emn show request cted.

as often they can experience sensory

All adjustments must be considered on

overloads. Employers should think, can

an individual basis. What might be

they adjust the lighting, noise and

considered a reasonable adjustment for

heating in the workplace if not is there a

one person with a disability may not be

room where the individual can work? If

the same for someone else with the

not, how else could the workspace be

same disability, as they often manifest

adapted or could they work better from

differently. Employers are advised not

home?

to make assumptions on what they think

Reasonable adjustments could also include adjusting internal policies, for example, discounting absences related to a disability for absence management

or allowing an employee to be accompanied by a family member at a disciplinary or grievance hearing for support. Many companies are rigid in their policies and respond stating it cannot be done when they have a legal obligation to make reasonable adjustments.

The EHRC Code contains a nonexhaustive list of potential adjustments that employers might be required to

make.

Case Studies 1. An employee suffers from ADHD and anxiety. They start work without clear targets and criteria, as the Employer’s policy is to ‘set your targets’. Reasonable adjustments would have been to provide the employee with targets in writing and agree on these with them, due to

their disability.

will be a reasonable adjustment but to ask the individual and involved experts if they are not sure.

Recruitment The duty to make reasonable adjustments also applies to applicants during the recruitment process.

Candidates should be asked if they will require reasonable adjustments under the EqA to complete the interview process.

For example, many neurodiverse individuals often struggle with traditional interviews. Using tests and

tasks to complete from home or work trials can all be better ways to assess these candidates.

Other potential adjustments that could be made to a recruitment process, include providing interview questions in advance, offering more time during assessments, ensuring the environment takes account of sensory needs, or the use of assistive technology for an

interview.

2. An employee suffers from borderline personality disorder (BPD). They are particularly unwell and ask that all contact is made through their mental health team whilst they are on sick leave. Their manager calls the employee directly. The employee alleges a failure to make reasonable

Reasonableness Assessing the reasonableness of adjustments is fact sensitive. There is no duty to take measures that would impose a ‘disproportionate burden on the employer’.

adjustments.

ioh.org.uk

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Ultimately, the needs of the individual

and of the business must be balanced. If something is going to cost the business a lot of money (like installing an expensive lift as a ramp wouldn’t work on the stairway) then this can be a factor to consider but should not be the only determinative factor. Thought should be given to the extent to which the step would disrupt the employer’s activities,

Occupational Health Employers should not assume what could constitute a reasonable adjustment. They should ask the individual or involve their GP or an Occupational Health provider to obtain medical advice and then speak to an employment lawyer to help you determine this legal question.

as well as the resources available to the

Whilst an individual’s GP can provide

employer. Larger employers may be

advice in respect of their impairment,

expected to make adjustments that are

they are not always best placed to

not strictly speaking cost effective,

provide recommendations in respect of

given their resources. If the employer is

potential reasonable adjustments in the

going to refuse a request for reasonable

workplace. This is where Occupational

adjustments, then this must be

Health comes in, as work-place focussed

objectively justified.

advice in line with an individual’s

Practically speaking, even where it doesn’t seem that someone meets the definition of disability, if refusing a proposed adjustment due to the potential cost would mean losing a valued member of staff, then it may make business sense to invest to keep them.

impairment, can be provided. To get the most out of any Occupational Health service, employers need to ensure they ask relevant questions when they make the referral. It is also helpful to instruct an Occupational Health provider who

specialises in the individual’s impairment (especially in cases of a

Supportin assists in retaining and value employee helps to p issues wit term sick absence. beneficia individua the busin

mental, physical impairment and neurological conditions) so they can

Jodie Hill Mana

Crystal Boyde A

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ng staff

g skilled ed es and prevent th long kness This is al to the al and ness.

apply their knowledge and experience in the

assessment and subsequent report.

At Thrive Law we signpost our clients to Simply People.

Risk of failing to make reasonable adjustments If an employer unreasonably refuses to put adjustments in place for a disabled individual, they risk facing disability discrimination claims. The compensation in such claims is an ‘injury to feelings’ award, which is uncapped.

Also where a dismissal is seen to be discriminatory the individual may be able to claim loss of earnings too - meaning the sky’s the limit when it comes to compensation. This can therefore be extremely costly for the business, not to mention the reputational damage a discrimination claim going through the Tribunal can have.

There is also the risk of unfair dismissal claims (if a person is dismissed) or constructive unfair dismissal claims (if someone resigns as a direct

employment, and this could include

refusing to make a reasonable adjustment).

Practical Advice for Employers It is in everyone’s benefit to act pragmatically and preventatively when it comes to considering reasonable adjustments, and to address issues head on when they arise. If an employer becomes aware that an employee is

suffering from an impairment then consideration is required on whether they need adjustments, and what the employer, manager, or colleague, can do to support that individual with their physical or mental impairment.

