Category Archives: Blog
Kevin Bampton’s Blog
Diana Kloss is always an inspiration and a prompt for reflection. A few years ago we fell to chatting about the paradox of the employer’s duty to protect health, but the worker’s right to keep aspects of their health confidential. It’s a thought I keep returning to. In parallel, I have had ongoing debates about the one size fits all approach to health standards which is at the heart of our health and safety regulatory systems.
Consideration of the differential impacts of workplace hazards on asthma sufferers and neurological disorders. Looking at a very large health data set this week, it became apparent that to be effective in managing a healthy workplace there needs to some resolution.
The Department of Business and Trade has signalled probable changes in the determination of cost-benefit analyses in the context of workplace health. Their direction is likely to directly impact on population groups with specific health conditions.
Should the threshold of workplace health protection be set in order to ensure adequate protection of a minority of the workforce, whether it be gender or ability of health susceptibility? Or should it be proportionate, even if that creates exclusion or higher risks to certain populations.
Of course, this is not an academic question. HSE statistical evidence and employment tribunal reports are consistent with the notion that workplaces turn a blind eye or are oblivious to setting standards to protect those who may be most at risk from workplace hazards. The relationship between workplace health standards and equality legislation is still not a clear or easy one. How much harder is it to then put into consideration undeclared illness and vulnerability?
To a certain extent this conundrum is hangover from a forgotten era. Once upon a time the State was the major employer, but also the provider of health support and of social services. The cost benefit analysis was whether the State put effort into preventing someone being made ill by the workplace or whether it was cheaper to pick up the consequences through the NHS and the social security system. Ultimately, the State was omniscient and omni-benevolent.
However, the world has changed. The employer is invariably not the State, has duties to protect, but still only so far as practicable and to the extent of proportionate cost. This creates a different dynamic from the original proposition. The right to a “healthy” working environment is now the only employment right that depends on how wealthy the employer is.
Theoretically, if more workers become ill, then corporation tax will increase and so there is more resource to cover the costs to benefits and the NHS. However, this mechanism does not exist. In reality, it is likely that the majority of the businesses that create workplace health risks are amongst the businesses who collectively underpay A336bn in corporation tax , equivalent to a potential additional 15% of the total cost of the NHS.
Britain’s postwar consensus started breaking down almost 50 years ago, but we act, as a country as if the State should foot the bill to fix the people that business may not be willing or able to prevent from falling into ill-health. This, even though the fiscal deal with business that was wrapped in to National Insurance or corporation tax has long become a fiction.
So what is the solution and how does this relate to Diana’s dilemma? The answer is, to my mind, going to come down to one of two outcomes. Leave it to market or reform regulation.
Our current trajectory leaves matters increasingly to the market. The Government is likely to continue to roll back statutory duties, rely more upon the benevolence of employers and hope that by being less fussy about work and health we will create more jobs, more profit and more benevolence. This pre-WWII model, reminiscent of early industrialisation, would have the employers setting the standards for their peers on protecting workplace health.
However, this will not happen in a vacuum. If regulatory standards hit an even lower tide, it opens up opportunities for the lawyers. Employers owe a duty of care to prevent employee health being harmed or worsened by the workplace. These are legal standards set through the Common Law. Addressing the Common Law – judge made law, based on longstanding general legal principles, encouraged lawmakers to create our current regulatory standards that we currently have.
If regulatory standards fall, the common law of negligence will still be there. And in the law of negligence, you take the claimant as you find them. If they have a “thin skull” then you should have anticipated and protected them. Just because you are not subject to prosecution, does not mean you can’t be sued successfully. In the context of a negligence claim, the fact that a vulnerable person exercised their right to keep their medical condition confidential may be immaterial. In such a context, Diana’s dilemma disappears.
The return of the common lawyers to the field of workplace health is already happening with gusto. A large law firm runs an exposure database to help potential clients diarise their hazard exposure levels. It’s not a question of if they launch a class action, but when, how much for and how often it is repeated. Another law firm recruits health exposure victims in the way US lawyers started to do in the 90s around “toxic torts” that forced corporations to part with billions. Law firms can turn on press outrage and Parliamentary meetings in a way I have never before seen in my legal career.
The trajectory of workplace health regulation leads us all towards last century’s boom days for Personal Injury Litigation. There will be winners and losers, but the victim – the worker – will always be the loser; as well as the NHS, the taxpayer and Society.
