OH Today Volume 30 Issue 3 - 2023

Health Psychology Highlights from EOPH Conference | Ethical Dilemma Structure of OH Team | Prehabilitation Concussion Rehabilitation | Making Spirometry Work

Partners of OH Today

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OH TODAY

Volume 30 Issue 3

CONTENTS

Editor LYNN PRATT Assistant Editor JANET O’NEILL

From the President

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Health Psychology in Occupational Health: What is it and how can it help?

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Highlights and takeaways from the EOPH conference for all OH professionals

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Ethical Dilemma

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How to structure an Occupational Health Team : An Anglian Water Case Study

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The importance of prehabilitation for patients undergoing cancer treatment.

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Rehabilitation strategies after concussion

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Making spirometry work for you: Helping to achieve high quality spirometry results every time

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iOH News

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Production Editor IAN GARNER

Copyright © iOH 2023 Registered Charity No. 1205635 Published by iOH, The Association of Occupational Health and Wellbeing Professionals

ioh.org.uk

email: admin@ioh.org.uk

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

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

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From the President Lynn Pratt

W

IOH Achieves Charity Status e are thrilled to announce

The iOH annual Ruth Alston Memorial

that iOH, The Association

Lecture and Gala Dinner will take place

of Occupational Health and

at The Birmingham Hilton Metropole

Wellbeing Professionals, has been

Hotel on Tuesday, March 12th, 2024, at

awarded charity status as a charitable

7pm. This follows day 1 of the Health

incorporated organisation (CIO). This is

and Wellbeing at Work conference held

a significant milestone for our

at the NEC.

organisation.

The Ruth Alston Memorial Lecture will

As a charity, iOH will be able to enjoy

be given by Professor Neil Greenberg on

several benefits, including tax

the topic of “Creating a psychologically

exemptions, access to funding

resilient workplace – lessons from the

opportunities, and increased credibility.

military”.

We believe that this new status will enable us to better serve our members and the wider community.

The objects of the CIO are: For the public benefit, the advancement of public health, particularly workplace health, by: 1. Providing or assisting in the provision of professional knowledge, skills, and experience for occupational health practitioners.

2. Promoting good practice among occupational health practitioners.

Neil is a consultant academic, occupational and forensic psychiatrist based at King’s College London. He

served in the United Kingdom Armed Forces for more than 23 years and has deployed, as a psychiatrist and researcher, to a number of hostile environments including Afghanistan and Iraq.

We are pleased to offer iOH members a discounted rate of £45 which includes pre-drinks, a 3-course meal, and wine.

Additional tickets can be purchased for any non-member colleagues or friends

iOH are delighted to be partnering again

you would like to bring along at £58.

with the Health & Wellbeing at Work

Numbers are limited so BOOK NOW. It

Conference taking place on the 12th &

would be lovely to see you all for this

13th March 2024 at the NEC. iOH

relaxing night with fabulous food and

members can save 10% on tickets and a

drinks, networking, and fun!

limited Early Bird rate is now active in

For now, wishing you all a relaxing

addition. To save use this code IOHSAVE10 and this link only https:// healthwellbeingwork-2024.reg.buzz/ioh

festive season and look forward to continuing our work with you as a registered charity in 2023.

Lynn Pratt, President iOH

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

2024 Ruth Alston Memorial Lecture & Gala Dinner 12th March 2024 at 7pm Hilton Birmingham Metropole Hotel, NEC

The Ruth Alston Memorial Lecture will be delivered by :

Professor Neil Greenberg The title of the Lecture will be:

Creating a psychologically resilient workplace – lessons from the military

Professor Neil Greenberg is a consultant academic, occupational and forensic psychiatrist based at King’s College London. Neil served in the United Kingdom Armed Forces for more than 23 years and has deployed, as a psychiatrist and researcher, to a number of hostile environments including Afghanistan and Iraq.

Event open to Members/Non-members Join the iOH Event details can be found on the iOH Website Tickets are limited and available at Eventbrite discount for members

Health Psychology in Occupational Health: What is it and how can it help?

By Dr Julie Denning

I

always knew that I wanted to be a

pay the rent and so was a jobbing researcher /

psychologist, since observing an

Lecturer / PhD student for 6 years. My real

educational psychologist on a work

break, although I didn’t realise it at the time

placement when I was 17 and seeing the

was when an occupational health physician

difference it made to children’s and their

contacted me out of the blue. He and his

parents’ lives, it was what I wanted to do. I

colleague, an occupational health

didn’t stick with educational psychology, I

physiotherapist, were trying to solve their

didn’t want to teach (you had to, way back

mystery of how to help a small but significant

when) and this became a barrier. Instead, I

group of patients experiencing persistent pain

opted for Health Psychology. I loved it. The

who weren’t recovering using traditional

MSc was interesting; my research thesis

physiotherapy approaches. They knew they

investigated condom use behaviours in

needed some psychological input, and it

teenagers at an FE college. As a shy 21-year-

turned out that I was their Gal. I know now

old, this was a bit of a challenge as most of

that this was my first role as a health

the students were only a few years younger

psychologist in occupational health.

than me! My PhD was a baptism of fire and took me longer than expected as I needed to

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But let’s rewind a bit. What is a health psychologist?

I am more often than not introduced as a clinical psychologist, even after stating my health psychologist status. This is as frustrating as being called Julia when my name is Julie. Same derivative but very different. So, for clarity here is the definition of health psychology as outlined by the British Psychological Society:

The goal of health psychology is to study the psychological processes underlying health, illness and health care, and to apply these findings to the promotion and maintenance of health, the analysis and improvement of the health care system and health policy formation, the prevention of illness and disability, and the enhancement of outcomes for those who are ill or disabled. (https://www.bps.org.uk/member-networks/division-health-psychology)

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What is interesting for me is when this descriptor is crossreferenced with ACAS’s explanation of occupational health: An employer might want to use occupational health to help: • • •

when an employee is struggling with their physical or mental health make the right reasonable adjustments for disabled people at work when an employee has been off sick for a long time or is returning to work after sickness absence

•

reduce the amount of time people need to take off sick

• •

keep to other health and safety regulations control risks to mental health, such as too much pressure at work, bullying and harassment Occupational health could be through the employer's occupational health service or an outside agency.

•

(https://www.acas.org.uk/using-occupational-health-at-work)

Health psychologists are very well placed to support occupational health providers in developing health and wellbeing interventions.

Health Psychologists are here to study

well as the design and delivery of

the processes underlying health illness

interventions to change

and healthcare to enhance outcomes for

health behaviours. Classic examples

those who are ill and disabled and

include helping people to eat a balanced

occupational health helps employees

diet, take regular physical activity or

struggling with their physical or mental

stop smoking. We use behaviour change

health.

models and theory to help formulate our

Health psychology can be directly applied to help occupational health achieve its goals. This is what I have been doing now for the past 23 years in my role as a health psychologist working within occupational health and vocational rehabilitation. Let me explain from four different perspectives: 1)

wellbeing, 2) absence management, 3) OH staff support, 4) OH departmental support.

Wellbeing: Health psychologists are very well placed to support occupational health providers in developing health and wellbeing interventions. We are trained in research methods and data analysis as

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thinking and create an underpinning and framework for the interventions that we design. We are data-driven as a profession, both quantitively and qualitative and will always be focused on evaluating what we design to ensure that it is fit for purpose and that it works. In my career, I have developed many an intervention and services for employees, and I have been dogged about collecting the best data I can in a real work research setting. This isn’t always easy I might add and challenges my PhD training!

