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RETURNING TO WORK AND LONG COVID

RETURNING TO WORK AND LONG COVID

28 May 2021

Covid legacy will be a long journey back to work for many

Just over a year ago Covid-19 took on the global force of a pandemic. Just about every country in the world would have to bow to the devastating impact this would have on our health, our economies and our quality of life. Despite the desperate death toll there was hope as millions recovered from this cruel disease and we began to find ways to limit the spread of infection and establish a new normal. But, for many, this return to ‘normal’ has not been the journey they were hoping for, with as many as 10 % of Covid-19 patients left living with Long Covid.

What is Long Covid?

Long Covid is a diverse syndrome in patients who are still experiencing symptoms of the disease more than 28 days after testing positive for Covid-19. The symptoms affect multiple body systems with commonly reported symptoms including fatigue, shortness of breath, muscle pains, chest pain, cognitive impairment, headache, and psychological disorders. It is difficult to predict who will develop Long Covid but what is clear is that it is more likely to be seen in people with pre-existing health conditions, who are over 50, obese, female and have had more than five Covid-19 symptoms.

Work and Long Covid

This is a debilitating condition and a patient’s health will fluctuate as symptoms progress or resolve.  Healthcare requires a multidisciplinary team approach focused on rehabilitation and symptom management. The NHS has established nearly 70  Long Covid clinics and several occupational safety and health organisations, including IOSH, have developed guidelines to assist managers with the return to work (RTW) process.  A significant aspect of this journey back to work is assessing a worker’s ability to assume their normal work, with attention given to those with unresolved cardiac, respiratory or neurological symptoms. Long Covid symptoms affecting the ability to cope at work include shortness of breath, fatigue, brain fog and chest pain. Whether it is physical restrictions (shortness of breath) or cognitive impairment (brain fog), you are managing workers who may be unable to cope with work for entirely different reasons, necessitating an individualised approach to care.

So, it is important to include the line manager and the worker in in decision making. Ask the worker for suggestions on working life adjustments (such as working from home, flexible working hours etc) to facilitate RTW. Address the mental health issues through good communication and provide realistic reassurances and advice where necessary. A worker may experience highs and lows and functionality will need to be monitored regularly to accommodate these transitions.

What does the future hold?

The impact of Covid 19 has been massive and its legacy will continue to be felt through Long Covid. It is not clear how long it will take workers to fully recover from Long Covid but there’s a real prospect we’ll have to manage the safety and health of workers with Long Covid for years to come. Successful integration into the workplace will very much call for a collaborative approach, with the wellbeing of the worker, the patient at the centre.

Further information

 

Dr Karen Michell

Research Programme Lead Occupational Health

IOSH

Supporting NHS staff with Post COVID-19 Syndrome (Long Covid)

Supporting NHS staff with Post COVID-19 Syndrome (Long Covid)

The gift many had been waiting for (alongside the vaccine!) has arrived; the NICE COVID-19 rapid guideline: managing the long-term effects of COVID-19 (hyperlink to document https://www.nice.org.uk/guidance/ng188).It provides clear definitions for Acute COVID-19 (signs and symptoms up to 4 weeks), Ongoing symptomatic COVID-19 (4-12 weeks) and Post COVID-19 syndrome (more than 12 weeks). This clarity will help healthcare professionals collect data and offer a stepped care approach to return to work interventions as for many people, their symptoms will resolve within 12 weeks. So, what does this mean for NHS staff now who are struggling to return to work after COVID-19?

Acute COVID-19

The NICE guidelines state that crucial in the earlier stages is assessment, offering advice and written information about possible fluctuating symptoms and self-management. How the symptoms affect the person’s life and activities such as work should start at the assessment stage. Introductory advice is offered inYour Covid Recovery(hyper link to site https://www.yourcovidrecovery.nhs.uk/your-road-to-recovery/returning-to-work/)

Ongoing symptomatic and Post COVID-19 syndrome

If people develop longer term symptoms, the guidelines indicate that they may require a greater level of multidisciplinary assessment, support and rehabilitation to return to work. This would include using shared decision making to set realistic goals, treating fatigue and respiratory symptoms, and supporting people in discussions with the employer about what a phased return to work would look like. The use of graded activity, problem solving and worksite assessments will be key. It is hoped that this group of people will also be able to benefit from new sections in Your Covid Recovery that will provide more in-depth return to work advice.

