OH Today Volume 31 Issue 3 - 2024

The Rising Tide of Knee Osteoarthritis in the Workforce

Partners of OH Today

From the President

Lynn Pratt

Lately, the OH news has outlined many of the challenges facing our OH professions. One which caused deep worry for the iOH nurse members is the results of the Independent Culture Review concerning the Nursing and Midwifery Council (NMC), our regulatory body for nurses and midwives. As specialists in Occupational Health, it is difficult to stay silent when our primary responsibility is to ensure the wellbeing of employees within their workplaces. iOH has written to the NMC to share your concerns, seek additional clarity on the subsequent steps, and offer their expertise as specialists in workplace health and wellbeing. Since then, the NMC has released their forthcoming plans for change, and you will find more details inside the journal.

Another major challenge is how as OH professionals we work to improve the health of our UK workers with the health of the working-age population being reported to be worsening, with over 2.5 million people now economically inactive due to long-term illness. This is an increase of more than 400,000 since the start of the COVID-19 pandemic. The high rate of mental illness among younger workers threatens their lifelong employment, health outcomes, and overall quality of life. This is reducing the labour market, slowing economic growth, and increasing inequalities. This deterioration of the health of the workforce is a significant long-term

challenge for the new government. In the past ten years, the welfare of working-age individuals has significantly burdened the NHS, public services, and the welfare system, with these challenges anticipated to intensify especially with long wait lists for NHS treatment.

Following the General Election, the new Labour government has reaffirmed its commitment to enacting a wide array of employment laws that will affect occupational health and safety within its first 100 days in office. We will await their plans.

Whatever lies ahead, iOH is here to support our multi-disciplinary team members with CPD, networking, and support. Together, we can create safer, healthier, and happier workplaces.

Lynn Pratt, President iOH

The Rising Tide of Knee Osteoarthritis in the

Workforce

By Dr Sara Aspinall

Knee osteoarthritis (OA) is becoming increasingly prevalent among the working-age population. The number of total knee replacements (TKRs) performed on individuals under 68 years old has risen significantly, with a 188% increase observed between 2000 and 2015 (AAOS, 2014). This trend is attributed to rising obesity rates, sedentary lifestyles, an ageing workforce, and increased physical demands in certain occupations.

The Impact of Early TKR

While TKR can be an effective treatment for severe knee OA, it presents unique challenges for younger patients:

1. Approximately 20% of TKR patients report dissatisfaction with the outcome, with younger patients more likely to experience ongoing pain and stiffness (Bourne et al., 2010).

2. The average lifespan of a knee implant is about 15-20 years, potentially less for those in physically demanding jobs (Kurtz et al., 2007).

3. Research indicates that TKR performed under age 55 often leads to poorer satisfaction and outcomes (Parvizi et al., 2014).

These factors underscore the importance of delaying surgery when possible and exploring alternative management strategies.

Preventive Strategies and Early Intervention

Occupational health professionals play a crucial role in helping employees manage knee OA and potentially delay the need for surgery. Here are some key areas to focus on:

The Value of Prehabilitation

Prehabilitation, or "prehab," has gained recognition for its potential to improve

Every pound of weight gained results in an additional four pounds of pressure on the knees

outcomes both before and after surgery. Implementing strength training, flexibility exercises, and cardiovascular conditioning can help patients better prepare for surgery or potentially delay its necessity.

Weight Management and Exercise

Excess weight puts additional stress on knee joints. Every pound of weight gained results in an additional four pounds of pressure on the knees . Encouraging weight loss through diet and exercise can significantly reduce knee pain and slow OA progression. For patients who find weight-bearing exercises painful, recommend low-impact alternatives such as:

• Stationary cycling

• Aqua jogging

• Swimming

Pain and Inflammation Management

Effective pain control is crucial for maintaining mobility and function. Advise patients to:

1. Take prescribed pain medication as directed, maintaining a regular schedule rather than waiting for pain to become severe.

2. Use ice therapy regularly, especially if unable to take anti-inflammatory medications.

3. Consider topical anti-inflammatory gels as an alternative to oral medications.

Maintaining Knee Extension

Loss of knee extension (straightening ability) can lead to gait abnormalities and muscle imbalances. Even a small extension deficit of 3° to 5° can affect walking patterns, leading to:

• Increased quadriceps activation

• Calf muscle tightness

• Altered patellofemoral mechanics

• Reduced gluteal muscle activity

Research indicates that limited knee extension during gait can cause abnormal joint loading and increased strain on the patella tendon, which in turn affects the overall gait pattern and muscle function (Shelbourne and Gray, 1997).Early identification and treatment of extension deficits are crucial. Recommend exercises such as hamstring stretches, calf stretches, and quadriceps exercises.

Key Tips for Patients

1. Education: Provide information on weight loss, diet, and appropriate cardiovascular exercises.

2. Pain Control: Encourage regular use of prescribed pain relief as directed.

3. Inflammation Management: Emphasise the importance of ice therapy.

4. Maintain Knee Extension: Teach patients to recognise and address early signs of extension loss.

5. Low-Impact Exercise: Recommend non-weight-bearing exercises like stationary cycling or swimming.

Dr Sara's Top Tips for Managing Knee Osteoarthritis

1. Minimise Inflammation

• Modify activity where possible

• Educate about the importance of pain killers/anti-inflammatories; unpick negative beliefs

• Don't underestimate the power of ice - encourage icing at work during breaks

2. Daily Routine

• Calf stretch

• Seated hamstring stretch

• Knee extensions while sitting in a chair to end of range extension

• Gluteal and core activation bridge

• Educate about

Calf stretch Seated hamstring stretch Knee extensions while sitting in a chair to end of range extension

Gluteal and core activation bridge

3. Weight Management

the power of weight loss in reducing knee stress and pain

1. Arthritis Foundation. "Osteoarthritis of the Knee." Available at: Arthritis Foundation

2. AAOS (2014). American Academy of Orthopaedic Surgeons Annual Meeting Proceedings.

3. Bourne, R. B., et al. (2010). "Patient satisfaction after total knee arthroplasty: Who is satisfied and who is not?" Clinical Orthopaedics and Related Research, 468(1), 57-63.

4. Kurtz, S. M., et al. (2007). "Future clinical impact of revision total knee arthroplasty in the United States: a population-based projection." The Journal of Bone and Joint Surgery, 89(3), 1-8.

5. Parvizi, J., et al. (2014). "High level of residual symptoms in young patients after total knee arthroplasty." Clinical Orthopaedics and Related Research, 472(1), 133-137.

6. Shelbourne, K. D., & Gray, T. (1997). "Minimum 10-year results after anterior cruciate ligament reconstruction: How the loss of normal knee motion compounds other factors related to the development of osteoarthritis after surgery." The American Journal of Sports Medicine, 25(5), 591-595.

Dr Sara Aspinall is a leading physiotherapy and orthopaedics expert with over 18 years of experience. She is the only physiotherapist globally with a PhD in arthrofibrosis (knee stiffness and pain), combining scientific expertise with a dedication to patient care.

Dr Aspinall created the STAK tool to allow patients to gain and maintain therapy progress at home. The STAK tool helps break down scar tissue, enhances strength, neuromuscular control, and improves range of motion and quality of life.

Dr Sara Aspinall, PhD, MSc, BSc (Hons), MCSP Founder & Physiotherapist, STAK Orthopaedics

Website : https://stakkneestretcher.com/

NMC Independent Culture review

July 2024

The iOH board was very distressed to read the findings from the Independent Culture Review relating to the NMC, our registering body for nurses and midwives. As Occupational Health professionals it’s hard to stay quiet when the core of our speciality includes keeping employees well in the workplace.

Findings from the Review highlight a lack of diversity within panel experts, racism, disability discrimination, bullying and an abundance of micro-aggressions. Currently the NMC is trying to get through a huge backlog of Fitness to Practise cases, which is close to 6,000. Some registrants have been waiting up to five years for a decision and sadly, there have been six suicides during the last year “of registrants who are going through the Fitness to Practise process”.

It is strange that the Professional Standards Authority (PSA) who’s role is to “check on how well the regulators have been protecting the public and promoting confidence in health and care professionals and themselves”, in their 2022-2023 “short” performance review gives little to indicate what the Rise Culture Review has uncovered.

In brief the Review, published in July 2024, was commissioned by the NMC after a whistleblower in 2023, claimed a “deep seated toxic culture” was leading to skewed and failed investigations. In 2008, 2012, 2013, 2016 and 2018 several investigations highlighted “serious concerns” about the NMC including “weakness in governance, leadership, decision making and operational management”, and a culture that “failed to act with an appropriate

level of care and compassion”. Also, in 2018 the PSA published a ‘Learned Lessons Review’ into handling of concerns relating to the fitness to practice regarding the NMC’s handling of documentation relating to midwives at Furness General Hospital. They found “further cultural failings and concluded that the NMC had adopted a “defensive approach”, communicated without empathy and made puerile and derogatory comments about the public”. Additionally in 2020 more failings came to light that included staff often not raising concerns because they were fearful of repercussions and apathetic about things ever changing. Rise Associates, led by Nazir Afzal OBE, who completed this latest 2024 review, state that the repeated promise from the NMC to learn lessons is hard to believe as being a genuine commitment.

With 85% of staff responding through a staff survey and 65% of panel members via a separate survey, Rise Associates state that they “believe this is one of the most thorough investigations into the culture of a UK health regulator and the high levels of engagement reflect a sense of emergency among staff to restore a clear sense of purpose and push through reforms that are long overdue”.

The following quotes are a selection from current and past employees, key stakeholders such as trade unions, staff networks and chief nursing and midwifery officers; they paint a deeply distressing picture:

“The NMC are leaving people in limbo and because there are too few clinical voices in the process, they often don’t understand what they are investigating”.

NMC Independent Culture review

There’s a “…low trust environment characterised by suspicion, fear, blame, resistance and silos it is personally and professionally upsetting to be part of a leadership team which is allowing its poor behaviours and differences in view to open up old divides, destabilise the organisation and distract from its core focus of protecting the public”.

“I know the NMC needs to be an independent professional body but it’s too adversarial and disrespectful towards nurses and midwives. There is no compassion and it’s affecting their health. They have been off sick, and people are taking their lives because they just can’t cope with it.”

“We handled a fitness to practise case really terribly and children were harmed because we didn’t intervene and I said to senior people afterwards, ‘do we apologise?’,” …It was like tumbleweed. How are we ever going to learn if we don’t open our minds? We are asking health professionals to be honest and have a duty of candour, but we don’t do this.”

“I am ashamed to say I work for the NMC…I had to leave because I couldn’t take it anymore but to this day, I still feel sorry for members of staff that I couldn’t protect”.

“The gap between what our leaders say and do is worrying. For example, saying that equality is important, but then not acting on research findings for registrants and colleagues, instead prioritising numerical targets such as getting the FTP [fitness to practise] caseload down. It’s also difficult to see the lack of diversity at senior levels. There is a lack of transparency. Policies are implemented inconsistently. Kneejerk reactions to things happening,

rather than strategic, long term work tackling issues.”

“The culture in my Directorate is extremely toxic - my previous manager was forced out of her job due to the bullying, harassment and racism. It set the standard of behaviour for the team; namely do not raise concerns, do not raise issues and if you don’t like it leave, hence the fact that seven people have been recruited and subsequently left during the last two years. The team is massively under resourced and there are so many incidents of unfair treatment.” “Some hiring managers find it difficult to trust someone who doesn’t look or think like them. There is an overriding perception that certain people, particularly from black and ethnic minority groups are just not good enough for certain positions, so I have found it difficult to get the exposure to be seen to belong in certain spaces”.