Absence management: Health psychologists are well versed in supporting people to manage their

illness whether it be pain, fatigue,

meaningful conversations with their

adjustment, fears about symptoms

patients to truly understand their

recurring or flaring up and coping. We

perspective and thereby enable them to

are trained on individual differences and

achieve improved health outcomes. I will

automatically therefore take an

never tire of training in the

individualized and holistic approach to

biopsychosocial approach and still, all

our understanding of health behaviours.

these years later, marvel at how most

We have numerous models we can draw

clinicians avoid asking questions about

upon. For those of you who are nerds

emotions. I still have never had an

like me, check out the illness

answer to my question ‘What are you

representations model (Leventhal et al

most afraid of when asking about

1991), the stages of change model

mood?’ My hunch is fear of enabling

(Prochaska and DiClemente, 1982), the

suicidal action. In my experience to

theory of planned behaviour (Ajzen

date, I am more concerned when people

1991), or if you’re feeling it, head over to

don’t tell me about their emotions than

the COM-B Model (Michie et al 2011).

when they do. Upskilling clinicians has

All these help us to understand what

been one of the most rewarding

factors we need to take into

elements of my career as a health

consideration when helping someone

psychologist. So often a patient doesn’t

who is struggling with their symptoms

need a psychologist, rather they need,

to self-manage and improve their

say, an upskilled physiotherapist who is

quality of life. Implicit in this (and

comfortable exploring (all) the elements

something I am working on to make

of the biopsychosocial model to

explicit as my role as Chair of the

facilitate behaviour change and in many

Vocational Rehabilitation Association) is

cases make a huge difference to

the role of work as a health outcome and

someone’s life.

putting that at the heart of interventions to reduce sickness

OH department:

absence. This is a work in progress:

Health psychologists can also support

watch this space. In any case, a health

OH at a departmental level helping them

psychologist can help you to unpick your

to better understand the health status

reasons for sickness absence on many

and general wellbeing of their

levels and will provide you with helpful

employer’s workforce. They can help

solutions.

with wellbeing surveys, analysis of big

OH Staff:

organizational health data,

implementation of tools such as the HSE

I have consistently delivered training

management tools, wellbeing policy

supporting allied health professionals,

design and strategy development. In

nurses, intercalated medical students

response to findings, they can design

and even trainee psychiatrists on how to

initiatives to help the whole group as

apply psychological theory to improve

well as the individual with, for example,

health outcomes. I have done this

targeting wellbeing initiatives.

through training, mentoring and supervision and upskilling health professionals in having more

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I am sure that there are many other ways that health psychologists can help OH and I am always happy to have

my brain picked, so I welcome conversation and discussion on this. We are a yet untapped profession that could be just what is needed to help OH. Just as I did all those years ago on my first OH gig.

I hope this article has helped go a little way to your understanding and you will now be able to say... ‘you’ll need a health psychologist to help you with that…’

References: Ajzen, I. (1991). The Theory of Planned Behavior. Organizational Behavior and Human Decision Processes, 50, 179-211.

Leventhal, H., Benyamini, Y., Brownlee, S., Diefenbach, M., Leventhal, E. A., Patrick-Miller, L., & Robitaille, C. (1997). Illness representations: Theoretical foundations. In K. J. Petrie & J. A. Weinman (Ed.), Perceptions of health and illness: Current research and applications (pp. 19–45). Harwood Academic Publishers.

Prochaska, J. O., & DiClemente, C. C. (1982). Transtheoretical therapy: Toward a more integrative model of change.

Susan Michie,

1 Maartje M van Stralen,2 and Robert West3 The behaviour change wheel: A new method for

characterising and designing behaviour change interventions. Implement Sci. 2011; 6: 42.

Dr Julia Denning | Linkedin Dr Julie Denning, CPsychol (Health) Managing Director Working to Wellbeing Supporting people back to work Chair, Vocational Rehabilitation Association 2021 VRA Winner

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Highlights and takeaways from the EOPH conference for all OH professionals

I

n early November a gathering of occupational health delegates attended the first EOPH conference in Guildford. You may have heard of EOPH, we are a social enterprise whose aim is to support the professional development needs of occupational health professionals. Our thought leading speakers covered a broad range of topics of interest to the profession. For those who missed the event - or those that want a summary of content - we trust this article will be of interest.

AI and Emerging Technologies in Occupational Medicine Dr Paul Williams covered this game changing topic for occupational health. AI is going to have a pivotal role in

how the patient services of the future will be delivered and how our practices are run. The insights shared, especially the eye-opening statistics on the adoption of online services, fueled meaningful reflections on the changes we are already witnessing. For example, while Netflix took 3.5 years to reach 1 million users, Chat GPT took just 5 days!

Paul encouraged us to explore how best we can embrace the change to drive positive outcomes in occupational medicine. This could come in the involvement of AI in OH practitioner tasks, such as reviewing audiograms, spirometry, looking for trends in surveillance data and the auto writing of reports. Paul closed with the question ‘will machines replace people’? Of course, OH is a people focused profession, but his opinion was that people who are comfortable with machines will replace people who are not. So, as a starting point, why not download and get familiar with Chat-GPT?

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What should Audiometry Health Surveillance look like for the 21st Century?

Talking

Dr Finola Ryan and Neil Court of Amplivox covered the significance of audiometric examinations,

Stress & M

both objective and subjective, in occupational health surveillance. Objective tests such as OAE, ABR,

This sessio

received in

and Middle Ear measures were explored for their use in occupational assessments, as were subjective

provided th

tests such as Air Conduction (AC), Bone Conduction (BC), Speech, REM measures, and VNG

Her passion

measurements. They also covered the significance of obtaining consistent and accurate AC test

and suppor

results, as well as the 2021 HSE guideline revisions that aim to ensure a healthier workforce.

of addressi

The presentation concluded with a recommendation for delegates to familiarise themselves with the

and allowin

latest 2021 HSE guideline revisions and industry best practices in audiometric examinations. And, to

through su

explore innovative methods and technologies, integrating them into practice to enhance accuracy and

Anyone int

efficiency in hearing health assessments. We are grateful to Neil and Amplivox for the insightful

Mental Hea

discussions that closed this session.

bookwhen.

Challenging Employment Law Scenarios for OH Practitioners

Clean Language & First Response

Employment Law specialist Mark Landon focused on

focus on neurologically diverse individuals. Clean Langu

implementing reasonable adjustments in the workplace, in the context of some common challenging scenarios.

Dominic Keohane from Innate Change enlightened dele

create connections in their minds that allow them to he

express values, and coping mechanisms for an individua

These included sick absence management and the ‘trigger

and solution focused responses.

points’ for warnings and the consideration of dismissal

Dominic introduced the 12 basic Clean Language questi

and performance management - including identifying where this might result from underlying health or disability. Mark also addressed the underlying medical conditions contributing to supposed misconduct - e.g. where ‘disruptive’ workplace behaviour results from neurodivergence.

Mark covered the interaction between management and

and emotional control. What truly stood out was his exp

communication and how Clean Language serves as a po

access their full potential. His presentation was highly i

they could apply Clean Language in their fields. The ses use within both Cordell Health and EOPH.

OH in managing these issues, advising a partnership

Ergonomics Principles of Complex

approach between the employer, employee and OH

Physiotherapist Sarah Nisar delivered an insightful pres

clinician, and that management need to be proactive in

seeking OH input on a timely basis. What’s more, in cases of sickness management, these are inevitably fact specific - so absences need to be properly recorded and that a culture of mutual trust and confidence would help managers and employees work in partnership. In addition, Mark stressed the importance of fairness in any performance management process.

application in future DSE assessments. Her engaging ta

Covering topics including physiology, biomechanics and

recommendations that stressed the importance of envir

understanding of the risk factors for musculoskeletal di

It was inspiring to witness fellow Occupational Health (

surface during ergonomic workplace assessments. Sarah the need for adherence to DSE regulation guidelines.

EOPH - future courses and 12

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Discover more about EOPH and health professionals - for occup

g about Suicide: the why and the how?

on was led by Independent Occupational Health Nurse Practitioner, Workplace Wellbeing Specialist and trainer in

Mental Health, Libby Morley-Hassanali. Anecdotal evidence shows that many OH professionals say that they have

nsufficient training on the subject of mental illness or how to complete a mental health consultation. Libby’s session

he basis to understand the skills needed and point us to many valuable resources.

n for breaking down the stigmas surrounding mental health was palpable, and her commitment to fostering a proactive

rtive workplace culture truly commendable. Libby's presentation left us with a greater understanding of the importance

ing mental health in our professional lives. One of her many tips was the importance of listening and reflecting back

ng silence in conversations. Likewise, to show empathy and hope and that with support, many people can work

uicidal thoughts and stay safe. It was good to see so many people asking questions on this important but sensitive topic.

terested in mental health may also benefit from this course, run by Libby in January: A Concise Guide to Supporting

alth in the Workplace for Occupational Health Practitioners. Click the link for more details and to book: https://

.com/eoph/e/ev-sx5y-20240117093000

egates with his presentation on Clean Language, with a particular

Work-related skin problems

uage was designed to help people explore their own issues and

Dr. Katrin Alden is an occupational

eal more readily. It can be used to discover the underlying rules,

al, and to gain clarity and promote awareness of self-actualisation

physician and speciality doctor in dermatology with interest in work-related skin problems. Covering many conditions

ions and how they are used to coach self-awareness, independence,

affecting the skin, particularly involving

ploration of metaphors that are evidently used in our everyday

hand health, Katrin used an immersive

owerful tool for unlocking experiences that empower individuals to

presenting style that resonated well with

interactive, with delegates discussing what they had learnt and how

our professional audience - particularly as

ssion provided us with some incredible techniques to take away and

‘Dr Google’ was banned from the session!

