Occupational Health and Safety services for Small employers and their staff Healthy Working Lives in

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Occupational Health and Safety services for Small
employers and their staffHealthy Working Lives
in Scotland

• Dr Ewan B Macdonald OBE
• Head of Healthy Working Lives Group, University
  of Glasgow
• Director of Salus, NHS Lanarkshire

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Securing Health TogetherSupport Programme Action
Group report -2003

• GB- working population of 27.7mill
• Doing 29.5 mill jobs
• 3.7 million small businesses
• 99 less than 50 employees
• 45 of UK non-governmental employment
• 38 of turnover

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Support Programme Action Group

• Chair
• Ewan Macdonald, Salus Occupational Health
  Safety
• Members
• Jo Berriman, Royal College of Nursing,
  Occupational Health Manager, Sainsbury Plc Gail
  Cotton, Association of Occupational Health Nurse
  Practitioners Christine Hunter, General Manager,
  Occupational Health Parkside David
  Beaumont, Independent Occupational Health
  Physician
  Peter Rimmer, Head of DIAS, Health Safety
  Executive
  Miriam O'Connor, Health Education Board
  for Scotland
  Elizabeth Johnson, Department of
  Health - NHS Plus
  Susan Scott Parker,
  Employers Disability Forum
  Jacqueline Jeynes,
  Forum of Private Business
  Kit Harling,
  Department of Health, NHS Plus Nicky Hoyle,
  Kirklees Metropolitan Council Lawrence Waterman,
  Sypol Limited Mick Williams, Keighley Worksafe
  Steven Blake, Cabinet Office Sue Shilabeer,
  Back Care
  Dave
  Bennett, ASLEF

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Securing Health Together- report of the Support
Programme Action Group-2003www.hse.gov.uk/sh2/pa
gs/supportreport.pdf

• Vision--- is of a minimum level of integrated
  occupational health, safety, rehabilitation and
  job retention service established for all. The
  objective of such a service is to maximise the
  functional capacity of individuals, the
  organisations in which they work and the wider
  economy

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Scotland 2008

• Ageing population which has largely given up
  reproduction
• Declining population 5.2 mill 5million (but for
  immigration)
• Poor health record
• Areas of deprivation and inequality
• Relatively full employment

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Jimmy age 45years
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Jimmy a 45 year old distribution worker

• Irritant dermatitis
• Back injury in past
• Osteoarthritis of spine,shoulders , elbows and
  knees
• 6 visits to accident and emergency
• One hand fracture
• Getting a bit past it

• Contractor
• Minimal health and safety
• No eye protection
• No ear muffs
• Early noise induced hearing loss
• Vibration white finger
• Several Eye injuries in past

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Jimmy

• Left school with no qualifications
• Jobs on building sites
• Frequently does overtime
• Sometimes in black economy
• Few of his employers have occ health and safety
  resource

• Average housing
• Poor diet, not much fruit, veg or fish
• 4 pints of beer a night (occas drink at
  lunchtime)
• 20cigs a day
• No leisure exercise

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Jimmy

• Separated lives with partner and two stepchildren
• Two children by ex wife
• Financial problems
• Child care issues

• Has been on courses to use power tools
• No other education
• Reads paper occasionally
• Has home computer-on internet

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Jimmy

• He has an accident- pipe rolled on leg fracture
  of right tibia and fibula
• Taken to hospital transferred to orthopaedics
  surgery, plated , discharged on crutches after
  two days (superb treatment)
• No record of job in the hospital notes
• No physiotherapy
• Attends GP given sick note
• No guidance about rehabilitation

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Jimmy

• Rests at home , watches TV (gets depressed)
• Progresses to walking with a stick
• Wasting of quadriceps (50) and reduction in
  power both legs, pain at fracture site
• After 2 months GP organises physio - once per
  week for six weeks
• Pain and weakness still a problem , GP says job
  will be too much for him
• Follow up hospital appointment- no discussion
  about work

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Jimmy - Options

• Friendly with the boss- given job driving the
  dump truck
• Sacked goes on to Incapacity Benefit after six
  months