“The thrive app is not a meaningful intervention and is just a legal tick box. It is widely joked about that if you died tomorrow the NMC would replace you and forget you as they have done with previous staff who suffered suicide/ mental health issues. The NMC only cares about the output you can offer them in your work”.

“…the micromanagement and lack of time to complete a case is not considered and the registrants get a poor deal”.

These comments, especially when considered alongside the four core values of the NMC (fairness, kindness, ambition and collaboration), make hard reading. As already mentioned, the report also states that “since April 2023, six people have died by suicide or suspected suicide while under, or having

concluded, fitness to practise investigation”.

Chair of the Council, Sir David Warren, in response to the review stated that

“The NMC commissioned Nazir Afzal and Rise Associates to do this review because we knew they would not hold back. We now have clear recommendations to take the organisation forward. I’m grateful to all our colleagues who have spoken up about these issues. I know that what matters to them now is action, not words.”

The NMC have fully accepted the review findings and are now taking steps including the following commitments:

• We will appoint an equality, diversity and inclusion (EDI) advisor to the Executive Board to support decision making.

• We will work to increase the diversity of the Executive Board.

• The Freedom to Speak Up Guardian is now available to colleagues to raise concerns and get independent support from a trained professional.

• Listening circles facilitated by trained professionals are now available for all colleagues to enable them to openly discuss and decompress about issues raised in the report.

• We’ve invested in a partner to improve psychological safety in teams, starting in our Professional Regulation directorate which includes fitness to practise, and registration and revalidation.

• We are extending the offer of decompression support to any colleagues working on sensitive casework. This involves professional counselling from a trained psychologist. We are doubling the amount we spend on learning and development. By October, this investment should enable us to start rolling out improvements in leadership and line management, safeguarding, casework and tackling some of the behaviours in

the report such as microaggressions.

•An external equality, diversity and inclusion (EDI) partner is undertaking a review of our EDI learning and making further recommendations to improve our mandatory training.

We are actively working on a new behavioural framework to support recruitment, development, career progression and performance management, for launch in September.

In addition, in March 2024 the Council agreed a £30m investment in an 18-month plan to make a step change in fitness to practise, with a clear goal to reach decisions in a more timely and considerate way.

In a letter from Nazir Afzal to Sir David Warren, NMC Chair of Council, he writes

“Many of these voices felt they had not been heard within the NMC before and I know this will come as a great disappointment to you. Their testimony came from a place of deep frustration and anguish, and they want to be part of the changes that we recommend and help create a better working environment for all. It is because of this that we are hopeful that our review can act as a turning point for the NMC. We do not underestimate the challenges ahead, but we are confident that the NMC can become the regulator that nurses, midwives and the wider public all want to see”.

iOH have written to the NMC to express their concerns, request further reassurance on what their next steps are and to offer support as specialists in workplace health and wellbeing. This letter can be found in the members area via this link

Since writing this article the NMC has published their next steps towards change; details can be found at NMC sets out next steps toward changeThe Nursing and Midwifery Council

Libby Morley-Hassanali

MSK Red flags: Cauda Equina

By Ali Wilmore

The HSE reported that for 2022/2023, 27% of work-related ill health cases were musculoskeletal disorders (1). These issues led to an estimated 6.6 million working days lost, with 41% of these involving back disorders (2). Many of us have experienced back pain ourselves and we will frequently see patients with this issue. Most back pain, about 9095%, is non-specific lower back pain and not serious (3). However, in occupational health, we are ideally placed to identify early more serious spinal conditions like cauda equina syndrome (CES) early.

CES is a relatively rare but serious condition that needs immediate

attention, affecting 1 to 3 per 100,000 people with around 8,000 suspected cases annually. The commonest cause for cauda equina syndrome is an acute lumbar disc protrusion, involving a large part of the disc which protrudes centrally into the spinal canal. This is different to when a lumbar disc protrudes and compresses on a nerve root, which branch out at the side of the spinal column and travels down to the corresponding leg. This could cause radicular pain, commonly known as sciatica and not cauda equina syndrome (see Figure 1.) Other less common causes include haematoma, trauma, infection, tumour, or spinal/epidural anaesthetic.

British

Recognising CES

If not treated promptly, it can lead to permanent loss of bladder and bowel function, sexual dysfunction, and lower limb paralysis. Early treatment is vital to reduce the risk of permanent disability. Diagnosing CES involves recognizing a collection of symptoms and signs since no single symptom or MRI alone is definitive.

Additionally, 23% of litigation claims for spinal surgery in England relate to CES2. Between 2008 to 2018, NHS Resolution received 827 claims for incidents of CES. Of these, 340 were settled with damages. This has cost the NHS £186,134, 049 (4).

Figure 1.

Association of Spine Surgeons. Cauda Equina Syndrome 2022

Figure 2. British Association of Spine Surgeons. Cauda Equina Syndrome 2022

Getting it Right First Time Pathway

Fortunately, in 2023, the Getting It Right First Time (GIRFT) team developed a new interactive pathway to support clinicians to better recognise and care for patients with this rare and serious spinal condition without delay and improve patient outcomes.

The pathway offers best practice along all stages of the patient pathway, from initial presentation to surgery and on to post-operative care. It is supported by detailed guidance outlining when and how to carry out stages of the pathway.

Getting it Right First Time Cauda Equina Interactive pathway

The pathway is very user-friendly and I would recommend keeping a link to it or print out the relevant sections for your practice. It provides clear instructions and guidance on what actions to take and where to send your patient, along

with the necessary information.

In 2015 an investigation into Cauda Equina Syndrome (CES) revealed significant issues with how questions were posed and communicated, particularly regarding bladder, bowel, and sexual dysfunction (5). The findings from this investigation are summarized in the following video: "Cauda Equina Syndrome - A Surgical Emergency."

Cauda equina syndrome - a surgical emergency

The MACP (The Musculoskeletal association of Chartered Physiotherapists) developed the CES warning card which is also referenced within the GIRFT guidelines was developed and inspired by research by Dr Susan Greenhalgh, Chris Mercer and Laura Finucane. This can be useful as a supplement to utilising the above pathway. It has also been translated into 28 languages, an example of this is shown below. It can be downloaded here: Cauda Equina Information Cards | MACP

Utilising both the GIRFT pathway and the CES

warning card will help to ensure the best outcomes of those patient presenting with lower back pain and additional symptoms.

A link to the full written guidance can be found here : National Suspected Cauda Equina Pathway GIRFT

References

1. Statistics - Work-related ill health and occupational disease (hse.gov.uk)

2. Work-related musculoskeletal disorders statistics in Great Britain, 2023 (hse.gov.uk)

3. Prevalence | Background information | Back pain - low (without radiculopathy) | CKS | NICE

4. https://committees.parliament.uk/writtenevidence/40115/html/

5. An Investigation into the Patient Experience of Cauda Equina Syndrome (CES) | Request PDF (researchgate.net)

Ali Wilmore graduated in Physiotherapy in 2017 and chose to initially specialise in Musculoskeletal working in a variety of sectors including the NHS, Private MSK clinics, medicolegal, disability analysis and within the prison service. The last two years Ali has completed further training within Occupational Health and is currently working in OH for a manufacturing/engineering company. Beyond this, Ali runs a small practice, providing MSK and OH services to those dealing with chronic, long-term MSK or neuro MSK conditions. Ali’s special interests are in ergonomics, hypermobility and neurodiversity.

Bacterial Viral Filters: Protect the Patient, Protect Yourself

By Joe Topham, Vitalograph Product Specialist

Infection control is at the forefront of everyone’s minds in the post-Covid era. We are all familiar with the basics such as cleaning surfaces, disinfecting items that have come into contact with patients, and disposal of single-use items. Slogans such as “coughs and sneezes spread diseases” and the more recent “catch it, kill it, bin it” are widely used. During the Spanish flu outbreak in 1919, the public were advised to use face coverings1 just like

• Infection control

• Cross-contamination during spirometry

• One-way mouthpieces

• How bacterial viral filters work

• Why you should use a BVF

during the COVID-19 pandemic, showing that the concept of creating a barrier to prevent the transmission of disease was understood over 100 years ago. This is the same principle on which bacterial viral filters work. We are creating a barrier to prevent pathogens entering the environment.

Infection Control

Infection control procedures are evidence-based and protect patients and staff from avoidably spreading infections. From washing your hands to

wiping down equipment once you have seen the patient and every step in between, infection control is essential to ensure the safety of patients and clinicians.

Mouthpieces and nose pegs should be single patient use, with the latest ATS/ ERS spirometry standards stating that the use of in-line filters has become standard practice in most testing facilities.

Cross-contamination during spirometry

Spirometry is a maximal test and is one of the few diagnostic procedures that rely fully on the patient’s effort. Although spirometry is not considered an aerosol-generating procedure (AGP), the effort required can often induce coughing, leading to droplets and aerosols being produced and spread in the testing vicinity. When a patient performs spirometry, they exhale at a much higher flow rate than during relaxed breathing, and they exhale until they are empty. During maximal manoeuvres, bacterial or viral particles may be ejected from the patient into the device and the room if there is no barrier in place to stop them. We need to take a broader view of not only the risk of transmission of pathogens from patient to patient, but also from patient to clinician and anyone else who might enter the testing room.

Most spirometers on the market today are flow sensing spirometers, which means that they measure the flow of air passing through them and are open at both ends. As a result, expired air and everything in it passes into the spirometer and out the other end. This can be unpleasant for the clinician if droplets pass into or through the device.

One-way mouthpieces

One-way cardboard mouthpieces may be used to prevent cross -contamination. This may reduce the risk of user-to-user inhalation, but it does not prevent the risk of contamination of the device and the air within the room. The ATS/ERS statement 2019 on spirometry states that inline filters will reduce contamination of the device2

When thinking about the contamination of the wider environment, we can consider how long certain bacteria and viruses survive outside the body. The SARS-CoV-2 virus which causes Covid-19 can live up to three days on hard surfaces, whereas TB can live up six months on hard surfaces, if not in direct sunlight.

Cardboard mouthpieces may appear to be the more environmentally friendly option; however, they are typically more difficult to recycle due to their thin plastic coating. They also contain different types of plastic, which presents challenges for the recycling process.

How do Bacteria Viral Filters work?

A Vitalograph Bacterial Vital Filter (BVF) will remove droplets, aerosols, bacteria, and viruses (including MRSA, TB, Influenza & SARS-CoV-2) out of the airstream with >99.999% crosscontamination efficiency. This can give added confidence that staff and patients are safe, as the majority of potentially harmful pathogens are trapped inside the filter. With the use of a cardboard mouthpiece, the potentially harmful bacterial and viral particles will simply pass through, entering the device and surrounding environment. Professor Colum Dunne and colleagues at the University of Limerick studied the effectiveness of Vitalograph BVFs in preventing bacterial or viral particle transfer to and from respiratory equipment. Results showed >99.999% effectiveness for prevention of microbial transfer to equipment. BVFs also reduced potential transfer from equipment to user to below levels of detection.