There is, of course, another way. We accept that the world is different from when we came up with this model, and learn the lesson I learnt in Environmental Law Regulation. The polluter pays principle was always hard in hard cases, but it made everything else pretty clear cut.
We can cut out the complications and move to a simple economic proposition. The employer has an absolute duty to prevent his workers from being made ill through work and if they do become ill, the employer (or their insurers) should pay for cost of the consequences.
This is neither a radical, new, or untrusted idea. In varied forms, it is found at the heart of systems in the United States and in also in the Scandinavian countries. It is clear and it is achievable.
The contract of employment exchanges skills, labour, control, loyalty, creativity and opportunity for pay and reward. No part of that can ethically ever also be contracting out longevity, freedom from pain, suffering or limits to human dignity. The sacrifice of those things are features of bondage, servitude and slavery, not of employment.
As health professionals, ethical practitioners or just decent human beings, we need to be clear about what the deal on workplace health really should be. It’s not politics, it’s economics. Either the employer pays or everyone pays.
Time for Change: Kevin Bampton’s Call to Reform Occupational Health
Time for Change: Kevin Bampton’s Call to Reform Occupational Health
At this year’s Ruth Alston Memorial Lecture, our board director, Kevin Bampton delivered a thought-provoking speech on the state of modern-day Occupational Health and Hygiene. He argued that, despite advancements in medicine and workplace safety, the UK faces challenges in establishing a comprehensive occupational health system that effectively prevents illness and injury.
He started off his lecture with this reflection:
“There is a country where the state provides and mandates that you have a health care worker within work teams. They provide free medicine and free prescription. They have a generous system of time off from work if you’re feeling ill. And they also have a really, really effective record keeping system. So which country do you think this is?” It was Ancient Egypt, 2500 years ago.
Drawing on various historical comparisons, Bampton highlighted how ancient Egyptian workers benefited from structured health provisions and yet, as he says, “3000 years later we are still scratching our heads about these things”. In contrast, modern occupational health practices in the UK have evolved alongside economic shifts, the introduction of the NHS who will pick up the ill and injured and ‘fix it’, privatisation, and regulatory changes, leading to a more fragmented approach.
He described the relationship between public health and workplace safety regulations, noting that greater alignment could support better health outcomes for workers. He also discussed how access to health data and early detection of occupational illnesses play a key role in improving workplace well-being.
Bampton shared examples of workplace health risks and the importance of ensuring that protective measures are in place to safeguard workers. He suggested that adopting aspects of the Finnish model—where employers have a legal duty to prevent workplace illness and facilitate early detection—could help strengthen occupational health frameworks in the UK. He made an interesting point about the lack of empowerment individuals have over their own health data and the disconnect this has to manage their health when they visit a GP for example.
His speech provided valuable insights into the historical, ‘what once was an effective occupational health model’ and the future alignment of occupational health, emphasising the need for continued focus on prevention, accountability (government and regulators included), and worker well-being. he ended with this statement: “whether we look at three thousand years BC or current 21st Century, it doesn’t matter, it’s time for change”.
This synopsis is written by Mandy Murphy, Board Director at Council for Work and Health
Thoughts on Mental Health First Aid in the Workplace – Abigail Hirshman
Blog by Abigail Hirshman, Co-chair, Mental Health Group, Council for Work and Health
A few weeks ago, I delivered some mental health training for managers. During the session I was asked what you should do when someone has a panic attack. I gave some pointers and also mentioned their mental health first aiders might be able to provide support. When a participant asked, ‘What is a mental health first aider?’ I nearly fell off my chair.
The person then said, ‘Oh, so in a mental health emergency we have to ask them for help?’ ‘Well, not exactly,’ I replied. ‘Oh, so they train others in mental health..?’ ‘Well, not exactly,’ I replied. Clearly my explanatory skills needed some work, however it struck me afterwards to wonder what the purpose of mental health first aid (MHFA) is, and what value it can bring to the workplace.
This is particularly topical, as the private members bill proposed by Dean Russell MP to make MHFA a legal requirement is approaching its second reading in parliament[i]. Whilst we must assume that Mr Russell is acting with the best intentions, his lack of consultation with industry experts is concerning, given that many of us view this proposal as misguided and reductive.