Supporting staff assists in retaining skilled and valued employees and helps to prevent issues with long term sickness absence. This is beneficial to the individual and the business.

response to the Company fundamentally breaching their terms and conditions of

aging Partner Thrive Law

Associate Solicitor Thrive Law

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Voice care in the workplace

L

anguage is a defining feature of

element of speech. At rest, the time

what makes us human. This is

taken to breathe in and out is about

and is our predominant method

equal. However, during speech, our

of communicating ideas, thoughts, and

breathing pattern changes, we breathe

feelings. Speech is our main method of

in quickly and slowly release air in a

articulating language and is therefore

controlled manner utilizing the

essential to almost all job roles.

diaphragm and abdominal muscles. The

However, some roles such as teaching

pitch, speed and volume of speech

or call handling are more heavily

dictate how quickly we need to expel the

dependent on vocal communication

air. Longer sentences require larger

than others.

volumes of air. Respiratory conditions

“Approximately 1 in 40 people experience some form of long-term voice problem during their

that restrict airflow can therefore affect speech, as has been recently clearly demonstrated by COVID 19.

lives. However, incredibly, 30% of

Phonation (voicing): Exhaled air is

people suffer from some kind of

pushed up through the glottis, the gap

voice problem during their lifetime”

between the vocal cords (also known as

Source, The Larry Project

the vocal folds) making them vibrate at

How do we produce speech?

Respiration: Airflow is an essential 18

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speed. In turn, this causes the exhaled air to vibrate. The vocal cords are membranes stretched across the larynx which, when we are silent, are relaxed

Written by Stephanie Foster RGN, BSc OH, PGC OH

and open allowing air in and out the

voice problems developing.

lungs unobstructed. Vocal cord disorders

(https://iosh.com/media/1477/

are often caused by vocal abuse or

iosh-working-voices-full-report

misuse, disease or surgery. Symptoms

-2011.pdf)

may include a raspy, hoarse, low, or

•

For those who find apps helpful,

breathy voice, or trouble swallowing or

the “One Minute Voice

coughing. Ageing also causes changes in

WarmUp” has been developed

both the vocal cords and the muscles

with speech and language

that control them, affecting the quality

specialist input to teach

of the voice. Some medication can also

techniques to reduce the risk of

have an impact e.g. Ramipril can induce

vocal damage.

a persistent cough and inhaled steroids, such as those used in the treatment of

•

Whispering. Rather than saving the voice, it puts additional stress

asthma, can cause hoarseness, although

on the vocal cords. If you are

using a spacer device can help reduce

unable to manage anything more

the risk of this.

than a whisper, it is advised to not talk on the phone or via online

Resonance: The vibrating exhaled air is

platforms for prolonged periods.

amplified and modified by the cavities of the throat, mouth and nasal passages. It

It is suggested to limit this to 5

is the nature of these cavities which

minutes at a time as we tend to talk louder and more forcefully

create an individual’s recognisable voice.

when using these methods of

Articulation: Is the process of

communication. Text or email

manipulating the sound using our

communication could be utilized

tongue, teeth and lips to produce words.

as an alternative.

•

Mindful. Consider the pitch of

Self-care and adjustments

your voice, we tend to talk louder

•

techniques to release muscle

and at a higher pitch when we are stressed and emotional. Using

Warm-up. You would not run a

tension can be helpful. Highlight

marathon without first doing

with management any workplace

stretches. This could include neck

issues as they arise, as support can

and shoulder rolls as well as

only be offered if they are aware

articulation exercises (chewing an imaginary marshmallow, lip trills, tongue twisters). County Durham

Approximately 1 in 40 people experience some form of long-term voice problem during their lives.

there is an issue.

•

Avoid dehydration- keep a water

& Darlington NHS Speech and

bottle with you and keep sipping.

Language Therapy have produced

Caffeinated drinks and medicated

a useful warm-up video. (https://

lozenges should be avoided as

www.youtube.com/watch?

these dehydrate the vocal cords.

v=GaidlbNxDYc)

Antihistamines can also have a drying effect on the vocal cords.

•

Train the voice. IOSH has

•

Remember to breathe. Fill the

identified that vocal training in

lungs. Long words and sentences

the workplace can significantly

take more air. Try breaking long

reduce the risk of physiological

speeches down into smaller ioh.org.uk

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sentences. Posture can assist with

talk louder, which when

breath control so ensuring an

prolonged can cause

ergonomic DSE set up for those

inflammation of the vocal cords.

working via phone/ digital

•

•

Alternatives to raising your

platforms is important.

voice. There is a whole range of

Try to avoid coughing.

technological solutions to amplify

Coughing slams the vocal cords

the voice from sound systems to

together at 300 miles an hour

portable voice amplifiers. The

which can cause injury and

Larry Project has a web page

inflammation, instead try

dedicated to providing some

swallowing or taking a sip of

examples, however, if the issue is

water. Sucking sweets or chewing

long term then a referral to

gum also encourages saliva

Access to Work may be

production that lubricates the

appropriate.

throat and reduces the need to clear the throat.

•

Give your voice a rest. If your role requires prolonged periods of talking, build in periods of silence into your day. Teachers may wish to consider rotating teaching methods regularly warm-up, increasing the use of videos, handouts or self-guided activities

to help facilitate this. Regular 510 minutes breaks may be more helpful than prolonged rest after a long period of talking.

•

Quit smoking or vaping. The inhaled particles cause irritation and inflammation.

•

Acid reflux. Stomach acid can irritate the vocal cords resulting in a persistent cough and vocal issues. It may therefore be

appropriate to suggest a GP review if this is suspected.

•

Useful resources The Larry Project – Support and advocacy for individuals with vocal issues The British Voice Association – provide a good range of health promotion leaflets regarding the

“working” Voice

Asking for silence – A “getting attention” routine As a child I attended the brownies.

When Brown Owl wanted us to be quiet, she would hold up her hand and as each child noticed her action, they too would put their hand in the air and be quiet.

