The Effects of The Effects of (Ill)Health on Work(Ill)Health on Work

Jeremy OwenJeremy OwenArmy Professor of Occupational MedicineArmy Professor of Occupational Medicine

Royal Centre for Defence Medicineand

Institute of Occupational & Environmental Medicine, University of Birmingham

March 2006

Royal Army Medical Royal Army Medical Corps CadetshipsCorps Cadetships

• Final 3 yrs at Medical SchoolFinal 3 yrs at Medical School

• Annual Salary £12,500 - £15,000Annual Salary £12,500 - £15,000

• Tuition fees paid & Book AllowanceTuition fees paid & Book Allowance

• Clinical and Academic supportClinical and Academic support

• Elective Placements abroadElective Placements abroad

• Package worth about £42,000 Package worth about £42,000

• Excellent training prospects after graduationExcellent training prospects after graduation

• Enquiries: 01276 - 412744/45Enquiries: 01276 - 412744/45

Learning PointsLearning Points

• Recap – Role of OH Team

• Defining the scale of the problem

• Identifying & Assessing Ill-health in the Workplace

•DDA

•Fitness to Drive

What is Occupational Medicine ?What is Occupational Medicine ?

Occupational Medicine is the clinical Occupational Medicine is the clinical

component of occupational health….component of occupational health….

……It is a discipline concerned with the effects of It is a discipline concerned with the effects of

work on health and the influence of pre-existent work on health and the influence of pre-existent

health problems on the capacity to work.health problems on the capacity to work.

Health >>>> Work >>>> HealthHealth >>>> Work >>>> Health

To ignore the two way interactions between work and health is to risk To ignore the two way interactions between work and health is to risk misdiagnosis, mismanagement and overall failure to do your best for your misdiagnosis, mismanagement and overall failure to do your best for your patients and society at large.patients and society at large.

Extent of Sickness Absence and Extent of Sickness Absence and Occupational IIl Health in UKOccupational IIl Health in UK

Annual bill for GB work related illness and injuryAnnual bill for GB work related illness and injury isis

£10 Billion£10 Billion

Musculo-skeletal conditions Musculo-skeletal conditions £5.5 billion£5.5 billion

Averaged absence per employeeAveraged absence per employee 7.8 days7.8 days

Averaged cost per employeeAveraged cost per employee £400 - 500£400 - 500

2 Million 2 Million believe they are suffering from illness,believe they are suffering from illness,caused by workcaused by work

OH Stakeholders

Individual

- Employee

- Patient

Work

- Colleagues

- Employer

- Customers

- Investors

- Public

Society

- Family &

Community

- Health Service

- Country/Govt

- Legislators

- Media?

And don’t forget ... YOU and I!

Occupational Health TasksOccupational Health Tasks

• Identify Identify hazardshazards• Assess Assess risksrisks to health in the to health in the circumstancescircumstances• Manage/control the Manage/control the risksrisks

• Match people with appropriate jobsMatch people with appropriate jobs

Health & WorkDrivers for widening the workforce:• Moral

– Work is good for you– Inclusive society

• Financial– Individual Benefits– Organisation Benefits– Societal Benefits

• Legal– HSW Legislation– Disability Discrimination Act

Hazards/ExposuresHazards/Exposures

ChemicalChemical

PhysicalPhysical

MechanicalMechanical

BiologicalBiological

Psycho-social/OrganisationalPsycho-social/Organisational

Matching Jobs and PeopleMatching Jobs and People

• People: People: Health/Fitness, SusceptibilitiesHealth/Fitness, Susceptibilities

• Jobs: Jobs: Ergonomics + Minimising RisksErgonomics + Minimising Risks

• Psychosocial: Work-Life balance, StressPsychosocial: Work-Life balance, Stress

• Evidence Based Standards Evidence Based Standards

• Common SenseCommon Sense

Ill-Health in the Workplace

• Few medical conditions are an absolute bar to work

• Many conditions impose a relative reduction in capability in certain jobs

• However individual can still be productive

• ‘Suitable Workplace Adjustments’

