NEBOSH International Diploma in Occupational Health and Safety

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Version 1.2c (06/11/2012)

Element IB11 - Managing Occupational Health.

Learning outcomes
On completion of this element, candidates should be able to demonstrate understanding of the
content through the application of knowledge to familiar and unfamiliar situations and the critical
analysis and evaluation of information presented in both quantitative and qualitative forms. In particular, they should be able to:
1. Outline the nature of occupational health;
2. Describe the principles and benefits of vocational rehabilitation, including the role of outside support agencies;
3. Outline the management of occupational health (including the practical and legal aspects).

Minimum hours of tuition: 5 hours.

Relevant statutory provisions:
International Labour Conference, Provisional Record 20A, Convention Concerning the Promotional Framework for Occupational Safety and Health, International Labour Organisation, Geneva,
2006 Article 4: International System
International Labour Standards, Occupational Health Services Convention, C161International Labour Organisation, Geneva, 1985
Occupational Health Services at the Workplace, Dr V Forastieri, ILO

1.0 Nature of Occupational Health

B11.1 Categories of occupational health hazard
Every year in Britain alone, more than two million people experience symptoms of ill-health believed to have been caused or made worse by work, and around 33 million working days are lost.
The total cost of this ill-health to British society as a whole is around 15 billion pounds.
Health at work is primarily achieved by identifying those factors at work which could contribute to
ill-health; the workplace may have many visible and hidden hazards. The key categories are:
chemical (dusts and vapours);
biological (bacteria and viruses etc.);
physical (heat, light, noise, radiation, posture and motion);
psychosocial (stress, violence and bullying);
ergonomic (repetitive work, work that involves lifting);

Question 1.
Occupational health and hygiene is an applied science, concerned with.....
Multiple Choice (HP)
Answer 1:

Evaluation

Response 1:

Incorrect try again

Jump 1:

This page

Answer 2:

Control

Response 2:

Incorrect try again

Jump 2:

This page

Answer 3:

Anticipation

Response 3:

Incorrect try again

Jump 3:

This page

Answer 4:

All of these

Response 4:

Correct

Jump 4:

Next page

1.1 Chemical Hazards

We encounter chemicals every day in both our personal and working lives in a variety of guises,
each of which will present different levels of risk according to their individual properties.
The Control of Substances Hazardous to Health (COSHH) Regulations 2002 (as amended) outline those substances and preparations with the potential to cause harm should they be inhaled,
ingested or absorbed through the skin.
Substances exist in a variety of forms including solids, liquids, gases, dusts, fumes, vapours,
mists, fibres and smoke and employers are required to control exposure to such substances to
prevent harm to their employees.
Each substance will pose different properties depending upon their chemical composition, physical state and concentration and fall into general classifications which are pictorially represented to
provide the user with a visual indication of risks posed, examples of which are as follows:

Chemicals are widely used, particularly in industrial and manufacturing environments, such as
pharmaceutical and chemical companies not only as raw materials and finished products but for
use in analytical laboratories to ensure quality control.

Chemicals are however used in most environments in one form or another ranging from cleaning
chemicals through to solvents and organic compounds such as thinners and paints used in motor
vehicle repair shops for paint spraying. They also range from being relatively innocuous to highly

toxic.
Although some substances will cause occupational health issues on initial direct contact (e.g.
burns), some materials have the ability to cause harm through repeated exposure and can cause
occupational health issues through sensitisation (i.e. becoming increasingly or abnormally sensitive over time).
Chemical hazards have been discussed in more detail in Element B2: Hazardous substances and
other chemicals.

1.2 Biological hazards

Biological health hazards arise from infection of individuals with viruses from contact with bodily
fluids. Check bacterial infection? This can lead to individuals contracting such infections as
Hepatitis B, Hepatitis C and Human Immunodeficiency Virus (HIV). Employees working in healthcare industries such as nurses and doctors who are regularly required to immunise individuals or
take blood products or body fluids from patients who may be carriers of infection or virus. Likewise, workers employed in analytical or research laboratories, pathologists and post mortem
technicians have the potential for exposure to biological hazards.
Biological hazards have been discussed in more detail in Element B5: Biological agents.

1.3 Physical Hazards.

Physical occupational health hazards include light, heat, noise, vibration, pressure and radiation.
There are various Regulations under which each of the above physical occupational hazards are
required to be controlled.
Physical hazards have been discussed in more detail in the following Elements:
Element B6: Physical agents 1 - noise and vibration
Element B7: Physical agents 2 - radiation
Element B10: Work environment risks and controls

1.4 Psychosocial hazards

Including stress, post traumatic stress disorder, severe or chronic fatigue syndrome, musculoskeletal disorders, multiple chemical sensitivity. Violence, bullying.
http://www.hse.gov.uk/stress/video/mollystory1.html
Psychosocial hazards have been discussed in more detail in Element B8: Pyschosocial agents

1.5 Ergonomic hazards

Ergonomic/mechanical hazards count for a large amount of occupational ill health, particularly in

the healthcare industry which can be attributed to the nature and types of load required to be
moved and handled.Manual handling techniques play a huge part in ensuring that employees
move and handle loads so as to prevent physical injury from the tasks they carry out.
When considering the high incidence of injury in the healthcare industry, most of the loads being
handled are human beings with mobility issues, e.g. the elderly, physically impaired.
It is therefore very difficult in some cases to know how patients will move.
Ergonomic hazards have been discussed in more detail in Element B9: Musculoskeletal risks and
controls

1.6 The prevalence of work related sickness and ill-health with reference to reportable and
self reported sources.
Duties are placed on employers, the self-employed and people in control of work premises (the
Responsible Person) to report serious workplace accidents, occupational diseases and specified
dangerous occurrences (near misses) under Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995 (http://www.legislation.gov.uk/uksi/1995/3163/contents/made).
A full list of occupational diseases is available at http://www.riddor.gov.uk/diseases.html
The list includes:

Anthrax
Asbestosis
Carpal tunnel syndrome
Hand-arm vibration syndrome
Hepatitis
Legionellosis
Leptospirosis
Mesothelioma
Occupational dermatitis
Tuberculosis

1.7 Internal and external sources of information on occupational health.

Internal sources of information
Organisation's policies and procedures.
Reports from health surveillance.
Risk assessments.
Results of monitoring noise, dust etc.
Safety data sheets.
Supply labels.
Occupational health and Safety Manager.
Occupational health and safety department -nurse/physician.
External Sources of Information.
Chemical Abstracts Service (CAS) Medical databases
Every chemical available is allocated a unique number and stored on the CAS Medical database.
Occupational and Environmental Medicine Publications.

This is a monthly journal published by the British Medical Journal (BMJ) group concerned with
areas of current importance in occupational medicine and environmental health issues throughout
the world.
Barbour Index.
The British Medical Association (BMA) library has a microfiche file and printed index of this resource. It includes full text British standards as well as other useful resources
Health and safety information including legislation.
Employer guidance on how to comply with legislation and best practice.
British, Irish and European health and safety legislation.
HSE reports and guidance.
Trade union reports.
Fire protection association reports.
British standards.
British Standards Institute (BSI).
BSI Management Systems operates worldwide to provide organisations with independent thirdparty certification of their management systems, including ISO 9001:2000 (Quality), ISO 14001
(Environmental Management), OHSAS 18001 (Occupational Health and Safety).
HSE.
Health and Safety Executive produce publications and guidance notes on all aspects of occupational health and safety.
HSG series CS, EH, GS, PM.
Legal series COP, HSR, and L.
MS series e.g. MS26: A guide to audiometric testing programmes, which is a priced publication in
the medical guidance series.
Guidance notes.
Industry advisory committee publications.
MDHS series Methods for the Determination of Hazardous Substances (MDHS) provides a
range of guidance identifying and promoting good practice in the use of hazardous substances.
Information sheets.
Acts of parliament.
Delegated legislation (regulations).
Approved Codes of Practice (ACOP) and Guidance.
European Directives.
World Health Organisation (WHO).
The World Health Organisation is the United Nations specialised agency for health.
It was established on 7th April 1948.
WHO's objective, is the attainment by all peoples of the highest possible level of health. Health is
defined holistically as the state of complete physical, mental and social well-being and not merely
the absence of disease or infirmity.
International Occupational Health and Safety Information Centre (CIS)
The CIS collects and disseminates world literature that can contribute to the prevention of occupational hazards. CIS, together with its network of National and Collaborating Centres, collects
and disseminates world information on occupational health and safety and provides a computerised indexing and abstracting service.
International Labour Organisation (ILO)
The ILO provides the formulation of international labour standards; technical assistance; training
and advisory services. Safe work brings together information on the ILO's standard-related activities
Institution of Occupational Safety and Health (IOSH)
Europe's leading body for occupational health professionals.
The Central Index of Dose Information (CIDI).
The CIDI is the Health and Safety Executive's national database of occupational exposure to ionising radiation. It is operated under contract by the National Radiological Protection Board (
NRPB). CIDI receives annually from Approved Dosimetry Services (ADS) summaries of radiation
doses recorded for employees designated as classified persons in the United Kingdom.
The Employment Medical Advisory Service (EMAS)