Your Covid Recovery Group

So, can this be put into practice with potentially larger groups of employees with Long Covid in the NHS? Occupational therapists working in NHS Occupational Health have been doing just this offering both group and individual interventions.

Sara McGinness from Liverpool University Hospitals Foundation Trust has set up the “Your Covid Recovery” group which starts with a screening telephone appointment and is offered to NHS staff experiencing symptoms that significantly impact on their daily function and ability to work. The group runs for one hour a week for six weeks and uses the Work and Social Adjustment Scale (WSAS) and Warwick and Edinburgh Mental Wellbeing Scale (WEMWBS) as outcome measures. The main topics cover – what Long Covid is, fatigue and respiratory management, returning to physical activity, cognitive dysfunction, acceptance and mental wellbeing.

Early results show improvements on both measures, particularly the WEMWBS. The group have also started their own WhatsApp group for ongoing peer support and are offered monthly group catch ups for 6 months. This focuses on ongoing symptom management and building on goals. They are also offered individual reviews with the occupational therapist for more tailored advice and intervention. The group is proving to be a life line for many, who would otherwise fall out of the work place. Interpreting and implementing the NICE guidance in this way may be critical in helping our workforce get back on its feet after the worst pandemic our country has seen.

 

Genevieve Smyth

Professional Adviser

Royal College of Occupational Therapists

 

Blog from the Association of Charted Physiotherapists in Occupational Health and Ergonomics (ACPOHE)

2020 had been an extremely challenging year for everyone. Specifically, for Physiotherapists in Work and Health, it has required in a significant change to the way we work as well as a range of new challenges our patients and their employers are facing. For the ACPOHE it has been no different.  We have all had to change the way we operate almost overnight and have done so exceptionally well.

ACPOHE has been exceptionally busy throughout the year and have undertaken a myriad of activities. These range from: launching a new webinar platformto better network and deliver new content to our members and other Occupational Health (OH) Professionals; developing home working guidanceto support our patients and their employers during these challenging times; through to moving more of our education courses onlineto ensure more people have access to our training.

 

There are two additional areas of work that deserve a special mention:

  1. Long COVID Return to work (RTW) guidelines

In response to COVID, a working group was put together to develop a set of RTW guidelines specifically looking at rehabilitation and return to work guidelines for those patients suffering from Long COVID.  This comprehensive guide was launched as a live webinarin October will be a valuable resource for those physiotherapists and other OH professionals working this patient group.   https://acpohe.csp.org.uk/documents/acpohe-recovering-covid-19-rtw-guidance

  1. Online Open Access Journal

I am thrilled to announce that,  after much hard work, in 2021 we are due to launch a new journal titled the Journal of Physiotherapy in Work and Health (JPWH).  This is an open-access Internet-only journal, accessible to new researchers, early-career academics, and clinicians to share contemporary research and ideas regarding occupational health and ergonomics.

The JPWH is now open for submissionsand invites you to submit contemporary research, reviews, discussion papers, opinion pieces and editorials in relation to occupational health physiotherapy practice.  https://publications.coventry.ac.uk/index.php/JPWH/index

 

ACPOHE hopes that these tools and resources continue to support shared learning across all OH Professionals and facilitates closer multi-disciplinary working. As an active member on the Council for Work and Health, ACPOHE will continue to share these and any other new developments with council members.

 

Miles Atkinson

Chair ACPOHE

IOSH: Decade of action for occupational safety and health

As the ‘Decade of Action’ (2020-30) for the United Nations Sustainable Development Goals (SDGs) grows in urgency, what should it mean for occupational safety and health (OSH) and ensuring that allwork is good work? How do we best address the needs of a virus-affected world and the challenges and opportunities of the 4thIndustrial Revolution, the digital and green economies, demographic and technological changes, and the future of work? How do we ensure that we revitalise our support systems and ‘build back better and healthier’?

Many of the SDGs relate to work and to OSH, as highlighted in the IOSH sustainability policy, particularly SDG Goal 3 ‘Ensure healthy lives and promote wellbeing for all at all ages’ and SDG Goal 8 ‘Promote sustained, inclusive and sustainable economic growth, full and productive employment and decent work for all’, which includes ending modern slaveryand human trafficking.