Cleaning guidance is provided with each device, however using a Vitalograph spirometer in conjunction with a Vitalograph BVF overcomes the need to deep clean the flow head between patients, reducing the downtime of the device. An annual service by Vitalograph is required, at which point the flow head is replaced.

Why should I use a Vitalograph BVF?

Using a BVF protects both the individual being tested and the test operator.

It reduces the downtime required for device cleaning, allowing more time to be spent helping patients to give their best effort. Devices should always be cleaned according to the manufacturer’s standards.

Vitalograph makes its BVF in Ennis, on the west coast of Ireland. The proximity of this location ensures lower shipping costs and also lessens the risk of supply chain issues. Vitalograph BVFs are fully recyclable and exceed recommended guidelines on flow impedance, ensuring reliable test results.

In conclusion, the use of one-way valve mouthpieces may go some way to reducing the risk of cross-contamination from patient to patient, however, they do not eliminate the risk to the surrounding environment and the spirometer itself. Guidelines recommend the adoption of in-line filter mouthpieces to not only prevent cross-contamination2 but to also protect patients and clinicians. The use of BVFs should be adopted in all clinical settings to ensure that patients and clinicians are protected to the highest possible level.

References

1. Morens DM, Taubenberger JK, Fauci AS. A Centenary Tale of Two Pandemics: The 1918 Influenza Pandemic and COVID-19, Part II. Am J Public Health. 2021 Jul;111(7):1267-1272

2. Graham, B.L. et al. (2019) 'Standardization of Spirometry 2019 Update. An official American Thoracic Society and European Respiratory Society Technical Statement,' American Journal of Respiratory and Critical Care Medicine, 200(8), pp. e70–e88. https:// doi.org/10.1164/rccm.201908-1590st.

Collaborative Solutions for Effective Occupational Health Outcomes

By Janet O’Neill

This reflection draws on the 2023 Disability Forum Survey and Report which found OH lacking in several areas and effective in only 25% of interactions. The issues raised in this report must be addressed! Getting it right increases the chance of reducing sickness absence and the number of people falling out of work (Gov.UK 2023). The recent task force (2024) to build employer awareness of the benefits of OH in the workplace, led by Dame Carol Black, emphasises the need for a trusted and useful service.

To add context; - disabled people in employment increased from 2.9 million in 2013 to 5.1 million in 2023; a 77.2% increase (Gov.UK 2023). Due to:

- Disability prevalence. A 60% increase in people reporting mental health

conditions and “other health problems or disabilities”

- Disability employment.

It is disappointing that the report has not shown OH in a good light. To increase access to OH through voluntary participation, as proposed by the government, we must address the gaps identified.

We can take learnings from both the positive and the negative. The lagging and leading indicators, to reach our potential.

OH, has the potential to: -

- Be skilled in managing health and work by supporting people, businesses, and the economy (SOM 2022).

- Positively impact health inequalities (NHSE 2023) of which those with a disability are at risk (Kings Fund 2022).

But this relies on two key elements: Practice and utilisation!

OH, has immense potential with quality practice and effective utilisation. Figure 1 demonstrates the breadth of delivery and service which benefits disabled employees and their employers.

Figure 1. The role of OH

Substantial evidence shows that OH has a positive impact when used effectively. Dame Carol Black’s 2008 report and various government publications, including “Health is Everyone’s Business”, “Occupational Health Working Better,” and the recent “None of Our Business” policy exchange document, all highlight this.

The employer commissions OH. Supporting people to remain in work and work as effectively and safely as possible, forms the return on investment (ROI) from a moral and financial perspective. Quality attendance management and fitness for work advice is crucial. Providing an opinion on the likelihood of disability per the Equality Act 2010 is a common question. A service to both the employer and the employee is provided. Representing the former to the latter and representing OH from a customer service perspective is key to building trust.

OH, is objective, providing information that will be helpful to both parties and delivering justified and evidence-based opinions. There will, however, always be an element of unrealistic expectations that are misaligned with what OH can or can’t do as an advisory service, from either party (SOM 2023). OH, is well-versed in navigating the agenda of the employer and/or the employee, however, this can lead to unhappiness. As one provider put it: “We could produce the best, evidencebased report, but if it conflicted with what the employee or manager wants, then the reflection will be poor.” For example, the administrator who wishes to have a paid gradual return despite having no limitations the manager who does not want a person to return to work or remain in work as they are difficult to manage

What did the survey find?

25% of employees had positive experience i.e. leading factors. Employees said what worked was: -

- Motivation to attend OH

- Trust between employee and employer/ manager and OH

- An awareness of what to expect

- Listened to and understood

- Realistic and relevant advice i.e. added value

Importantly, employees felt “Good conversations with managers reduced the need for OH”

What employers and employees see as the sticking points.

Employers

Unbalanced reports if line managers aren’t involved

Employees

Distrust of OH

Reports regurgitating what the employee says Poor outcome i.e. nothing happened following the assessment

Unclear and non-committal reports that could have been suggested without OH

A tick box exercise

Impractical advice and recommendations

Poor training on how to use OH

Accessing appointments and flexibility in access due to disability

No value added by the OH report i.e. unclear reports

Unclear as to the role difference between OH and their clinical team

Tick box exercise i.e. referrals to OH for adjustments they knew they needed

A lack of OH understanding of their condition and disability

Inferior quality reports with cut-and-paste and repeating what they have said

The use of OH to handle difficult conversations

Approaching primary care for a report alongside an OH referral

Figure 2. The lagging factors.

Common themes appear related to poor use of OH by the employer and poor OH practice. Reversing this can be a key factor for a successful outcome. Both parties need to work together!

What will make a difference?

Figure 3.

Processes:

Ensuring the tender process is bespoke encourages a deeper understanding of OH and how this aligns with culture and workforce, encourages partnership and therefore worth. Any contract should stipulate quality as a key performance indicator with both parties agreeing to the framework of quality.

Implementing robust processes for attendance management, in conjunction with OH, helps to reduce the risk of a tick box approach, while ensuring managers are upskilled and flexible enough to adjust to each employee’s needs. Effective policies and processes foster trust and communication. (Gov.UK 2020)

Quality procedures within OH including competency assessments, audits, feedback, and complaint trends, are essential. Good compliance and clinical governance with accreditation schemes such as ISO and SEQOHS (iOH 2024), assist with continual improvement and confidence in the service and quality outcomes.

Communication:

Communication creates a relationship, relationships achieve outcomes! Effective communication based on policy, leads to quality.

Training OH to understand the employer, their workforce, and the specific job demand alongside training the employer, managers, and employees on the role of OH, fosters relationships and knowledge of each other's roles. Line managers who appreciate the value of OH, are likely to positively explain OH to employees and thereby, reduce the lack of understanding noted in the survey. OH, reports are also more likely to be effective and useful.

The line manager is pivotal in supporting disabled employees to remain or return to work (CIPD 2010). Training on good and courageous conversations with employees will reduce unnecessary referrals and increase trust. If employees come into an OH consultation without understanding why they are there, and what to expect, the interaction is not likely to be successful.

Valuable information provided within referrals is key to conveying what is required from an assessment and the background situation (Personnel Today, 2017). This forms the basis of communication between the line manager and OH. Ensuring the employee is fully aware of the information provided helps to set their expectations and allay any fears. Training is essential. The common saying of “good in and good out” and visa vera, within OH is based on experience and could relate to some of the comments in the report. Many in OH advocate generic conversations with the employer to help them create an ideal referral for what they need to know. Triage is another crucial factor in improving outcomes, ensuring the case gets the right clinician and the right service (OH at Work, 2021)

Once within the consultation, building rapport is an essential OH skill and starts with setting expectations for the employee. Outlining the role of OH, what is expected from the referral i.e. what questions OH need to answer, the consent process and how the assessment will proceed is essential. Good history-taking, matched to the role requires active listening skills help the employee to feel listened to and understood. Motivational interviewing assists in providing the employee with a sense of control. The consultation can affect how individuals perceive OH and their employer, they can help to build trust.

Case conferences, with consent, can open

dialogue with all parties and explore the possible or come to pragmatic conclusions where everyone agrees.

Reports are the product OH sells! A report is an effective communication tool between employee and employer and even between employee and GP! The Society of Occupational Medicine (SOM) has produced an excellent guide to an OH assessment and report which covers the quality essentials expected from OH. Simple but essential are good grammar and spelling, plain English with clear advice on actions. Further advice is found in this iOH, 2020, article.

Of singular importance, is the need for line managers to follow up the OH report, being clear on what can and can’t be accommodated and creating a plan. This was highlighted in the Disability Forum report

From a service perspective and quality improvement, regular meetings with HR, line managers and unions, are encouraged to reinforce messages, keep knowledge fresh and encourage advocacy.

In conclusion, good processes, and communication lead to quality outcomes! The responsibility lies with both the employer and OH. OH, will never make everyone happy all the time. But, when OH is used effectively and provides a good service, a significant difference can be made in people's working lives.

Disability and the impact of secrecy

By Chris Jay

What is the impact of staff members keeping a hidden disability a secret in the workplace? Managing Director of Bascule Disability Training, Chris Jay offers guidance on developing a workplace culture that encourages openness…

Being open about a disability is essential for any worker who needs their employer to make reasonable adjustments. But what if workers fear that their employer might not be supportive? What if they are worried that colleagues might react negatively or offer unwanted attention or sympathy? What if they have a suspicion that their progress may be hampered if they reveal they have a disability?

The short answer is- these people will hide it. Unfortunately, the impact of

doing this can be negative, and detrimental to mental and physical health, as well as a person’s general wellbeing.

How do you hide a disability?

To many people, the act of keeping disability a secret might sound unlikely or almost impossible, and this is mainly due to our perceptions of what disability is, or more importantly, what we believe disability ‘looks like’. As we all know, the universal symbol of disability is the

icon of a wheelchair user, but in actual fact only a small percentage (believed to be less than 8%1), of people with a disability are wheelchair users.

It's actually estimated that around 80% of all disabilities are non-visible2, and so this means that roughly 11 million people have disabilities they are able to conceal, therefore a vast number of workers will be in a position where they make a conscious decision of whether or not, to be open about their disability in their workplace. Sadly, it’s estimated that as many as 43% of people with hidden disabilities choose to keep them a secret from their employer3 .

What is a ‘hidden disability’?

Put simply, a hidden disability is a disability that is not immediately apparent to other people. These can

include a vast variety of impairments including visual and auditory disabilities, ADHD, dyslexia, diabetes, asthma, Crohn’s Disease, chronic pain, depression, bipolar, epilepsy, dyspraxia, rheumatoid arthritis- to mention just a small number.

Unlike visible disabilities, hidden disabilities do not have any obvious physical signs, and this can often cause misunderstandings and confusion amongst coworkers with little or no awareness of disability, which can also lead to the needs of individuals being overlooked by managerial staff.

The health implications of concealing a disability

It goes without saying, that people with disabilities are under no legal obligation or requirement to reveal, or be open about their disability, and if it is their

wish to keep it to themselves, they have every right to. However, there is an abundance of evidence that shows that this is likely to, not only impact performance, but health too. One area it has a noticeable impact on is stress levels.