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If we treated our professional footballers the
same way as we treated our workers -there would
be no football played any Saturday
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IB population as of working age
population(Brown J, Hanlon P, Macdonald E. J.
Pub Health 2007)
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Facts about Incapacity Benefit in Scotland (Brown
J, Hanlon P, Macdonald E. J. Pub Health 2007)

• 2.5 of Working age population go on to IB each
  year (3.5 in Glasgow)
• 55-59 yr old males- 18 on IB (35 in Glasgow,
  60 in some localities)
• Mental Health problems cause 50 of IB
• 10 years ago main cause was musculoskeletal

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Worklessness is the single most important cause
of health inequality, social exclusion,
deprivation , and mortality
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The Process of becoming workless

• Failure of the Education and Skill development
  sector
• Lifestyle factors not addressed systematically
• Lack of Occupational Health and Safety
• NHS doesnt bother about return to work
• GP- its not my job to get people back to
  work
• Surgeon we are far too busy to take that
  on as well
• The NHS does not have maximisation of functional
  capacity as a treatment outcome measure

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Working years
2040
2000
Economy
2000
2040
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Workers covered by OHS(Source Hämäläinen et al
2001)

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Multidisciplinary Occupational Health and Safety
in the UK-who gets it?

• Large employers
• Public sector
• Not in SMEs or self-employed.-
• No continuity of provision if move job
• Occupational Physicians look after a survivor
  population
• Contracted services are employer specified
• Those who need it most dont get it

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Developments in Services

• 1996-NHS Lanarkshire workplace assessment service
• 1996-Scotland Health at Work award (SHAW)
• 2001- Lanarkshire Pilot OHS advice line (HSE
  funded)
• 2002- Scottish Safe and Healthy Working service
  (SaHW)
• 2002- Scotland -Healthy Working Lives paradigm
• 2003 -UK Support Programme Action Group report
• 2005- Scotland Centre for Healthy Working
  Lives-merger of SHAW and SaHW
• 2006-7 England-Workplace Health Connect pilot
• 2007 Scotland Healthy Working Lives Award
  launched

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Improving Health The Challenge2002Scottish
Policy- All Departments

• 4 Target Areas -
• Early Years
• Teenage Transition
• WORKPLACE
• Communities

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SO WHAT CAN WE DO ABOUT THE WORKPLACE?
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Finnish workability model
Work environment
Physical Capacity
Work organisation
Skills
Mental capacity
Work ability
Professional competence
Knowledge
The workplace
Social capacity
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THE HEALTHY WORKING LIVES STRATEGY

• A healthy working life is one that continuously
  provides working age people with the opportunity
  ability support and encouragement to work in ways
  and in an environment which allows them to
  sustain and improve their health and well
  being.It means that individuals are empowered and
  enabled to do as much as possible, for as long as
  possible, or as long as they want,in both their
  working and non working lives

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Essentials of Healthy Working Lives

• Everyone at some time or another needs
• Health improvement
• Health protection
• Rehabilitation
• Life long learning
• Employability services
• Whether they get it at the right time or not
  depends more on CHAOS theory

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The Partners

• PHPs

LAMH
See Me
physiotherapy
Safe and Healthy Working
Job Centre Plus
Salus
Library services
Health safety
Local authority Sport and recreation
Get Active
Manual handling
PHPs
A E
NHSL
Working Backs
Scotland against drugs
Environmental health
Occupational health physician
SHAW
hygienist
HOPE
IT
Lifelong learning
Work Positive stress risk assessment
CAVOC
Job Action Teams
Occupational therapy service
Counselling and other psychological services
National telephone adviceline
Primary Care
HSE
Local authority social work housing
Trade Unions
Health promotion
research
Progress to work
Smoking cessation services
Alcohol and Drug Action Teams
DWP
Scottish Enterprise Lanarkshire
Braveheart nurses
employers
Health policy development
NHS Health Scotland
Employees and out of work people
Risk assessment
Local colleges and learning centres
Occupational therapy service
Up For It
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Scottish Centre for Healthy Working Lives
www.healthyworkinglives.com 0800 0192211
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More than the Sum of the Parts
Scottish Centre For Healthy Working Lives
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Diverse Delivery
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Joining-Up Delivery
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Joined-Up Delivery
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HWL Operational Framework
Delivery Components
Local Delivery Partners
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An Integrated Approach
Work-related accident and ill-health prevention
Work-related health and well-being creation
Providing support, promoting better practice and
sharing information and expertise
Well managed return to work
Proactive attendance management and rehabilitation
Improving the health of the working age
population of Scotland
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Client
HWL Adviceline 0800 019 22 11
HWL Website www.healthyworkinglives.com
Advice
information
H S
OH
HP
Fire
Employability
Vocational Rehabilitation
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Adviceline
Recent Enquiries Health Safety