Importantly, as we’ve all witnessed, the Coronavirus pandemic has reinforced the intrinsic links between environmental, public, occupational and general health, as well as shining a light on health inequalities and the need to better protect health and social care workers and others on the frontline, and to ‘build back better and healthier’. This includes ensuring effective test, trace and isolate systems, and access to personal protective equipment, vaccines, therapeutics and ongoing mental health support. Central to delivering improvement is SDG Goal 17 ‘Strengthen the means of implementation and revitalise the global partnership for sustainable development’. This UN call for international capacity-building and multi-stakeholder partnerships to ‘mobilise and share knowledge’ is a clear request for stronger multidisciplinary working and for all health and health-related professionals to contribute.

 

 

 

This is where I believe the collective health community, professional bodies and networks have pivotal roles, both now and in the future. We need to see OSH / OH professionals increasingly harnessed to help public policymakersand organisations tackle the complex work-related health challenges, such as from climate change, air pollution and extreme weather; increased sedentarianism; extended working lives; the needs of workers with health conditions and disabilities; tackling communicable and non-communicable diseases at work; and the exponential growth in new workplace technology, automation and artificial intelligence.

We need to work together to ensure greater focus on human-centred public- and corporate-policy and on managing psychosocial risk at work, with mental healthfinally gaining parity with physical health, and stigma ended. And we need to collaborate to support diverse and inclusive workforces, protect vulnerable groups and embed OSH risk-intelligence as a key life- and employment-skill, essential to long-term social value and achieving SDG Goal 4 ‘Ensure inclusive and equitable quality education and promote lifelong learning opportunities for all’.

Thankfully, in the decade ahead, I think we can expect to see better-informed public opinion continue to drive higher societal expectationsand requirements on organisations and leaders seeking new ‘social licenses’ to operate and govern. And also see improved performance evaluation and transparency increasingly sought by stakeholders wanting assurance, not only that no-one is being harmed by public policy or corporate activity, but that people’s health and wellbeing is actively enhanced in line with our more socially conscious world.

This demand for transparency and comprehensive corporate reportingwill help drive meaningful and comparable OSH performance reportingat global, national and corporate levels and recognition that good OSH must be a fundamental right worldwide. Professionals have key parts to play, fostering positive and learning cultures; designing-in OSHand evaluating interventions; developing meaningful indicators and utilising data; and making recommendations to improve OSH performance across regions, organisations and supply chains.

So, what key changes are needed to tackle the millions of work-related deaths each year, improve OSH and wellbeing and deliver on the SDGs? I believe they must include:

 

  • Recognising OSH as essential to public and socioeconomic good, so that it is designed into all public-policy,global trade, international development and corporate strategies
  • Building global OSH capacityand improving access worldwide, including for micros, SMEs, the self-employed, migrant and informal workers and all those on the frontline
  • Harmonising and standardising meaningful OSH performance reportingto drive global, national and corporate decision-making and investment for prevention, emergency planning and improved OSH and wellbeing

To close, can I just urge that, as professionals, influencers and networks, we continue working together and reaching out to ensure that this decade is one in which the true value of OSH / OH is harnessed to support good work for all, healthier populations and sustainable futures.

If you’d like to know more and support IOSH’s advocacy work on ‘building back better and healthier’, please contact the IOSH Policy team at publicaffairs@iosh.com.

 

Richard Jones

IOSH

13 November 2020

Leadership in occupational health over the first wave

Leadership in occupational health over the first wave

As the pandemic hit, time seemed to alter, and intensity increased. The pace of “leadership responsiveness” required multiplied. Suddenly, we needed to be “just in time” rather than the days or weeks that medical societies usually take.

The office team “disappeared” in March to work (very effectively) at home. A new, wider, team emerged beyond the Society of Occupational Medicine, of professionals from different disciplines and organisations.  Subgroups focused on PPE and mental health at work were formed. New communication channels opened with daily briefs, weekly webinars, and front-line networks.

Expert leadership was important. Occupational Medicine experts quickly called out the Government’s position on PPE standards and supply. But we knew little about Covid, for example in terms of transmission mechanisms. We quickly hosted a webinar with an Italian occupational medicine expert, ahead of the UK in terms of Covid impact, as to what they were experiencing in hospitals.