Myself and colleagues at the Council for Work and Health (CfWH) have supported the approach taken by three ex MHFA Board Members, Amy McKeown, James Brown and Robert Manson who have written to Mr Russell seeking a wider and much needed consultation [ii]. At the CfWH we have long debated the merits or otherwise of MHFA and concluded that there is a place for it in the in the workplace. However, we believe it is ill-advised to mandate an intervention, where the evidence of its effectiveness is so limited[iii]. There are also a number of other unintended consequences of this approach.
Firstly, it is a distraction; the cost of mental health problems is equivalent to around 5% of the UK’s GDP[iv], and those with a long-term mental health condition lose their jobs every year at around double the rate of those without a mental health condition[v]. To address this requires proper training for managers and leaders of the benefits to making practical and supportive adjustments at work to those who live day to day with a mental health condition.
Secondly, it removes any obligation to consider the wider risk and protective factors to mental health at work. The implication that mental health is a static state that works just fine until you have an ‘accident’ and need first aid suggests mental health is fixed rather than a dynamic and complex experience driven by our early experiences, our genetics and our current environment. In 2022, the World Health Organization (WHO)[vi] published guidance highlighting the risks associated with mental health at work, none of which will be resolved by MHFA and nor should they be. MHFA is not a preventive measure but like physical first aid is aimed at those in need of immediate help.
Thirdly, this proposal ignores the need for an informed debate on mental health and how the workplace can be both a cause and a cure. The Stevenson Famer report triggered a huge change in the way we think and talk about mental health at work. Whilst this has generally been positive, it is also clear to me that just because we talk about something more doesn’t mean we understand it more. Six years on from the report, I continue to hear the same old tropes and biases, none of which will be eliminated by mandating MHFA.
We are starting to learn from research, lived experience and expert insights what is effective. This potential bill has galvanised industry experts to collectively debate what government could mandate that would actually make a difference. Mental health is complex, there is no one cause or one solution. Mental health at work doesn’t just happen on a Thursday or on a # or because that lovely lady in accounts trained as a mental health first aider. It is about organisations taking a strategic, systemic and systematic approach that evolves and adapts in line with the changing workplace landscape.
Abigail Hirshman is Co-chair of the Mental Health Group at the Council for Work and Health and Director of Charlie Waller Workplace.
[i] First-Aid (Mental Health) Bill – Parliamentary Bills – UK Parliament
[iii] RR1135 – Summary of the evidence on the effectiveness of Mental Health First Aid (MHFA) training in the workplace (hse.gov.uk)
[iv] Mental health problems cost UK economy at least GBP 118 billion a year – new research | Mental Health Foundation
[v] Thriving at Work: a review of mental health and employers – GOV.UK (www.gov.uk)
Welsh RCAP Group Workforce paper: The Welsh health and care workforce at 75
Welsh RCAP Group Workforce paper: The Welsh health and care workforce at 75
The mental health and wellbeing of UK university employees
The findings of our three national surveys of UK university employees (conducted between 2008 and 2014) found that the overall level of work-related wellbeing was poor. Most of the psychosocial hazards included in the Health and Safety Executive (HSE) Management Standards framework increased over time, particularly job demands, control, role and relationships, and the extent of self-reported mental health problems also gave cause for concern. Earlier this year, we were commissioned by Education Support to revisit the wellbeing of university staff and identify their support needs.
Our sample comprised 2,046 academic and academic-related employees working in UK universities. As well as revisiting the HSE hazards and other key sources of strain, we also examined employees’ perceptions of the psychosocial safety climate of their institutions, mental health and work-life balance. Some key findings include:
- The psychosocial safety climate was typically perceived to be poor – more so than in studies of other organisations. More than three-quarters of the sample (78%) strongly disagreed or disagreed that their psychological health is considered as important as productivity.
- University employees continue to report lower wellbeing than average for all the HSE’s psychosocial hazard categories. Job demands, support from managers and colleagues, working relationships and role clarity were all identified as requiring urgent action. The HSE framework recognises that job control can help employees manage the demands of their work, but this has also been steadily eroding among university staff over the years.
- The overall level of mental wellbeing found was considerably lower than population norms.Using a well-validated measure (the Warwick Edinburgh Mental Wellbeing Scale), less than one-third of respondents (29%) achieved scores indicating average mental health with more than half (53%) showing signs of probable depression. Moreover, many were showing signs of burnout, with 29% feeling emotionally drained from their work daily.