Coping with stress has become a part of working in the modern world, and as a result of a faster pace of living, stress is said to impact as many as 79% of all UK adults for at least one day every working month4, and 7% of people say they feel stressed every single day5

Stress has been proven to take its toll on the body, physically exacerbating issues such as headaches, breathing problems, nausea, pain, digestive problems and depression. Many of these are also symptoms of a number of hidden disabilities, meaning the physical challenges of having a disability will be compounded or enhanced by concealing it. If a person is already in a job where pressure and stress is commonly experienced, maintaining this role and hiding a disability will certainly enhance the difficulties stress already evokes. For example, consider someone who has chosen not to openly reveal that they are diabetic. Imagine that they are caught in a long all-day meeting, and that stopping to eat, or take medicine, may appear to be inappropriate in these conditions, despite it being essential for them and their health. As well as being a health risk, stress levels and anxiety will rise, and their job will become more difficult as a result. However, if the person’s diabetes is known about, simple adequate adjustments can be provided for this person.

Consider also, a staff member who has chosen to conceal a chronic pain

condition. They may need occasional breaks, or they may struggle with timings on certain days. Without an understanding of this, an employer may misinterpret a person’s symptoms for poor behaviour- which will lead to disciplinary action, adding pressures to the staff member and pushing them to work through the difficult and challenging times an employer would otherwise support them through. This would again, enhance symptoms and raise stress levels. The business might then have to deal with the awkward situation of someone revealing a disability they have been forced to reveal during a disciplinary process.

As well as increasing stress, hiding a non -visible disability also impacts feelings of sadness, nervousness, isolation and anxiety. This was demonstrated in an American study that found that employees who do reveal their disability are more than twice as likely to feel happy or content at work than those who do not (65% versus 27%). They are also less likely to regularly feel nervous or anxious (18% versus 40%) or isolated (8% versus 37%)6

So, with so many serious implications to health and wellbeing, why do people continue to hide their disabilities?

Why hide?

If staff choose to hide their disability, it is nearly always an indication that an organisation needs to improve its cultural approach to creating a more inclusive workplace. If disability and difference is genuinely embraced, and meaningful steps are taken towards creating an accessible organisation, people are much more likely to freely and openly discuss their own disability.

If staff choose disability, it is nearly indication that an needs to improve approach to creating inclusive workplace.

choose to hide their nearly always an an organisation improve its cultural creating a more workplace.

When Bupa investigated the most common reasons for not revealing a disability, 30% of respondents said it was because they didn’t want to cause a fuss with colleagues, 25% didn’t want to be treated differently and 23% said they had worries that they would not be believed7 .

All three of these reasons demonstrate an issue in terms of how disability is perceived by people. The key issues are built around the attitudes, reactions and perceptions of colleagues and managers, meaning the most important step forward is developing an improved awareness and understanding of disability.

Developing Awareness

Disability awareness training allows members of staff to develop a more positive understanding of disability by raising confidence and removing any barriers that may exist. This should be done by educating all staff members (and provided as onboarding training), at all levels of the company hierarchy. The content should challenge perceptions and consider various issues such as etiquette, correct use of language, communication, hidden disabilities, and inclusive behaviour, as well as legislation, disclosure, reasonable adjustments, and adapting the physical environment.

Training managerial staff is particularly important as awareness and understanding of disability will be fed down to all other staff, which will result in a more inclusive and supportive workplace culture. The impact of training has been known to have an immediate effect, as in the past, our programmes have prompted people to reveal their hidden disability for the first

time, in the knowledge that the company has evidently made new efforts to embrace inclusivity.

Losing the ‘D’ word

One way to encourage more staff members to be open about their disability, is to use an alternative to the word ‘disclosure’. This word implies that disability is a dark secret, or something to be confessed. It suggests that disability is a bad thing, but with an open and inclusive workplace culture that celebrates difference, secrecy won’t ever be necessary. Instead of using this terminology, try sentences like ‘helping you to bring your best self to work’. This sets out the stall for a much more open, positive and supportive culture.

Further improvements

Other ways openness around disability can be improved is by demonstrating the success of others with disabilities. This can be done by asking staff to be the subject of HR case studies, that clearly exemplify the support the organisation has shown, when staff are open about a hidden disability. These should evidence how the company has made reasonable adjustments to fully support them, empowering them to be a healthier, happier, more productive individual.

Consider disability steering groups that are comprised of staff in all teams, across various seniority levels and give these parties a voice in all company movements. Change recruitment policies, improve accessibility physically and digitally, adapt your services for people with disabilities and watch the cultural shift gradually resonate, and make more staff feel comfortable in being open about their own disabilities. You could survey staff, and ask them –

how well are they supported? What can be improved? Ask people if you are getting it right.

Once they understand that you care, there will be a shift in their perception of their employer’s priorities.

References

1. Source: CSR Europe, ‘Disability: facts and figures'

2. UK Parliament - Invisible Disabilities in Education and Employment-

3. Bupa- Employees avoid telling employers about less visible disabilities | Bupa Group

4. Workplace stress statistics in the UK (ciphr.com)

5. Workplace stress statistics in the UK (ciphr.com)

6. Disabilities and Inclusion (Global and U.S. Findings) (talentinnovation.org)

7. Employees avoid telling employers about less visible disabilities | Bupa Group

Chris Jay | Linkedin Managing Director Bascule Disability Training

www.bascule.com

Born with cerebral palsy, Chris has been a wheelchair user for over 25 years. He has used his life experience of having a disability to create a social enterprise that offers training to help organisations understand the true benefits of being more inclusive. He is an accomplished entrepreneur, training facilitator, public speaker, guest spokesperson and writer on the topic of disability awareness in business.

Empowering women at workaddressing the health challenges

By Dr Nikki Cordell

Despite the increasing awareness of female health issues, the workplace is seeing record numbers of women falling out of work. Between 2018 and 2023, the number of women economically inactive as a result of poor health had risen by over half a million to 1.54 million. This represents a 48% increase over the period and is a drain of talent and opportunity that organisations, and women themselves, can ill afford.

I believe that organisations can and should do more to counter this. I write this with some experience, not only as an occupational physician but as a female CEO of an organisation employing over 90% women and with a 100% female leadership team. So, I very much recognise the value of supporting women in the workplace, both as an employer as well as a clinician.

In this article I will cover some of the causes and challenges affecting women’s health at work, as well as share my thoughts on some of the approaches organisations can take to better support and retain female talent.

Why are women finding it so hard to stay in work?

The numbers are alarming. In the period between 2018 and 2023, absence due to musculoskeletal issues in women rose by 126,000. Sickness absence due to cancer rose by 19,000, and depression, anxiety and mental illness rose by 69,000. But the causes are many and aren’t just health related.

There’s the impact of caring and family support roles that often fall to women, lack of workplace support that often sees women struggle with conditions such as the perimenopause - as well as the physical toll of age. What’s more, there is still very much a stigma experienced by women, many of whom feel that they can't speak up or expect reasonable adjustments to be made by their employer. And if all of this weren’t already a long list, research finds that one in five believe they have been discriminated against. Let’s look a little deeper into the issues.

Musculoskeletal disorders: These are very common health issues for women. Women have a higher burden of musculoskeletal disease, greater pain, and functional impairment and do not appear to recover to the same level as men. Structural anatomy, neuromuscular differences, greater degree of hyper mobility, and reproductive hormones and genetics are thought to be important in the differences observed. As an example, in our practice we are seeing more women with RSI, particularly in manufacturing and in pharma where they're using a lot of pipetting and lab equipment. And it does seem that women get a lot more of these symptoms than men.

Mental health and burnout: Whilst there are no variations in the overall incidence of psychopathology between genders, there is a difference in usage of mental health services and also the type of mental health disorders that are diagnosed are different between men and women. Women are more likely to be diagnosed with depression and anxiety in adulthood than males and are also more likely to consider quitting jobs and experience burnout with stressors and pressures with interpersonal conflicts at work. And certainly, I have seen women particularly but also men, who are so significantly burnt out with work-related stress that they actually have symptoms of post-traumatic stress disorder. In my practice we have needed to use treatments for post-traumatic stress and some of them have never recovered which is a terrible indictment on some workplace cultures.

Perimenopause: I've seen a number of women in very high-powered positions within organisations who have had to change their job role or give up work due to the impact of the perimenopause. And particularly when they had other underlying health conditions and the perimenopause symptoms were added on top of that, which tipped them from being able to cope with work to not being able to cope. Similarly, in the care and education sectors where there is a high proportion of women, the physical demands of the roles are combined with the challenges of menopausal symptoms.

Fibromyalgia and fatigue: There is currently a lot of research in this area and there appears to be significant gender differences. There's quite a lot of work going on at the moment around oxidative stress and at a cellular level

what might be mediating some of the symptoms. And we're certainly seeing functional neurological disorder and some of these other global disorders having more and more of an impact on women at work. Unfortunately, these conditions have a very poor prognosis, and we are regularly seeing women with these cases fall out of work. There have also been gender differences observed in chronic fatigue, irritable bowel syndrome, and headaches.

Caring responsibilities: We’re finding more and more issues as the requirement for family support is very much provided from resources within the family. As a consequence, women are needing to make a choice about whether they work or whether they meet their family responsibilities. This is particularly seen in women of colour. The impact of type of work: Women are overrepresented in the lower paid sector such as healthcare, education, and admin support, which can have significant physical and emotional demands. The women that I'm seeing falling out of work, particularly in and around the 50s and early 60s, are not physically fit to do any work. Even if they could work, they're often not qualified to do the work that they would be fit for. In contrast, men dominate higher paying fields like engineering, finance, and technology, and these have lower physical demands and people can therefore stay longer in work in these roles. As a consequence, I'm getting more and more concerned that women can't stay and work until their pension age.

How can we better support women in work?

An inclusive culture: As an employer of women, I think it is really important to provide a safe and inclusive environment where everybody can have a voice and feel valued. The majority of people leave their organisation because they no longer feel valued, and this is particularly the case when women feel they don’t have a voice.

Consider work design: It’s likely that with the physical differences between men and women that work design needs to be different, but very rarely do you see that in current practice. Where you've got men and women working together using the same equipment, how do we adjust aspects of the work so that it is designed by gender? The data is available. We can look at the roles that are causing most of the issues and focus attention where it’s needed - as was done in the pharma example mentioned earlier.

Supporting flexibility: At Cordell Health we provide extremely flexible working hours, and every single person has a bespoke timetable and job plan. And that has allowed them to balance their responsibilities of childcare, parent care, and delivering work. And the same goes for people with a disability. We are a disability confident employer, and we don't just wear the badge. We actually really look at how we can bespoke work to try and meet the individual's needs so that they can hopefully deliver good work for as long as possible.

Closing the gender pay gap: We lead by example on this. At Cordell Health you are paid on the type of work you

deliver and the job role you do, and there are no differences between men and women. And in fact, our salaries are very bespoke to people's workload and caseload, based on their flexible hours. This suits a lot of people, both women and men, because they don't necessarily want to be under pressure in work, particularly at times where they might be under pressure outside of it.

Professional development: It’s really important to professionally develop staff, mentor, and provide networking opportunities. It’s also important to recognise that not everyone may necessarily want advancement in responsibilities, but what they do want is a mixed and interesting workload. This can help when there aren’t that many management roles. I think focusing on development has helped us retain women that I think we would've otherwise lost.

Recognising achievement: This isn't just for women; this is for everybody. It is so important to give your people positive feedback. And I don't know how many times people are actually falling out of their particular work because they feel their achievements have not been recognised. People very much need to feel that their work is valued for them to want to stay.

In conclusion

I hope that this has set some food for thought about the issues affecting women’s health in the workplace, and how we can better support women in work. I think we really need to start to think differently if we're going to make a difference and keep as many valuable women in work that we can and for as long as they want to work.