It was inspiring to see leadership elsewhere. As Covid-19 deaths tragically increased, a former Windsor Leadership Trust Alumni, and a former President of the SOM, David McLoughlin kept me in touch as to the military’s amazing work setting up the Nightingale Hospitals. Many occupational health professionals working in the private sector volunteered to work in the NHS. NHS England put in place procurement to support NHS occupational health teams.

In April, we decided to move to proactive challenge and focus on the occupational health risk of health care professionals. Dr Will Ponsonby, the SOM President, publicly rejected the Government’s rhetoric of professionals on a front line “war”. Instead we campaigned with the BMA and others “that no health care worker should die of Covid transmission” if proper controls are in place. Amnesty International subsequently produced a report highlighting this issue[i].

In the middle of this, a refreshing culture emerged ofleadership that was still about rationality, objective truth and weighing up the evidence but also about warmth, collaboration and energy (although energy was hard to maintain when it was all online).

With the end of the initial lock down in sight, we focused on the risk of return to work. A collaborative, leadership style continued with new partnerships emerging. We achieved in weeks what would previously have taken months with organizations such as Mind, CIPD, BITC and Acas to offer advice and toolkits. And, even with the frenetic pace of activity, we found out a bit more about each other and our solaces (in my case re watching a lengthy BBC Programme about a shepherd taking Herdwick sheep off a hill).

Despite our new confidence of working with trusted partners, with the launch of effective new advice and “toolkits”, we struggled to influence.  Government was in an emergency “command / control mode”. Responses from the “Centre” on key issues were delayed or not forthcoming. It felt a bit Vicky Pollard … “yeah but no but yeah”.

Some things we did not get right. I regret not reacting to data that emerged showing that some occupational health groups such as minicab drivers and security guards were more at risk of dying from Covid. We must highlight the inequality that Covid is creating and avoid a “white collar” prejudice at the expense of those working in low income public facing roles or factories such as in meat packing who have a higher Covid risk.

In July we launched a new report on the mental health of nurse and midwives, but like many by the end of July, I needed a break. Zoom calls blurred into one and it was hard differentiating online with real life. I needed to practice what I preach in our “mental health in the workplace toolkit” and take a break.

In September, we started again with the confidence that we have a social purpose to make a difference to workplaces.  We were profiled in New Scientist magazine. However, pressures quickly started again though in terms of questions on testing and how any vaccine would be delivered.

Questions remain. In terms of risk, one risk of Covid transmission can be reduced in place of another in terms of the health risks of unemployment. We are hosting, with partners, a summit on this on 10thNovember (at https://www.som.org.uk/civicrm/event/info%3Fid%3D313%26reset%3D1)

It is important to celebrate success (with an awards process for innovators who have come up with tools such as the “Covid Age” next month). We need to support current and future leaders through mentoring and peer support. We should be offering leadership training to those occupational health individuals who have the potential to become our leaders of the future. We are actively looking for funding for this.

We now need to pace ourselves for the winter…

[i]https://www.amnesty.org.uk/press-releases/uk-among-highest-covid-19-health-worker-deaths-world

 

Nick Pahl

Long-term Furloughs During COVID-19 Hold Risks for Employee Health and Wellbeing

Long-term Furloughs During COVID-19 Hold Risks for Employee Health and Wellbeing

 

By Carol Black and Christian van Stolk

 

Governments around the world have offered furlough schemes to try to delay employers from making any restructuring decisions during the COVID-19 crisis. The public purse covers a specific percentage (80 per cent in the UK) of a salary up to a certain level (typically the average annual wage in an economy). Employers then have the option to top up this wage.

 

An estimated 25 per cent of UK workers are now part of the government furloughing scheme, which has been extended until October. Employers will be asked to contribute pension payments and national insurance from August and a larger salary share from September.

 

The aims of such programmes are laudable. They may, however, come with unintended consequences. Two reviews for the UK government, Working for a Healthier Tomorrow and Psychological Wellbeing and Work, suggest the importance of ensuring that employees in furlough schemes stay connected to work and the need to look after the mental health of the workforce.

 

Currently, employees are not allowed to work at all while they are part of the furlough scheme. We know that an employee who is away from employment for a period of about six weeks becomes deconditioned — in effect, less likely to return to employment. At that point, an individual is more likely to enter the benefit system.

 

Furloughed individuals also may lose touch with the workplace altogether. They may be less likely to access the occupational health provision or health and wellbeing programmes offered in many workplaces. People could become cut off from some of their normal support networks. Without these networks, relationships at work could break down, and as a result, a fundamental part of an individual’s social fabric.