EMAS is an integral part of HSE and is staffed by specialist occupational health professionals,
both doctors and nurses. They are available to give expert advice on medical matters relating to
work to a wide range of organisations and individuals. This includes employers, employees, trade
unions, all Directorates in HSE, Local Authority environmental health officers and also other
health care professionals.
Occupation Health Advisory Committee (OHAC)
OHAC was set up to advise the HSC (now part of the reformed HSE) on encouraging systems for
managing health at work; developing occupational health services and competencies; improving
data on occupational disease and promoting health in the workplace. Details of OHAC's meetings
and its terms of reference when it met are found at the bottom of this page.
OHAC has now evolved into the Occupational Health Reference Group (OH Reference Group) as
part of the new HSC Strategy which gives a key place to Occupational Health in achieving improvement in working days lost and the incidence of cases of ill-health.
The OH Reference Group (which includes ex-members of OHAC) meet several times during the
year to discuss areas of work on occupational health issues that HSE is developing and specifically those related to the delivery of the Securing Health Together[1] agenda.
A core element of this work is developing around the areas of innovative engagement, testing
several different types of partnership working in the areas of Worker Involvement, Corporate Social Responsibility and Occupational Health Support and Rehabilitation to determine whether new
forms of intervention are more successful at tackling the health agenda.
OHAC's Terms of Reference
To consider and advise the Commission on the health of people at work (excluding matters pertaining to other subject advisory committees) and in particular on:
encouraging systems for managing health at work;
developing occupational health services and competencies;
improving data on occupational disease;
promoting health in the workplace;
specific matters referred by the HSE

Question 2
The Employment Medical Advisory Service (EMAS) gives advice on all aspects of occupational
health and aims to promote awareness of health-related matters in the workplace.
True/False (HP)
Answer 1:

True

Response 1:

Correct

Jump 1:

Next page

Answer 2:

False

Response 2:

Incorrect try again

Jump 2:

This page

1.8 The links between occupational health and general/public health, with reference to
current government strategy for managing health in relation to work including
arrangements to deal with epidemics.
Costs of working age ill health are highly substantial and have resulted in a great deal of time and
resource being invested into this pubic health issue. In 2005 the UK Government published a
White Paper entitled 'Choosing Health: making healthier choices easier'

Please see link below :http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/Publicationsandstatistics/Publicati

ons/PublicationsPolicyAndGuidance/Browsable/DH_4097491
The White Paper sets out the key principles for supporting the public to make healthier and more
informed choices with regards to their health.

2 Nature of occupational health

IB11.2.1 Meaning of vocational rehabilitation
A definition of Vocational Rehabilitation (VR)
Although VR grew out of efforts to rehabilitate people with disabilities, today it encompasses the
provision of assistance to a much broader group, including people with physical health conditions
and mental health problems.
Vocational rehabilitation: a process to overcome the barriers an individual faces as a result of injury, illness or impairment when accessing, remaining in or returning to purposeful activity, work
and employment. This process includes the procedures in place to support the individual, their
family, friends or carers, their employers or others in the community. It includes help to access
and practically manage the delivery of vocational rehabilitation and the wide range of interventions that help people with a health condition and/or impairment to overcome barriers to work and
remain in, return to or access employment or work opportunities. (Based on definitions in Occupational therapy in vocational rehabilitation (Barnes and Holmes 2007) and in Building capacity
for work (DWP 2004).
Early in 2007, the (then) Scottish Executive published Co-ordinated, integrated and fit for purpose: A Delivery Framework for Adult Rehabilitation in Scotland.
The Framework sets out how provisions for VR in Scotland should operate.
It defines VR as:
"a process that enables people with functional, psychological, developmental, cognitive and emotional impairments or health conditions to overcome barriers to accessing, maintaining or returning to employment or other useful occupation." (pg 32)
The focus of VR is to help people retain or regain the ability to participate in work, rather than to
treat any illness or injury itself.
However, it is now well recognised that, as well as providing economic benefits, engagement in
work or other meaningful and valued activity has health benefits for the individual, and can aid
recovery from physical or mental health problems.
The process of VR
Provision of VR can require input from professionals from many different disciplines, including
medical professionals, disability advisers and career counsellors.
According to the Vocational Rehabilitation Association (VRA), the techniques used can include:
assessment and appraisal
goal setting and intervention planning
provision of health advice and promotion, in support of returning to work
support for self-management of health conditions
career (vocational) counselling
individual and group counselling focused on facilitating adjustments to the medical and psychological impact of disability
case management, referral, and service co-ordination
programme evaluation and research

interventions to remove environmental, employment and attitudinal obstacles

consultation services among multiple parties and regulatory systems
job analysis, job development, and placement services, including assistance with employment
and job accommodations
the provision of consultation about and access to rehabilitation technology.

2.2 Benefits of vocational rehabilitation within the context of the employee and the
employer
Employers benefit from the employment of people with disabilities, who can make a significant
contribution at their place of employment, in jobs matched to their skills and abilities, if disability
related issues are appropriately managed. Employers can also gain from the retention of experienced workers who become disabled, and on indications that significant savings can be made in
terms of health costs, insurance payments and time lost, if an effective disability management
strategy is in place.

2.3 The basic principles of the bio-psychosocial model and how it relates to the health of
individuals
Biopsychosocial model of health and illness

In 1977, American psychiatrist George Engel introduced a major theory in medicine, the BPS
model. The model accounted for biological, psychological and sociological interconnected spectrums, each as systems of the body. The model prompted a shift in focus from disease to health.
Engel states:
" to provide a basis for understanding the determinants of disease and arriving at rational treatments and patterns of health care, a medical model must also take into account the patient, the
social context in which he lives and the complementary system devised by society to deal with
the disruptive effects of illness, that is, the physician role and the health care system. This requires a biopsychosocial model".
The biopsychosocial model (abbreviated "BPS") claims that biological, psychological and social
factors all play a significant role in the context of disease or illness. It holds that health is best understood in terms of a combination of biological, psychological, and social factors rather than
purely in biological terms.
This contrasts with the traditional biomedical model of medicine that suggests every disease
process can be explained in terms of an underlying deviation from normal function such as a
pathogen, genetic or developmental abnormality, or injury. The biopsychosocial model is also a
technical term for the popular concept of the 'mindbody connection'.
The model was theorised by psychiatrist George L. Engel at the University of Rochester, and discussed in a 1977 article in the journal Science, where he advanced the need for a new medical
model; however no single definitive, irreducible model has been published.
Model description and application in medicine
The biological component of the biopsychosocial model seeks to understand how illnesses might
arise from the functioning of the individual's body. The psychological component of the biopsychosocial model looks for potential psychological causes for health problems such lack of selfcontrol, emotional turmoil, and negative thinking. The social part of the model investigates how
different social factors such as socioeconomic status, culture, poverty, technology, and religion

can influence health.

The biopsychosocial model implies that treatment of disease processes requires that the health
care team address biological, psychological and social influences upon a patient's functioning.
The biopsychosocial model states that the workings of the body can affect the mind, and the
workings of the mind can affect the body. This means both a direct interaction between mind and
body as well as an indirect one.
A growing body of empirical literature suggests that patient perceptions of health and threat of
disease, as well as barriers in a patient's social or cultural environment, appear to influence the
way in which a patient will participate in behaviours such as taking medication, proper diet or nutrition and engaging in physical activity.
Psychosocial factors may predispose the patient to risk factors. An example is that depression by
itself may not cause liver problems, but a depressed person may be more likely to have alcohol
problems, and therefore liver damage. It may be that this increased risk-taking that leads to an
increased likelihood of disease, which in itself can exacerbate the depression.
Not all diseases are covered by the BPS model; it tends to work best when applied to those illnesses which are behaviourally-moderated, with known high risk factors, or so-called "biopsychosocial illnesses/disorders". An example of this is type 2 diabetes, which with the growing prevalence of obesity and physical inactivity, is on course to become a worldwide pandemic.
There are of course problems with the biopsychosocial model, inasmuch as it can be taken to extremes by those whose instinctive reaction is to distrust the biomedical model for various reasons.
Used as a tool to justify 'alternative' treatments, it can end up giving these treatments undeserved
validity. There is also the danger that the BPS model may highlight factors in the patient's condition which, if viewed as part of the problem can assist in treating the whole problem, using a wide
spectrum of methods, but which - if taken in isolation - may give misleading direction to a patient
and actually hinder the full treatment of the problem in question.
Nevertheless, BPS is a valuable tool in the doctor's armoury and can give another perspective
through which to view disease and ill-health.