The silence quickly spread amongst the group, without the need to raise a voice.

Behaviour management strategies to

Reduce background noise

limit the need for raising voice may be

levels. Trying to compete with

helpful for teachers.

loud ambient noise causes us to

Stephanie is an Occupational Health Advisor with the PAM Group

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ioh.org.uk

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C

ommunication is a process that should be simple, easy to adhere to, easy to follow, and be effective. However, this is not always the case. We use communication in Occupational Health (OH) to help exchange information, thoughts, and feelings between individuals through a common system of signs, symbols, behaviours, and words.

Effective Communication in Healthcare Written by Hardev Singh Agimal

Often, in the therapeutic elements of OH, such as Physiotherapy and Psychotherapy, we have the verbal communication of OH staff on one side, and the employee and their managers, or translators on the other.

We communicate in so many different ways, and these are typically split into two subsections: Verbal Communication: this involves the use of spoken and/or sign language to transfer information. It is often thought of as the most common type of communication, the most important and most efficient. This is particularly prominent now, as many of us in OH are operating remotely and undertaking telephone appointments, therefore, we are relying heavily on verbal communication2, 9.

Non-Verbal Communication: includes factors such as; body language, gestures, and facial expressions to convey information to others. This can be both intentional and unintentional. Despite non-verbal communication making up the majority of our communication, we cannot rely on this when we are operating remotely4.

If we use “closed” body language in OH such as crossed arms or legs, hunched shoulders, or sitting behind a computer screen, it immediately creates barriers.

Even whilst working remotely in OH, this is something we need to be aware of.

When undertaking video appointments, 22

OH TODAY

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we need to maintain eye contact and avoid sitting with our arms crossed or placing objects – such as books or papers – between us and the screen. The employee should feel they have our full attention and failing to give them our full attention is likely to result in poor communication, which is contrary to the codes of conduct set out by various healthcare bodies. This can make the employee feel anxious, angry, or nervous10.

It is our job as esteemed healthcare professionals to break these barriers down; not create them. How many times have we heard someone say something akin to: “I saw this particular healthcare professional and they just stared at their screen the whole time, they didn’t even look at me when I entered the room”. This situation could easily be avoided with simple, effective, and purposeful communication to show someone that we care, and that we are invested in their wellbeing and health.

Between 70-80% of communication is

Effective communication is therefore vitally important to all aspects of OH, as we often communicate with the client, employee and managers

non-verbal. In the current pandemic, many of us are undertaking remote, telephone appointments so we no longer have that non-verbal communication to rely on. We need to be even more aware of our verbal communication, and its importance and quality4.

they are feeling, we then show that we value that person and their feelings and needs. Ultimately, we should be doing this in OH to make sure that the employee is at the centre of the care we are providing4,10.

When people enter the OH system, they may feel anxious because there is a lot of uncertainty: what treatment will I have? Who will I see? What if it doesn’t work? What does this mean for my job? I have been sent to OH, does this mean they trying to sack me? These are all common concerns and worries for someone coming to OH, particularly for the first time. It is so easy for employees to feel like they are losing control, this can make them feel anxious, lost, hopeless and helpless; not only will this negatively impact their chances of recovery but it may also cause them to act out of character. If we can ensure we are communicating effectively, these feelings and negative outcomes can be avoided and we can empower individuals to regain control of their health and their lives1.

•

Active listening

•

Avoid using filler words such as “um”, “like”, “so”, or “yeah”

•

Be intentional, and make a genuine effect to display positive and open body language

•

Keep written communication simple, concise, remember not to rely on tone

•

Review your written communication to ensure it is up to your professional and organisational standards

•

Use visual aids when needed1.

Effective communication is therefore vitally important to all aspects of OH, as we often communicate with the client, employee and managers. Additionally, it can reduce the rate of re-referrals and, therefore, the cost for clients1. Another benefit is that effective communication can significantly help to reduce anxiety and worry regarding any medical jargon and conditions4. This can be done in our written communication in any reports, as this presents us with an opportunity to explain the employee’s situation and/ or condition. It can also be achieved by taking the time to explain these medical terms to the employee in a way they can understand. Our time is the most precious thing we can give to another person. When we show that we are prepared to listen to them, get to know them, and understand how

There is a simple set of 3 that we all use, that we could implement more, The Three E’s:

How Do We Do This?

Our time is the most precious thing we can give to another person.

What Else Can We Do?

Empowerment: we should give our service users within OH the authority and/or power to take control of their health and recovery. This can help them become stronger, and more confident, especially in controlling one’s life and claiming one’s right7.

Engagement: we should be present; we should be “in” the moment. This helps to build a rapport with our service users.

Taking an interest in them – ultimately resulting in better outcomes1.

Empathy: we should take the time to understand the feelings of those we are working with and helping. Empathy is ioh.org.uk

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important in helping to support the employees in managing their health and returning to and/or being supported in the workplace12.

Written Communication

The Take-Home Message

& Documentation The importance of written communication and documentation, particularly in OH, is well known11. Early in our careers, we are told of the importance of doing this, how to do it and we even get scored on it during placements we are audited in the workplace. However, as we get more comfortable in our practice we do not tend to document as thoroughly. This is usual for all clinicians, particularly those who have been working for several years3. We need to ensure we are using clear, concise, and accurate record keeping. This allows for good continuity of care8. Some of us may have had experiences where we have taken caseloads from our colleagues and not been able to follow their notes and record-keeping. This can mean having to repeat assessments, which do not offer the best continuity of care or value and increases the OH costs for the client.