 

Moreover, mental health tends to deteriorate when people lose their sense of social purpose. This sentiment may become more prevalent among people who are on furlough schemes where they may feel that they are kept out of work artificially or face delayed unemployment. Mental health is already a concern in the present crisis, in which general uncertainty is coupled with the disruption of routines at both home and work.

 

This matters. Evidence tells us that those with common mental health conditions such as anxiety and depression are much more likely to be out of work or find it difficult to maintain a job. They are the most common conditions among those claiming out of work benefits, with 50 per cent of claimants typically reporting it as a primary or secondary health condition.

 

Even if workers maintain their employment, there may be significant challenges to their health and wellbeing arising from the crisis. Most employees have seen rapidly and profound changes to their working patterns including new forms of remote working, flexible working, social distancing at work and increased shift working. Many have had to combine work and caring responsibilities more than before.

 

The mental health of many workers likely will worsen over the coming months. Before the COVID-19 outbreak, one in six working-age people in England had a mental health problem. The prevalence is higher for younger workers, who are especially at risk of losing their employment in this crisis.

 

There is a need to look at how to support all workers with their mental health. This need is greater for the self-employed and smaller businesses, which employ most of the UK workforce but may not have the resources to support their employees at this time. Supporting the mental health of employees requires employers and governments to provide access to occupational health and NHS support at a time when social distancing is perhaps limiting service provision. It is important to find space on the policy agenda for this.

 

It is heartening to see that the UK government is allowing part-time employment in its furloughing scheme from July, be it with employers paying fully for the hours worked. However, it may be advisable for governments to incentivise employers to stay connected to their workforce by allowing part-time working sooner and even subsidising it. They could also allow keeping in touch days while people are in the furlough scheme.

 

A broader priority for government and employers in this crisis should be to invest in the health and wellbeing of all workers, especially in mental health. This could help avoid workers losing employment, remaining in the benefit system longer and lowering the long-term productivity among those at work. One of the main legacies of the crisis should be an appreciation of the importance of good employee health and wellbeing.

 

Prof Dame Carol Black is a physician who has over the past 14 years advised government departments and arm’s-length bodies on work, health and wellbeing. RAND Europe executive vice president Dr. Christian van Stolk has conducted extensive research on health and wellbeing in the workplace.

 

Informing risk assessment for the more vulnerable

Informing risk assessment for those employees who may be more vulnerable to COVID-19

Robin Cordell, Director, Council for Work and Health

Our experience as occupational health clinicians over this last few weeks has revealed understandable anxiety among employers, employees and their families over the risk to those employees considered to be more vulnerable if they were to contract COVID-19.

Towards the end of March it became clear in published Government policy (now updated as at 1 May) at:https://www.gov.uk/government/publications/full-guidance-on-staying-at-home-and-away-from-others/full-guidance-on-staying-at-home-and-away-from-othersthat among those considered more vulnerable, which is broadly similar to those who have a ‘flu’ jab under NHS arrangements due to specified health conditions, there are those who are considered to be extremely vulnerable.

People in this very high risk group, about 1.8 million people, have been advised by the Government to be “shielded”, as at: https://www.gov.uk/government/publications/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19

Therefore there are three groups of people identified by Government in terms of the level of risk of a serious outcome.

At the top end of the scale, those at very high risk, who have been told they must not leave home for 12 weeks (or longer if the Government advises this).

The largest group is those at the standard level of vulnerability for the population as a whole.  The whole population are required to follow the enforceable measures introduced on 23 Mar 2020, as at: https://www.gov.uk/government/publications/full-guidance-on-staying-at-home-and-away-from-others/full-guidance-on-staying-at-home-and-away-from-others.  These social distancing measures include working from home wherever possible.

There is a substantial group in the middle, who have conditions that make them more vulnerable, and so are at increased risk, but who do not have the health conditions that make them extremely vulnerable and at very high risk of a serious outcome if infected.

Employers will all know that (at: https://www.hse.gov.uk/workers/employers.htm#) they have a legal duty to protect the health of their employees, and other who may be affected by their activities.  Employers must do whatever is reasonably practicable to achieve this.

Some employers have directed all employees who are more vulnerable to remain at home.  This is an effective social distancing measure, and will enable organisational outputs to continue if these employees can work entirely from home.