Katrin's collaborative approach brought case studies to life, sparking fantastic discussions and energising the entire room.

x Display Screen Equipment (DSE)

We are excited to announce an upcoming

sentation on the core principles of ergonomics and their practical

course, 'When Working Skin Stops

alk included impressive posture and workstation demonstrations.

d anthropometrics, Sarah concluded with workplace design

ronmental, psychosocial and organisational considerations and

isorders (MSDs).

(OH) professionals agree and share common factors that often

h used a number of case studies to illustrate her points, mentioning

Working', in the new year. This will be a

deep dive into managing work-related skin problems and risk assessment. If you're keen on joining Katrin for more insights on skin surveillance, click the link for more details and to book: https://bookwhen.com/ eoph/e/ev-sbbe-20240131090000.

d webinars

d the range of courses and webinars designed by occupational pational health professionals. https://eoph.co.uk/

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By Rachel Martin Occupational Health (OH) can be challenging. This is a case study, detailing a particular legal and ethical dilemma which occurred during a management referral consultation.

I

am an OH Nurse Advisor, undertaking

both the Health and Safety Executive (HSE)

management referral assessments and

and Local Authority Environment Health

providing a report to management,

Officers (HSE, 2010). There is a National Code

answering questions which include fitness to

that has been designed to guarantee that Local

work. “Jane”, a peripatetic sales

Authorities (LA) health and safety (H&S)

representative, was referred following a

regulators take a more consistent and

pulmonary embolism (PE). During the OH

proportionate approach to enforcement of HSE

assessment, she had stated she had

(2013). Whilst the primary responsibility for

experienced fainting episodes (syncope), a

managing health and safety risks lies with the

sudden disabling event, which her employer

business that creates the risk, LA H&S

was unaware of. Jane’s role required her to

regulators have an important role in ensuring

drive on company business. My role was to

the effective and proportionate management

ascertain whether she had been advised to

of risks, supporting businesses, protecting

inform the Driver and Vehicle Licencing

their communities, and contributing to a wider

Agency (DVLA). She hadn’t, which caused a

public health agenda.

legal and ethical issue for her and her employer, but also, due to the NMC code of conduct, for me as a registered nurse.

Managing risks in the workplace is the responsibility of both Jane and her employer.

Employers are obliged by legislation,

A peripatetic worker is someone who works in

(HASWA,1974) to undertake health and safety

a variety of contexts ACAS (2021), usually

risk assessments, matched to the nature of the

away from their base. They are governed by

duties and to assess the risks to those who are

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not employed i.e. the general public (MHSWR

produced clear guidance regarding the risk,

(1999). Therefore the employer is responsible

which I matched to the history provided. They

for considering not only Jane’s health and

hold responsibility for assessing an

safety but also anyone else who may be

individual’s ability and safety to drive (Poole

harmed if she continues to drive with a health

and Hardie, 2019). The driver is responsible for

risk. Alongside the employer's responsibility,

informing the Secretary of State whether they

legislation dictates that employees are held

are suffering or have suffered from any

accountable for their actions when at work.

prospective disability. An assessment of the

Therefore, if her employer knowingly allowed Jane to drive her car for work, they could face

driver’s physical fitness is governed by the Road Traffic Act (RTA) (1988).

legal action as they would not have taken all

During the consultation, I talked over my

reasonably practical steps to reduce the risk

concerns with Jane (TUC, 2009), advising that

(HASAW 1974). As Jane had not been advised

in my role, I needed to make a decision on her

she could not drive, and she had not disclosed

fitness for her role and the tasks within it,

the syncope to her employer, they would have

including driving. Within the DVLA guidance,

been unaware of the impact her peripatetic

it is identified that Doctors should advise

role would have on her safety and the safety of

individuals on the impact of their medical

others if they had not referred to OH or been

condition to ensure safe driving, which had

aware of the need for OH services.

not occurred in this instance, whilst treating,

The International Commission on Occupational Health (ICOH), 2014 states that OH provides worker and environmental health and safety in collaboration with others. OH is

designed to preserve and promote workers' health. The aim is to enable the working population to benefit from employment without putting their and others health in danger (Kloss, 2020; Everton et al, 2018; Tamin, 2020). OH promotes and protects workers' health whilst incorporating the work environment and any adaptations that may be required due to the workers' health ICOH (2014). HSE (1999) indicates that good health is good for business, and there is solid evidence to support this (Hill et al., 2007).

To provide context on the risk, in 2015 a Fatal Accident Inquiry was held relating to a workplace incident. An employee suffered a sudden neurocardiogenic syncope, resulting in the death of six pedestrians. This is an example of the risk of syncope. Any person who suffers from a medical condition likely to cause a sudden, disabling event whilst driving should not drive. The DVLA (2021) has

managing, and monitoring the individuals’ condition. Exposing employees and others to known risks can present an ethical dilemma, and I needed to be clear about the risks I deemed acceptable (Everton et al, 2018). It was evident Jane should not drive and to not advise her or employer of this would be an unacceptable risk. Jane was unhappy with this outcome which created tension within the consultation. This led to a difficult position as on one hand I had a duty to fulfil but on the other, I was causing distress. OH professionals, whilst subject to the law and relevant courts, are governed by ethical codes which may not always align with legal obligations. The ethical concern here was that Jane felt fit to drive and

was aggrieved by my strong recommendation to inform the DVLA, and morally I wished to support Jane. Tamin, 2020 tells us OH professionals may be required to provide advice that may not be well received by employees or employers.

As professionals, we are challenged daily with ethical dilemmas and moral challenges, therefore we need to be competent in such situations (Westerholm, 2009). Ethics are a ioh.org.uk

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As professionals, we are challenged daily with ethical dilemmas and moral challenges, therefore we need to be competent in such situations science based on morals encompassing correct

there is a risk of harm.

behaviour and standards of conduct (Aw,1997).

Individuals have the right to access their

As this was the first time I had been faced with this type of situation, I received support from my management team and peer group. This reinforced my decision-making and gave me confidence in addressing the situation.

records (Subject Access Request) as Jane was advised when she raised concerns over the

information I was documenting in her clinical records. Jane was signposted accordingly. OH Nurses have a duty within their NMC code of

As much as informing the DVLA was one

conduct to document robustly at the time of

difficult conversation, the other was informing

any appointment to have clear evidence of the

the employer. Confidentiality in the workplace

consultation and decision-making. OH reports

is protected by common law (Human Rights

require employee consent before being

Act 1998) as individuals have a right to a

released to the employer. However, OH

private life (Data Protection Act (DPA,2018).

Professions must act without consent if there

When breached, prosecution through civil

is a risk to individual or public safety NMC

courts (RCN, 2005) is possible alongside an

(2018) (Kloss, 2020). Jane was urged to inform

Information Commissioners Office (ICO)

the DVLA herself, which she eventually agreed

prosecution. Despite the information obtained

to, however, should she had not agreed to this,

and held from an OH assessment being the

I would have had to inform them myself.

property of the employer, under Common Law

The situation was challenging and I valued the

the information must remain confidential.

Information can only be shared with consent or when the interests of individuals and public safety override the need for confidentiality NMC (2018). OH must respect an individual’s right to privacy and confidentiality and should only share information with consent or when

wealth of support I received to help me navigate the consultation and the outcome.

However, this case has stayed vivid in my mind for the past three years and shaped the practitioner I am today. Through reflection on challenging situations, we can evolve as practitioners.

References Carter, T., Chang, R-W, Colvin, A. and HermJanes, R. (2019) ‘Transport’, in Hobson, J. and Smedley, J. (eds.)

Fitness for Work: The Medical Aspects. [6th Edition] Oxford: Oxford University Press.

Everton, S. (2018) ‘Health Surveillance’ in Thornbory, G. and Everton, S. (eds.) Contemporary Occupational Health Nursing: A Guide for Practitioners. [2nd Edition]. Oxford: Routledge.

Kloss, D. (2020) Occupational Health Law. [6th Edition] Oxford: Wiley Blackwell.

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Poole, J. and Hardie, R. (2019) ‘Neurological Disorders’, in Hobson, J. and Smedley, J. (eds.) Fitness for Work: The

Medical Aspects. [6th Edition] Oxford: Oxford University Press.