Impact of Illness at Work

• Increased risks to the Individual

• Increased risks to Colleagues

• Decreased ProductivityInfection

Accidents Injury

Workload AnxietyLitigation Risks

Illness at Work

• Coincidental / Inter-current

• Index cases

• Exacerbated by Work

• Resultant from Work

Matching the Person to the Job

• Functional Assessment

• Capability Based

• ‘Reasonable Adjustments’– Physical/Ergonomic– Psychosocial/Organisational

• Alternative Employment

• (Medical Retirement)

Medical Screening

• Pre-Employment/Pre-Placement• Initial Training• Periodic• Change of Employment• Clinical Indications• Return to Work/

Prolonged Sickness Absence• Retirement

How do you Screen?

• Questionnaire– Self Administered– OH Nurse Administered– Doctor Administered

• History & Examination– Doctor or OH Nurse led

• Investigations

Who gets What?

• Interview, Examination +/- Investigation:– Safety Critical Occupations

• Flying, Diving, Driving

– ‘At Risk’ Occupations• Specific Work Activity• Specific Workplace exposures (Bio, Phys, Chem)

• Questionnaire– Routine/Non-Hazardous Jobs

Maintaining Fitness for Work

• Medical Assessment/Medical Screening

• Advice to Management

• Company Health Policies

• Worker (& Management) Education

• Health Promotion

Fitness to Drive

Health & Driving

• DVLA Concerns - Sudden incapacity

• Legal Basis/Statute - Road Traffic Act 1988

- EC Directives

- Human Rights Act

• Medical Obligations - Individual

- Doctor

Medical Standard

• Is there a risk of a sudden disabling event?

• Is the condition likely to render that person a source of danger when driving?

• Civil Law Balance of Probabilities

Road Traffic Act 1988

• Individual responsibility to report medical conditions

• DVLA Medical Staff have authority to investigate medical concerns

• Can only restrict the duration of a licence and type of licence (Gp 1/Gp2).

• Appeal mechanism for individuals

Driving Licences

• Full– Gp1 – Age: 17 – 70yrs

• Restricted– Age: 3yrly over 70yrs with health self-declaration– Medical Condition: 1 – 3yrs with medical review

• Licence Classes– Gp 1– Gp 2

Driving Licences

• Class 1– Private Vehicles– Higher acceptable

risk• Vision• Medical Conditions• Medication

– ‘Grandfather’ rights

• Class 2– LGV/PSV– Lower acceptable

risk• Vision• Medical Conditions• Medication

– ‘Grandfather’ rights

DVLA v OH Criteria

• DVLA criteria– Does a medical condition currently affect a

licence holders entitlement– No requirement to consider employment or

occupational policies/standards– Only considering duration of licence being

issued (Restricted [1 – 3yrs], or Full)

Driving Licences

• Medical Obligations– Road Traffic Act– Risk Management (Sudden Incapacity)– Reporting to DVLA– Confidentiality

Medical Concerns• The Medical Condition:

– Sudden Incapacity (MI, Angina, DM)– Lack of Motor Control (Amputation)– Neurological Events (Epilepsy)

• Vision– Acuity– Fields of Vision

• Medication– Effects of treatment (Insulin)

• Fatigue– Sleep disorders (Narcolepsy)– Excessive Fatigue (Chronic Pain, Shiftwork)

• Alcohol/Drugs

DVLA Medical Guidance

DVLA 'At a Glance Guide to the Current Medical Standards of Fitness to Drive'

- A Guide for Medical Practitioners

http://www.dvla.gov.uk/drivers/dmed1.htm

To ignore the two way interactions between work and health is to risk misdiagnosis, mismanagement and

overall failure to do your best for your patients and society at large.

The Effects of The Effects of (Ill)Health on Work(Ill)Health on Work

Jeremy OwenJeremy OwenArmy Professor of Occupational MedicineArmy Professor of Occupational Medicine

Royal Centre for Defence Medicineand

Institute of Occupational & Environmental Medicine, University of Birmingham

February 2006