2.4 The role of overcoming any barriers to ensure that rehabilitation of the individual is
effective.
Rehabilitation has two main aims:
- to help employees return to work after an illness or disability
- to help employees with chronic health conditions stay in work.
Good rehabilitation practice involves employers, managers, employees and a range of other professionals working together to find solutions to achieving these aims. The methods they use include medical intervention and making changes to the workplace.
Rehabilitation should be part of a wider strategy on employees' health and wellbeing. The aims of
the strategy should be to tackle the causes of work-related ill health and injury, get involved before absence occurs, and through health promotion encourage employees to take responsibility for their own health.
A recent evidence review found that interventions involving employeeemployer partnerships,
and/or consultation, were the best approach. The review highlighted the benefits of addressing
both individual and organisational-level factors, and considering not only employees' health conditions, but also their attitudes and beliefs. It found that communication and co-operation between
employers, employees, occupational health providers and primary care professionals can result in
faster recovery, less recurrence of ill health, and less time off work.
This section outlines the steps that should be taken to assess the work adjustment needs of an
employee with a medical condition or impairment before they've been rehabilitated or given new

duties.
Who should carry out the assessment?
The assessor should normally be the employee's line manager, as they have a good understanding of the nature of the work. The employee should be involved in the assessment, as they will
know how the condition or impairment might affect their work. By focusing the assessment on the
needs of the individual, it's more likely that the employee will support the rehabilitation process. It
will also reduce the risk of discrimination. Specialists such as occupational health or occupational
safety and health practitioners should give advice when needed.
Why is an assessment needed?
An assessment is needed because the line manager may have to:
- make changes so that certain aspects of the work are accessible to the employee
- make adjustments to the work or workplace to help the employee work safely and not put others
at risk.
The assessment process will help the assessor make an informed decision about what adjustments are needed and whether they would be reasonable. The assessor should back up their
decisions with formally documented evidence. This will minimise the risk of not meeting employment, health and safety, age and disability discrimination requirements.
What information will the assessor need?
The employee should discuss their needs and possible access issues, but can withhold confidential information about their condition or impairment. The assessor may need a medical report,
preferably from an occupational health adviser who has an understanding of the nature of the
employee's work, although there may be enough information in the GP's medical certificate. The
report should give recommendations about what the employee can and can't do, if any modifications to the work are needed, and may include suggestions for more help and support. These will
form the basis of the assessment. The assessor and the employee have detailed knowledge
about the job, and both should have a close look at the nature of the work to decide if any adjustments are needed.
When the assessor carries out the assessment, they will need:
- the job description and/or person specification
- where necessary, a medical report describing any restrictions or adjustments
- a 'Work adjustment assessment form' for complex work, the assessor may have to divide the
work into several manageable chunks
- records of risk assessments that have already been carried out, as well as codes of practice and
other safe working procedures relating to the work
- risk assessment forms or checklists for specific areas, such as for manual handling or work with
computers
Can an assessment be carried out if there is no medical report?
In some cases, the assessment will be straightforward and can be carried out by the manager
and employee without a medical report. During the assessment, if the manager or employee becomes concerned about the employee's ability to carry out a task and needs a medical opinion,
they should speak to an occupational health adviser or the employee's GP.
Are there any confidentiality issues?
Information about an employee's impairment or medical condition should be kept confidential,
unless the employee has consented (with a signature) to the information being passed to others.
The manager and employee should agree what can be communicated.
Carrying out the assessment: a step-by-step guide
1 Record the work being assessed and where the employee will be based
2 Record the name of the employee
3 Record the name of the person carrying out the assessment
4 Record any barriers to working

To identify the potential barriers to working, use the assessment guidance tables (see pages 30
32), the job description and/or person specification, and any information given in the medical report or by the employee.
5 Identify any health and safety concerns
There should already be control measures in place for general risks, so the assessment only
needs to focus on extra risks relating to retaining or appointing the employee.
To identify hazards and assess risks, the assessor needs to take account of information in existing risk assessments and health and safety codes of practice, as well as the sources of information listed on pages 1920.
They should assess the hazards from:
- the work environment
- the use of work equipment
- the use of or exposure to dangerous substances or agents
- the work activity, including interaction with other people
- the employee if the condition or medication may affect their behaviour
- emergencies suitability of fire and first aid facilities for the employee.
The assessor must also identify who is at risk. This would normally be the employee only, although some medical conditions and impairments can affect the health and safety of other employees, as well as customers and contractors.
For some activities, such as using computers or manual handling, the assessor may have to use
the employer's existing risk assessment format to carry out an individual assessment that takes
account of the employee's impairment or condition.
6 Identify the measures needed to improve access and minimise risk
These will normally be actions that the employer and employee can take, without the need for
significant extra resources. This may involve, for example:
- adapting the work of the employee or team, so that the employee doesn't need to do certain
tasks
- changing the employee's working hours
- adapting the workplace or providing specialist equipment
- providing extra support, such as help with travelling
- revising certain practices, such as emergency procedures.
If the cost of adjustments is likely to be more than 300, the Access to Work scheme (UK only)
may be able to help. The assessor must carry out high or medium priority actions before the employee can return to work, unless they can introduce short term measures that reduce health and
safety risks to an acceptable level.
7 List any barriers or concerns that haven't been resolved through reasonable adjustments
The assessor should record any concerns they've been unable to resolve. This may be because
of a lack of information or expertise, or there may be major cost implications, such as changes to
the premises. The assessor needs to decide how much of a priority these issues are in respect of
allowing a safe return to work, and then get advice on these areas before they begin part 8. They
might have to speak to an occupational health adviser, occupational safety and health practitioner, building surveyor, or someone who can give them more specialist advice on access to work
or specialist equipment, such as a disablement resettlement officer or disability employment adviser.
8 Decide whether the work is, or can be made, compatible with the employee's condition or impairment
If the assessor hasn't been able to deal with medium and high priority concerns because reasonable adjustments can't be made, it may not be possible to rehabilitate the employee into their existing job. This could then involve redeploying them temporarily or permanently or, failing that,
retiring them on the grounds of ill-health or incapability. If the work isn't compatible with the employee's condition or impairment, the assessor should record the reasons.

The assessor should make sure they've explored all possible solutions before making their final
decision, and keep a copy of the assessment. If they're proposing a permanent change to an employee's duties, or retirement, the employee should be referred to the employer's occupational
health adviser. Such decisions should not be based purely on the GP's assessment.
9 Agree action
If reasonable adjustments can be made, the line manager should agree with the employee what
action will be taken, who will take it and when. The line manager should make it clear what must
be done before the employee can return to work.
The line manager should agree with the employee what information can be shared with work colleagues. While confidentiality is important, work colleagues can become resentful if they think that
an employee on restricted hours or duties is being paid the same as them, unless the reasons are
explained. A lack of information can also lead to gossip or conjecture about the employee's condition. This can be a particular problem if the employee has had a mental health condition.
10 Signatures
Once the manager and employee have agreed to the assessment and the action to be taken,
both should sign and date it. If they can't agree, they can get advice from a human resources
specialist.
Depending on the circumstances, the employee may want to discuss the implications of the assessment with someone else, for example an employee representative, before they sign the assessment.
11 Record the date for the interview
The assessor should agree a suitable date to formally review the assessment, to make sure actions have been taken and are effective. This should be within the first three months of the employee's return to work.
12 Continue to support the employee
The manager should tell the employee how their progress will be monitored. One way of achieving this is for the manager to get a fellow employee to act as a mentor. Everything should be
done to make sure the employee feels welcome when they return to work, and that other employees are treating the employee well.
If the measures put in place don't work, or if the employee's condition changes, the line manager
and employee should agree a realistic way forward, for example redeployment.

2.5 Agencies to support rehabilitation

Managing rehabilitation successfully relies on good occupational health advice. Employers who
use occupational health advisers are much more likely to meet their legal obligations under employment and disability discrimination law.
If an employer relies on advice from the employee's GP, they should bear in mind that GPs
should only act in what they consider to be the best interests of their patient, and need to be convinced that rehabilitation is appropriate. They have no responsibility to the employer and are under no obligation to give them advice. However, some GPs will respond to requests for help and
guidance, particularly if it comes from the employee.
Most GPs don't have occupational health expertise and can't offer the type of advice that occupational health professionals can. For instance, an occupational health specialist can:
- advise on whether return to work is appropriate and what's practicable
- examine the employee, advise on whether rehabilitation is an option and, if so, the adjustments
to the workplace that may be needed
- monitor employees on a rehabilitation programme
- give employees advice and recommend specialist advice or treatment