Additionally, if we can offer better continuity of care with the same clinicians, or between colleagues – including the wider multi-disciplinary team – then it can help support and aid in the recovery and management of conditions. Less time would be spent ‘repeating’ our assessments.

Furthermore, clinical notes, particularly in OH, may be required in legal cases.

Therefore, any notes need to meet the professional regulations as, if they do not and the notes are needed in legal proceedings, this may have consequences for the clinicians.

24

OH TODAY

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Be clear

Be concis

Listen to what is being said, and not just listen to respond

Document everything you need to: it is for the good of everyone in OH

Show the e ployee that understan and that yo care

se

emyou nd ou

References 1.

2.

3.

4.

5.

6.

7.

Braun, S., Roeser, R., Mashburn, A., & Skinner, E. (2018) “Middle School Teachers’ Mindfulness, Occupational Health and Well-Being, and the Quality of Teacher-Student Interactions” Mindfulness 10(1) 245-255 Kourkouta, L., & Papathanasiou, I. (2014) “Communication in Nursing Practice” BMC Medical Education 26(1) pages 65-67 Ley, P. (1998) “The Use and Improvement of Written Communication in Mental Health Care and Promotion” Psychology, Health & Medicine (3)1 page 19-53 Marziniak, M., Brichetto, G., Feys, P., Meyding-Lamadé, U., Vernon, K., & Meuth, SG. (2018) “The Use of Digital and Remote Communication Technologies as a Tool for Multiple Sclerosis Management: Narrative Review” JMIR Rehabil Assist Technol 2018;5(1):e5 Mathioudakis, A., Rousalova, I., Gagnat, A., Saad, N., & Hardavella, G. (2016) “How to Keep Good Clinical Records” Breathe 12(4) pages 369-373 Merriam-Webster, 2020.

“Communication”. Accessed from: 07/07/2020.

Ocloo, J., & Matthews, R. (2016) “From Tokenism to Empowerment: Progressing Patient and Public In-

volvement in Healthcare Improvement” BMJ Quality & Safety 25(8) 1 -7 8. Penoyer, D., Cortelyou-Ward, K., Noblin, A., Bullard, T., Talbert, S., Wilson, R., Jason, R, Schaffhauser, B. & Briscoe, J. (2014) “Use of Electronic Health Record Documentation by Healthcare Workers in an Acute Care Hospital System” Journal of Healthcare Management 59 (2) pages 130-144 9. Ratna, H. (2019) “The Importance of Effective Communication in Healthcare Practice” Harvard Public Health Review 23(1) pages 1-10 10. Royal College of Nursing, 2017.

“Why communication is important”. Accessed from:: 07/07/2020.

11. Vermeir, P., Vandijck, D., Degroote, S., Peleman, R., Verhaeghe, R., Mortier, E., Hallaert, G., Van Daele, S., Buylaert, W. & Vogelaers, D. (2015) “Communication in Healthcare: A Narrative Review of the Literature and Practice Recommendations” International Journal of Clinical Practice (69)11 pages 1257-1267 12. Vogel, D., Meyer, M., & Harendza, S. (2018) “Verbal and Non-Verbal Communication Skills Including Empathy During History Taking of Undergraduate Medical Students”

Hardev Singh Agimal is a Physiotherapist, working for PAM Group

ioh.org.uk

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26

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How Does Investing in Your Team’s Mental Health Save You Money?

S

tress, anxiety and depression are

when it comes to workplace mental

thought to be responsible for

health and wellbeing:

Written by

Leaveism: Being unable to ‘switch off’ from work.

Danny Clarke, Simply People

Absenteeism: Being absent from work.

CMIOSH

almost half of the working days

lost in Britain due to health issues1.

With a sixth of workers experiencing a mental health problem at any one time, it’s no surprise why.

Though there has been a shift in recent years regarding the discussion of mental health in the workplace, there is still a long way to go before a period of true change occurs, including the benefits for employers who invest in their team’s mental health.

So, why does investing in your team’s mental health and wellbeing save you money?

It begins with absenteeism, presenteeism and leaveism.

In a digital age, now more than ever, it can be difficult to ‘switch off’ from work, alongside an increased pressure to show up regardless of your mental state.

Here’s what you have to contend with

Presenteeism: Putting aside mental

and physical ailments to attend work.

The combined annual cost to employers as a result of the factors above is £45bn, comprising of £7bn in absence costs, £27bn-£29bn in presenteeism costs, and £9bn in costs of staff turnover – not including the costs to employers as a result of reduced productivity, creativity and team dynamics2.

• Leaveism

As remote working and flexible working have become more popular during the pandemic, it’s become even harder to separate your work life and personal life.

Leaveism can occur when employees are given work that cannot be completed in working hours, or when they feel obligated to complete work whilst on leave or holiday. ioh.org.uk

OH TODAY

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1 in 4 employees reports feeling

if they make their mental

mentally exhausted due to

health issues formal3.

increased connectivity.

The biggest contributor? Emails.

Employees that are sent out of hours emails often feel obligated to not only respond but to also complete the work or tasks mentioned in the email.

• Absenteeism Though the number of workplace

absences has fallen in the last decade, days lost due to mental health have risen, with stress,

of those surveyed said they would feel comfortable talking to a line manager about mental health.

So how does focusing on employee mental health save money?