Dr Nikki Cordell

is CEO of Cordell Health Ltd and Educational Director of EOPH Ltd.

Nikki is an experienced specialist occupational physician, researcher and educator, passionate about developing further understanding of employee health, wellbeing and performance and its links to productivity.

As CEO of Cordell Health, Nikki leads the social enterprise delivering a wide range of occupational health, wellbeing and training services.

How to choose and implement an Occupational Health Software system

By Oliver Bridge MD at Orchid Live

Whether you are moving from a paper-based system, upgrading from Microsoft Excel or transitioning away from a particular software platform, it can be a daunting process to evaluate and implement a new occupational health software system.

Any new system is going to be at the heart of how your team or business works, so choosing the right software is absolutely critical - here are a few thoughts on how to do it right.

Assemble a MultiDisciplined Purchasing Team

Setting up a new occupational health system is going to touch many areas of your business outside of occupational healthHR, Finance, IT & Data, Health & Safety are all likely to interact with the software in some shape or form. Make sure you’re clear on their requirements (and crucially what is essential versus a ‘nice to have’) so that you can add them to your list of questions during any software demonstrations.

Outreach

There are a relatively small number of specialist occupational health software providers, so you should be able to easily create a short list from colleagues in other occupational health teams and by reviewing relevant software-related posts on JISC Mail and the Occupational Health Professionals Facebook group.

The next step is simply to contact each provider via their website and ask for a demonstration of their software, making sure you bring your list of system requirements from across your organisation. As well as these specific requirements, here are some

important general considerations which we’ll be addressing the next section:

• Security & data protection

• Ease of use, training & support

• Can the system be customised?

• Are they a reliable partner?

• Can you import your existing data?

Important System Considerations

Security

& Data Protection

This software system will be holding some of the most sensitive data that your organisation owns, so it is critical that it is well protected.

As an absolute baseline, your occupational health software provider should be ISO27001 accredited. This is an internationally recognised standard which ensures that the software system itself and the company’s internal processes are robust and secure and minimise the risk of a data breach. If you are an OH provider, it is important to consider that many end clients (i.e. your clients) will require ISO27001 as standard if you’re going to hold their clinical data, so don’t give yourself a headache later by opting for a software platform that doesn’t have this accreditation.

It is also vital to ask about the infrastructure hosting your data - check that it’s one of the wellknown and highly robust and secure cloud infrastructure services like AWS, Azure or Google Cloud, where your data is automatically backed up and can be synced across multiple data centres. If it’s not, there’s a chance that the software is actually on a single server in the client’s office which exposes you to a single point of failureshould there be a flood or fire, you could be left with no system online, and in a worst case scenario, a loss of your data.

Many organisations (and end clients) will require strong user-level security such as Single Sign On, Multi-Factor Authentication and IP restrictionsmake sure you check if these are available. It’s also

advisable to check that your software provider conducts regular penetration tests by a CREST accredited provider, to make sure that they’re as protected as possible from a potential hacker.

Ease of Use, Training & Support

Even the best and most intuitive systems will be a little different to what you’re used to at first, so make sure that your software provider can offer comprehensive on-boarding and top-up training throughout the lifetime of your relationship with them. Some organisations will offer you prerecorded training videos - in practice these aren’t terribly effective, as the training can’t be tailored to your requirements, and of course you can’t ask clarifying questions as you go.

You should also expect to receive a handbook or user manual that is regularly updated with any changes to the software.

Ask the software provider about their approach to customer support and bug fixes - it’s imperative that when issues do come up, that they’re resolved quickly so you and your team can get back to work. Customer support normally works best when it is provided by a local team who speak your native language and operate in your timezone, so be sure to check this.

Can the system be customised?

Even if you think the off-the-shelf version of the software you’ve seen matches your needs, you need to be prepared for your requirements to change over time as your organisation evolves and/or different clients come on board. Make sure that you can configure the system options, assessments, workflows, report templates and branding on the platform to suit what you need.

It’s worth asking where the development team are based - it’s going to be easier to collaborate with a team based in the UK whose native language is English. Additionally, check how big the development team is to ensure there is depth, whether they are directly employed by the software company, and ask how quickly they could tackle any custom work for you.

Are they a Reliable Partner?

You’re going to be trusting this software company with one of your most valuable assets - your employee’s clinical data, and potentially they’ll need to hold it on your behalf for 40 years: you want to be confident as you can be that this business is going to last the course.

Firstly - take a look at their Companies House profile - are they up to date on their filings? If not, this can spell trouble.

Secondly - ask to speak to existing clients and make sure they’re happy.

Third - don’t be afraid to ask some difficult questions about the company’s financial situationhow many clients do they have? Is this a loss making startup or a one-man band with no financial backing? You want to avoid a scenario where the software company holding your most important data goes into bankruptcy.

Lastly - check whether there are any conflicts of interest - is the software company owned by another occupational health provider that might be competing with you for the same client contracts for example?

Can you import your existing data?

To do your job most effectively as an occupational health team, it’s helpful to have all your employees’ clinical data in one place - this means you can quickly gain context on an employee’s situation when they are referred to you, rather than having to franticly search on Sharepoint, or worse, in a dusty old filing cabinet.

Check that your software provider can import the data from your current software system, and map it against your employee’s records in the new system. They should also be able to accommodate digitised versions of any paper records, so that you can truly have everything in one place.

The Procurement Process

After evaluating the different software systems, you’ll likely be starting to get a feel for which

platform will suit your organisation best, and you may be in a position to start the official procurement process.

Firstly you’ll want to get a detailed quote from the software provider to understand what licence, support & training fees they will be charging you. Be sure to clarify if your annual costs will increase as you grow your clinical team.

Secondly, your IT and legal team will most likely want to verify that the company’s data security and legal processes are sufficiently robust, and will probably ask the company to fill out some long questionnaires to evidence their compliance with various regulations and standards. This can take a few weeks of back and forth if either your IT/legal teams or the software provider aren’t ready and responsive, so make sure you line everyone up in advance to avoid any delays.

Implementation & Go Live

Once you have the contract signed, your focus will now turn to getting your new system live.

Wherever possible, it’s preferable to have a crossover period between swapping systems - that way you put yourself under less pressure to do a complete instant switchover, which will give you less margin for error if you discover anything unexpected with the new system.

Ensure that your whole team has access to comprehensive training before you launch - even the best systems will take some getting used to. If there are areas where people are getting stuck, don’t just accept that as ‘a tech problem’, but make sure the software provider gives you the follow-up support and training you need to use the platform effectively.

If you’re making any custom changes to the system, you’ll need to put together a detailed specification for the software developers who are working with you - this will include examples of how any new screens will look, word for word paragraphs of any new text you need, and potentially flow diagrams if you’re changing workflows. Although putting together this information takes some time, it will

allow you to move faster through the implementation phase as there will be less backand-forth with the software developers.

You’ll need to set aside some time or bring in a dedicated team to test any custom changes after they’re complete - does the new system work exactly as you expected it to? Once you’ve signed off the changes it’s hard to go back later and ask for any amendments.

Ongoing Relationship

Once your system is up and running, your relationship with the software company doesn’t end there.

Make sure you contact them once or twice a year to

make sure you’re getting access to any new features they’re releasing.

Your team will inevitably require some refresher training at some point, this will ideally be free of charge, so make sure you take advantage of that if it’s available.

And lastly, even with the best system, you’re likely to have some support queries - whether those are ‘how do I’ type questions, or because you’ve discovered some small bugs. It’s worth understanding exactly how the company’s support process works - what kind of information they need from you to effectively investigate an issue etc, that way you’ll get useful responses more quickly.

Orchid Live (OrchidLive.com) is a specialist occupational health software platform serving OH providers, public and private sector organisations across the UK. With over 1 million employee records under their care and thousands of clinicians using their platform every day.

If you’re considering your options on occupational health software, please contact Oliver directly (Oliver@OrchidLive.com) to arrange an initial discussion.

Assignment/research topics for Occupational Health/ Public Health

and Workplace Health and Wellbeing postgraduate

By Lucy Kenyon

Are you a health professional embarking on a post-registration course next month?

Delving into the realm of occupational health can significantly enhance your practice and patient outcomes. Occupational health is changing rapidly with the technological and information revolutions.

As a former post-registration student and practice educator myself I know how hard it is to identify a dissertation topic. I’ve recently reviewed the literature for gaps in OH knowledge. This has highlighted critical areas within occupational health that warrant further exploration, which are summarised below by topic.

By researching these areas, you can gain valuable insights into the underlying causes and preventive measures, ultimately contributing to safer and healthier work environments. I encourage you to explore these findings to deepen your understanding and make a meaningful impact in your field.

Assignment/Research Topics

Cancer and return to work

To gather compelling evidence on factors that influence Return to Work (RTW) in cancer survivors due to variable quality and mixed methodologies of studies (Forbes, 2023).

Climate change and the workplace

To confirm if a link exists between hazards that may be affected by changes to the physical environment (Lan, 2022). Specific areas for identified for research include the following exposures in facilities management and the impact of climate change:

• Bioaerosols

• Cleaning agents and disinfectants

• Legionella

• Pesticides

• Soil-borne diseases

• UV light

Cyber-security and data protection

How organisations can learn from incidents and reduce risks to (working) society (Patterson, 2023). Inclusion criteria:

• Competing priorities of security management

• Incident response (teams)

• Investment in learning

Digital workplaces

Understanding of negative psychological effects that employees may experience when working digitally (Marsh, 2022). Inclusion criteria:

• Adverse effects of digital workplaces on job outcomes including stress and strain

• Anxiety mediation between the technology and negative effects

• Contributing elements in the digital workplace

• Emotional attachment to technology

• Full range of ways that overload may manifest, e.g. in relation feature or application proliferation etc.

• Impact of employee health monitoring

• Information overload - how and for whom?

• Interaction of the various effects

• Levers by which anxieties may be reduced

• Sequential progression from one effect, e.g. addiction to another, e.g. stress

Eating habits at work

Effectiveness of any single intervention type to formulate sound guidelines for efficacious nutrition interventions in occupational settings (Hyży, 2023). Inclusion criteria:

• Intervention design

• Workplace setting

• Target group characteristics

Ergonomics and the use of virtual reality

How virtual reality (VR) can support the analysis of ergonomics (da Silva, 2020). Specific areas for research include:

• Force applied by the operator in assembling parts

• Assessment of ergonomic risks already in the product development stage

Health outcomes in a thermo-dynamic environment

The relationships between dynamic temperature, temporal effects and health outcomes (Reitmayer, 2023). Six areas requiring investigation were identified:

• Interaction of stress and the reaction of the thermoregulatory system following ramp (increasing) temperature conditions

• Interrelationship of the human circadian rhythm under different dynamic temperature patterns

• Potential positive and/or negative health effects of temperature variations

• Stress responses, BMI, cognitive performance, and immunity reactions to evaluate health impact (s)

Inclusion parameters:

• Measurement of physiological parameters

• Dynamic temperature pattern

• Time dependence Vector-borne diseases

Health promotion in the context of environmental issues and organisational frameworks

Quantitative measurement of workplace health promotion and management. Correlations between organisational framework conditions and healthrelated outcomes as a baseline and follow-up (Bleier, 2022). Specific areas of research include workplace violence.