- assess whether it would be useful for the employer to pay for certain treatments
- provide a second opinion on a GP's report, and discuss any differences of opinion they may
have
- assess an employee's eligibility for retirement or disability benefits
- support the prevention of work-related illness and injury by advising on a health-related risk assessment, carrying out health surveillance, giving advice at the early stages of
an occupational disease, and promoting health.
Legally, if an employer is thinking of dismissing an employee on the grounds of ill health, they
must demonstrate that they've taken reasonable steps to discover all the relevant facts. This
means getting advice from an occupational health specialist, rather than relying solely on information provided by the employee's GP.
If organisations don't have access to full time occupational health support, other options include:
Employee's GP or specialist
While they may not have occupational health expertise, they will understand the medical aspects
of their patient's condition.
Employment Medical Advisory Service
This service, part of the HSE, offers information on the availability of local occupational health
services. You can find your local EMAS office in the phonebook, under 'Health and Safety Executive'.
Insurance companies
Some insurance companies offer rehabilitation support, particularly where absence is workrelated or prolonged.
IOSH
IOSH's free Occupational Health Toolkit gives occupational safety and health practitioners a wide
range of resources to help tackle key occupational health issues. The site is an occupational
health 'hub' for non-medical practitioners, and has lots of tools to help deal with occupational
health issues. Currently, it covers MSDs, stress, inhalation hazards and skin disorders.
To find out more, visit www.ohtoolkit.co.uk.
NHS Plus
In England, some NHS trusts sell occupational health support services to small businesses. For
more information, visit www.nhsplus.nhs.uk. Similar arrangements are available in Wales
(www.wales.nhs.uk), Scotland (www.healthinfoplus.co.uk), and Northern Ireland (www.ni.nhs.uk).
Occupational health service providers
The Commercial Occupational Health Providers Association (COHPA) is a not-for-profit trade association that can help you find a commercial occupational health provider. Find out more at
www.cohpa.co.uk.
Rehabilitation or case management specialist companies
Case management is a collaborative process that assesses, plans, implements, co-ordinates,
monitors and evaluates the options and services needed to meet an individual's health, care,
educational and employment needs. For more information, contact the Case Management Society UK on 0870 850 5821 begin_of_the_skype_highlighting 0870 850 5821
end_of_the_skype_highlighting or visit www.cmsuk.org.
Scottish Centre for Healthy Working Lives
This provides free, confidential advice and information in Scotland on a widerange of workplace
health issues, including health promotion, occupational safety and health, employability and vocational rehabilitation (t +44 (0)800 019 2211 begin_of_the_skype_highlighting +44 (0)800 019
2211 end_of_the_skype_highlighting), as well as workplace visits.
For more information, see www.healthyworkinglives.com.
Workboost Wales
This government-funded service offers confidential, practical and free advice to small businesses

and their workers in Wales on workplace health and safety, managing sickness absence and return to-work issues. Visit www.workboostwales.net or call 0845 609 6006 begin_of_the_skype_highlighting 0845 609 6006 end_of_the_skype_highlighting

3 Managing Occupational Health

IB11.3.1 The concept of monitoring health
Health monitoring is an informal, non-statutory method of surveying your workforce for symptoms
of ill health.

3.2 The meaning of occupational health

DEFINITION:
Occupational Health is the promotion and maintenance of the highest degree of physical, mental
and social well-being of workers in all occupations by preventing departures from health, controlling risks and the adaptation of work to people, and people to their jobs.
(ILO / WHO 1950)
OCCUPATIONAL HEALTH SERVICES
Definitions and functions:The ILO Convention on Occupational Health Services (No. 161) and the ILO Recommendations
on Occupational Health Services (No. 171) were adopted in 1985. In the Convention the following
definition was given:
"The term 'occupational health services' means services entrusted with essentially preventive
functions and responsible for advising the employer, the workers and their representatives in the
undertaking, on the requirements for establishing and maintaining a safe and healthy working environment which will facilitate optimal physical and mental health in relation to work, the adaptation of work to the capabilities of workers in the light of their state of physical and mental health".
This link gives a more detailed view on the ILO's approach to Occupational Health.
There is a wide range of activities associated with Occupational Health and these include
identification and assessment of the risks from health hazards in the workplace;
surveillance of the factors in the working environment and working practices which may affect
workers' health;
a systematic approach to the analysis of occupational "accidents", and occupational diseases;
advising on planning and organisation of work and working practices, including the design of
work-places, and on the evaluation, choice and maintenance of equipment and on substances
used at work;
providing advice, information, training and education, on occupational health, safety and hygiene
and on ergonomics and protective equipment;
surveillance of workers' health in relation to work;
contributing to occupational rehabilitation and maintaining in employment people of working age,
or assisting in the return to employment of those who are unemployed for reasons of ill health or
disability;
organising first aid and emergency treatment.

3.3 The role of occupational health services

he role of Occupational Health Services is to provide specialist medical advice, and to assist

Managers to ascertain the true medical position on which to base decisions about their staff.
The Physician and Nurse in Occupational Health provide an independent, impartial advisory service. They are responsible for the provision of clear medical advice to Managers about the individual cases referred to them.
Their advice is based on factual evidence obtained from the following:
* Full background to the case e.g. absence records, job demands.
* Medical assessment including physical examination where relevant.
* Workplace assessment where relevant.
* Monitoring of the progression of a case over a period of time.
* Reports from an employee's family Doctor (GP) or Specialist.
Occupational Health Services do not make decisions about an Employee's continuing employment, redeployment, or future deployment. These decisions are made by management and
should take into account the advice of the Occupational Physician, but they will also be based on
other factors such as service demand, risk assessment of health and safety considerations, legal
framework and financial constraints.
To give you an overview of likely costs and benefits associated with introducing occupational
health services to your business, NHS Plus have compiled a number of cost studies

Question 3
The role of Occupational Health Services is to provide specialist medical advice and to assist
Managers to ascertain the true medical position which to base decisions about their staff.
True/False (HP)
Answer 1:

True

Response 1:

Correct

Jump 1:

Next page

Answer 2:

False

Response 2:

Incorrect try again

Jump 2:

This page

3.4 The Functions of Occupational Health Services

Functions that an Occupational Health Service may perform include:* pre-employment medical screening;
* medical/health surveillance;
* assessment of fitness for work;
* counselling;
* health promotion.
We will now look at the above in a little more detail.

3.5 Pre-employment Medical Screening

Assessing a person's ability to carry out the duties of a job can be an important selection tool.
Pre-employment medical checks should be seen as a way of:

* screening candidates in - not screening them out;

* identifying any risks to prospective employees, colleagues or clients;
* identifying any support needed by the prospective employee to do the job effectively;
* identifying any disability issues, such as potential reasonable adjustments;
* identifying any potential attendance problems;
* providing a base-line of health for future reference.
The level of check can take various forms, from verifying the number of days' absence with the
previous employer to requiring the employee to undergo a thorough medical examination. The
type of check that is undertaken should depend upon the requirements of the job.
Checking days absent.
The previous employer, in their reference, should be asked to verify the number of days' absence
the employee had when in their employment. However, it will be necessary to justify using the
number of days' absence as a criterion for selection if the absence arises from a disability.
Health questionnaires.
Where it is not necessary to examine all new recruits, it may be appropriate to use a health questionnaire to highlight any cases that give rise to concern. Referrals can then be made to the GP or
the occupational health adviser. Care should be taken to ensure that disabled people are not referred simply because they have a disability. The reason for the referral must relate to the requirements of the job.
When developing a health questionnaire, consideration needs to be given to the questions that
will be asked of the potential employee, how the information will be assessed, by whom and confidentiality issues. There will also need to be clear guidelines as to when further information
should be sought from the individual's GP or the occupational health adviser. The applicant
should also be made aware of their rights and responsibilities. It is suggested that the questionnaire is designed in consultation with the occupational health advisers.
Medical referral.
When referring a prospective employee to their GP or a occupational health adviser, it is essential
that the employer provides detailed information on the requirements of the job, including the type
of tasks that the individual will be expected to undertake.
The employer should also be clear about what information they are seeking from the medical expert. As well as advice on whether or not the candidate is medically suitable for the job, the employer should seek information on whether the employee has a disability and if so, whether any
reasonable adjustments could be considered to enable the candidate to be appointed to the job.
Medical reports.
As part of the medical referral process, the employer or the occupational health adviser can obtain a medical report about the applicant, provided that they comply with the Access to Medical
Reports Act.
Medical Examinations.
An examination should only be carried out where it is necessary to determine the applicant's suitability for the post. For example, to see whether he or she has sufficient physical strength to carry
out the work. The applicant should be informed of the reason for the examination and what is being looked for.
Disability Discrimination Act.
If a health check does reveal a condition which will mean that an employee will have difficulty carrying out any of the job duties, then the employer should consider whether a reasonable adjustment could be made, as required by the Disability Discrimination Act 2005.
Data Protection Act and Human Rights Act.
For the purpose of data protection, information about a person's health condition should be considered sensitive and personal. The employee should be asked to consent to the obtaining, hold-

ing and processing of health information. The reasons why the information is required, for what it
will be used and to whom it may be disclosed, for example, occupational health, should be provided.
Requiring an employee to complete a health questionnaire or have a medical could be seen as
an interference with a person's right to respect for their private life, and a breach of the Data Protection Act.
Employers should consider carefully whether they are necessary in light of the job in question,
and only relevant information should be obtained.
The benefit to the employer should be balanced against the extent of the intrusion for the individual. Employers should consider whether other, less intrusive ways of making the necessary
checks, for example, using a questionnaire instead of requiring a full medical, would be appropriate

