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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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Presentation Transcript
slide1
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

slide4
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.

slide5
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.

slide6
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
slide8
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
slide10
Hazards/Exposures
  • Chemical
  • Physical
  • Mechanical
  • Biological
  • Psycho-social/Organisational
slide11
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
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

slide31
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.

slide32
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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