Poole, J. and Hardie, R. (2019) ‘Neurological Disorders’, in Hobson, J. and Smedley, J. (eds.) Fitness for Work: The Medical Aspects. [6th Edition] Oxford: Oxford University Press.

Rachel Martin | Linkedin Rachel Martin is an RGN, qualifying in 2007. She moved into Occupational Health 3 years ago, joining PAM OH with whom she has remained. She values the knowledge and skills gained within this time along with the support in obtaining her BSc in OH, for which gained a first. She is passionate about health promotion, empowerment and knowledge for employees and employers regarding the effects of work on health and health on work. Caring, compassionate and hardworking, she has three young children who keep her on her toes and she enjoys dog walks. Rachel is a strong believer that work is good for health!

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How to structure an Occupation An Anglian Water Case Study

By Jonathan Hill Introduction

I

t’s been fifteen years since Dame Carol Black’s landmark workplace health report ‘Working for a Healthier Tomorrow’,

highlighted the need to reconfigure OH due to uneven provision and inconsistent quality. This was later echoed by Ste

Knowing the perfect OH model for an organisation can be difficult. The ideal model will be one that allows the strengths o

challenges that geography imposes, and the team needs to be diverse enough to ensure the full range of expertise is avail determining factors that shape the structure of the OH team. With so many different organisations and limited access to Other questions also arise, should the OH team be internal, external or a mix? Where should it sit, under the Safety team company, Anglian Water.

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nal Health Team

, which raised the profile of Occupational Health (OH) and set a new vision for health and work in the UK. The report

eve Boorman who suggested the need for remodelling Occupational Health services.

of the team to be maximised and deployed efficiently. An Occupational Health Department (OHD) needs to mitigate

lable within the OH field. The size of an organisation, the type of industry and the culture of the organisation will be OH this can lead to a lack of standardisation across OHDs. or HR or stand alone? This short case study will give insight into the structure and functions of a OHD within Utility

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Anglian Water Anglian Water is the largest UK water company by geographic area, stretching

from Hartlepool to Southend. It employs over 5,000 direct employees. Around half are office based and the other half are operational. The organisation has three core business units, Water Services (the water that comes out of taps), Water Recycling (wastewater that travels from toilets and drains to recycling centres), and Customer and Wholesale (billing and customer enquires). Many common OH concerns exist such as lone working,

shift working, driving and potential exposure to hazards such as noise and vibration.

OHD Team Structure To support the workforce in becoming Happier, Healthier and Safer, which is Anglian Water’s internal goal for its employees, different teams exist including safety, HR, Wellbeing, and Inclusion. Anglian Water currently use the below team structure for their OH function.

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The OH team reports into Anglian

management. This allows diversity

Water’s ‘People Team’ commonly

within the team and increases the scope

referred to as HR. They operate as an

of Anglian Water’s internal OH

internal function with external

function.

contracts. Anglian Water has a diverse team and currently employees eight OH advisors, seven who have a background in nursing and one as an Occupational Therapist. A senior OH team leader coaches the OHAs. The department head; the Head of Occupational Health, who has a background in Physiotherapy.

This highlights how the traditional approach to Occupational Health has changed to become more multidisciplinary.

mental health conditions (Day 1) and musculoskeletal conditions (Day 3). Fit for assessments and health surveillance also takes place. In addition to this, the team accepts early management

referrals for prehabilitation for anyone who is due surgery. Health promotion also takes place in the form of ‘Know your number’s campaigns’ involving the

business units which has multiple

and BP levels using the make every

benefits including improved knowledge

contact count principle.

Governance

work within each business unit. In

To create an environment to allow an

addition to this, there is improved

OHD to flourish, the table below shows

stakeholder engagement and greater

the scope of activities at Anglian Water.

opportunities for active management

This supports governance and ensures

activities. Advisors are located across

clinical standards are met to allow for

the region, allowing for speedy

continuous improvements.

deployment for pre-placement medicals, health promotion and so on. However,

Teamwork

this can lead to issues associated with

Anglian Water’s OH team manages over

isolated working. Anglian Water

5,000 employees, therefore, working

mitigates this through regular team

collaboratively and closely with other

meetings, FIKA time (a Swedish coffee

departments (Safety, Wellbeing, legal,

break) and site visits.

HR, Leadership etc.) is valued. OH

Each OH Advisor will also have a

Advisors have a background in clinical

specialist area. These include topics which are relevant to the water industry and align with certain ‘management of’ processes such as the management of disease and hygiene, health surveillance, new and expectant mothers, DSE and manual handling.

Other areas of specialism include ergonomics, functional capacity evaluations and crisis trauma OH TODAY

reviews and early intervention calls for

measurement of glucose, cholesterol,

that exist and recommendations that

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complete management referrals,

Advisors are assigned to certain

of job roles, understanding the hazards

Occupational Health has changed to become more multidisciplinary

Like other departments, the team

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care. Project and stakeholder management, alongside writing policies is not something healthcare professionals commonly undertake.

However, when a wider team collaborates, the shared knowledge, diversity and added political power can achieve fantastic results. For the OHD to be successful, Anglian Water relies on teams working closely to achieve goals,

Event

Description

Frequency

Audits

Self-designed audit to encompass bioSix Audits every Six psychosocial approach. Completed internally by months for each advisor. our Senior Team Leader and externally by our Occupational Health Physician (Clinical Lead).

CPD Sessions

90 Minute recorded CPD sessions completed by Every eight weeks the Occupational Health Physician (Clinical Lead).

OH Internal Conference Annual in-house Occupational Health Once a year conference. This year included speakers from cardiology consultants, National School of Occupational Health and MSK specialists from other organisations such as BT. Clinical reasoning sessions

Opportunity to discuss the thought process of Every eight weeks complex case management with peers, guided by a Senior Occupational Health lead.

Training Matrix

Numerous training options, all Advisors have extended training such as SCPHN, Degrees, Masters, PhD.

As required

PDRs

All Advisors have similar objectives around decreasing sickness absence, increasing stakeholder engagement, policy review and increasing area of extended scope within OH

Yearly

Clinical supervision

Advisors will spend certain days with Senior OH As required lead

Active Management

All Advisors to attend operational sites to support understanding of workplace hazards and support recommendations

Horizon Scanning

Involves analysing the future and considering Monthly how emerging trends and developments might potentially affect Occupational Health in the Water Industry

As required

This table gives a high-level framework that helps the OHD demonstrate working knowledge into Anglian Water policies and practices.

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demonstrating the value of a truly integrated

plan. A clear purpose helps the rest of the

team. This was demonstrated when the OHD

organisation understand what the OHD’s

and safety team recently worked together to

responsibilities are.

ensure a rapid response to ensure ADR drivers had the appropriate medicals in place. Another example is when the OHD, Safety, Wellbeing and Inclusion teams put on an event in which 4,500 virtually attended. Named ‘Time Out for Life’ employees could listen to fantastic keynote speakers, practical tips, and guidance to build confidence in supporting yourself and your colleagues. This is now an annual virtual event to support your health, safety, and wellbeing. When teams coordinate and work together, it is far more powerful than a department trying to influence in isolation.

The advent of the recent Water UK Occupational Health group demonstrates team working. This group supports continuous improvement in standardisation within OH

Through continued professional development, team working and a structure which fits the organisations’ needs, success has been demonstrated with the recent achievement of ISO45003. Anglian Water was the first water company to achieve this certification, which recognises the important work we the company does to support our employee health and wellbeing.

Although there is no blueprint for guaranteed success, Anglian Water’s OHD demonstrates some of the key principles as suggested from the NHS health at Work network: • Clinically led and evidence-based service • An equitable and accessible service

companies across the water industry.

• Impartial, approachable, and receptive

External Contracts

• Contribute to improved organisational

Anglian Water’s OHD are also involved with

the account management of external contracts. For example, Alliance Health Group is Anglian Water’s private health scheme provider who offer numerous benefits including a virtual GP with direct referral to a range of consultants, self-referral to mental

productivity.

• Work in partnership with healthcare services • Underpinned by innovation.

• Offer diversity and depth of specialisation and training opportunities.

health and physiotherapy support. Through

This is an exciting time for the world of

strong relationships, they have worked

Occupational Health as government are

together to design bespoke programmes of

currently (at the time of writing) in

support including a 12-week COVID

consultation about tax incentives to

programme, a 12-week Get Active programme

encourage greater employer provision of

and Ossur Knee Bracing. The OHD also works

occupational health services. Occupational

with Mental Health At Work to provide

health services enhance employee health,

bespoke mental health awareness training to

workforce productivity, business performance

line managers, employee and unique courses

and therefore improve the economy. Despite it

to certain business units. The department also

being fifteen years since the ‘Working for a

manages Anglian Water’s Employee Assistance

Healthier Tomorrow’ report, we hope that by

Programme (EAP).

sharing examples from a range of organisations, we can improve OHD modelling

Strategy The OHD has a five-year plan which aligns to Anglian Water’s overarching five-year business

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across the board.