When investing in the mental health of your employees, you can expect a return on investment (ROI) of £5 for every £1 spent, according to Deloitte.

depression and anxiety being

However, this isn’t accounting for the

cited increasingly as reasons for

ROI on larger-scale initiatives that are

absence.

focused on preventative measures and

Many employees might not disclose their real reasoning

more in-depth support, which can have increased returns.

behind absence therefore these

Organisation-wide culture and

numbers may not be

awareness training have the biggest

representative. The rise in remote

impact, with an average 6:1 ROI,

working as an alternative to

including initiatives that have screening,

taking time off and absenteeism

personalised feedback, and referrals to

can be detrimental to the

occupational health.

workplace.

Cognitive Behavioural Therapy (CBT) sessions via email delivered by a

• Presenteeism Presenteeism has been on the rise in recent years, due to employees choosing to attend work despite poor mental health, meaning reduced productivity and burnout are imminent risks.

A large contributor to presenteeism is a fear of the stigma around mental health: •

1 in 10 employees who have disclosed a mental health problem were dismissed, demoted or disciplined.

•

1 in 4 employers said they fear negative consequences

28

It isn’t all negative, though – 44%

OH TODAY

Summer 2021

therapist had the lowest returns, at 3:1.

What does this tell us?

Organisation-wide, preventative initiatives are more successful and a better investment than reactive,

individual-focused ones.

Early-stage support is important, having one of the highest potential ROIs at 10.8:1 for a training-based intervention.

Even when employees rely more on awareness and culture change in the workplace (if other interventions seem too costly at the time), there is still an almost equal ROI, as a more accessible and cost-effective method to promote

genuine change.

The key takeaway?

because it can save money, increase

productivity, and foster genuine change in the culture of a workplace at a time

The most effective initiatives and

when change is so vital and necessary.

programmes are those that are truly

Encouraging a good work/life balance is only the beginning – providing great development opportunities for staff, inhouse counsellors, having easy access to occupational health providers, allowing flexible working hours, and encouraging employees to give feedback are all part of a well-rounded mental health and wellbeing culture at work.

If you’re struggling to find the right occupational health provider, let us help you find the support you need, whether by a service or by a practitioner – or even if you’re not sure what you’re looking for just yet.

embedded into the organisation over a longer period of time – not those used as a temporary, quick fix.

If you want to have the biggest impact on the ROI of mental health interventions for your team, factors that positively impact it are:

•

Universal training or training to targeted groups.

•

Utilising technology to increase uptake and reduce stigma.

•

Using adequate diagnostics and screening to target based on need.

It is in the interest of employers to

https://www2.deloitte.com/uk/ en/pages/consulting/articles/mentalhealth-and-employers-refreshing-the -case-for-investment.html 1, 2, 3

invest in their employee’s well being

Danny Clarke, Simply People

ioh.org.uk

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You’ll also have the op do an additional three placement of your cho

You will study alongside disciplines with module particular OH focus such

T

The University of Derby Experience

he University of Derby has been offering the Specialist Community Public Health (SCPHN) Occupational Health (OH) Course for the last 4 years. The course starts in September and can be taken over 1 or 2 years.

This intense but extremely rewarding course will take OH Students on a tremendously exciting journey to enhance practice and academic skills that will help focus the future workforce of Occupational Health practice.

The course is run at undergraduate and postgraduate levels. The undergraduate route is specifically designed for those that have a diploma in nursing, whilst the Master of Science (MSc) / Postgraduate Diploma (PgDip) route is for those that already have a degree in nursing. The undergraduate course is the same as the final year of a degree course. The cost depends on the level of study but is in the range of £6000 -£7250 currently.

On completion of the PGDip programme students can step off with the Part 3 registration or decide to complete the full Master’s by taking up a 60 Credit Independent Study or Systematic Literature Review. There are 5 years from qualifying to take up this offer.

Successful completion allows the registration onto Part 3 of the NMC Register.

30

OH TODAY

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There are currently around 3000 on the Occupational Health part of the Register.

The course will also allow you to: •

Build your understanding of OH clinical practice, wider public health and leadership and management

•

Develop specialist OH assessment, leadership and management skills

•

Develop and build on your existing OH knowledge to ensure that you meet the competencies set by the Nursing and Midwifery Council, and you’re eligible to gain a registrable qualification

•

Become part of the public health workforce working toward improving people's lives and their health outcomes.

Practice Assessment will encompass all the four domains of care, facilitation of learning, leadership and management, research and development.

By completing this programme you will be able to demonstrate a critical understanding of OH clinical practice, care and caseload management, OH clinical practice leadership and OH clinical practice development to enable you to become a proficient and skilled member of the OH workforce.

•

Evidence Based P

•

Leading for Quali

•

Principles of Prac

•

Public Health and Promotion.

•

Principles of Long Condition Manag

•

Ergonomics in Pra

How you will le

You’ll be taught in a var such as clinical practica discussions and lectures half of your time on pra so you’ll get hands-on e well as learning the theo

How you're ass

You will be assessed thr observations, assignmen presentation and a pract You will also be assessed placement by your pract

Who you will m

Neil Loach is the Occupa Pathway Lead and has in health protection, risk m sickness absence manag Clinical Supervision.

Suzanne Le Blond, a Hea the HV pathway leader, child development, educ vulnerable families. Suz undertaking her PhD.