Inclusion criteria:

• Employee satisfaction surveys

• Health promotion factors and barriers

• Health status

• Subjective social capital

• Workability

Migrant workers and the influence of culture

Promotion of culturally sensitive workplaces (Balante, 2021). Inclusion criteria:

• Culturally relevant interventions

• Ethnic groups of professionals

• Interventions that foster social integration

• Strategies to reduce bullying and discrimination

• Understanding of nuances because of cross-cultural professional practice

Assignment/Research Topics

Telemedicine (mental health)

Paired study to identify patient subgroups that benefit more from televideo versus in-person assessment by using direct comparison of acceptability, efficacy and cost-effectiveness (Guaiana, 2021).

Vocational rehabilitation and ex-offenders

The relationship between occupational therapy (OT), forensic psychiatry and vocational rehabilitation (Muñoz, 2020).

Inclusion criteria:

• Assessment causal attribution

• Programme planning

• Skills development interventions

Young workers living in and leaving care: Impact

of

OH engagement

The impact of occupational interventions and support on the longer -term health outcomes of careexperienced young adults' when transitioning out of their care placement to independent living due to weak methodological designs, qualitative methods and/or limited sample sizes (Blair, 2024). Inclusion criteria:

• Comparison with validated needs assessment data

• Quantitative measures of the effectiveness of interventions

Bibliography and references

Balante, J., van den Broek, D. and White, K., 2021. How does culture influence work experience in a foreign country? An umbrella review of the cultural challenges faced by internationally educated nurses. International Journal of Nursing Studies, 118, p.103930.

Blair, C., Leonard, R., Linden, M., Teggart, T. and Mooney, S., 2024. Allied health professional support for children and young adults living in and leaving care: A systematic scoping review. Child: Care, Health and Development, 50(1), p.e13140.

Bleier, H., Lützerath, J. and Schaller, A., 2022. Organizational framework conditions for workplace health Management in Different Settings of nursing a cross-sectional analysis in Germany. International Journal of Environmental Research and Public Health, 19(6), p.3693.

da Silva, A.G., Winkler, I., Gomes, M.M. and Pinto, U.D.M., 2020, November. Ergonomic analysis supported by virtual reality: a systematic literature review. In 2020 22nd Symposium on Virtual and Augmented Reality (SVR) (pp. 463-468). IEEE.

Forbes, D., Lisy, K., Wood, C., White, V., Evans, S., Afshar, N., Ristevski, E., Sharma, A., Changrani, K. and Jefford, M., 2024. Factors beyond diagnosis and treatment that are associated with return to work in Australian cancer survivors a systematic review. Asia‐Pacific Journal of Clinical Oncology, 20(2), pp.198-209.

Guaiana, G., Mastrangelo, J., Hendrikx, S. and Barbui, C., 2021. A systematic review of the use of telepsychiatry in

depression. Community mental health journal, 57, pp.93-100.

Hyży, A., Jaworski, M., Cieślak, I., Gotlib, J. and Panczyk, M., 2023. Improving Eating Habits at the Office: An Umbrella Review of Systematic Reviews and Meta-Analyses on Nutritional Interventions.

Lan, T., Goh, Y.M., Jensen, O. and Asmone, A.S., 2022. The impact of climate change on workplace safety and health hazard in facilities management: An in-depth review. Safety science, 151, p.105745.

Marsh, E., Vallejos, E.P. and Spence, A., 2022. The digital workplace and its dark side: An integrative review. Computers in Human Behavior, 128, p.107118.

Muñoz, J.P., Catalano, A., Wang, Y. and Phillips, G.A., 2020. Justice-Based Occupational Therapy: A Scoping Review. Annals of International Occupational Therapy, 3(4), pp.162-174.

Patterson, C.M., Nurse, J.R. and Franqueira, V.N., 2023. Learning from cyber security incidents: A systematic review and future research agenda. Computers & Security, 132, p.103309.

Lucy is a Specialist OH Nurse Consultant and digital health entrepreneur.

She is an Honorary Senior Lecturer at the University of Chester and has been teaching and mentoring in Occupational Health since 1996 for the RCN, Universities of Birmingham, Chester, Coventry, Derby and West of Scotland.

She delivers professional development courses for the National Performance Advisory Group, Cordell Health and employers, for whom she researches and develops evidence-based practice.

She has been a member of the iOH board since 2014, President from 2017 - 2020 and a Non-Executive Director since 2021.

She has a Master of Medical Science and the International Certificate in Occupational Hygiene from Birmingham, where she has taught and worked on research projects.

Lucy Kenyon | Linkedin

Capability v Capacity – finding the confidence to return to work with a long-term health condition.

By Amanda Mason

My journey into Vocational Rehabilitation began almost 20 years after qualifying as a Careers Adviser when in 2015 when I worked on a pilot project as an Employment Adviser embedded in the ME/CFS clinic at North Bristol Trust. This led me to working as the Career and Employment Consultant for Vitality360, where I work alongside a multidisciplinary team of clinicians specialising in persistent pain and fatigue. My role is to focus on the work aspect of their rehabilitation whether that is identifying challenges and solutions to a sustainable return to work, career redirection or job seeking skills – all underpinned with an understanding of the need to integrate condition management strategies into the workplace or a new role.

I work with many people who describe themselves as driven and passionate

Work is a huge part of who they are and when they become ill it hits them hard, so how can I support them when it feels as though that part of themselves has gone?

about their job, spending years building up their skills, experience, and qualifications. Work is a huge part of who they are and when they become ill it hits them hard, so how can I support them when it feels as though that part of themselves has gone?

The clients I work with have persistent pain and/or fatigue, so their symptoms are likely to be long term and fluctuating, and unlike some disabilities the symptoms aren’t always obvious to other people. Work seems impossible, and they wonder how on earth they can go back to those demands when they can barely think straight. When they visualise going back, they imagine they will be flung straight back in as though they have never been away – back to the same amount of work at the same intensity. No wonder it seems like a mountain to climb.

We can talk about phased returns and adjustments, but this really tends to deal with the functional aspects, it doesn’t help someone manage how they feel about work when they are dealing with a ‘new normal’. When I talk to clients who are going through this, it becomes apparent that for some of them they no longer have confidence in their capability, for example they don’t trust their ability to make decisions or write a report well.

For many of the people I work with their disability or health condition is invisible. Consequently, they feel as though they will be disbelieved by their manager and colleagues, which can be exacerbated because at times they can ‘push through’ despite the payback. I’ve also had clients themselves who doubt they can really be ill because of this. At the same time, we hear the challenges for managers and colleagues who struggle to understand how that person is feeling when they appear able to ‘push through’ but also why they aren’t ‘looking after themselves’. It can be difficult for colleagues and managers to understand that all their energy is going into being at work, but that maintaining this has a huge cost outside of work. It might mean having to rest when they get home or struggling with managing the other aspects of daily life – like housework, cooking or socialising. We often hear clients’ frustration on being told they look well, when they feel quite the opposite. One of my clients referred to ‘unseen symptoms’ rather than an invisible disability, and I have wondered whether for some people this helps them to explain their health more easily to others.

Alongside this, people put huge amounts of pressure on themselves –

not wanting to ‘be a burden’ or for their colleagues to feel as though they are taking advantage. In so many workplaces today people are doing the work of at least two people so they already feel guilty about having ‘dropped the team in it’ by taking time off, or not feeling they can work the reduced hours that have been recommended.

All these factors can make it difficult for someone to put into place the strategies that will help them work sustainably and productively. This creates a vicious cycle, which can lead to a ‘failed’ return to work.

So, what is the solution – how do we as professionals help? Our approach at Vitality360 is to ‘explore, enhance and sustain.’ This framework helps us work collaboratively with the client to explore what aspects of their job might have (or are having) an impact on their ability to do their job. As well as thinking about the difficulties it is important to recognise what is helping with managing their symptoms – whether at home or at work. We then think about how to enhance and improve their situation. Are there different strategies that would be better? Or is there a way of making existing strategies more effective? What would help put these in place and utilised on a regular basis?

This brings us on to what I think is one of the most important factors –sustainability. How do you keep putting those strategies in place at workwhether that is taking regular breaks, leaving work on time or using the talk to text software that has been provided? All too often I talk to people who have been back at work for a while, and they have stopped doing this. This can be

because of the concerns mentioned earlier about being disbelieved or a burden, but it might also be because someone has started to feel less unwell, and these strategies seem less needed or because they have just got carried away in the role.

I find that this links back to the issue of confidence I talked about earlier, and this is where the idea of capability v capacity comes in. I believe it is so important to help people understand that they still have the same skills, experience and knowledge that they had before they became unwell, but they just might have to do the job differently –even if only temporarily. Those adjustments might mean reduced hours or shorter meetings or asking someone to check your work before you send it. Anything that helps build confidence and capacity. One client really stays with me and illustrates this perfectly. When we talked about her still being just as capable but having a different capacity it completely changed the way she felt about managing her long-term health condition at work. She realised that despite having stepped back from some of her role, and working less hours, she was still a productive and valued member of the company because of her skills and experience. This realisation gave her the confidence to feel OK about setting her boundaries, suggesting other and more efficient ways of working in terms of organisational processes (often something that helps one person helps everyone in an organisation) and using her extensive knowledge and experience to support colleagues. An even bigger win was that her employers gave her a promotion!

If you want to find out more about what Vitality360 can offer as specialists in persistent pain and fatigue or how to refer to us, then please visit our website at https://www.vitality360.co.uk/ and book a 15-minute call or contact us direct on info@vitality360.co.uk.

Amanda Mason | Linkedin

Amanda is a qualified Career and Employment Consultant, and member of the Career Development Institute and Registered Career Development Professional. For over twenty years she has supported people to identify their career goals and work towards them in a positive, solution-focused way. She has specialised in working with clients with persistent pain and fatigue for the last nine years and has lived experience.

Progression –A career in OH series

Part 2

Reflections of a Public Health Specialist turned Consultant

Occupational Health Physician

By Dr Sade Adenekan

Dr Sade Adenekan is a dual accredited specialist in Occupational Medicine and Public Health in the United Kingdom. Her career in both public sector (NHS) and industry, has taken her on a “unique” journey that has involved a number of clinical and non-clinical roles over the last 30+ years. She is passionate about preventative medicine having started her initial career in that field; and now focuses on integrating lifestyle medicine within workplace health. Her Occupational Health career journey has been one of curiosity, resilience and purpose as she continues her commitment to delivering excellence and quality improvement within the health & well-being space.

Foundations: Humble

Beginnings in Clinical practice

I qualified as a physician in Nigeria at the esteemed Obafemi Awolowo University. After a stint in General Paediatrics and A&E (Accident & Emergency Medicine), I got fed up with seeing young babies and children dying from preventable diseases and switched my career options into preventative medicine (Public Health). I subsequently moved to the United Kingdom and obtained my master’s degree in Public Health; and a subsequent MSc in Health Services Management at the London School of Hygiene & Tropical Medicine. I then went on to pursue a career in the NHS (National Health Service) - unbeknown to me, in addition to becoming an accredited Public Health Specialist and a rising clinical leader, I did not realise I had also gained the necessary “soft” skills of listening, kindness, empathy as well as acquiring technical “hard” skills in undertaking and leading on needs assessments, health equity audits and project / programme managementskills I would find very invaluable as I navigated my career in Occupational Health later on.

So why make the change?