References The Future Configuration of NHS Occupational Health Services - Helen Kirk MA BSc (Hons) BA RGN RM SCPHN (OH) Occupational health_ the_value_proposition.pdf (som.org.uk)

Jonathan Hill | Linkedin Before becoming Head of Occupational Health Jonathan Hill spent time working for TFL, Welsh Government and Fit for Work. He started his career in professional sports as an athlete and then later as a sports physiotherapist. His time in professional sport has helped draw parallels between high performance athletes and employees and the importance in investing in employee health and wellbeing whilst using a biopsychosocial approach. He is currently a SOM mentor and ACPOHE Committee member and recently supported Anglian Water to become the first water company to achieve ISO45003.

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Cancer prehabilitation is a way of preparing patients prior to cancer treatments. Rucinska & Osowiecka (2022) state that, although prehabilitation is a vital part of the cancer pathway, it has only, in the last decade, gained momentum in the UK.

C

ancer prehabilitation is a way of preparing patients prior to cancer treatments. Rucinska & Osowiecka (2022) state that, although prehabilitation is a vital part of the cancer pathway, it has only, in the last decade, gained momentum in the UK.

It is estimated that, on average, someone is diagnosed with cancer every 90 seconds. There are three million people living with cancer, currently, in the UK. This figure is set to rise to four million by 2030 and to 5.3 million by 2040 (Macmillan Cancer Support 2022). A growing aging population, who is at higher risk of developing cancer, alongside, improvements in cancer diagnosis and its treatment, are some of the reasons behind this.

It was first recognised in the 1990s, that if surgical outcomes were to be improved, robust perioperative care was required, and this needed to be a vital component of surgical treatment. This was pioneered in colorectal surgery, through the development of a framework with the aim to optimise patients prior to surgery. This led to the Enhanced Recovery After Surgery (ERAS) protocol being developed (Durrand et al 2019). The protocol utilises the time between the patient’s first outpatient appointment to time to surgery to improve the patient’s fitness, nutrition, and emotional wellbeing, as well as addressing lifestyle factors such as smoking and alcohol consumption. The overall aim being to have the patient in the best position possible, prior to surgery, with the overall aim to aid recovery and to minimise post-surgical complications.

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Would you run a marathon without any training?

No, me neither!

The importance of prehabilitation for patients undergoing cancer treatment.

By Melanie Freedman

Treatments for cancer vary, they include surgery,

the time of (a) cancer diagnosis and the beginning

chemotherapy, radiotherapy, immunotherapy or a

of acute treatment. It includes physical and

combination of these, with the aim to control or

psychological assessments that establish a

cure the disease and to enhance the patient’s quality

baseline functional level, identifies impairments,

of life. None of these treatments are an easy

and provides targeted interventions that improve

undertaking and, in recent years, they have been

a patient’s health to reduce the incidence and

likened to running a marathon without any training.

severity of current and future impairments (Silver

You would not do this, yet, this is the expectation

2015).

we have of our cancer patients, every day, when they agree to and consent to embark on these treatments.

Moreover, if we want our patients to have a favourable outcome and a good quality of life, whilst

on treatment, it is pivotal that we fully prepare them for the road that lies ahead. This is where prehabilitation has a fundamental role to play in the cancer patients’ pathway. Whilst it is important for all cancer patients, it is especially so for those who will require long term cancer treatments, for some cancers, patients can require treatment for the rest of their lives.

Cancer prehabilitation has been described as ‘a process on the continuum care that occurs between

The possibility of or a confirmed cancer diagnosis has the potential to motivate health behaviour changes to promote better health outcomes, this is known as the ‘Teachable Moment’. McCarthy

(2016) suggests that it is during this time that people are more likely to rethink their lives. It is at this time that they are, potentially, more amendable to adopting lifestyle changes, and for this to be sustained, than at any other point in their lives.

Leedham & Gantz (1999) suggest that, at a time when patients are given a wealth of information about their cancer diagnosis and its treatment, there is a growing need to provide more ioh.org.uk

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information and education on the areas

of prehabilitation. They all work within

that come under the prehabilitation

a recognised framework, with the aim to

umbrella. However, it is vital that we as

optimise cancer patients, prior to

health care professionals, remember

treatment, for favourable outcomes

that, although prehabilitation is an

(Macmillan Cancer Support 2020).

important part of the patient’s pathway, at the time of a cancer diagnosis,

Canc is a m team

patients may be too overwhelmed, worried, and upset to take on board any lifestyle changes (Giles & Cummins 2019). Therefore, it is crucial, that, we are mindful of this, and that prehabilitation programmes, alongside the help and support that goes with this, is offered to patients again, further into their treatment pathway.

Crevenna et al (2021), states that cancer prehabilitation has many benefits.

These include: • Improvement in overall survival.

• Reduction in some long-term effects of cancer and its treatment.

• Patients may have more treatment options open to them.

• It may reduce the side effects in

Trust and the resources that they have, however, the underlying principle of prehabilitation remains the same. These are: • Increasing physical activity.

• Nutrition and eating well.

• Emotional and mental wellbeing.

• Smoking cessation.

• Advice on reducing alcohol consumption.

• Medical optimisation (Shukla et al, 2020). Examples of this are,

chemotherapy and immunotherapy

improving iron and haemoglobin

treatments.

levels prior to surgery or

and aid post op recovery.

• It can enhance and improve patients’ overall quality of life.

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depending upon each individual hospital

relation to complex and challenging.

• It can reduce surgical complications

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The delivery of prehabilitation varies

optimisation of other comorbidities.

Boyd & Jackson (2005), suggest that it is vital to adopt a holistic view and to address all the above collectively. It is widely known that together, they can

All of these are beneficial for every

reduce the bodies resilience to manage

patient, no matter where they are in

the physiological stress of cancer

their cancer journey.

surgery and other cancer treatments.

Cancer prehabilitation is a

Previously, prehabilitation used a

multidisciplinary team affair.

unimodal approach, whereby, only one

Physiotherapists, occupational

core component was addressed, this

therapists, health coaches, dieticians,

could be physical activity or nutrition.

psychologists as well as the site specific

However, more recent research,

medical and nursing teams, all have a

demonstrates that using a multimodal

fundamental role to play in the delivery

approach is more favourable and

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superior in term of effectiveness. An

Interventions: This can be either,

example would be combining physical

universal, targeted or specialist.

activity with nutritional support, smoking cessation, alcohol consumption or interventions to help reduce stress.

Universal Interventions: are appropriate for any patients who have a cancer diagnosis and can self-manage following assessment and signposting to

cer prehabilitation multidisciplinary m affair

the appropriate resources, if required.

Patients will also be advised on how to recognise any changes in their health/ condition, which would require support from the health care team.

Adopting this approach has shown to be

more successful in improving patient outcomes, overall care, and patient experience (Stout et al, 2021).

Targeted Interventions: are applicable

to cancer patients with other long-term conditions, who have identified specific needs that require support from the

The key to an effective cancer

healthcare team such as physical

prehabilitation programme, is early

activity, nutrition, or psychological

identification of patients for whom this

intervention. These interventions can be

would be effective, in conjunction with

delivered in a group or a ‘buddy’

appropriate, individualised assessment,

programme and will be monitored for

intervention as well as monitoring and

their effectiveness.

evaluation. Below is an example of a

Specialist Interventions: are applicable

prehabilitation framework (Macmillan

Cancer Support 2020).

for patients with complex needs who will

embark on complex treatments such as

Screening: This should occur at the

major surgery or intensive

earliest opportunity following a cancer

chemotherapy regimens, who have

diagnosis. However, for some pathways

underlying disability and/or severe

i.e., colorectal cancer, this can happen

impairment that requires 1:1 supervision

prior to a confirmed cancer diagnosis.

from a professional.