However, many organisations are engaged in essential work that cannot be done from home.  This includes healthcare and social care workers, those in local authorities, working with the most vulnerable people in society and providing essential services, and those in logistics. A risk management based approach has been undertaken by these clients.  Occupational health clinicians can advise on the vulnerability of their employees, and to suggest how the increased risk in more vulnerable individuals might be mitigated. Government provides guidance to employers on social distancing in the workplace at: https://www.gov.uk/guidance/social-distancing-in-the-workplace-during-coronavirus-covid-19-sector-guidance

Following referral by clients, a short occupational health teleconsultations is undertaken with employees followed by a short report is sent (with consent) to the employer.

The outcome of these assessments is tailored advice, given the employee’s individual health conditions and work circumstances, in order to inform the employer’s risk assessment.  We have found that “shading” the level of vulnerability within the more vulnerable group has been helpful, as our experience is that some in this middle group are more vulnerable than others.  We now use a GREEN-YELLOW-AMBER-RED risk indicator.

The following risk management table is based on Government guidance on social distancing at,and professional consensus documents, including those provided by the Faculty of Occupational Medicine (FOM), the Royal College of Obstetricians and Gynaecologists (RCOG).  Assessment of ethnicity as a risk factor is also included, in view of the observed disproportionate number of deaths among those of BAME ethnicity as at: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30922-3/fulltext,.

Description Level of risk of severe illness if contract COVID-19  as compared to the general population Risk Mitigation the employer is advised to put in place
Those under 70, who may have underlying health conditions, but based on occupational health assessment do not have conditions defined in Government guidancethat would place them in the more vulnerable group if they were to contract COVID-19. STANDARD

(GREEN)

Social distancing – the standardrisk mitigation advised by the Government for the population
Those considered to be more vulnerable to serious illness if they contract COVID-19.  These are people over 70, or those under 70 with the underlying health conditions listed.  Occupational health clinicians will advise specifically on the vulnerability of those who are pregnant, depending on the environment where they work. INCREASED

(YELLOW)

Social distancing, stringently applied (as specific to each workplace)
There will be some people the occupational health professional making the assessment considers highly vulnerable. These may be those more severely affected by one of the conditions the Government advises makes that person more vulnerable, or those who have a combination of conditions that further increases their vulnerability.  This is co-morbidity. Occupational health clinicians will also advise on whether other factors might further increase vulnerability among the more vulnerable, including ethnicity, age and gender, and smoking. HIGH

(AMBER)

Social distancing, stringentlyapplied. Occupational health clinicians may provide further advice on controls on a case by case basis as needed.
Those considered to be extremely vulnerable.  People with conditions set out in Government guidance on shielding, and who will usually have had a letter from the NHS advising them of this. VERY HIGH

(RED)

Shielding for 12 weeks, or longer period as advised by Government

Robin Cordell, Director, Council for Work and Health

Testing for COVID-19 infection and for immunity

Testing for COVID-19 infection and for immunity

Robin Cordell, Board Director, Council for Work and Health

 

Why is testing useful and what types of test are there?

Testing for COVID-19 is likely to significantly enhance risk assessment and management:

There are two types of tests.

  • The Antigen test, a laboratory test, looks directly for the virus’s genetic material (RNA) through a process termed polymerase chain reaction (PCR).
  • Antibody tests are currently being evaluated, which look for evidence that the person has been exposed and has immune antibodies to the virus.

Antigen testing

Testing for presence of the coronavirus (the antigen test) in those self-isolating at home with symptoms has now been extended to all essential workers (as defined at: https://www.gov.uk/government/news/coronavirus-testing-extended-to-all-essential-workers-in-england-who-have-symptoms).

Eligible workers (or their household contacts with symptoms) include:

  • all NHS and social care staff, including hospital, community and primary care, and staff providing support to frontline NHS services (for example accommodation, catering) and voluntary workers
  • police, fire and rescue services
  • local authority staff, including frontline benefits workers and those working with vulnerable children and adults, victims of domestic abuse, and those working with the homeless and rough sleepers
  • defence, prisons and probation staff, and judiciary
  • other frontline workers as determined locally or nationally, including critical personnel in the continuity of energy, utilities and waste networks, and workers critical to the continuity of essential movement of goods

Those eligible and with symptoms of a high temperature or new continuous cough and would like to be tested for the virus should speak to their employer.  The process for getting tested is at: https://www.gov.uk/guidance/coronavirus-covid-19-getting-tested.

