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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