3.6 Assessment of Fitness for Work

When employees have been absent for an extended period - some weeks - because of illness or
injury, they are often able to begin doing some part of their work quite some time before they are
fully fit to manage all their normal activities.
It is always better for people to keep in contact with their colleagues and their work as much as
possible, rather than to be completely away from it for a long time, to prevent loss of familiarisation and to maintain their interest in ongoing projects.
If people had to wait until they were fully able before returning to some work many would be absent for a long time.
Returning to work after an extended absence is the beginning of a rehabilitation process, rather
than the end of recovery.
An assessment of fitness for work includes the travel to and from, and activities carried out during
work, the extent of the intrinsic demands of the work, and the necessary interactions with colleagues.
The OH staff can advise about how they believe the process may best be handled, but cannot
always judge how that may fit with the possibilities available to the manager; the recovery process is best agreed individually for each person, and may involve temporary assignment to alternative work within the department, or a graduated re-introduction to the normal assigned work.
Such arrangements are always temporary, and it would be normal to review progress regularly
with the person concerned.
HR personnel are often in the best position to judge the progress which someone makes if their
work involves temporary secondment or assignment, and should be able to discuss what alternatives may be available in other departments to assist a recovery programme. They also help to
manage questions about salary structure and benefits, which may well arise during extended absence

3.7 The Fit Note

From 6th April 2010, there have been a number of changes to the sick note, or medical statement, that employees get from their GP to certify sickness absence.
Previously a sick note simply stated whether a doctor believed that a person should or should not
be in work. The new medical statement will either indicate that a person is not fit for work, or that
they might be fit for work under certain circumstances. The doctor will also be able to suggest
changes that would assist a return to work. There is no requirement for the GP to write anything

apart from that the person is not fit for work and how long the person is "signed off" for, and in
most cases the patient and employer will see no change in the information that the medical
statement gives.
In addition, in the future, the note will be completed and stored electronically by the GP rather
than handwritten, although it will still be given directly to the worker to send to the employer.
There will be no change to the basic purpose of the medical statement and it will still be used by
employees as confirmation of illness if claiming sick pay.

Background
The key to reducing long-term sickness absence has three components. The first is prevention of
injury and illness, both in the workplace and outwith. Secondly, early access to treatment and, if
appropriate rehabilitation. Thirdly, good return to work policies which are worker-centred and
which aim to support the worker in the transition back to work.
The idea that a person is either too ill to work at all, or well enough to fulfil their full duties does
not reflect the real experience of those who are recovering from a long-term illness who would
often like the opportunity of returning in a phased or supported way.
The new process
The new medical statement will still be evidence that an employee cannot work due to injury or
illness, and normally will not be required until after the 7th calendar day of sickness.
The present arrangements for Statutory Sick Pay (SSP) and any occupational sick pay scheme
that you may have will not be changed. As at present, the form is advice that is given to the
worker to use to give to the employer as evidence of illness for the purposes of sick pay and is
not binding.
The changes will be:
The form will now have two options. That the patient is "not fit for work" or that the patient "may
be fit for work taking account of the following advice."
There will be four types of alterations listed which the GP can tick. These are:
A phased return to work
Altered hours
Amended duties
Workplace adaptations
There will be space for the doctor to provide more information on the condition and how it may

affect what they do.

In most cases there will be nothing to recommend and, as at present, the worker will go back to
work once the GP feels they are ready to. There will not however be an option for the GP to say
that a person is "fit for work". The doctor will simply not issue a new medical certificate.
The doctor should only recommend a return to work if the person is not fully recovered after discussing it with the patient and making sure they are fully aware of what is being suggested.
The doctor is likely to propose a phased return to work where someone is suffering from an illness that has left them fatigued, or has been away for a long period of time and is not confident
about returning full-time. It may also be used if a person has an injury where the doctor believes
that their strength has to be built up gradually. Often a phased return to work may be proposed
along with other changes such as amended duties.
Altered hours is slightly different. Here the doctor will recommend that the pattern of working
hours is changed. This may be recommended if the GP feels that the person may not be able to
travel in rush hour public transport, or if shift working should be avoided.
The GP should recommend amended duties where they believe that an employee cannot fully do
their former work but may be able to do their job if some duties are avoided or changed. This
could include not doing any kind of lifting if recovering from a back injury, or avoiding any work
with the public if a person is recovering from workplace stress.
Workplace adaptations may be recommended if the GP believes that some physical adaptations
are needed to help the person return to work. An example of this could be moving someone's
desk to the ground floor of a building if they have trouble with stairs.
In each of these cases the GP should base the recommendations on what the patient has told
them about their workplace and should discuss the proposals and the implications fully with the
patient.
The medical statement will then be given to the patient, as at present. The patient should then
send it to the employer. It is good practice for the employer to then discuss the proposals with the
employee and agree what changes will be made. If they disagree then the employer should not
force the employee to come back until they feel comfortable with the changes proposed.
The employer does not have to accept the advice on the medical statement, but if they do not do
so then the statement should be treated as though the doctor has advised "not fit for work". Many
employers will try to say that the employee is ready to come back and is no longer "signed off".
This is not the case and the government advice on this is clear.
The employer also must do a revised risk assessment if they make any adaptations or changes to
an employee's duties to ensure that these do not introduce new risks.
In addition, if the employee is disabled and covered by the Disability Discrimination Act then the
new "fit note" procedures do not alter the duty on the employer to make adequate adjustments
regardless of what a GP recommends.
There are certain other groups where the medical statement cannot over-ride an employer's responsibilities not to allow a person back to work when ill, even if a GP recommends this. This includes some workers in safety critical jobs and some transport workers where there are separate
regulations.
Employers and workers know the workplace and what a job entails far better than a GP, and if
there is any possibility that allowing an employee to return before they are fully fit, then the employer should put the safety of the workforce before any recommendation on a medical statement.

3.8 Counselling

What is counselling?
Counselling enables an individual to talk in confidence with a therapist about emotional difficulties
that he or she feels unable to resolve alone.
Counselling is not about giving advice, but provides a safe opportunity to explore and understand
confusion, anxiety and difficult feelings.
The counselling process can help an individual deal with personal difficulties, and can provide an
opportunity to make positive changes leading to a better quality of life.
Confidentiality.
Members of staff should have direct access to counselling support and need not inform anyone at
work. However, if an appointment is booked during working hours, the staff member may need to
inform their manager that they will be absent from work.
Work-related or personal stress.
The counselling service is intended to provide support for staff experiencing personal difficulties
and/or work-related problems.
However, if a member of staff is experiencing work difficulties, they should first talk with their
manager about concerns. If they feel unable to do so, they should contact Occupational Health so
they can discuss in confidence, the best way forward to manage or resolve their difficulties.
Counselling service covers a broad range of issues including:
Anxiety.
Problem solving.
Bereavement.
Physical illness.
Depression.
Dealing with change.
Career issues.
Substance abuse.
Family.
Stress.
Relationship issues.

3.9 Personnel within the Occupational Health Services

The role and function of Occupational Health Services specialists.
Health promotion can be defined in many different ways, but perhaps one of the most useful
models is the model which defines the content of health promotion, rather than the practice by
delineating the boundaries of health promotion and includes negative and positive aspects of
health as well as taking on a political dimension. (Tannahill 1985).
Health Promotion is constructed of three overlapping spheres of activity; health education, health
protection and ill-health prevention.
Health Education: communication activity aimed at enhancing well-being and preventing ill-health
through favourably influencing the knowledge, beliefs, attitudes and behaviour of the community.
Health Protection: refers to the policies and codes of practice aimed at preventing ill-health or
positively enhancing well-being, for example, no smoking in public places.
England implemented a smoking ban in public places and workplaces on 1st July 2007. Subject
to some exemptions (designated rooms in adult residential care homes, adult hospices and residential mental health treatment settings or designated bedrooms in a hotel, guest house or hostel
or membership clubs etc) all public places, including workplaces and premises where voluntary

work is carried out , are now smoke free. The law prohibits smoking in all public places which are
`enclosed' or substantially enclosed'. UK Smoke-free legislation includes:
Smoke-free (Premises and Enforcement) Regulations 2006
Prohibition of Smoking in Certain Premises (Scotland) Regulations 2006
The Smoke-Free Premises etc. (Wales) Regulations 2007
These are discussed in detail in Element B10: Work environment risks and controls under the
heading `Provision of facilities for smokers'.
Ill-Health Prevention: refers to both the initial occurrence of disease and also to the progress and
subsequently the final outcome.
Tannahill Model of Health Promotion