Assessment: This is vital to provide the

Monitoring: the effectiveness of all

interventions the patients require, prior

interventions should be monitored

to treatment. These assessments can be

closely, and adjustments made if

used to measure physical activity, i.e.,

required.

how far they can walk in a certain time,

For any cancer prehabilitation to be

alongside tools to address malnutrition, (i.e., MUST Screening tool) to psychological assessment tools used for anxiety and depression. Collectively, these will enable healthcare professionals to identify the patients’ needs prior to offering individualised intervention.

effective, ideally, this should be commenced at the earliest opportunity following a cancer diagnosis, or a high suspicion of cancer, for it to be fully effective. However, it is important to remember that, even the smallest of change can make a significant difference, and these can be seen in as little as 2 weeks. The impact this can make on a patient’s outcome to ioh.org.uk

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treatment should not be underestimated.

With ongoing improvement to cancer care such as, faster diagnosis and multiple available treatment options for patients, there is overwhelming evidence to suggest that cancer prehabilitation has a key role to play in the cancer patients’ pathway.

Prehabilitation supports patients to actively participate in their treatment and care, which can enhance their overall quality of life and wellbeing. This will increase tolerance and compliance to treatment and can improve their outcome. Therefore, it is vital that we do all that we can to promote and endorse prehabilitation as an integral part of the cancer patient’s pathway.

References: Boyd O & Jackson N (2005) Clinical review: How risk is defined in high-risk surgical patient management.

Critical Care; 9: 390 Crevenna R et al (2021) Cancer Prehabilitation: a short review. Magazine of European Medical Oncology; 14, 3943 Durrand J, Singh S. J & Danjoux G (2019) Prehabilitation Clinical Medicine 19: 6 458 – 464. Royal College of Physicians Giles C & Cummins S (2019) Prehabilitation before cancer treatment. BMJ; 366: 15120 Leedham B & Gantz P.A (1999) Psychosocial concerns and quality of life in breast cancer survivors. Cancer Invest 17: 5 342-348 Doi: 10.3109/0735790990932876

Melanie Freedman | Linkedin Melanie Freedman RN, BSc Personalised Care Lead, Northumbria Healthcare NHS Foundation Trust Melanie’s NHS career spans 3 decades, with much of this time spent within Cancer Services. Prior to her current role, Melanie was a Macmillan Haematology CNS for 18.5 years. One of her key interests was improving the cancer patient’s journey. Melanie advanced her

knowledge and clinical skills to develop a nurse led transfusion service, which has transformed the pathway for patients undergoing long term blood product support. This service offers bespoke, holistic care to these patients, which in turn, enhances their quality of life and well-being.

In her current role, Melanie is passionate about patient centred care & cancer prehabilitation. She continues to support patients and the wider Cancer Multidisciplinary Teams to embed this into current practice.

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Rehabilitati

By Claire Odd

Welcome to the sec focussing on rehabi recovery from concu

Taking a holistic viewpoint Much is still unknown about the wholebody impact of a concussion; current best practice has evolved from research with male elite athletes. This does not readily translate into the general

population. Accounting for the differences in the general population is made more challenging when you take into account the impact of hormonal changes and physiological differences between genders (Patricios, 2023). This leads to a difference in commonly reported longer recovery times for females, which is largely thought to be based on the cyclical nature of female hormones.

Given the interconnectedness of the human body, concussion rehabilitation requires a whole-person approach. Even more so now that concussion is considered a metabolic injury (Patricios, 2023). I’ve broken down what a wholeperson approach could look like based on my own recovery and supporting others through their recovery journey both as a lead practitioner and working within a shared care team: 36

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• Mindset & Nervous System Reset Our autonomic nervous system will be disrupted due to the concussion.

The human body is pretty good at masking what is going on, but as soon as we start to go about our normal lives many of our traditional

concussion symptoms appear. The first step to a great recovery is learning how to restore calm to your nervous system. Mindset and emotional coaching can be beneficial to help with the positive framing of the journey ahead (Cassandra, 2023, Price et Al, 2022)

• Managing inflammation & healthy nourishment The metabolic injury mentioned earlier is all about the inflammatory response. It drains the brain of ATP, through what is commonly known as the cytokine storm, leading to low energy levels (van Erp et Al, 2023, Dooley, 2022). The gut-brain axis connects through the vagus nerve.

Given interconnec the hum concussion r requires a w appr

ion strategies after concussion

cond part of recovery after concussion; this time we’re ilitation strategies that can be employed to help the ussion or post-concussion syndrome.

n the ctedness of man body, rehabilitation whole-person roach

The tight junctions in our gut

• Hormones and Stress

spontaneously open, initially inducing

Hormones regulate almost every

nausea and sickness as a form of self-

process in your body and when these

protection. We know that our gut

are out of sync, the symptoms are

health affects our mood, emotions,

like concussion such as low energy,

cognitive abilities, and overall brain

mental fatigue, headaches, anxiety,

health. Rebuilding and restoring the

etc (Lowen, 2023, and Dooley, 2022).

energy in our brain is physically hard

Inevitably, this comes from the

work and consumes a lot of energy. In

pituitary gland and hypothalamus

the perfect client, it can take between 21

literally being in a state of shock or

-28 days.

freeze following the impact (Dooley,

It’s common to become more sensitive

2022). One of the most useful

to foods and have digestive issues. This is where following an anti-inflammatory or keto diet can be helpful. Bone broth can be helpful in restoring gut health.

Using Red Light therapy can be beneficial in the early stages of healing (Dooley, 2022, Chao, et Al, 2020).

• Sleep One of the most important, and most underappreciated things that we can do to optimize our health, reduce our inflammation, and regulate our hormones is getting proper restorative sleep. Sleep hygiene is crucial as an aide to recovery and certainly impeded my own recovery.

analogies that I’ve found when talking to people about the effects of a hormone imbalance from a concussion is that is very similar to the peri-menopause brain fog having had the personal experience of both.

• Movement and Exercise Previously, it was thought that the only recovery from a Concussion was protection and rest. Sitting in a dark room and avoiding any kind of activity that would stimulate the brain. However, research by Patricios (2023) has shown this to not only be unhelpful but detrimental past the first few days. The key here is that it should be gentle and not exacerbate

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any of the symptoms of concussion; often

traumatic unforeseen event, assessing the

this is controlled by using heart rate to

status of primitive reflexes can be very helpful

moderate exertion levels (Patricios, 2023).

in resolving legacy issues. It may also be

• Balance, Vision & Co-ordination Restoring balance back to both the visual and vestibular system. They work together so that your body can orientate itself in space and time and make sense of the world. This is often a crucial piece of the rehabilitation care that is missing for many people who have suffered concussion.

• Traditional Rehabilitation Most concussions will have a physical injury alongside, generally, it’s a whiplash.

Restoring optimum neck movement is essential to prevent the development of referred pain and compensations.

Generally sustaining a concussion is a

worth exploring somatic or trauma care pathways. In my experience, clients with concussion prefer gentler and less forceful hands-on therapy such as cranial sacral therapy instead of traditional sports massage (this is all to do with the capacity of the nervous system).

Depending on the site(s) of impact for the original injury there will always be a variation

in cognitive symptoms. There will always be an entrance and exit point of impact of the force, and it may not always be linear.

Depending on the mechanism of injury there may be more than one entry and exit point.

These will have an impact when it comes to planning return-to-work support.

Figure 1: Brain anatomy and function 38

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Case Management Strategy The picture indicates some of the challenges in recovering from concussion and indeed putting together a holistic and specific targeted rehabilitation programme as part of the case management process.

training and competencies I’ve listed above to

work alongside your team as they are quite niche.

Building a robust case management strategy will require communication and consultation between providers and the client to ensure that contradictory advice is not given, and that

I found great success working with a practitioner who used a combination of Neuro Kinetic Therapy, Proprioceptive Deep Tendon Reflexes, and Cranial Sacral Therapy.

Realistically, it is likely that multiple care providers will be involved in a well-rounded concussion rehabilitation program. It may be necessary to look outside of your own team to

client is not overwhelmed. When I think about my own journey, it took me quite some time to be able to start normal daily living activities, so concussion sufferers need to be prepared to be flexible. Remember the massive energy

depletion that takes between 21-28 days to rebuild (Patricios, 2023).

gain access to a practitioner with some of the

References Cassandra, S., (2023). Re-Thinking Concussion Support: From Psychological and Social Needs to Leveraging Mental Performance Consultants. PhD Submission, University of Ottawa.

Conder, R., & Conder, A. A. (2015). Neuropsychological and psychological rehabilitation interventions in refractory sport-related post-concussion syndrome. Brain Injury, 29(2), 249-262. https://

doi.org/10.3109/02699052.2014.965209 Sports Concussion Office Assessment Tool (SCOAT 6) Sport Concussion Assessment Tool (SCAT 6)

About the Author Claire is a Health Coach, Rehabilitation Therapist, Sports Scientist and Chartered Health & Safety Practitioner. Before moving to independent practice and consultancy she worked in senior leadership positions in high-profile safetycritical organisations leading their health, safety, and wellbeing programmes.