With the transition of public health from the NHS into the local government authority in 2013, I thought it was time for a change after serving 20+ years there. Having done a number of workplace health initiatives as part of my health improvement portfolio and following an inspiring talk by Dame Carol Black, then FOM (Faculty of

Occupational Medicine) President, I decided to retrain in Occupational Medicine, which I did – a decision that I have never regretted! For me, Occupational Health is a unique speciality within the medical field and as clinicians, we can certainly make a difference when it comes to ensuring that the workplace and being employed, has a positive impact on health & wellbeing. Many of us come into Occupational Medicine from various backgrounds and mine was not unusual coming from a public health background with specialism in health promotion and health services management.

What was your initial concern when considering the change?

For me, retraining in another speciality was not just about a career change – but it was more about a career “ move” that would add value to what I had already achieved working at “consultant” level and in leadership as an Assistant Director in Public Health – although, there was still a lot to consider at the time. I subsequently decided to train in industry having done two “exploratory” placements (one in NHS and one in a corporate energy firm) and following a number of discussions with a few Occupational Health Physicians and Regional Training Programme Directors at FOM.

A training opportunity arose (by chance), and I applied and subsequently did my diploma in Occupational Medicine whilst awaiting the outcome of the interview that I attended. Fortunately, I was accepted pending approval by the regional deanery (since it was an industry training programme) and within three months of commencing

my “training,” I was granted an interview at the London Deanery who approved my eligibility to be placed on the Occupational Medicine Higher Specialist Training Programme.

Although the speciality training meant taking a “huge pay cut”, keeping my eye on the “prize” gave me both the resilience and motivation to get through and apply the transferable skills I had obtained throughout my career in public health, to completing the task before me over the next four years!

Now that you made the change, what added value do you think it brought to your career?

Reflecting on the many years of work experience, I think the additional expertise gained in Occupational Medicine did add value to my career! Having worked in different environments (public sector, industry and corporate settings) has given me a well-rounded perspective of how to tackle a wide array of health & safety risks, hazards as well as manage people (behaviours), processes, policies and strategies in different cultures. More importantly, it has given me the opportunity to share, learn, network and grow as a clinician, manager and leader.

I am naturally a “people person” and a DEI (diversity, equality & inclusion) champion which has led to me to become a founding member of the Society of Occupational Medicine EDI Taskforce. This led to a commitment to working more closely with key stakeholders like labour relations specialists (HR), lawyers, employee resource groups, and even trade unions councils - both locally and

internationally - to ensure that colleagues and employees always feel they belong and feel included within the workplace – be it directly or indirectly through my role as an Occupational Health specialist, a colleague or leader.

Can you share any other specific reflective insights?

I have a strong specialist background in Women’s Health and Paediatrics and even though I work predominantly now with working age group populations, I have been able to apply many of the transferable skills gained through the years to date. I have been able to lead on projects that have led to external accreditations and continue to champion Women’s Health (both menopause and menstrual health), disability (focus on impact of physical and mental long-term health conditions and hidden ones including neurodiversity within the work setting) with a particular interest in tackling health inequalities around health outcomes, access to appropriate information, treatment and support for colleagues and employees through engagement, health campaigns and employee resource groups.

With my passion for preventative medicine, I have leveraged my public health skills and focused more on primary prevention which led to pursuing certification as a lifestyle physician through the International Board of Lifestyle Medicine, which has not only given me the credibility and confidence to be a more authentic clinician, but it has also help to give me a better focus in providing strategic oversight to the health & wellbeing

programme planning that I lead on (and continue to).

Any advice for clinicians or other health professionals looking to come into Occupational Health?

Making any change one’s career can be daunting, especially after specialising for many years in another medical field, however it is important that you do your “research” into how you can apply your existing knowledge, skills and expertise into any new field of medicine being considered and weigh ALL your options. There are potentially many “routes” you can take within Occupational Health once you qualify as a specialist for example, in health surveillance, general “complex case” management or illhealth retirement assessments for those who cherish working in a clinic setting predominantly. There is also the option of going into more specialised areas like radiation, diving or aviation medicine for those who want to add more what they do within the clinical setting the world is essentially your oyster.

For those like me, who want to venture more into strategic clinical leadership encompassing policy and health services management or well-being programming, there are also many options with my public health background, I have been able to advance my career in clinical practice initially for my first six years after becoming a Consultant in Occupational Medicine and move into a more leadership working role within the commercial sector before taking up a “chance” opportunity in the corporate sector

including in Oil and Gas (yes, physicians can get head-hunted too!) and have since found “my home” and not looked back!

It has also been very important for me to give back to my profession by developing others and mentoring young professionals just starting out (or considering similar career options). That is why I am a Clinical Appraiser –again, something to consider and take advantage of as you grow in your career!

What 3 key lessons have you learnt …. so far?

1. Self-care is important : it is important you take time to take care of yourself!

2. Networking is key - both within and outside the field of Occupational Health – as they can lead to “chance” opportunities!

3. Be curious but try and focus on adding “value” to what you already have!

So, what’s next?

My passion for primary prevention and health & well-being has become my “niche” expertise area as I continue my career in Occupational Health and has informed how I have been able to flourish in my current role in clinical leadership. Becoming a certified Lifestyle Medicine physician has helped to further hone my preventative medicine and health & well-being “programming” skills, but there is so much more to do!

As a strong advocate for tackling health inequalities within Workplace Health, I see my current role as a great opportunity to promote physical and

mental health and well-being at work through collaboration and effective partnership working which I continue to instil into my approach to work and I hope to do more research in this area and hence, look forward to pursuing that further in the near future.

Finally, I have been both fortunate and truly blessed to have such a unique career in Occupational Health and can honestly say that I love what I do! If anyone had an opportunity to make a difference integrating their skills and passion to help others on a daily basis, I am sure they would say the same!

Progression –A career in OH series

Part 3

My Occupational Health Journey

By Stephanie Foster

To support the government’s drive to increase access to Occupational Health (OH) we need to grow the OH workforce (Gov.UK, 2023). An obstacle to achieving this, as Norrie. et al. (2024) highlighted, is that clinicians do not know enough about the OH career opportunities that are available. So, in response, I have been asked to share my journey from novice to leader. As you will see, it is not necessarily a linear progression, but each role has taught me something important. To highlight, for those who might not know, OH services can be managed internally (in-house) by the employer or externally by a contracted provider. My journey includes an experience of both.

My first exposure to OH, as it is for most nurses, was my vaccination check on starting training. Granted, I qualified over 30 years ago, but I do not remember OH being discussed much during lectures. However, I was fortunate to have a community placement with an enlightened District Nurse. She arranged for me to spend a morning with the University’s Occupational Health Nurse (OHN). She introduced me to the concept of hazards and her role in reducing the risk of work associated ill health. She achieved this through a combination of health surveillance, education and advising management. The experience raised my awareness of OH and helped me to decide to specialise in it.

Like many, I faced the problem that you need experience in OH to get your first job, and a job to get that experience. My opportunity came with the offer of a training post with Boots the Chemist. At the time, the in-house OH department was led by an OH physician with the support of a team of experienced OHNs. The service covered, research facilities, head office operations, production, warehousing, distribution, as well as the shops. The role exposed me to much of the remit of OH providing me with a solid foundation. This included immunisation for travel health, health surveillance, Display Screen Equipment (DSE) assessments, fitness for role medicals and management referrals with report writing. I also had the opportunity to get involved with health promotion events and contingency planning for pandemics. The latter coming into use shortly after with the emergence of swine flu. A highlight of my experience at Boots was the

opportunity to visit a variety of workplaces and have a go at different jobs. They had a policy of head office staff helping to get the stores ready for Christmas. Working on the shop floor and serving customers gave me a great insight when it came to management referrals. Nothing beats real-life experience.

My fellow OHNs at Boots introduced me to the Nottinghamshire OH Group (NOHG). This was an opportunity to network and share best practice with clinicians who supported a variety of different industries. The group taught me that not only do we specialise in occupational medicine, but in understanding the specific job demands, hazards, challenges, legislation, and guidance associated with different sectors. I learned the value of the “Hive mind” and that in OH, asking for advice is a positive thing. We cannot know everything, so being able to research and connect with the wider community of practice is essential for our professional development.

To broaden my experience of different sectors I moved to a medium-sized OH provider. I provided services at three food manufacturing sites, requiring travel of up to an hour. The customer employed their own Occupational Health Technicians (OHT) whose work required my sign off. The experience was an interesting one, if not for all the right reasons. I moved from a model where OH was a strategic partner to one which felt more transactional. The stakeholders did not understand the value of OH, they perceived that they were the experts and were not prepared to engage with advice. This plus having no influence over the OHTs professional practice, felt like my registration was at

risk. Consequently, I did not stay long. While I gained food industry experience, more crucially, I learned the value of involving clinicians in setting up a contract to help manage customer expectations.

To try and gain the strategic partnership and influence I felt was missing in the last role, my next job was in-house. I was employed directly by a food manufacturer serving three different sites, again requiring travel. I worked as the senior OH clinician supported by an OHT and an outsourced Occupational Health Physician (OHP) when needed. My amazing OHT was an ex-midwife who understood vicarious liability and was a dream to work with. I provided data on service use and sickness absence trends to the Senior Management Team (SMT), using this information to inform and support a wellbeing programme. Part of this programme included a stopsmoking service I ran in partnership with the local NHS.

On reflection, I would consider this my intermediate stage of experience. While I delivered all the above to a reasonable standard, there was room for improvement. At the time I did not know what it was that I did not know. I was at a phase in development where it is easy to overestimate your ability, which makes having access to clinical supervision / mentoring essential. NOHG, the UK Occupational Health Practitioners Facebook group, and networking with other OHNs working in the food industry fulfilled this role for me. However, as my knowledge developed, I recognised areas where I needed to grow. I began to miss having access to clinical governance and the support of other clinicians. When there was a change in leadership, my

involvement with the SMT stakeholders was reduced and the focus on health and safety changed. I learned that the culture of a business really does come from the top down. I decided it was time to change roles and continue my professional development elsewhere.

Next, I worked remotely for a large OH provider, with regular onsite visits to their national and public sector clients. The ten telephone cases per day were higher than in my earlier experience. This, combined with a strong focus on customer service, helped me hone my consultation technique and report writing skills. Regular audits of my work and a supportive clinical manager helped my growth. While I had already completed a postgraduate OH course, I decided it was time to study for a SCHPN-OH qualification. While I completed my degree, I did not gain the desired NMC (Nursing and Midwifery Council) part 3 registration. Unfortunately, problems accessing a practice teacher combined with bereavement t prevented this. As I took on a caring role at this time, I chose to become an associate (the OH equivalent of bank work). For the next few years, I had what is called a portfolio career. A mixture of associate and temporary part -time contracts for different providers. Although this gave me greater control of my workload and hours, the disadvantage of this was that work was not guaranteed.

During a lean period when work had dried up, I was offered a permanent role with a provider I had been working with. Their business was growing, and they offered me a senior role, with a mixture of clinical governance, account management, and clinical work. Not managing a team meant I could act as an

independent manager dealing with complaints etc. This provided me with an introduction to people management and a whole new set of skills.