Occupational nurses and physicians in the workplace, there may be an occupational health nurse
and/or an occupational physician.
The historical image of occupational nurses and occupational physicians as fulfilling mainly a
treatment role on site, or a pre-employment screening function is outdated.
They have an important function in assessing risks to health, giving advice on reducing risks, as
well as rehabilitating people.
Think back to the Tannahill model of Health Promotion which was introduced above, and consider
how these functions illustrate the 'overlapping' activities of health education, health protection and
prevention within the workplace setting.
Occupational Hygienists
Occupational health and hygiene is an applied science, concerned with the anticipation, recognition, evaluation and control of chemical, physical and biological agents arising from work activities. If you think about this definition for a little while, you will probably recognise that it is very
similar to that used when explaining what is involved in a risk assessment, that is :-

identification of hazards (i.e. recognition),

assessment of the risks (i.e. evaluation),
control of the risks.
So, in essence, occupational hygiene is concerned with risk assessment of health hazards in the
workplace.
The occupational hygiene profession first developed in the United States in the 1930s, and really
took off there in the 1970s with the implementation of the Occupational Safety and Health Act.
The roots of the profession in the UK also go back to before the Second World War, and today
there are more occupational hygienists in the UK than in any other country, except the USA.
The real skill of the professional occupational hygienist is identifying a potential problem in the
first place, deciding how it should be assessed, interpreting the results from the sampling exercise (and other sources of information) and developing cost effective solutions.
Full-time occupational hygienists are employed in industry (normally only in larger companies), by
consultancies, and by the Health and Safety Executive (normally as Specialist Inspectors). However, there are only around 500 qualified hygienists in the UK, so occupational hygiene duties are
often performed as an additional aspect of the job of other professionals, such as occupational
health nurses and analytical chemists.
Most employers have a very low level of awareness of occupational hygiene, and are not sure
what to look for. When selecting either someone to employ directly, or an outside consultant. It
can be a particular problem with consultants, as there are many organisations who offer hygiene
services that are not necessarily competent.
So what should a prospective employer look for when selecting an occupational hygienist?
As with other occupational health and safety specialisms, the occupational hygiene profession is
governed by a professional body - the British Institute of Occupational Hygienists (BIOH). This
organisation is involved in developing and promoting occupational hygiene, and is responsible for
awarding professional qualifications.
Ergonomists
Ergonomists advise on adaptations to the workplace to suit workers, and tend to have particular
expertise in issues of handling, workstation design etc.
These 'experts' are most likely to be involved in the effects of organisational structures and procedures (e.g. management style) on the well-being of people working within the organisation.
Occupational Psychologists.
Workplace stress is a good example of an area where occupational psychologists are often consulted (see also the case study on workplace stress which comes later).

Question 4
.......communication activity aimed at enhancing well-being and preventing ill-health through favourably influencing the knowledge, beliefs, attitudes and behaviour of the community. This is the
definition of which of the activities within health promotion?
Multiple Choice (HP)
Answer 1:

Health Education

Response 1:

Correct

Jump 1:

Next page

Answer 2:

Health Protection

Response 2:

Incorrect try again

Jump 2:

This page

Answer 3:

Ill Health Prevention

Response 3:

Incorrect try again

Jump 3:

This page

3.10 Typical services offered by an Occupational Health Service

The following tables list the types of specialist services that could be made available. They are
divided into two categories:
services aimed at the 'individual', and
services aimed at 'employers'.
The further columns describe what the service would aim to deliver for the client and any comments on the mode of delivery, links to other services or the content.
Individual-focused Services
Service

Outcome

Comments

Pre-employment Screening
(Fitness for Work)
Health Questionnaire

Advice on suitability / work

restrictions / suitable
adjustments

Health Interview

as above

Medical Assessment

Conducted if referred after

questionnaire reviewed
as above, and/or statutory
requirement for nature of work

Pre-placement Screening
(Fitness for Specific Work)
as above

Includes statutory
requirements

Attendance Management
Case Review and Action Plan

Advice to management Review

of workplace Referral to
specialist provision of service
(e.g. physio) etc.

Systems operating in which

initial review by OHNA invokes
next steps for individual and/or
organisation.

Management of individual
Advice to management
(protecting confidentiality)

Wide range of health

surveillance already in place,
provided by many different
types of competent person.
Includes statutory
requirements

Health Surveillance
Audiometry, Skin Checks,
HAVs, etc.

Work-related Immunisation

Programme
Specific to control of infection
Rehabilitation

Degree of immunity/protection Provider determined by

associated activity such as
counselling, briefing, etc.

Rehabilitation
Physiotherapy

Provision of technical service

to speed recovery/return to
work

Occupational Therapy

Provision of technical service

to speed recovery/return to
work

From assistance with access to

NHS or other statutory services
to substitute provision from
private sector.

Summary of Services (cont.) 2

<><><%3-%-4%> <><><%3-%-4%>
<><><%3-%-4%>
Employer-focused services
Service

Outcome

Health & Fitness Programme

Provision of technical service

to speed recovery/return to
work

Comments

Redeployment and
Resettlement
Management Advice/Training

Employer develops ability to

support/participate in
rehabilitation programme

Specialist Service

Provision of technical service

to speed recovery/return to
work

Workplace / work adjustment

Modification of workplace or
The work stressors and the
work to facilitate return to work condition of the individual will
advice to employer
determine the specific competent person/service required to
assist

Mental Health
Occupational Psychological
Services

Assistance to individuals
coping skills etc.

From assistance with access to

NHS or other statutory services
to substitute provision from
private sector.

Raising awareness

Individual briefings to
employees on range of
personal health issues

Personal choices (smoking,

diet, etc.) may be influenced

Life Style Screening Personal

Health Services Dental

Provision of technical service

to minimise work disruption

From assistance with access to

NHS or other statutory services

Training inc. relaxation

techniques
Work / Life Balance

to substitute provision from

private sector.
Career and Education
Career advice

Individuals able to explore

Link with DfES schemes for
options for future career moves employers and adult learners
particularly where health
changes may have an impact
on what they currently do

Basic Skills assistance

Assistance with accessing
Vocational training or CPD

Link with DfES schemes for

employers and adult learners
Signposting to professional or
technical bodies, especially for
those with special needs

Summary of Services (cont.) 3

Employer-focused services
Service

Outcome

Policies and Strategies

Advice on corporate policies

and strategies across
occupational health issues

Comments
The provision of the support is
likely to come from different
sources, partially dependent
upon origin of stimulus to
action

Set of corporate policies and

strategies which integrate with
HR management and H&S risk
management

Guidance on the collection,

Corporate strategy for collecand assistance in the analysis, tion of health data, analysis
of data
and use

The provision of the support is

likely to come from different
sources, partially dependent
upon origin of stimulus to action
The data needs to inform future decision-making, and will
require a team effort to generate and use. Confidentiality
and ethical issues.

Health Risk Assessments

Evaluation of workplaces and
work activities establishing
significant risks to health

COSHH and other risk

assessments in accordance
with legal requirements

May be two stage process

initial identification of key risks,
followed by detailed
assessment by specifically
competent person

Risk Reduction Advice

Advice on reducing risks
identified by assessment

Reduction in exposures to risks In construction, risks may be

reduced by architects
everyone with control over
work and workplace should be
encouraged to participate in
risk reduction

Monitoring Risk Exposures

Quantification of risk exposure Data for comparison to

Semi-quantitative methods

against agreed standards

occupational exposure limits

etc.

applied by ergonomists and

others

Health Surveillance
Advice to management on
Policy and strategy for health
appropriate health surveillance surveillance of specified worker
groups and use of data to
manage risks

Database management IT
staff
consultation/communication
HR professionals

Attendance Management
Advice to management on
attendance management
strategies

Policy and strategy for

management of attendance

Provided to absent individuals

see "Individual-focused
services"

Management of attendance
data

Developing baselines and data From help with access to NHS

on attendance, to identify
or other statutory services to
opportunities for improvement direct provision from private
sector

Summary of Services (cont.) 4

Employer-focused services
Service

Outcome

Comments

Advice to management on
retention/rehabilitation
strategies

Strategy for maximum

retention of staff and early
return to work

Equipping the employer to deal

with individuals

Advice to management on
retention / rehabilitation for
individuals

Specific retention or return to see "Individual-focused

work programme for individual, services"
which may include
workplace/work task
adaptations/reasonable
adjustments (DDA)

Retention / Rehabilitation

Information, Instruction &

Training
Occupational health and safety Development and delivery of
training etc.
training courses etc. for every
level of organisation

From including health

protection guidance in work
instructions to Boardroom
Briefings

Work / Life Balance

Advice to employer on working Development of management
hours issues
system for gaining best from
workforce, minimising stress
etc.
Advice to employer of health
education

Development of policies and

communication strategies on
wide-range of lifestyle issues

Advice to employer on
workplace initiatives

Initiatives specific and

appropriate to nature of work
and workplace

Campaigns

Full programme likely to

involve many other
professionals

Advice and assistance in

running campaigns from workfocus (e.g. melanoma risk for
outdoor workers) to lifestyle
(exercise, healthy eating, etc.).

Employer consistently raises

Variable team composition,
profile of health issues, and
determined by campaign
facilitates employees making
content
informed choices (work-related
and personal)

Question 5
The Occupational Health Services advice is based on factual evidence obtained from which of
the following:
Multiple Choice (HP)
Answer 1:

All of these

Response 1:

correct

Jump 1:

Next page

Answer 2:

Medical assessment including physical examination where relevant.