Erica Lloyd is the Progra and School Nurse Pathw

pportunity to e-week oice.

e other es with a h as:

Project.

ity

ctice Assessment

d Health

g-Term gement

actice

research interests include sex education and parenting support of vulnerable families, Leadership and Quality Improvements.

Personal academic tutoring Your personal academic tutor will work with you to help you get the most out of your time at university. Having someone to talk to about your academic progress, your university experience and your professional aspirations is hugely valuable. We want you to feel challenged in your studies, stretched but confident to achieve your academic and professional goals.

Entry Requirements •

earn

sessed

•

Have at least one year post registration experience

•

The student who doesn’t already work in the field of OH will have successfully applied for a clinical secondment with a local employer after applying for this programme

alth Visitor and with interests in cation and zanne is currently

amme Leader way Lead. Her

1st University of the Year **UK Social Mobility Awards 2020

1st Social and Community Impact

120 credits at Diploma level or equivalent academic credits or Recognition of Prior Learning

ational Health nterests in management, gement and

**Global ISB Benchmark Group 2018

Have gained Occupational Health Nurse position from a seconding/sponsoring organisation

•

•

Top 10 in the world for international student learning experience

1st Higher Education Institution of the Year

•

meet

Top 10 Postgraduate Student Experience **Postgraduate Taught Experience Survey 2020

Hold a current nurse or midwife qualification and have a current registration with the Nursing and Midwifery Council

riety of ways, al sessions, group s. You’ll spend ctice placement, experience as ory at University.

rough exams, nts, a tice portfolio. d on your tice teacher.

We're rated Gold in the Teaching Excellence Framework (TEF)

An Enhanced Disclosure & Barring Service certificate is required. We will contact you with information on how to complete this once you have applied.

Why should you consider the University of Derby?

**2020 NEON Awards

**Guardian University Awards 2020

For more information: please contact Neil Loach on: n.loach@derby.ac.uk

YouTube Video: https://youtu.be/ tYsZXXoKKtk Applications MSc / PGDip: https:// www.derby.ac.uk/postgraduate/ nursing-health-care-practicecourses/specialist-community-publichealth-nursing-msc/

Applications BSc Honours: https:// www.derby.ac.uk/undergraduate/ nursing-courses/specialistcommunity-public-health-nursingbsc-hons/

We offer excellent teaching and student outcomes, and we give our international students a world-class experience. ioh.org.uk

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32

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iOH Welcomes a New Consulting Partnership

iOH is proud to announce a new partnership with GlobusHR Consultating Ltd. Sarah Hamilton-Gill FCIPD, is the creator of a programme aimed primarily at coaching HR professionals in launching their solo career. Sarah believes that principles apply equally to all people focused professions, and Occupational Health practitioners are among the 60+ successful graduates from the online business coaching programme The Virtual Bootcamp since its inception in March 2020.

Sarah is passionate about enabling those

she works with to make the transition from employee into the freedom and flexibility of running a successful business as an independent practitioner.

The intensive 6 and 12-week online programmes follow the tried-and-tested “5 Cs” – from Corporate to Consultant’

Collaboration – Working with business partners to create additional income sources (we introduce you to a hand-picked selection of our favourites); Courage Your Action Plan and the financial, technical and practical tools for the road

model, where the following are explored:

ahead.

Confidence -

The journey does not end with the

Identifying your strengths, and the practicalities of what you need to earn; Clarity – Your ideal customer, your niche and pricing; Credibility – Your online presence, brand, visibility

programme; there is a much-valued support community. The 110% Club is made up of like-minded practitioners who continue to work together to help each other. There is an ongoing curriculum of webinars, new guest speakers and learning material to support the individual with business growth and personal development.

and self-promotional tools; ioh.org.uk

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OH Practitioner, Anna Harrington joined one of Sarah’s Virtual Bootcamps in 2020 and proved to be one of her star students. Anna shares her experience with an interview with Sarah.

What drove you to join the bootcamp?

From a young age I dreamed about having my own business. I was keen to rely on oneself to deliver and make good decisions at the right time. It wasn’t ever about money for me; yes enough to be able to live the life I want, but seeking fortune has no interest for me at all. I am more motivated by enabling people to live happy healthy lives.

My childhood was very interesting, giving plenty of opportunities to develop characteristics, skills, and a mindset to navigate challenging situations and people. It also was a breeding ground for self-doubt. I wanted to address this.

What was your previous role?

I went into high dependency/intensive care nursing, transplant, head and neck reconstructive surgery after cancer and trauma. What a great place to learn about good decision making at the right time!

But NHS demands, shifts and ethics of healthcare got the better of me and I needed to look elsewhere for a career and yet use the skills and wisdom I had acquired from caring for people.

I worked for many of the large occupational health providers. I love people and hearing about their lives, what matters to them, and trying to 34

OH TODAY

Summer 2021

work with them to resolve issues.

It is a position of privilege. As a registered nurse the public automatically assigns a certain level of trust in you.

Health care professionals’ first motivation is about helping others. This can be a fault when running a business as I can see in myself and my peers that we tend to struggle to find the balance between giving and receiving. This is also evident in clinical care settings where the issue has a very significant impact on health professionals’ own health.

Why did you decide to move into consulting?

I tend to have very high standards that I want to be able to deliver. If this is challenged by a work context then I will be uncomfortable. This was one forceful driver for me seeking to be independent and move out of employment into my own business. Freedom for me is very attractive.

