Transcript No Slide Title

The Effects of
(Ill)Health on Work
Jeremy Owen
Army Professor of Occupational Medicine
Royal Centre for Defence Medicine
and
Institute of Occupational & Environmental Medicine,
University of Birmingham
March 2006
Royal Army Medical
Corps Cadetships
• Final 3 yrs at Medical School
• Annual Salary £12,500 - £15,000
• Tuition fees paid & Book Allowance
• Clinical and Academic support
• Elective Placements abroad
• Package worth about £42,000
• Excellent training prospects after graduation
• Enquiries: 01276 - 412744/45
Learning 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 ?
Occupational Medicine is the clinical
component of occupational health….
…It is a discipline concerned with the effects of
work on health and the influence of pre-existent
health problems on the capacity to work.
Health >>>> Work >>>> Health
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.
Extent of Sickness Absence and
Occupational IIl Health in UK
Musculo-skeletal conditions £5.5
billion
Averaged absence per employee 7.8
Averaged cost per employee £400
2 Million
days
- 500
believe they are suffering from illness,
caused by work
Annual bill for GB work related illness and injury is
£10 Billion
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 Tasks
• Identify hazards
• Assess risks to health in the circumstances
• Manage/control the risks
• Match people with appropriate jobs
Health & Work
Drivers 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/Exposures

Chemical

Physical

Mechanical

Biological

Psycho-social/Organisational
Matching Jobs and People
• People: Health/Fitness, Susceptibilities
• Jobs:
Ergonomics + Minimising Risks
• Psychosocial: Work-Life balance, Stress
• Evidence Based Standards
• Common 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 Productivity
Accidents
Workload
Infection
Injury
Anxiety
Litigation 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
• Legal Basis/Statute
- Sudden incapacity
• Medical Obligations
- Individual
- Doctor
- Road Traffic Act 1988
- EC Directives
- Human Rights Act
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
• Class 2
– LGV/PSV
– Lower acceptable
risk
• Vision
• Medical Conditions
• Medication
• Vision
• Medical Conditions
• Medication
– ‘Grandfather’ rights
– ‘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
(Ill)Health on Work
Jeremy Owen
Army Professor of Occupational Medicine
Royal Centre for Defence Medicine
and
Institute of Occupational & Environmental Medicine,
University of Birmingham
February 2006