Response 2:

Incorrect try again

Jump 2:

This page

Answer 3:

Reports from an employee's family Doctor (GP) or Specialist.

Response 3:

Incorrect try again

Jump 3:

This page

Answer 4:

Full background to the case e.g. absence records, job demands

Response 4:

Incorrect try again

Jump 4:

This page

3.11 An Occupational Health Case Study

A Radiographer working in a Hospital Trust has had alcohol problems for over fifteen years.
She sees the National Helpline advertised in the hospital and on posters on the tube. She phones
and is given information on services associated with alcohol abuse for self-referral and is put in
contact with the Trust's own Occupational Health Service (e.g. part of NHS Plus) for active treatment.
She sees a Senior Occupational Health Nurse Advisor and has screening tests e.g. liver function
test, and full blood count to assess liver damage. The nurse liaises with her Manager to discuss
her work place support, and she starts a rehabilitation programme, including physical assessment
in Fitness Suite, thereafter twice-weekly clinical exercise programme; consultation with psychologist to explore the feelings of poor self-esteem, lack of confidence and feeling of being 'let down'
by her husband, who had left her; a course of therapy for relaxation as well as psychological support; staff Development Review (SDR) to incorporate educational programme in personal awareness, self-esteem, or provide a basic lifestyle-coaching course.
The case of the Radiographer would be subject to monitoring and audit:
At regular intervals, a case conference with management, Occupational Health and the client will
plot progress, maintain support and provide goals for the future.
The Occupational Health physician, with other specialists, will audit the case management.

The records of this audit will be anonymous and included in records made available to the National Centre(s) of Excellence to assess the standard of service provided, and build an evidence
base for good practice.

3.12 Occupational competence within occupational health

Occupational health technicians
Occupational health technician is a developing role. With supervision from occupational health
qualified nurses and doctors and the correct training, they may be able to carry out some aspects
of health surveillance. This frees up doctors and nurses for other tasks.
Currently there are no published minimum standards but training programmes are being developed.
Occupational health nurses
Nurses who carry out occupational health surveillance should, as a minimum, be registered with
the Nursing and Midwifery Council (NMC). They may also hold an occupational health qualification at Certificate, Diploma or Degree level. If the nurse does not have an occupational health
qualification then they should work under the supervision of an appropriately qualified clinician
(doctor or nurse).
For a nurse-led occupational health service, the lead nurse should also be registered with the
NMC as a specialist community public health nurse in occupational health. Alternatively, they
should be qualified to register as such and have access to specialist occupational physician advice as needed.
Occupational health doctors
Occupational health doctors are expected to have skills and expertise that include:
an understanding of the health hazards that can arise at work;
an ability to assess risks relating to the health of individuals and groups;
knowledge of the law relating to workplace issues; and
an awareness and understanding of the way business operates.
There are currently three levels of qualification in occupational medicine for doctors:
Diploma in Occupational Medicine (DOccMed);
Associateship of the Faculty of Occupational Medicine (AFOM); and
Membership of the Faculty (MFOM).
Doctors who are members of the Faculty and have made a distinguished contribution to the specialty, and who demonstrate a greater depth of experience and expertise in occupational medicine, may also be awarded a Fellowship of the Faculty (FFOM).
Doctors without these qualifications who rely solely on experience gained in the workplace may
not meet the requirements for competence demanded by some health and safety legislation. It is
recommended that the Diploma in Occupational Medicine is used as the minimum standard of
qualification. However, occupational health doctors still need to work within the limits of their specific competence and seek more specialist advice when appropriate.
Minimum competence standards
As well as meeting the necessary legal requirements to employ clinical staff, it is recommended
that the following minimum levels of competence are applied:
doctors should hold the DOccMed qualification as a minimum;
nurses should be registered or qualified to be registered as a specialist nurse practitioner in public health in occupational health;
occupational health technicians should be trained in the specific elements of the service that they
deliver, and must be clinically supervised;
Some aspects of health surveillance require additional qualifications, eg:

HAVS: a Faculty of Occupational Medicine (FOM) approved training course in hand-arm vibration
syndrome, or equivalent level of competency.
Noise-induced hearing loss: a British Society for Audiology approved course for industrial audiometricians, or equivalent level of competency.
Respiratory: Association for Respiratory Technology and Physiology (ARTP) diploma, or equivalent level of competency.

3.13 General health assessment and health surveillance

Health Surveillance
Definition:
Health Surveillance can be defined as a process involving a range of strategies and methods
used to systematically detect and assess the early signs of adverse effects on the health of workers exposed to certain health hazards; and subsequently acting on the results.
Some forms of health surveillance are required by law. Other forms of health surveillance are undertaken as good practice, such as pre-employment assessments.
Management of Health Risks.
Health Surveillance should be part of an overall strategy for management of health risks, and not
a substitute for preventing or controlling harmful exposure.
It is important that a suitably qualified individual chooses the right technique of surveillance to
cause minimum harm to the individual, and in order not to cause unnecessary concern for employees.
Purposes of Health Surveillance.
Protection of health of the individual employee.
Detection at an early stage any adverse health effects.
Assisting in the evaluation of control measures.
Data may be used for detection of hazards and assessment of risk.
Other purposes: e.g. immune status assessment.
Criteria for conducting Health Surveillance.
Is the activity or substance known to harm health? i.e. is it associated with an identifiable disease
or other identifiable adverse health outcome?
Is there a valid technique for detecting indications of the disease or health effects? Health surveillance is only worthwhile where it can reliably show that damage to health is starting to happen or
likely to happen. A valid technique is specific to the disease to be identified, and is safe and practicable in the work setting.
Is there a reasonable likelihood that the disease or health effect may occur under the existing circumstances?
Is it likely to benefit the employee?
Other Factors to consider.
Is there a statutory requirement to undertake health surveillance?
Have there been previous cases of work related ill-health associated with the activity/substance?
Has an employee declared ill-health symptoms they attribute to their work?
Do you use PPE e.g. gloves, respirators? They cannot be guaranteed to give 100% protection
Must be done in consultation with employee as it may have implications for future employment.
Activities/ Substances/Individuals requiring Health Surveillance

3.14 The legal requirements for health surveillance

Legal requirements for health surveillance are contained in the following legislation:
The Control of Substances Hazardous to Health (COSHH) Regulations 2002 (as amended)
The Control of Noise at Work Regulations 2005
The Control of Vibration at Work Regulations 2005
The Health and Safety (Display Screen Equipment) Regulations 1992
The Control of Substances Hazardous to Health (COSHH) Regulations 2002 (as amended)
The COSHH Regulations place particular duties upon employers to ensure that work operations
using substances and chemical do not cause an adverse effect on the health and well-being or
employers or any other persons who may be affected by such work operations.
Regulation 11(1) of the COSHH Regulations states that:
'Where it is appropriate for the protection of the health of his employees who are, or are liable to
be, exposed to a substance hazardous to health, the employer shall ensure that such employees
are under suitable health surveillance'.
The Regulations further outline the situations when health surveillance would be deemed as appropriate.
(2) Health surveillance shall be treated as being appropriate where
(a) the employee is exposed to one of the substances specified in Column 1 of Schedule 6 and is
engaged in a process specified in Column 2 of that Schedule, and there is a reasonable likelihood that an identifiable disease or adverse health effect will result from that exposure; or
(b) the exposure of the employee to a substance hazardous to health is such that
(i) an identifiable disease or adverse health effect may be related to the exposure,
(ii) there is a reasonable likelihood that the disease or effect may occur under the particular conditions of his work, and
(iii) there are valid techniques for detecting indications of the disease or effect, and the technique
of investigation is of low risk to the employee.
The Control of Noise at Work Regulations 2005
Health Surveillance
9-(1) If the risk assessment indicates that there is a risk to the health of his employees who are,
or are liable to be, exposed to noise, the employer shall ensure that such employees are placed
under suitable health surveillance, which shall include testing of their hearing.
The Control of Vibration at Work Regulations 2005
Health Surveillance
7.-(1) If
(a) the risk assessment indicates that there is a risk to the health of his employees who are, or
are liable to be, exposed to vibration; or
(b) employees are likely to be exposed to vibration at or above an exposure action value,
The employer shall ensure that such employees are placed under suitable health surveillance,
where such surveillance is appropriate within the meaning of paragraph (2).
(2) Health surveillance, which shall be intended to prevent or diagnose any health effect linked
with exposure to vibration, shall be appropriate where the exposure of the employee to vibration
is such that
(a) a link can be established between that exposure and an identifiable disease of adverse health
effect;
(b) it is probable that the disease or effect may occur under the particular conditions of his work;
and
(c) there are valid techniques for detecting the disease of effect.