In her independent practice, she practices a whole-person approach, working with all aspects of women’s health, particularly perimenopause & post-operative recovery, and concussion rehabilitation, alongside supporting organisations with their workplace health and wellbeing programmes. www.restoring-balance.co.uk ioh.org.uk

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Making spirometry work for you Helping to achieve high quality spirometry results every time

By TASMIN SHARLEY & JOE TOPHAM, PRODUCT SPECIALISTS, VITALOGRAPH

Spirometry is frequently used in the assessment of respiratory conditions. It is the most commonly performed respiratory function test worldwide, and it is used in the diagnosis, monitoring and management of respiratory diseases.

T

here are many occupational

clinical setting, learning about the best

exposures which have the

way to instruct and encourage your

potential to cause lung damage,

patients, to understanding the common

and spirometry is useful to evaluate and

errors that you may see, and knowing

monitor a workers lung function over

how to correct them, you will

time. Often spirometry is considered an

consistently be able to achieve high

easy test to do. However, to do the test

quality results, ensuring that patients

well and to ensure your patients achieve

receive an accurate diagnosis and the

high quality results, training and

best treatment or management for

practice is key. From selecting the right

them.

spirometer that meets the needs of the

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Selecting the right spirometer for your location There are a number of things to consider when selecting the best spirometer for the clinical location or setting. Spirometers come in all shapes and sizes and have varying levels of functionality.

As such, you can have a spirometer that suits any situation or clinical requirements. For example, you can have a spirometer that will give instant results to document or download later and easily fits into a small bag, allowing easy transportation of the device from place to place. Or the spirometer may have a built-in printer allowing you to print results for you there and then. This variety of devices allows clinicians to perform test in a range of

locations if they need and gives them greater choice when purchasing. One of the most important considerations should be how the test results are presented and whether the report can be integrated into the local electronic health record.

Pre-test considerations Before the patient arrives at the testing facility, it is important for them to be aware of the pre-spirometry dos and don’ts. A pre-test information leaflet is useful to outline the pre-test instructions as highlighted in guidelines below. This will ensure the patient can perform the test to their best ability.

Contraindications should also be checked to ensure the patient can

perform the test safely. An example of a contraindication is whether the patient has recently had any thoracic or abdominal surgery shortly prior to performing the test. Spirometry is a physically demanding test which can increase intra-abdominal and intrathoracic pressure. To ensure spirometry is performed safely, the patient should wait for approximately 4 weeks after the surgery to perform the test1. However, the benefits and risks of performing the test should be considered. The use of single patient use bacterialviral filters help to reduce risk of cross-infection during the test and provides protection for the patient, operator and spirometer.

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Quality assurance Having a quality assurance protocol is important to ensure the spirometer is measuring data accurately and to ensure patients receive the correct results. It is recommended that a 3 litre calibration syringe is used for calibration verification on a daily basis at low, medium and high flow rates. If this fails, the cause should be identified and resolved, and the verification procedure should be

repeated.

During Testing Less is often more when coaching a patient to perform spirometry. A patient can often become confused and overwhelmed if they are overloaded with information when the test should be as simple as blowing into a tube.

Delivering clear, concise instructions along with a demonstration and active encouragement

throughout can be extremely useful in achieving good quality spirometry attempts quickly. The patient should rest between each attempt, and during this time it can be useful to reflect on the previous effort and discuss how they did and how

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it could be improved, or general feedback if it went well.

An example of a change that patients can often make quickly to improve their technique and results is optimising their posture for spirometry.

The patient should be sitting in an upright position with feet flat on the floor. This is to ensure the abdomen or diaphragm is not restricted and can move freely; a poor seated position could lead to sub-maximal results. It is important to monitor the patient throughout testing as their position may change and this may make it difficult to obtain reproducible results.

The flow volume loop below is an

example of an error-free spirometry attempt. There is a sharp rise to peak flow which shows that there was a forceful exhalation with no hesitation after the subject had inhaled fully. The flow rate reduces gradually during the expiratory portion, suggesting that there is no evidence of any obstruction at the mouthpiece, any cough or any sudden termination.

Common spirometry errors Studies have shown that poor quality spirometry can lead to misdiagnosis, this can either be under or over diagnosis of conditions such as chronic obstructive pulmonary disease (COPD)2. Errors in spirometry technique can affect results which may impact patient outcomes. As such, it is vital to be able to identify and correct any errors in technique.

This effort shows a good initial part of the exhalation however it ends very abruptly and early. This will reduce the patients FVC and elevate their FEV1/FVC ratio. If a patient terminates the exhalation early, they should be encouraged to keep exhaling for longer.

This attempt is an example of when a patient exhales repeatedly rather

than doing a single long and forceful exhalation. If a patient does several small blows, a demonstration of the correct technique is useful, and advise them to do just one long and fast exhalation.

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This effort suggests that the patient did not exhale forcefully and

instantly after they had inhaled fully. You can see that instead of there being a sharp rise to peak flow, the initial portion of the expiratory limb is slanted slightly, showing that there wasn’t a sharp rise to their peak flow. If you see this, you should encourage the patient to blow out sharper and faster once they have inhaled fully.

Once the patients technique has been optimised, the operator should aim to meet reproducibility criteria to ensure the results have clinical validity. The ATS/ERS 2019 guidelines state that there should be 3 technically acceptable attempts, of which at least 2 are within the recommended reproducibility criteria.

A study carried out in Holland highlighted the importance of following acceptability and reproducibility

guidelines when performing spirometry. It was found that when spirometry results were sent to two secondary care pulmonologists for review, when ATS/ERS criteria were not met their opinions on patient diagnosis could differ from that of the GP and each other3.

Post testing Once testing is complete and technically acceptable results have been achieved, spirometry results should be presented in an appropriate report displaying the recommended parameters as suggested in the ATS standardised lung function report4. In the occupational setting, it is useful to track lung function

changes over time. Trend or serial spirometry reports can be generated allowing the clinician to instantly plot a graph

“The primary measurement used to assess longitudinal change should be the FEV1, as it is less affected by technical factors than the FVC”5

displaying spirometric parameters from every test performed, depending on the capabilities of the spirometer and software.

References 1. 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.

2. Hangaard, S. et al. (2017) 'Causes of misdiagnosis of chronic obstructive pulmonary disease: A systematic

scoping review,' Respiratory Medicine, 129, pp. 63–84. https://doi.org/10.1016/j.rmed.2017.05.015 3. Van De Hei, S.J. et al. (2020) 'Quality of spirometry and related diagnosis in primary care with a focus on clinical use,’ NPJ Primary Care Respiratory Medicine, 30(1). https://doi.org/10.1038/s41533-020-0177-z 4. Culver, B. H. et al. (2017). ‘Recommendations for a standardized pulmonary function report. An official American Thoracic Society technical statement’. American Journal of Respiratory and Critical Care Medicine, 196(11), pp. 1463-1472. https://doi.org/10.1164/rccm.201710-1981ST 5. Redlich, C. A. et al. (2014). ‘Official American Thoracic Society Technical Standards: Spirometry in the Occupational Setting,’ American Journal of Respiratory and Critical Care Medicine, 189(8), pp. 984-994. https:// doi.org/10.1164/rccm.201402-0337st

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Summary of the Governments response to Occupational Health: Working Better Consultation Libby Morley-Hassanali, iOH Vice-President iOH were pleased to provide feedback on behalf of its’ members to the recent Government consultation that ran between and July and October 2023. Its aim was to propose ways to increase OH coverage and was jointly led by the DWP and the Department for Health and Social Care. Just one month after the deadline to respond, the Government published its summary of responses, in November 2023. The full response can be found at Occupational Health: Working Better - Summary of Responses to the Consultation and the UK Government Response (publishing.service.gov.uk) The Occupational Health: Working Better consultation specifically sought views on: a. The introduction of new national workplace health and disability standards, including a minimum framework for quality OH provision b. Whether there is applicable learning from best practice from other countries and other UK-based employer models and c. Shorter- and longer-term ways to develop and support a multidisciplinary OH workforce to help meet increased employer demand.

There were 182 responses from various sectors including public sector businesses, insurance, charities and trade unions and a full list of respondents can be found in Annex A, via the link above. ioh.org.uk

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The Government plans to take action by Supporting businesses through a voluntary minimum framework for quality OH provision, exploring a potential digital marketplace for SMEs to enable group purchasing, and the development of a multidisciplinary work and health workforce.

