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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

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The effects of ill health on work

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

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

Learning Points

Recap – Role of OH Team

Defining the scale of the problem

Identifying & Assessing Ill-health in the Workplace

DDA

Fitness to Drive


The effects of ill health on work

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.


The effects of ill health on 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.


The effects of ill health on work

Musculo-skeletal conditions £5.5 billion

Averaged cost per employee£400 - 500

Averaged absence per employee7.8 days

believe they are suffering from illness,

caused by work

2 Million

Annual bill for GB work related illness and injuryis

£10 Billion

Extent of Sickness Absence and Occupational IIl Health in UK


Oh stakeholders

And don’t forget ... YOU and I!

OH Stakeholders

Work

  • Colleagues

  • Employer

  • Customers

  • Investors

  • Public

Society

  • Family &

    Community

  • Health Service

  • Country/Govt

  • Legislators

  • Media?

Individual

  • Employee

  • Patient


The effects of ill health on work

Occupational Health Tasks

  • Identify hazards

  • Assess risks to health in the circumstances

  • Manage/control the risks

  • Match people with appropriate jobs


Health work

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


The effects of ill health on work

Hazards/Exposures

  • Chemical

  • Physical

  • Mechanical

  • Biological

  • Psycho-social/Organisational


The effects of ill health on work

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

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

Infection

Injury

Accidents

Anxiety

Workload

Litigation Risks

Impact of Illness at Work

  • Increased risks to the Individual

  • Increased risks to Colleagues

  • Decreased Productivity


Illness at work

Illness at Work

  • Coincidental / Inter-current

  • Index cases

  • Exacerbated by Work

  • Resultant from Work


Matching the person to the job

Matching the Person to the Job

  • Functional Assessment

  • Capability Based

  • ‘Reasonable Adjustments’

    • Physical/Ergonomic

    • Psychosocial/Organisational

  • Alternative Employment

  • (Medical Retirement)


Medical screening

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

How do you Screen?

  • Questionnaire

    • Self Administered

    • OH Nurse Administered

    • Doctor Administered

  • History & Examination

    • Doctor or OH Nurse led

  • Investigations


Who gets what

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

Maintaining Fitness for Work

  • Medical Assessment/Medical Screening

  • Advice to Management

  • Company Health Policies

  • Worker (& Management) Education

  • Health Promotion


Fitness to drive

Fitness to Drive


Health driving

Health & Driving

  • DVLA Concerns- Sudden incapacity

  • Legal Basis/Statute- Road Traffic Act 1988

    - EC Directives

    - Human Rights Act

  • Medical Obligations- Individual

    - Doctor


Medical standard

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

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

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 licences1

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 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 licences2

Driving Licences

  • Medical Obligations

    • Road Traffic Act

    • Risk Management (Sudden Incapacity)

    • Reporting to DVLA

    • Confidentiality


Medical concerns

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 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


The effects of ill health on work

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

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


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