The Health and Safety (Display Screen Equipment) Regulations 1992

Health Surveillance
5.- (1) Where a person(a) is already a user on the date of coming into force of these Regulations; or
(b) is an employee who does not habitually use display screen equipment as a significant part of
his normal work but is to become a user in the undertaking in which he is already employed,
His employer shall ensure that he is provided at his request with an appropriate eye and eyesight
test, any such test to be carried out by a competent person.
(2) Any eye and eyesight test provided in accordance with paragraph (s) shall
(a) in any case to which sub-paragraph (a) of that paragraph applies, be carried out as soon as
practicable after being requested by the user concerned; and
(b) in any case to which sub-paragraph (b) of that paragraph applies, be carried out before the
employee concerned becomes a user.
(3) At regular intervals after an employee has been provided with an eye and eyesight test in accordance with paragraphs (1) and (2), his employer shall, subject to paragraph (6), ensure that he
is provided with a further eye and eyesight test of an appropriate nature, any such test to be carried out by a competent person.
(4) Where a user experiences visual difficulties which may reasonably be considered to be
caused by work on display screen equipment, his employer shall ensure that he is provided at his
request with an appropriate eye and eyesight test, any such test to be carried out by a competent
person as soon as practicable after being requested as aforesaid.
(5) Every employer shall ensure that each user employed by him is provided with special corrective appliances appropriate for the work being done by the user concerned where(a) normal corrective appliances cannot be used; and
(b) the result of any eye and eyesight test which the user has been given in accordance with this
regulation shows such provision to be necessary.
(6) Nothing in paragraph(3) shall require an employer to provide any employee with an eye and
eyesight test against that employee's will.

3.15 The legal requirements for medical surveillance

Legal requirements for medical surveillance are contained in the following legislation:
Control of Substances Hazardous to Health Regulations 2002 (as amended)
The Control of Lead at Work Regulations 2002
The Control of Asbestos Regulations 2012
The Ionising Radiation Regulations 1999
The Control of Substances Hazardous to Health Regulations (2002) as amended.
Medical Surveillance
Regulation 11
Medical surveillance should be continued after exposure to a specified substance has ceased,
that medical surveillance must continue whilst the employee is still employed until the doctor indicates otherwise.
The Control of Lead at Work Regulations 2002
Medical Surveillance
10.-(1) Every employer shall ensure that each of his employees who is or is liable to be exposed

to lead is under suitable medical surveillance by a relevant doctor where

(a) the exposure of the employee to lead is, or is liable to be, significant;
(b) the blood-lead concentration or urinary lead concentration of the employee is measured and
equals or exceeds the levels detailed in paragraph (2); or
(c) a relevant doctor certifies that the employee should be under such medical surveillance,
And the technique is of low risk to the employee.
(3) Medical surveillance required by paragraph (1) shall
(a) so far as is reasonably practicable, be commended before an employee for the first time
commences work giving rise to exposure to lead and in any event within 14 working days of such
commencement; and
(b) subsequently be conducted at intervals of not more than 12 months or such shorter intervals
as the relevant doctor may require.
(4) Biological monitoring shall be carried out at intervals not exceeding those set out below(a) in respect of an employee other than a young person or a woman of reproductive capacity, at
least every 6 months, but where the results of the measurements for individuals or for groups of
workers have shown on the previoys two consecutive occasions on which monitoring was carried
out a lead in air exposure greater than 0.075mg/m3 but less than 0.100 mg/m3 and where the
blood-lead concentration of any individual employee is less than 30mg/dl, the frequency of monitoring may be reduced to once a year; or
(b) in respect of any young person or a woman of reproductive capacity, at such intervals as the
relevant doctor shall specify, being not greater than 3 months.
The Control of Asbestos Regulations 2012
Health records and medical surveillance
22.-(1) For licensable work with asbestos every employer must ensure that(a) a health record is maintained and contains particulars approved by the Executive for all of that
employer's employees who are exposed to asbestos; and
(b) that record, or a copy of that record is kept available in a suitable form for at least 40 years
from the date of the last entry made in it; and
(c) each employee who is exposed to asbestos is under adequate medical surveillance by a relevant doctor.
(2) The medical surveillance required by paragraph (1)(c) must include(a) a medical examination not more than 2 years before the beginning of such exposure; and
(b) periodic medical examinations at intervals of at least once every 2 years or such shorter time
as the relevant doctor may require while such exposure continues,
and each such medical examination must include a specific examination of the chest.
(3) For work with asbestos, which is not licensable work with asbestos, and is not exempted by
regulation 3(2), the requirements in paragraphs (1)(a) to (c) apply and(a) a medical examination in accordance with paragraph (1)(c) and (2)(a) must take place on or
before 30 April 2015;
(b) on or after 1 May 2015, a medical examination in accordance with paragraph (1)(c) and
(2)(a) must take place not more than 3 years before the beginning of such exposure; and
(c) a periodic medical examination in accordance with paragraph (1)(c) and (2)(b) must take place
at intervals of at least once every 3 years, or such shorter time as the relevant doctor may require
while such exposure continues.
(4) Where an employee has been examined in accordance with paragraph (1)(c), the relevant
doctor must issue a certificate to the employer and employee stating(a) that the employee has been so examined; and
(b) the date of the examination,
and the employer must keep that certificate, or a copy of that certificate for at least 4 years from
the date on which it was issued.

(5) An employee to whom this regulation applies must, when required by that employee's employer and at the cost of that employer, attend during the employee's working hours such examination and undertake such tests as may be required for the purposes of paragraph (1)(c) and
must furnish the relevant doctor with such information concerning that employee's health as the
relevant doctor may reasonably require.
(6) Where, for the purpose of carrying out functions under these Regulations, a relevant doctor
requires to inspect any record kept for the purposes of these Regulations, the employer must
permit that doctor to do so.
(7) Where medical surveillance is carried out on the premises of the employer, the employer must
ensure that suitable facilities are made available for the purpose.
(8) The employer must(a) on reasonable notice being given, allow an employee access to that employee's personal
health record;
(b) provide the Executive with copies of such personal health records as the Executive may require; and
(c) if the employer ceases to trade notify the Executive without delay in writing and make available to the Executive all personal health records kept by that employer.
(9) Where, as a result of medical surveillance, an employee is found to have an identifiable disease or adverse health effect which is considered by a relevant doctor to be the result of exposure to asbestos at work, the employer of that employee must(a) ensure that a suitable person informs the employee accordingly and provides the
employee with information and advice regarding further medical surveillance;
(b) review the risk assessment;
(c) review any measure taken to comply with regulation 11 taking into account any advice given
by a relevant doctor or by the Executive;
(d) consider assigning the employee to alternative work where there is no risk of further exposure
to asbestos, taking into account any advice given by a relevant doctor; and
(e) provide for a review of the health of every other employee who has been similarly
exposed, including a medical examination (which must include a specific examination of the
chest) where such an examination is recommended by a relevant doctor or by the Executive.
The Ionising Radiation Regulations 1999
Medical Surveillance
24.-(2)
The employer shall ensure that each of his employees to whom this regulation relates is under
adequate medical surveillance by an appointed doctor or employment medical adviser for the
purpose of determining the fitness of each employee for the work with ionising radiation which he
is to carry out.

3.16 Legal requirements for keeping health records and medical records
As a general rule, individual health records should be kept for those employees for as long as
they are under health surveillance. Some regulations - COSHH and those for lead, asbestos, and
ionising radiations - state that records should be retained for much longer (up to 50 years) as ill
health effects might not emerge until a long time after exposure.
Control of Substances Hazardous to Health Regulations 2002 (as amended).
The Regulations require that each employee subject to health surveillance, the records of that
health surveillance shall be maintained and retained for at least 40 years from the date of last entry.
The Control of Lead at Work Regulations 1998

Medical records and details of biological tests should be retained for at least 40 years from the
date of the last entry.
The Control of Noise at Work Regulations 2005
Good practice is to retain an individual's health surveillance record whilst they remain an employee and, once an individual's employment has ceased, whilst enquiries could still be made.
Any records of health surveillance carried out under the Regulations will be retained for at least
40 years after the date of last entry.
The Ionising Radiations Regulations 1999
Medical records should be retained until the person reaches 75 years of age, but in any event for
at least 50 years
The Control of Vibration at Work Regulations 2005
Good practice is to retain an individual's health surveillance record whilst they remain an employee and, once an individual's employment has ceased, whilst enquiries could still be made.
Any records of health surveillance carried out under the Regulations will be retained for at least
40 years after the date of last entry.
Control of Asbestos Regulations 2012
Medical records containing details of employees exposed to asbestos, medical examination certificates should be retained for at least 40 years from the date of the last entry.

3.17 The collection and use of sickness absence and ill-health data
Under he Health and Safety at Work etc Act 1974 and the Management of Health and Safety at
Work Regulations 1999, employers are responsible for health, safety and welfare of their staff at
work and carrying out appropriate risk assessments to identify and alleviate risks to their staff.
Sickness absence statistics, such as those collected on the levels and causes of absence, can
help organisations to effectively manage sickness absence and ill health. Not only can they identify trends and priorities for action, but they can also help to benchmark against similar organisations. Monitoring, measuring and understanding sickness absence allows organisations to tackle
the underlying causes of absence and promote a culture that encourages attendance. There are
many diagnostic tools available to assist organisations in collecting and analysing sickness absence data.