• Workplace / Welfare
• Traffic and Transport
• Electrical Safety
• Gas Safety
• Work at Heights
• Moving and Handling

Working Time CDM / Welfare Asbestos
Disposal Hazardous Substances Risk
Assessment Fire / Fire Risk Assessment
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Adviceline
Recent Enquiries Occupational Health

• Stress
• Bullying and Harassment
• Sickness Absence Management
• Musculoskeletal
• First Aid
• Accessing OH Services

Blood Borne Viruses / Immunisation OH Medical
Records Health Surveillance Drug / Alcohol
Testing Policies Maternity and Breastfeeding
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Source of Enquiry

• Telephone 3500 pa 74
• E-mail 14
• Direct to adviser 8
• Voicemail 2
• Other 2

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Category of Caller

• Employee 39
• Manager 22
• Director 16
• Unspecified 10
• MOP 5
• H S or Employee Rep 4
• Self Employed 2

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Enquiry Category

• Visit Request 21
• Occupational Health 9
• HWL OHS Services 7
• Health Safety Law 5
• Health Safety Development 5
• Workplace Welfare 5
• Risk Assessment 5
• Fire Safety 4
• HWL Award 4

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Advisors visits to SMEs 5- 600 per
annumProvide report and advice about HWL needs

• Hairdressers / Beauty Salon
• Healthcare
• Solicitor / Estate Agency
• Horticulture
• Hospitality/Tourism
• Engineering

Storage/Transport Voluntary Sector / Charity
Manufacturing Construction Catering Contract
Cleaning
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Business Sectors

• Unspecified 16.2
• Charity Voluntary 12.0
• Healthcare and medical 7.8
• Hospitality 7.3
• Local/National Gov. 5.3
• Business Services 5.0
• Construction 4.3
• Leisure/recreation 3.6
• Retail 5.1
• Mainly callers who didnt wish to give details.

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OCT 26, 2008 NOV 25, 2008
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Visitors Overview
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Scottish Centre for Healthy Working Lives

• 4.3 million- funded by NHS Scotland
• 112 staff- 18 regional OHS advisers -60
  Workplace Health promotion
• Alcohol and drugs
• Mental health and employment
• Physical activity
• Developing rehabilitation

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But what is Work? Its not only being in a paid
job with 6 months full pay and 6 months half pay

• Paid employment
• Self Employment
• Voluntary work
• Carer
• Homemaker
• Child rearing
• Full time/ part-time
• Community activities, clubs, church
• Etc
• ALL OF THE ABOVE ARE BENEFICIAL TO SOCIETY AND
  THE INDIVIDUAL PROVIDED THEY HAVE ENOUGH MONEY

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Evolving the Paradigm- the potential role of
Occupational Physicians and OHS

• For all working age people-not just the large
  employers
• From protection and disease focus to Maximising
  Functional Capacity
• At the heart of improving the public health
• Improving the quality of working lives for all

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Developing HWL Needs Assessment Tool

• Screening tool
• Ensure needs identified
• Self assessment
• Signposting

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Healthy Working Lives
WELLBEING HEALTH WORKABILITY
COMPETENCE and skill development
Multidisciplinary OHS
SOCIAL INCLUSION, Participation, Working
cultures Work organization
WORK ENVIRONMENT, Risk assessment, Risk
management Ergonomics Safety promotion etc.