Competency 6 – Working with colleagues: Understand the scope of delivery of occupational health services

Objective: to understand the differing roles of those in the multi-disciplinary occupational health team

KNOWLEDGE

Understand the scope of delivery of occupational health services and roles and responsibilities of occupational health team members (occupational health nurses, physicians, toxicologists, occupational hygienists, physiotherapists).

• Understanding ergonomics at work ^[1] – HSE publication

An occupational health service needs to have a clear outline of its objectives, roles and responsibilities. The World Health organisation in 1950 defined the aims of an occupational health service as:

‘The promotion and maintenance of the highest degree of physical, mental and social wellbeing of workers in all occupations’.

Since then, most ‘mission statements’ have continued to include the above aim with the addition of supporting an organisation’s health and safety policy. Occupational health is an integral part of any workplace and must work in partnership with all aspects of an organisation to provide specialist advice regarding the work environment, health and safety.

Any organisation that employs individuals would benefit from an occupational health service. The range of functions that the service provides must be suitable for the organisation. One of the main roles of any occupational health service is to correctly identify and suitably address such requirements.

A proactive approach to health and safety is strongly favoured, rather than a reactive service that responds to incidents and accidents. The role of occupational health is far greater than to provide wound dressings, simple analgesia or blood pressure measurements.

It is important for any occupational health service to:

• Develop an understanding of an organisation’s culture.
• Be able to identify the nature of the hazards and scale of risks involved in the company’s processes and products.
• Comply with relevant legislation and other applicable standards.
• Be able to support an organisation’s health and safety policy as well as establish clear policies on working practices to ensure standards of care.
• Be proactive in its approach as well as reacting efficiently to the needs of the organisation.
• Undertake working practices that are congruent with standards set by the GMC and Faculty of Occupational Medicine.
• Be autonomous and accountable.
• Be able to communicate well and effectively with the organisation, employees and colleagues.

The benefits of occupational health are diverse. The employee, the organisation, customers and local community can all gain from improved health and safety.

Benefit to the employee:

• Promotion of a healthier workplace, where physical and mental stressors are well controlled. Illnesses and injuries, both occupational and non-occupational, are detected earlier. Promotion of proactive rehabilitation of individuals back into the workplace after periods of ill health. Advice on healthy living.

Benefit to the Organisation:

• Promotion and provision of a healthier workforce. Advice around fitness for work in partnership with management sickness absence policies can be cost-effective. Focusing on high risk tasks, identifying emerging work related health problems and workplace stressors.

Benefit to the Customer:

• Improved efficiency drives down costs. A positive attitude to health helps lead to greater confidence in the organisation, better communication and organisational image.

Benefit to the Local Community:

• A culture that ensures high standards of health and safety will safeguard the community at an individual and environmental level.

An occupational health service is normally provided by means of an occupational health team. The members of which vary, according to the requirements, size and attitudes of an organisation.

In general, an OH team comprises:

1. Occupational health nurse:
   These are nurses who have specialised in occupational health and hold the occupational health nursing certificate (OHNC) or occupational health nursing diploma (OHND). They usually manage the day-to day running of an occupational health service and in general have close day to day contact with the employees and line managers working within an organisation.
2. Occupational health doctor:
   These are registered medical practitioners who have shown an interest in occupational medicine. Occupational medicine comprises of the diagnosis, management and prevention of disease due to, or exacerbated by, workplace factors. It is concerned with all aspects of the effects of work on health and health on work. The experience and knowledge of such doctors can vary, and there is no duty on an organisation (unless covered by legislation-appointed doctors) to employ a medical practitioner who has qualifications in occupational medicine. The level and variety of knowledge required in occupational medicine is beyond that covered in primary or secondary care training. The available qualifications in occupational medicine include the Diploma in Occupational Medicine (a basic qualification which is aimed at General Practitioners), Associateship of the Faculty of Occupational Medicine (a mid training qualification aimed at interested doctors in full time occupational health work) and Membership of the Faculty of Occupational Medicine (career specialist qualification, aimed at consultants).
3. Clerical staff:
   This is normally seen in large organisations such as the occupational health department within the NHS and large sized companies. Their role is often undertaken by the occupational health nurse in smaller organisations.
4. Toxicologist:
   The British Toxicology Society defines toxicology as ‘the study of how harmful effects may occur in humans, other animals, plants and the environment and how they can be avoided or minimised’. Toxicologists carry out and plan laboratory and field studies to identify, monitor and evaluate the impact of toxic materials and radiation on human and animal health, and on the health and status of the environment.
5. Occupational hygienists:
   Occupational hygiene has been defined as the science/art associated with the anticipation, recognition, evaluation, and control of the factors that may affect the health and well being of individuals at work or the community. An occupational hygienist’s role would include the ability to anticipate and prevent exposure, quantify exposures, identify how exposure arises, provide practical control measures and communicate risk. Examples of their activities include air sampling of certain hazards such as lead, checking the adequacy of ventilation systems that are used to control certain hazards like soldering fumes. Their professional body is The British Occupational Hygiene Society ^[2].
6. Physiotherapists:
   Physiotherapists provide health promotion, preventive healthcare, treatment and rehabilitation. Many physiotherapists work within hospitals. However, there are in some regions around the UK, significant delays in accessing these services. In response to this, there is now a growing private sector with the development of private based clinics that may be linked to private healthcare providers or working independently. The value of work place based physiotherapy services is increasingly recognised. On site services for employees can lead to significant reduction in time out of work for clinic appointments or sickness absence.
7. Ergonomists:
   Ergonomics is a science concerned with the ‘fit’ between people and their work. It puts people first, taking into account their capabilities and limitations. It ensures that tasks, equipment, information and the environment suit each worker. Ergonomic interventions could include altering the position of a visual display unit (computer) to reduce the glare of the sun off the screen, to changing the height of a workstation to accommodate a tall individual.

Most occupational health services are led by either an occupational health nurse, or an occupational health doctor depending on the size of the organisation, with other members of the team providing consultancy advice as needed. The day to day running of the occupational health service may be undertaken by a manager, an occupational health nurse or an occupational health physician. Clear polices outlining specific roles for the occupational health nurses and the occupational health doctors are important. This is especially noted on setting up a service to ensure accountability, and provision of the service in line with best practice and faculty guidelines.

The functions of an Occupational Health Service can range from being actively involved in policy making of organisations to providing additional services for employees such as counselling and physiotherapy. A list of possible services that it can provide is as follows:

• Source of information on matters affecting health and safety. Management, trade unions and employees often seek medical information in relation to the working practices of the organisation.
• Pre-employment screening; this can be carried out by means of a confidential health questionnaire and or a medical examination. It can help ensure that potential employees are fit for the prospective job, and help identify individuals with medical conditions who may require modifications or support in the post applied for.
• Health surveillance: This includes regular screening as required by health and safety regulations in addition to those statutory screening when working with lead, ionising radiation, and asbestos. (see competency five)
• Fitness assessment: This will help identify individuals who may have health problems affecting their fitness for work.
• Absence reviews: Provide independent assessment on individuals who may be absent from work with a view to identifying possible solutions. This may include a rehabilitation programme, or advice to both management and the individual.
• Health Promotion: This may include travel advice, provision of flu vaccines, fitness programmes, and medical screening (medicals targeting particular individuals).
• Research: This involves epidemiological research which is essential for many occupational health practices. It is dependant on accurate and detailed record keeping.
• Provision of policies, guidance, training and information.
• Treatment centres: This can include the provision of physiotherapists, dentists, counselling services, and general practice advice. This service has been deemed cost effective by some organisations as it reduces time spent by individuals travelling to such services.