- The pandemic was generally thought to have intensified workload pressure with key difficulties including the challenges of working online, inflexible deadlines and managing students’ expectations and wellbeing.
- More than six respondents in ten (62%) reported regularly working over 40 hours a week and 22% at least 50 hours. Unsurprisingly, work-life balance was poor, with 36% indicating that they always, or almost always, neglect their personal needs due to work demands.
- Respondents who reported poorer wellbeing relating to job demands, control, support, relationships and role and who worked longer hours were at greater risk of poor mental health, burnout and work-life conflict.
- The support that was most commonly available to help employees manage their work demands tended to be at the individual level (e.g. stress management training and mental health first aid), whereas the initiatives considered to be most effective were at the organisational level (e.g. tackling stress at source, input into decision-making and feeling appreciated and respected).
- Common barriers to accessing support for wellbeing were lack of time due to a heavy workload and an inflexible schedule and little information on what was available.
- Seeking help for work-related stress and mental health can be stigmatised in UK universities More than half of the sample (59%) feared being seen as weak if they sought support for their wellbeing, with just over seven out of ten (71%) agreeing or strongly agreeing that it would harm their career.
- Although respondents generally considered counselling and coaching to be helpful in supporting their wellbeing, they expressed some concerns about limited availability and a lack of insight among practitioners into their work pressures.
- Respondents who reported being able to access a wider range of support initiatives tended to perceive a more positive psychosocial safety climate at their institution. They were also at lesser risk of mental health problems and burnout and had a better work-life balance.
In our report, we provide recommendations to improve the support available to university employees and ensure it is fit for purpose. These actions will help institutions meet the challenges of the COVID-19 outbreak and ‘build back better’ in terms of a healthy and satisfied workforce. The full report can be found here.
Professor Gail Kinman, CWH Director and Visiting Professor of Occupational Health Psychology, Birkbeck University of London and Dr. Siobhan Wray, Associate Professor, University of Lincoln.
New factsheets to help organisations and individuals meet the challenges of Covid-19
New factsheets to help organisations and individuals meet the challenges of Covid-19
Professor Gail Kinman
CWH Director and Visiting Professor of Occupational Health Psychology, Birkbeck University of London
The Covid-19 pandemic has had a profound impact on the way that we live, and how and where we work. For many people it has been a time of setbacks and loss as businesses close, health is threatened, redundancy looms, and the effects of inequalities become ever more apparent. Although the economy seems to be recovering and we are gradually moving towards some degree of ‘normality’, the post-pandemic future is uncertain and little is yet known about its long-term implications for individuals and organisations. It is therefore crucial to support organisations and individuals in maintaining health and wellbeing during the pandemic and beyond and help policy makers meet the challenges they are facing.
Early in 2021, Public Health England commissioned the Society of Occupational Medicine (SOM) to organise a series of webinars and linked factsheets on the theme of ‘work, worklessness and wellbeing’. The project aimed to provide organisations and employees with practical guidance on key issues of concern during the pandemic. The project was guided by a steering group comprising leading experts and representatives from employers’ organisations. Along with the SOM, I organised these webinars and wrote the factsheets with input from the speakers and feedback from relevant bodies.
The webinars included high-profile speakers from organisations such as MIND, the Chartered Institute of Personnel and Development, Business in the Community, the British Psychological Society, the Health and Safety Executive, the Centre for Better Ageing and the Carnegie Trust. There were also presentations from leading academics in the field of work and wellbeing, business leaders and trade unions and professional associations. They were very well attended and feedback was overwhelmingly positive. Recordings of the webinars can be found here.
The factsheets have just been launched – each is informed by a review of research and provides a range of evidence-informed resources and tools to help organisations and individuals ‘build back better’. The topics addressed by the factsheets are shown below with links to download them:
- Supporting businesses to build back better: The benefits of age diversity
- Supporting your approach to workplace diversity and inclusion
- Creating better quality work and workplaces
- Managing stress, burnout and fatigue in health and social care
- Supporting workplace mental health and wellbeing during COVID-19 and beyond
- Developing a COVID-19 secure mental health and wellbeing strategy
- Managing change – restructuring, redundancy, and homeworking
Please disseminate the factsheets via your networks.
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
- IOSH Website, ‘Coronavirus Information’, https://iosh.com/coronavirus/
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:
- 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
- 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