The pandemic and furlough led to my decision to move on. I joined PAM, supporting an ambulance service as they negotiated the impact of COVID 19. However, when a role as a clinical trainer with PAM Academy became vacant, I seized the opportunity with both hands. I wanted my teaching practice to be as evidenced-based as my nursing, so PAM sponsored me to study for a Post Graduate Certificate in Higher Education (PGCHE). This helped me to design training that takes into consideration how students learn, rather than just focusing on knowledge. I am passionate about supporting students, encouraging them to accept they will not always get it right but having the courage to try anyway. Mistakes are after all important learning opportunities.

I hope I have demonstrated how reflection has shaped my development. Recent reflection on my role in resolving the OH skills shortage has highlighted my own skills and knowledge gap. Specifically, around workforce planning, including influencing stakeholder engagement and the role of data analytics. I do not like not-knowing and am always striving to improve. So, with the support of my employer, I am studying again, this time a CIPD strategic learning and development course.

By developing training and becoming an examiner for the FOM (Faculty of Occupational Medicine) Diploma in Occupational Health Practice, I now realise how unique our skill set is. Skills that are not readily obvious to others outside our specialism. They only see the tip of the Iceberg in the advice we offer, not the broad foundation needed to inform it. Nurses make up the majority of the OH workforce, but our expertise is often underutilised by our customers and even our employers.

I would argue that senior OHNs need to be able to build relationships with our customers that go beyond the transactional. By engaging and offering leadership in health and wellbeing we can support them to make meaningful change. Adding significant value to business and society by impacting the wider social determinants of health. I am playing my part to advocate for this by being a board member of the Faculty of Occupational Health Nurses (FOHN). Trying to support their role in ensuring the OHN’s expert voice is heard by key stakeholders when developing national policy and regulation. I am also involved in their accreditation scheme, which benchmarks an individual’s practice against a career framework from entrylevel to advanced practice (FOHN 2023).

Rather than being a linear career progression, each of my roles has given me scope to explore new elements of OH and build on my knowledge. I have been able to focus on different industries and their different hazards and job demands. I have experienced different models of OH service delivery, with their strengths and weaknesses. I have journeyed from being a novice practitioner to striving towards professional leadership with the support of the OH Community of

Practice. I hope my passion for OH will also support future Occupational Health Nurse leaders to take our specialism from strength to strength.

References

GOV.UK. (2023) Occupational health: working better Available at: https://www.gov.uk/ government/consultations/occupational-health-working-better/occupational-healthworking-better (Accessed: 27 May 2024).

Norrie, C. et al. (2024) Exploring the awareness and attractiveness of Occupational Health (Oh) careers. London: NIHR Policy Research Unit in Health and Social Care Workforce, The Policy Institute, King’s College London.

FOHN (2023) ‘Overview | fohn accreditation’ Available at: https:// accreditation.fohn.org.uk/overview/ (Accessed: 18 June 2024).

Stephanie Foster | Linkedin

Stephanie has been working in Occupational Health for 17 years and as a training and development manager for PAM Academy.

She is a member of the FOHN board and an examiner for the FOM’s Diploma in Occupational Health Practice. She has a keen interest in supporting OH Education.

Stephanie is currently studying a level 7 CIPD qualification in strategic learning and development.

Celebrating Over a Decade of Excellence: Occupational Health Staffing

Occupational Health Staffing stands as one of the UK's longest-established occupational health agencies, having made its mark in the industry since 2010. Our commitment to excellence and expertise in placing occupational health professionals has made us a trusted name across the nation. With a legacy of delivering quality and reliable services, we specialise in the placement of permanent, temporary, contract, and ad-hoc occupational health professionals, catering to the diverse needs of our clients and candidates.

Unparalleled Expertise and Knowledge

Our recruitment team has been embedded in the occupational health industry since 2003, providing us with over two decades of invaluable experience. We firmly believe that to excel in OH recruitment, one must possess an intimate understanding of the market, clients, and candidates. This philosophy is at the heart of our operations and distinguishes us from other agencies. Our in-depth market knowledge allows us to offer unparalleled insights and solutions, ensuring that both our clients and candidates achieve their goals.

A Reputation Built on Success

Occupational Health Staffing thrives on its stellar reputation within the occupational health industry. Our success is not measured merely by numbers but by the trust and recommendations we receive from our candidates and clients. Our dedication to hard work and our consistent ability to fill roles and place candidates successfully has earned us a high level of respect and loyalty. We operate as a crucial link between employers and qualified professionals, employing strategic recruitment practices, thorough candidate evaluations, and tailored placement strategies to meet the specific needs of every client and candidate.

Comprehensive Support for Candidates

Are you seeking a new opportunity in the occupational health sector? At Occupational Health Staffing, we provide comprehensive support to help you succeed. Our services include professional CV creation and meticulous interview preparation, ensuring you present your best self to potential employers. With our support, you can navigate the job market with confidence and find the perfect role that matches your skills and aspirations.

Tailored Solutions for Employers

Finding the right talent can be a daunting task, but with Occupational Health Staffing, it doesn't have to be. We offer cost-effective and tailored recruitment solutions designed to meet your specific needs. Whether you are

looking for a permanent addition to your team or need temporary cover, we have the expertise to find the perfect match for your organisation. Our strategic approach ensures that you receive the best candidates, saving you time and resources while enhancing your workforce.

Join Us in Shaping the Future of Occupational Health

As we continue to grow and evolve, we invite you to be a part of our journey. Whether you are a candidate looking for your next career move or an employer seeking top-tier talent, Occupational Health Staffing is here to support you every step of the way. Together, we can shape the future of the occupational health industry, one successful placement at a time.

For more information, visit our website or contact our team today. Let Occupational Health Staffing help you achieve your professional goals and take your career or organisation to new heights.

Email: enquiries@ohstaffing.co.uk

Tel: 020 8952 6278

Web: www.ohstaffing.co.uk

The Interview

Feature Interview with Elaine Kerr

By Lynn Pratt, iOH President

I had the pleasure of catching up with Elaine Kerr, Clinical Performance Manager at Kays Medical to find out more about her OH career.

What’s your background?

I began my nursing career at Stirling University aged 17. Looking back now I was very young! I qualified at 20 and at the time, there were very few staff nurse positions, but I was lucky enough to do bank shifts in A&E at what was Stirling Royal Infirmary. I worked in A&E for several years; however, following a family illness began looking for a 9-5 job to help with caring responsibilities. I began working for a private company completing functional assessments which gave me the chance to learn key skills in taking a robust clinical and functional history and report writing.

How did you get into OH?

The company I worked for was owned by a larger company which also managed an occupational health provider. On a whim, I decided to apply internally to join the OH provider. I travelled down to Manchester, extremely nervous and much to my surprise was successful in gaining a post within OH. I underwent intense training and returned home to begin my career as a remote case manager in OH. I thoroughly enjoyed my role and learned so much from my colleagues and senior OH staff. I was lucky enough to successfully gain a clinical lead position within a year of

beginning my OH journey. Following several changes within the company, I decided to move to another OH provider Kays Medical Ltd, and this is where I work now. I now manage a team of 8 nurses. What is your educational background?

I completed my BSc in adult nursing in 2010 and was out of education for a long time, however in 2022 with the support of my employer began the Robert Gordon University (RGU) BSc in Occupational Health. I completed my course in May 2024 and await graduation which should be in December 2024.

What were the key elements of the RGU course which you feel will be most beneficial?

The RGU course has been extremely helpful in developing my skills in multiple areas of OH. The course covers mental health, health surveillance, leadership, absence management and health promotion, to name a few. The module I found most beneficial was the leadership module and has really helped me in my new role as a clinical team manager. It helped me understand the type of leader I am and how to get the best out of the team.

I learned that as an occupational health clinical team manager, driving partnership working and providing effective leadership within OH requires a combination of leadership skills. The leadership module helped me develop my communication and active listening skills as a leader to support and encourage those around me.

It must have been tough working full time as well as studying? How did you cope with it all?

It was very tough; the course was intense and finding time to study was challenging. I was extremely lucky in that my employer gave me study time each week. Working full time is hard, however, I work consolidated hours and take each Wednesday

off, which helped. The course is very well structured, to allow you to work through the modules consolidating your learning at the end of each module by producing an assignment.

Did you have any challenges during the way?

Unfortunately, in the middle of my course, I also became unwell and spent a month in hospital and was absent from work and University for 3 months. With the support of my RGU lecturers, manager, colleagues, family and friends I was able to catch up, but this was challenging. The time out helped me to structure learning and study time around spending time on myself.

This must have been hard for you with multiple demands?

Absolutely, but I am lucky to have a static holiday home and ensured that every second weekend or so I went away with my husband and our dog to take some time out with long walks by the seaside to clear my head. I also like to use my exercise bike as a way of de-stressing. My advice to anyone doing any study while working is to plan out study, work and personal time ensuring that you do take breaks and do not become overwhelmed by it all.

What would your normal day look like in your role?

To be honest, I don’t really have a normal day! My days are extremely varied, which is what I love about OH. No two days are the same, and no two employees are the same. I work from 8am until 630pm Monday, Tuesday and Thursday and 8am to 6pm on a Friday. I usually start the day with a large coffee and read through any emails I've received. I undertake a combination of management duties and also OH work, including management referrals, clinical queries, pre-placement questionnaires and BFE (body fluid exposure) calls. I try to ensure that I keep on top of any pre-placement questionnaires to ensure my team feel supported. I attend quite a lot of meetings, usually with our management team or with clients several times per week.

I support a team of eight nurses, which includes mostly remote case managers and also two nurses who work onsite within a factory and a laboratory. I also like to check in with my team and have a weekly clinical team meeting on a Tuesday morning via Teams. This is to discuss any challenging cases, share any up-to-date clinical guidance and generally have a chat. I find this really helps keep the team, who are largely all remote connected. I am available throughout the day to pick up any work and to support my team with any queries. I also respond to any clinical queries from managers and develop SOPs and any training material. I have a rescue dog called Ferry, he is from Cyprus and is very high-energy, so always take him for a walk at lunch, even on the busiest of days. Ferry likes to make an appearance while I am on teams and is fondly known as my office manager!

What

emerging OH

risks do you see that may impact OH over the next

decade?

I think one emerging risk would be the development of AI. While technology can help improve workplaces, I worry about the risk to jobs with the introduction of technology such as humanoid robots and AI systems undertaking tasks, that were previously completed by employees. Now that we so heavily rely on technology, those who never worked with computers or tech may need to learn a whole host of new skills which some employees may find unnerving and daunting. Additionally, workplace stress is an increasing problem which appears to come up in a large percentage of our OH referrals.

With the changes in technology, competition, and pace of life it appears work stress is on the increase. Unfortunately, as changes keep coming to working life, I see more and more work stress cases emerging. I hope that workplaces will use OH services to help manage and improve this for their employees.

For anyone thinking of moving into OH, where would you advise them to start?

Firstly, do your research. There are so many avenues within OH that you can take, whether that be remote case management, health surveillance or onsite. I would look at joining a company that will support a new OH nurse and provide them with robust training and support. There is a great Facebook page which is run by OH nurses with lots of members, I would recommend joining this as other members can provide lots of valuable information about interviews, what skills are needed and where to look for jobs.

I would also highly recommend looking at a course such as the RGU BSc in Occupational Health. This course gives you an overview of all aspects of OH and builds skills and knowledge within each area, giving you a foundation to build your career on. I would also advocate joining iOH as this gives you access to journals and webinars and to develop networking with other OH colleagues. I love being an OH nurse, and I hope that we continue to grow, and more companies begin to realise the benefit that OH can bring to their workplace.

Visit the iOH website for more webinars