As well as regional testing sites, where most people will have appointments, and increasing numbers of home testing kits, 100 mobile units run by the Armed Forces are now available for essential workers who work in more vulnerable settings, as at: https://www.gov.uk/government/news/mobile-coronavirus-testing-units-to-target-frontline-workers

A note of caution – no test is 100% reliable

Testing for presence of the virus will make a significant contribution to risk assessment. It is considered that sensitivity (picking up the presence of the virus) of the PCR antigen test is at most 90%. This means though that of 100 people tested who actually have the virus, at least 10 will test negative; a false negative.  Therefore having a negative test does not necessarily mean the individual does not have the virus, and is safe to go back to work.

We recommended that employees be asked to contact the occupational health provider as soon as they have the test result, whether this is positive or negative for the virus.

An occupational health clinician can then call to help the employee in their return to work, depending on the test results and any symptoms they still have.  Following this they can be certified as fit to return to work, or not fit pending further occupational health review if this is needed.  It is possible some people will need to be tested again.

Antibody testing (for immunity to the virus)

The antibody test is a blood sample (finger prick) applied to a reagent strip with immediate result and is being manufactured in high volume. This device is expected to be suitable for wider community use, once reliability is confirmed.

The Government’s specification for antibody devices is to accurately and reliably measure the presence of IgG (longer term response) antibodies to the virus, indicating infection at least 2 to 3 weeks earlier. Some devices also measure IgM (immediate immune response) antibodies, present for up to 3 weeks after infection.

At present there are no antibody tests sufficiently reliable to safely inform decisions on risk assessment. Development of these tests is a key element (Pillar 3) of the Government’s strategy at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/878121/coronavirus-covid-19-testing-strategy.pdf.

Testing strategy and plan for your organisation

We suggest teleconference meetings between clients in sectors prioritised for testing and occupational health to discuss how this may be implemented in their organisation.

This will be to consider how antigen testing will be done for essential workers and/or their household contacts with symptoms (within the first three days of onset), in accordance with Government policy, and for all clients, how antibody tests will be accessed and the results used in future, once those shown to be at least 98% reliable are available.

Dr Robin Cordell, Director, Council for Work and Health

Launch of the Healthy Ageing Consensus Statement

Last week saw the launch of the Healthy Ageing consensus statement, produced by Public Health England and The Centre for Ageing Better. The Council for Work and Health fully supports the vision of the consensus statement; for England to be the best place in the world to grow older. Good work can provide people with a sense of purpose, belonging and self-respect as well as the known health and financial benefits that work gives. However, it’s becoming more important than ever to recognise that older people are not only choosing to work for longer because they can but also because they have to for financial means. And with this, we are seeing a profound shift in our workforce demographic.

Older workers bring a broad range of skills and experience, loyalty, stability and reliability to the workplace and this is becoming important for employers as we see skills shortages in specialised roles across all industry sectors. Employers need to have good, proactive age management practices in place to meet the needs of all staff as their workforce ages.

We must have a realistic perspective with our ageing workforce and understand the physical and mental changes with come with the ageing. An understanding that we are living longer with long-term health conditions and advances in medical care enable us to continue to work whilst managing these health conditions and living our lives well. What is of vital importance is how we can raise awareness for employers, employees and healthcare practitioners on how work can be adapted to support people to stay in work for longer and still be well. There are many ways to do this not least looking at how others approach it, such as the good practice seen in employers such as BMW and B&Q, considering flexible working opportunities, adapting business strategies where they take advantage of older people’s rich experience, giving them mentoring and consultative projects.  It may also be about providing access to additional training or coaching to support career moves later in life.

Proactive support, in the form of access to wellbeing initiatives and early interventions such as access to occupational health, physiotherapy and psychological therapies, have been proven to be very effective and supportive to both the older employee and the business. Employers who take a solution focussed approach to a diverse and multi-generational workforce have benefitted in terms of productivity and retention of experience.

For individuals as well, it is important they consider the fact that they may need to work differently or in a different capacity in the later stages of their career. There are many ways to do this and employers and local organisations can provide guidance and support to help individuals consider and plan for this.

It is important to remember that age is a protective characteristic of the Equality Act and employers have the same responsibilities for health and safety of older employees as they do for all their employees.

