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…



Nick Pahl

Remploy – Supporting your employees at work

This email was sent to anna@forumconferences.com from communications@remploy.co.uk
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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.


Returning to work toolkits for employers and occupational health professionals

Returning to work toolkits for employers and occupational health professionals

Managing the safe return to the workplace of millions of UK workers needs careful planning.

Our toolkits, produced in partnership with the Advisory, Conciliation and Arbitration Service (Acas), the Chartered Institute of Personnel and Development (CIPD), Business in the Community (BITC), and Mind, the mental health charity, will help businesses plan to reopen shuttered workplaces.

Free toolkits

There are two toolkits: one for employers and one for occupational health professionals, who are supporting businesses make the workplaces covid-secure. You can download them for free.

Planning workers’ return

Here are five things any business needs to do before employees come back

  1. Contact workers about coming back to the workplace as far in advance of their expected return as you can
  2. Be prepared to have more than one conversation with your employee and use every contact to reassure them about the care you’re taking to open up the workplace
  3. Together with your employee, identify anything that might be an obstacle to their return. Obstacles can be personal, such as difficulty with childcare, practical, such as how they travel to the workplace, and even anxiety about catching covid-19.
  4. Agree with each member of staff a return to work plan which lists who will do what and when.
  5. If the obstacles identified are more than managers and HR departments can resolve, call in occupational health (OH) professionals. OH professionals support the well-being of workers, preventing ill-health, providing independent advice to organisations, facilitating steps to reduce sickness absence, and controlling infection risks.

Conversation starters

Not sure how to start conversations with your furloughed staff?  Here are some conversation starters you can use.

  • “How has life been?”
  • “Are you OK about coming back?”
  • “Do you feel safe coming back?”
  • “How we can make your job better?”
  • “Do you know who to talk with if any problems crop up?”

If someone has existing common health problems, questions could include

  • “Do you feel up to doing your usual job?”
  • “What parts of your job do you think you will find difficult and what can we change to help overcome the difficulties?”

Getting the UK back to work

Work is good for us and the country needs to get back to good, safe jobs, in which people are safe and feel supported. Our Returning to the workplace toolkits can help all kinds of business achieve this. Download them for free from the Resources section.

Vulnerability to COVID-19

Vulnerability to COVID-19


Dr Robin Cordell, a director of the Council for Work and Health, and a Fellow of the Royal College of Physicians has this week brought our attention to the following piece within the President of the Royal College of Physicians of London most recent update to members of the Royal College.


In this update, Professor Andrew Goddard MD PRCP highlights the importance of assessing those who are more vulnerable should they be infected with COVID-19, so informing individual risk assessment by management as to how such people may be protected in their work.


We were very pleased that the President of the Royal College of Physicians has highlighted the essential work done by occupational health staff, and that he made a specific point of thanking occupational physicians (the Faculty of Occupational Medicine being a faculty of this Royal College) and so by extension all those supporting health and work at this time.


This is the key part of this message from the President of the Royal College of Physicians:

“The creation of a list of 1.8 million people as a ‘clinically extremely vulnerable’ group who need ‘shielding’ from COVID-19 was both a mammoth task and one that all involved should be proud of. Risk, though, is not a binary thing. As our understanding of what makes people more vulnerable to the effects of COVID-19 improves, we may need to be a bit more flexible about who needs shielding and who does not. This will be especially true as the rest of the population comes out of lockdown and being shielded may be seen by some of the shielded as a curse rather than a blessing.


Such risk needs to take into account the susceptibility of an individual to infection and the severity of disease that results. Some of this will be defined by obvious parameters such as age, comorbidities, medications, ethnicity and sex. The risk will also depend on the exposure risk in the community (will we have a local COVID-19 level as we do for pollen, pollution and UV exposure?), occupation and means of commuting. Lastly, each of us has our own perception of what we will accept when it comes to risk. As we refine ‘shielding’ it will need to be as personalised and thought about as any shared decision we make about a treatment in clinic or on the ward.


The role of ethnicity remains something that many are rightly worried about. There are several pieces of work going on in both PHE and NHSE looking at this. Occupational medicine has a large role to play for us as physicians and the letter from Simon Stevens formally tasked trusts with risk assessing staff. Anne de Bono, president of our Faculty of Occupational Medicine, is working hard on this with colleagues, including the Society of Occupational Medicine. This is going to be a massive amount of work for an understaffed part of our workforce.


This week’s shout out therefore goes to them. Thank you to all our occupational physicians.”



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


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


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


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


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.