I dabbled about seven years ago in being self-employed. It worked well for balancing the family and I did get a lot of reward. But the foundation of fragile self -belief limited me and prevented me from taking it further at that stage.

What transferable skills did you identify would be useful in your new role?

My final employed role was as a clinical

lead. It gave me a secure foundation to test my ideas and decision making. I learned to develop leadership, and people management. It was a testing role. This was perfect as it gave me that opportunity to be scrutinised. I received frequent positive feedback. This galvanised the internal changes that were already occurring with regards to perception of self and confidence. It also gave me that clear path to start my own business delivering what I love, in the way that I love and standards that I set.

What went well during the transition?

That transition was quite easy. My confidence had grown and my voice was stronger; not louder, but more powerful.

What role did the Bootcamp play in your transition?

For me to flourish I need people, but the right people. That is why I did the Bootcamp. Sarah is careful to construct Bootcamp groups to create an environment of nurturing, encouragement and when things go wrong (which they will; you will make rotten decisions) a group to wrap you up and be there for you.

What are your top 5 tips for someone who is currently working in a full-time employed role and wants to move into being self-employed as you have?

Be kind to yourself. Treat and speak to yourself as you would your best friend. I know this is American but “be your own cheerleader”! Hug and forgive yourself when you make errors.

but try to do it when it can fit with your family and self. This may mean you have to wait. In the time period of waiting, gather information, learn from others and develop ideas.

Be a giver. You will be a taker as well but start and continue to look for ways to give to others.

Know your strengths. Too often we embed ourselves in what we perceive to be our weaknesses. Stop it right now; switch it round and recognise what is great about you. I find using the VIA of character strengths from Professor Martin Seligman is very useful to clearly identify your powers.

Enjoy it and if you are not enjoying it then change it. Why on earth would you stick with something that results in the balance between demand and reward being off kilter?

What have you enjoyed most about the Bootcamp?

I love freedom. The feedback and the response that I’ve been given from being in the group has been a substantial part of building that self-belief and confidence; I find that it’s them pushing me. Sometimes they tell me off, but this is valuable too – sometimes you need that!

You can’t just be a one-person band and be successful. That’s not a scenario that exists. It’s all about association, collaboration, relationships; and a huge part of that is what you are giving back to the group; listening to what others need and thinking about how you can help them.

The time to do it will never be perfect ioh.org.uk

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When you’re having a day when things are perhaps a little bit wobbly, how do you bounce back?

I contextualise it. Recognise that this is only one moment in time. Take that step back, go outside, do the self-care stuff that you know you should do; get your exercise, have a laugh with somebody, come back into it with a fresh pair of eyes.

Talk to somebody else. Get resources.

Get involved. Get a different perspective on it.

The first dedicated OH Bootcamp is in Autumn 2021; to find out more and register your interest see the web page

You can also read more about how to

What are your plans going forward?

I have created an online resource for Long Covid. There is a real need to train the people who are responsible for employee health and wellbeing – the line managers, and HR. What they can do to assist people who are returning back into work with the condition; this is something that I have started to deliver via a programme of Zoom webinars.

What would be your Top Tip for somebody considering doing the Bootcamp?

Get your wellies on, get in that mud and get stuck in, have a laugh, and play around stomping with your muddy boots on! By that I mean, get in there, and get totally and utterly involved in all of it.

The first dedicated Health Practitioners’ Bootcamp is in Autumn 2021; to find out more and register your interest see the web page

You can also read more about how to follow the From Corporate to Consulting 5Cs model in the Leap into HR Consulting book, available here in paperback or Kindle edition. When you purchase the book you will also receive a login for online access to a wealth of constantly-updated downloadable workbook material.

Meanwhile iOH members are invited to join the ongoing programme of free webinars We look forward to working with you!

Sarah Hamilton-Gill FCIPD Managing Director GlobusHR Consulting Ltd 36

OH TODAY

Summer 2021

W

orking with

touch is of most importance (NICE

Cancer states that there

guidance), but it is equally important to

are approximately 900,000

keep checking in on those that remain in

people of working age living with cancer in the UK, a number, which is expected

By Janet O'Neill

to increase to 1,150,00 by 2030 with

Clinical Nurse Director PAM

Healthyworkinglives stating an extra 130 000 people are likely to want to return to work by then.

Work can be really important for those who have cancer as it can restore a

Director iOH RGN, dip OH, MSc

work (HealthyWorkinglives). Feeling isolated from the workplace or feeling unsupported can lead to difficulty in returning to work or remaining in work (DWP 2013).

Support with cancer needs to be truly person-centred as every cancer and

sense of normality and help with

treatment is individual and affects

financial wellbeing. However, the

people differently. The starting place is

symptoms and effects of cancer and

for managers to chat with the employee,

treatment can have a impact on the

which may be difficult for both parties.

workability of individuals. Employers

However, a manager's confidence can be

can do a lot to support individuals who

built by undertaking the Cancer and

are going through this, whether

Work eLearning from Macmillan, as this

remaining at work or becoming absent.

enables the manager to become better

For those becoming absent, keeping in

informed. Occupational Health can also ioh.org.uk

OH TODAY

37

be a support mechanism for those at

work or absent due to cancer and a far more in-depth, 3 hour, e-learning module for health professionals, is also available, to support the knowledge they already have.