We urge employers and society to remove the stereotype of older people and their ability to contribute to the workforce, it does not reflect the older worker to in today’s society and we are simply not oldat 60 anymore. All workers should be treated individually as any changes in health are very different in each person. Adapting work practices based on individual needs is very important and assessing it on a case by case means and not making assumptions based on out of date stereotypes.

The Council for Work and Health welcomes the opportunity this consensus brings to focus on promoting good health and good work to benefit of both older employees and the businesses they work for.  Find out more about the consensus statement and its five pillars here .

We urge as many employers and organisations as possible to sign up to the consensus statement and raise awareness about positive approaches to successful ageing workforce policies.

 

 

Lung disease in the construction industry – the role of occupational hygiene in prevention

Lung disease in the construction industry

– the role of occupational hygiene in prevention.

By Chris Keen, Policy and Technical Committee, BOHS

The burden of respiratory disease in construction

Exposure to airborne dust is often considered to be an unavoidable part of working in the construction industry, and historically there has been a view in some parts of the industry that ‘it’s just dust’ and doesn’t represent a serious health risk. In reality, the facts are very different. Construction dusts contain a mixture of individual contaminants, and often these have the potential to do serious, irreversible harm if exposures are not properly controlled. And because of the long latency of most lung diseases associated with these exposures, the true impact is often not fully appreciated. This is compounded by the transient exposure patterns typically found in construction. The provision of long term health surveillance is notoriously difficult in this industry, and many cases of ill health go un-reported and remain hidden. The true burden of respiratory disease in construction workers isn’t accurately known, but estimates are that several hundred people die each year as a result of historic exposures to respirable crystalline silica. The issue is so big as to be the subject of a recent public inquiry, co-ordinated by the All-Party Parliamentary Group (APPG) on Respiratory Health.

The role of Occupational Hygiene and the Breathe Freely Campaign

As these facts have become more apparent, the construction industry have responded and much has been done in the past few years to drive improvements in the industry. Key to providing solutions is the implementation of good practice to prevent, or at least control, the exposures which cause respiratory disease. The recognition, evaluation and control of harmful workplace exposures is the bedrock of the occupational hygiene profession.In 2015 the British Occupational Hygiene Society (BOHS), the chartered society for worker health protection, launched theBreathe Freely in Construction campaign. Historically, interaction between the occupational hygiene profession and the construction industry has not been commonplace, which may go some way to explaining the disease burden associated with construction. The Breathe Freely campaign aimed clearly to address this, and to provide the construction industry with effective support to drive down the dust exposures which are at the root of occupational lung disease.

The basis of occupational hygiene is the hierarchy of control. This recognises that all risk control measures are not equal, and that some are far more reliable than others. Clearly, the elimination of a hazard entirely, or if that is not possible, the control of emissions at source, provides a far more robust control approach than a reliance on personal protective equipment. But we still see, all too often, dust masks being used as the only control against dusts which are known to cause cancer and other life changing diseases. Through Breathe Freely, we have worked with stakeholders including the Health in Construction Leadership Group, the Construction Dust Partnership, the Healthy Lungs Partnership and more to produce a suite of materials providing guidance on effective dust control across a wide range of construction tasks. We have created training materials which allow the upskilling of site supervisors to allow a better understanding of respiratory risks and the associated need to control exposures.  And through a series of roadshows, we have reached well over a thousand construction industry stakeholders directly, to spread our messages. 117 high profile business operating in the UK construction sector have signed up as campaign supporters.

There is no doubt that the Breathe Freely campaign is part of a sea change in controlling respiratory disease risks in construction. Major construction clients, and large principal contractors are now giving this topic much more attention. The application of exposure controls, other than the ubiquitous dust mask, is now the norm on larger construction projects. Dust exposures are reducing and the future burden of lung disease should follow on from this as a natural progression.

However, there is still much to do. The overriding number of businesses operating in the construction industry are SMEs. The level of risk awareness, and the accompanying standards of exposure control, still have a long way to go within this sector of the industry. As our campaign moves forward, we will provide a greater focus on reaching these businesses, with specific targeting on the construction trades known to be at highest risk of dust exposures.  We are always looking for new campaign supporters, and we would especially welcome interest from stakeholders operating in, or interacting with, construction SMEs. You can find out more by visiting our website.