The case for providing further support to employers via the tax system is still being explored, and Joint HMTHMRC consultation on tax incentives for occupational health ran as a separate consultation alongside the Working Better consultation.

The consultation consisted of three chapters, and a total of 21 questions.

Chapter 1: Opportunities for greater employer action, best practice sharing and voluntary health at work standards.

Brief summary: 1. Most respondents supported the development of national workplace health and disability standards and a minimum framework for quality OH provision. This should be built on existing legal requirements and be tailored to organisations by size or turnover. Further these standards should be created by the Government with support from an expert group.

2. Pressure on the NHS could be reduced if a sustainable, flexible and multidisciplinary OH workforce was developed.

Chapter 2: Lessons from international comparators and successful UK-based employer models to drive OH take-up.

Brief summary:

1. Legislation and/or tax incentives were mentioned as a method of increasing uptake of OH services, in over one third of responses.

2. Accessing OH could be inclusive of other services that enable work and health support, such as Vocational rehabilitation and group income protection via insurance.

3. Reasons for not mandating use of OH services for all included the cost that SME’s may find impossible to cover without support and exacerbating existing market challenges.

Chapter 3: Developing the work and health workforce capacity, including the expert OH workforce, to build a sustainable model to meet future demand.

Brief summary:

1. Wide support for building a sustainable MDT: To include clinical and non-clinical professionals and that had flexible delivery channels, including online. A standardised multidisciplinary training programme that covered multiple OH roles was suggested, alongside including OH modules in existing undergraduate or postgraduate courses.

2. Factors influencing OH career choice: Pay, career progression, professional support, and work-life balance are the main factors that affect people's decisions to join or stay in the OH profession.

3. Ways to market OH career: Career events, case studies, mentoring, placements, and apprenticeships. They also noted that there is a lack of awareness of the full scope and opportunities of OH among potential candidates.

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4. Optimal touchpoints to promote OH at entry level: Diversifying the entry points into OH, and

recommended focusing on career changers and health care leavers. They identified some touchpoints, such as having children, returning from a career break, or considering leaving/retirement, where OH could be promoted. They also suggested reaching out to other relevant professions, such as health and safety and physical activity roles.

5. Actions and mechanisms to utilize multidisciplinary OH workforce: The respondents highlighted the importance of flexibility and technology in enabling the effective use of a multidisciplinary OH workforce.

They mentioned the use of triage, online bookings and workflows, AI, and data sharing across health care interventions and provider networks. They also suggested providing self-management tools and self-referrals for employers and employees.

6. Ways to encourage SME OH providers to adopt multidisciplinary approach: The respondents agreed that SME OH providers should adopt a multidisciplinary approach to service provision. They proposed some ways

to achieve this, such as collaboration and partnerships between providers, cross-sector working and shared referral pathways, interprofessional education, financial incentives, and guidance and frameworks. They also emphasized the need to educate providers and employers on the benefits and value of a multidisciplinary approach.

7. Government actions to increase OH take-up and capacity: The UK government is taking action by supporting businesses through a voluntary minimum framework for quality OH provision and exploring new voluntary national workplace health and disability standards. It is also exploring options for a new SME group purchasing framework supported by a digital marketplace and using the learning from the existing Workforce Expansion scheme to develop a long-term strategic OH workforce approach.

8. Government plans for further OH reform activities: The UK government is also progressing on the existing

OH reform programme, which includes the OH subsidy pilot for SMEs, the £1 million Innovation Fund for developing innovative models of OH, and the fit note reform consultation and trial. The government is also working with the devolved administrations to consider the implications of the proposals on devolved matters.

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iOH: Responding to the Scottish Social Justice and Social Security Committee's proposal for a Scottish Employment Injuries Advisory Council (SEIAC) Lucy Kenyon, iOH Non-Executive Director

iOH was asked to provide evidence on a proposed Employment Injuries Advisor Council for Scotland. Lucy Kenyon, iOH Trustee and Non-executive Director stepped up and delivered a briefing note to the Social Justice and Social Security Committee (SJSSC), before delivering evidence on the proposed Scottish Employment Injuries Advisory Council (SEIAC) Members’ Bill. This is our inaugural public engagement piloting our new operational model as a charity. A landmark for iOH and its members, as we now have the facility to source funding for projects directly of benefit to public health, particularly workplace health.

Alongside Lucy, Professor Ewan MacDonald, founder of Glasgow University’s Healthy Working Lives Group and

Chair of the Academic Forum for Work and Health, hosted by SOM, provided evidence to the https:// www.parliament.scot/bills-and-laws/bills/scottish-employment-injuries-advisory-council-bill.

To provide our audience with an understanding, we have replicated some of the questions and Lucy’s answers.

The full recording is available on Scottish Parliament TV.

Committee questions and key messages delivered by Lucy on the 16th of November: 1. What involvement (if any) do you have with the Industrial Injuries?

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2. In your experience, does this have any wider influence on the extent to which employees are supported or

preventative measures put in place in the workplace?

As an independent practitioner, Lucy looks after Small to Medium Enterprise (SME) employers and has referred two cases through the Group of Occupational Disease Specialists (GORDS) network, which came into Occupational Health (OH) at quite a late stage of the diagnostic process. I had anticipated this question and would like to do more research into the evidence for case-specific examples and send these to the committee.

I asked how can we exclude occupational disease as a cause of symptoms when presented to GPs. 3. If SEIAC has a role to educate and promote health and safety in the workplace by sharing their findings widely, this could serve to educate employers, particularly concerning new and emerging issues.

Lucy acknowledged Ewen’s comment relating to the challenges of silo working but emphasised the great work being done by HSE, publishing robust guidance and how responsive they are to the research reports when

developing new information and guidance for employers. She highlighted that the gap in the prevention of occupational disease is due to a slower onset than occupational injury, which is easier to diagnose and prognose in terms of rehabilitation and recovery.

4. Does the proposed role of SEIAC to investigate and review emerging employment hazards which result in disease or injury” duplicate the activities of other organisations?

Lucy reported that she had reviewed the IIAC research reports from 2017 onwards, and how the findings had not translated into any amendments to the 2023 IIAC prescribed diseases list. An example of occupational health risks for pilots and aircrews was given.

NHS Scotland has 1.8m workers suffering from Occupational ill-health, but only 17000 made claims to the IIDB. Insufficient applications are made which limits the financial burden which would inform and push

occupational disease further up the agenda. Scotland has a good record of accomplishment of OH with the universities but 55% of UK workers do not have access to OH. Lucy mentioned she had picked up a late-stage HAVS case that had not been picked up by previous employers Scotland has an opportunity to dovetail research services with the IIAC rather than duplicate them.

5. The Bill documents estimate a research budget of £30,000 per year. Do witnesses have any views on whether that is adequate for the work proposed?

Lucy suggested benchmark evidence from Dr Martie Van Tongeren, Professor of Occupational & Environmental Health at the University of Manchester and head of THOR is obtained.

Conclusion Lucy identified that Scotland's occupational health and wellbeing professionals have a lot to offer to the social justice and social security debate in Scotland and deliver more effective health monitoring and evidence to inform research. She hoped that our input would help shape the policies and practices that will benefit the people of Scotland.

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Vocational Rehabilitation Association Awards 2023

Mandy Kelly, iOH’s Director of Occupational Therapy was the winner of VRA Vocational Rehabilitation Champion Award this month. The award acknowledges an individual who has made an outstanding contribution to enhancing the profile of vocational rehabilitation in the UK, including widening the reach and impact of VR development, provision and/or evaluation.

Mandy’s nomination for the award highlighted her 25 + years of practice as an Occupational Therapist in the field occupational health and vocational rehabilitation in both the UK and Australia as well as the various leadership roles she has held over this time such as her pioneering and then leading the occupational therapy service at Royal Mail Group, her clinical governance leadership for a medical rehabilitation company, her independent practice in OH and VR, her role as Vice Chair of the RCOT Specialist Section in Work and her role as the Director of OT in

iOH. In keeping with Mandy’s focus on continuing to bring awareness and utilisation of vocational rehabilitation skills to the wider occupational health community, the nomination outlined that Mandy is the first Occupational Therapist to complete the pre-requisite course for the Diploma of OH Practice, is teaching on the NUTH NHS Foundation Trust course on vocational rehabilitation in occupational health and is actively involved in the VRA Team participating in the SOM led training of GPs in Functional Medicine.

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