Having an employee who develops cancer is a strong possibility in any workplace and therefore a really useful

Some symptoms and issues which need to be explored and taken into account when considering adjustments: •

Fears over the uncertainties surrounding the future even after successful treatment

Policy to include, for example: •

•

Mood reduction and/or anxiety

•

Concerns over how others might react either due to unfamiliarity with cancer or because they might

Risk assessing the role and

need to undertake more of the

environment •

workload

Respect for the employee’s dignity and privacy

•

work with a diagnosis Ensuring the employee suffers no financial detriment •

Continuing to provide employment benefits

Worry over which of their colleagues should be informed

Maintaining employee involvement and engagement in

•

•

and when?

•

Time off to accommodate

consultations and treatment •

Being more prone to infection as a side effect of cancer treatment

•

Extreme fatigue may last months or years or fluctuating fatigue

•

Adopting a flexible approach

•

Continuing to provide access to

may include feeling sick, sore

development opportunities

mouth, hair loss, diarrhoea or

Providing the employee with

constipation and numbness in the

•

•

hands

information and support

•

Supporting the team affected by the employee’s situation.

Other side effects of treatment

•

Trauma symptoms

•

Possible changes in eating or toilet habits following surgery or with medication to take into

Every experience is different and depends on the type of cancer, the type of treatment, other health issues the individual may have, the support they have at home, their coping strategies and their health beliefs.

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Summer 2021

consideration •

The rapid development of menopause symptoms in some circumstances, depending on the cancer type and treatment including surgery.

Examples of reasonable adjustments: •

More flexible hours to avoid travel to and from work at busy times

•

•

•

•

model of assessment that is undertaken,

hazardous substances or

encompassing all these factors and

infections)

more. As per NICE guidance,

Time to attend appointments

psychological health for any long-term health condition, especially cancer, must be considered and this should be

Asking colleagues to be

part of any good OH assessment with

supportive and to help with some

clinicians usually using validated

of the workload

assessment tools such as the brief PHQ4

Allowing short breaks to rest or

unless symptoms indicate the more in-

Allocating a parking space near to

depth PHQ9 & GAD7 is required.

Another validated assessment tool that can be really useful is the Fatigue Assessment Scale (FAS) as fatigue is a

Allowing work to be done from

common symptom caused by cancer

home if feasible

treatment. OH, should also be able to

Finding lighter work if the job

assess what signposting may be useful depending on the concerns the individual may have.

Respecting any wishes for privacy and confidentiality Arranging for a colleague to be a work ‘buddy’ responsible for keeping an employee up to date with key developments during any temporary or extended absences

for treatment •

Occupational Health is a great resource

reduced immunity (such as

heavy lifting

•

diagnosed.

adjustments due to the biopsychosocial

involves physical exertion and/or •

proceed when an individual is

associated with their treatment or

the building entrance •

framework for managers on how to

for managers when ascertaining

lie down •

support policy. This should provide a

Redeploying from any risks

and/or treatment sessions •

tool for employers to have is a cancer

Scheduling regular consultations with the line manager to discuss work issues

Making any reasonable adjustments to premises, equipment, travel arrangements and provision of support workers in line with the Equality Act (2010) must be considered, as cancer is an automatic

disability.

Sometimes it may not be clear that an employee has cancer related to the Equality Act. In the case of Lofty vs Hamis, the employee had a precancerous skin condition that initially was not deemed a disability, a decision that was overturned by the Employment Appeal Tribunal. This makes it even more important for employers to seek advice and to ioh.org.uk

OH TODAY

39

consider adjustments even if they are

increases the risk quite considerably due

not sure, as mentioned in Thrive’s

to a reduced immunity level and

article on Reasonable Adjustments in

therefore any return into the workplace

this publication.

does not only need to take into account the individual’s symptoms and function

The role of Occupational health is not only to tailor advice for the individual on adjustments but also to signpost to resources.

but also their COVID 19 risk. The Society of Occupational Medicine (SOM) has published a good general guide on factors to take into consideration, however most OH professionals will be

Although most individuals should be

able to match their advice to the role

able to receive psychological support via

and tasks required of the individual.

their oncology department, signposting to the Employee Assistance Program (EAP) for benefits advice and psychological support could be helpful but also wellbeing services for nutrition and lifestyle advice, local cancer support centres or Maggies.org a support service for those with cancer and

Links: Macmillan NICE psychological support for cancer

perhaps Access to Work depending on

Working with cancer

the person’s needs. It is possible that

DWP telephone assessment 2013

individuals may need longer-term management of their health and a WAP (Wellness Action Plan) may be appropriate for them to discuss and agree with their employer. Although

NICE long term sickness absence

Equality Act 2010 Society of Occupational Medicine

designed for mental health this could be

Healthy Working Lives Cancer

useful for any chronic health condition.

MIND WAP

A reduction in resilience to usual workplace stressors is also a possibility and therefore managers may wish to use

HSE stress risk assessment Society of Occupational Medicine

the HSE stress risk assessment (SRA) or their organisations SRA to help the individual feel supported but also to

pick up any issues quickly.

Another supporting role OH can play is in the individual risk assessment for COVID 19. Individuals who have been diagnosed with cancer are considered at a higher risk of severe ill-health with COVID. OH, generally use the ALAMA tool to calculate the individual's COVID age, which takes into account several risk factors to calculate the overall risk.

Diagnosis of cancer in the last year 40

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Summer 2021

Janet O'Neill Clinical Nurse Director PAM Director iOH

ioh.org.uk

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Ioh.org.uk OH TODAY 42